Project Brief: Epidemiology of Caste: Public Health Implications of Caste and Tribe Attributes

Project Team: Sagnik Bhattacharya, Adithya Beera, Dishani Roy, Sreemoyee Paul, Sucharita Sarkar

Medical doctor examining health of poor villagers at health check up camp initiative started by NGO Chinmaya Organization India (Image: Alamy)

The notion of ‘caste’ is probably one of the most complex concepts in the Social Sciences primarily due to several divergent phenomena being simultaneously noted as ‘caste.’ At the simplest level, as Dilip Menon notes, caste is a combination of two rather separate phenomena ‘varna’ (lit. ‘colour’; referring to the fourfold division of early ‘Hindu’ society) and ‘jati’ (referring to professional groups) underlying both the hierarchies of which lurk the disdain for manual labour—which may in a rather reductionist fashion be regarded as the distilled essence of caste hierarchies. And yet, the overt distinction that dogs this broader hierarchy is based on the notion of ‘ritual purity.’ The latter seems to shadow the former hierarchical basis in a direct relationship.

This idea of ritual purity is well studied and documented in anthropological literature going back to (most prominently) Mary Douglas (1966) who added to it the notion of danger and threat from impure communities toeing the line of argumentation set by Victor Turner (1964). Upon close introspection, caste-dynamics demonstrate similar attitudes and practices and this project proposes to attempt a conceptual study along similar theoretical frameworks. An epidemiological study of ‘caste’ is therefore deemed extremely essential as well as a call to epidemiologists to include ‘caste’ as a regular parameter in medical estimations and discourses which seem to have largely been avoided/overlooked so far.

Yet, accounting for caste as a major social determinant is crucial as research by Patil (2014) seems to indicate. Caste not only determines the extent to which populations can access welfare schemes but also affects targeted programmes such as immunization drives conducted regularly by the Government of India in conjecture with the different State governments. While specific data on caste is relatively scarce, its effect on the Scheduled Tribes (ST) of India has been researched and is noteworthy. Maity’s (2017) research comparing health outcomes across various minorities shows that Scheduled Caste (SC) and ST attributes can be the single most pervasive factor determining health outcomes and similar results have been found In other studies. While Maity (2017) also suggested studying the ST population in isolation to determine their unique disadvantages, such attempts may already be covered under the aegis of the “Away from the Privilege: Impact of COVID-19 on Healthcare Accessibility for Adivasis of Jharkhand, India'' project of the Center for Regional Research and Sustainability Studies.

The present project aims to piece together the existing research on caste and tribes as social determinants in Indian epidemiology and study how they have been played out and consequently have been managed in previous decades and centuries. The malaria and cholera epidemics during the British Raj are very well documented and may be used in this matter to gauge the developments of social determinants in subsequent decades. The aim of the project would be a number of reports and review papers aimed at a multifaceted study of social attributes and its impact on public health in India.

Research Questions:
  1. How have notions of purity and pollution impacted the Indian understanding and handling of infectious diseases historically?

  2. How do notions of purity and pollution continue to affect attempts to mitigate the impact of infectious diseases in India?

  3. How important are notions of infection-as-pollution as a social determinant in Indian epidemiology?

Project Output:
  • A state-of-the-field report collating existing research on the implications of caste and tribe-based attributes on public health planning and policy implementation.

  • A conceptual article on the viability of studying caste/tribe-based medical exclusion along the lines of ‘perceived purity’ and pseudo-medical paradigms (including its legal aspects such as its history via the controversial Contagious Diseases Act, 1898.) This will largely be historical and anthropological in nature as it will also look at historical public health policies in India.

  • A statistical report on the existence of (separate) caste and tribe-based differences in public health policy implementation – largely looking at immunization drives (mainly polio and BCG) – including potential mapping of certain areas where conducive data may be found.

  • Periodical articles by participating researchers and interns.

  • A joint multi-authored publishable article.

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