Health and the Indian caste system

Abstract

I read the Lancet Editorial1The LancetThe health of India: a future that must be devoid of caste.Lancet. 2014; 384: 1901Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar on health in India with interest, but also with great disappointment. I agree that economic inequality has a substantial effect on the health of India. However, the Editorial raises two issues, health and caste, and links them together, which I believe is wrong. The caste system is a social evil and it should be eradicated. However, to imply that Gandhi's vision and his defence of the caste system caused “mass paralysis within India's society”1The LancetThe health of India: a future that must be devoid of caste.Lancet. 2014; 384: 1901Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar and then link this notion to the present health status in India is implausible. Gandhi was bitterly criticised by many well-known individuals for his stance on caste and some claim that Gandhi had changed his views on caste in his final years.2Lindley M Changes in Mahatma Gandhi's views on caste and intermarriages (updated version). Hacettepe University Social Sciences Journal, Ankara2002Google Scholar Many factors perpetuate the issues of the caste system, such as ignorance, unwillingness of politicians to act, and positive discrimination of people from so-called low castes in education and employment, which itself creates inequality and unfairness. The Editorial seems to imply that quality of health and caste are linked, but they are not, the principal factor for health across all castes is economic status. Mohanty and Ram's report3Mohanty SK Ram F Life expectancy at birth among social and economic groups in India. IIPS research brief.http://www.iipsindia.org/pdf/RB-13%20file%20for%20uploading.pdfDate: 2010Google Scholar (table) emphasises this point.TableLife expectancy at birth for Indian caste groupsLife expectancy (years), 1998–99Life expectancy (years), 2005–06Lowest castes61·564·6Other Backward castes63·565·7Poor, tribal populations57·556·9Poor, upper castes61·962·7National average63·865·5 Open table in a new tab I declare no competing interests. The health of India: a future that must be devoid of casteIn 2011, The Lancet published a special Series on the progress and future of health in India. The central message was a call for universal health coverage by 2020. Despite India's Prime Minister at the time, Manmohan Singh, being supportive of this goal, the move towards universal health coverage in India has gained little traction. Public health spending remains desperately low at 1·3% of gross domestic product, while more than 40 million Indians are driven into impoverishment from out-of-pocket health expenditure every year. Full-Text PDF