CASTE AND CASTEISM 101

What are we talking about when we talk about caste and casteism? 

Caste: The concept of caste is often associated with the Indian caste system, which historically separated people into categories with different levels of social status. In this system, a group known as Dalits lay at the bottom and were considered outcasts. Dalits often face violent discrimination today, despite the official banning of the system. [1, 2] More broadly, caste refers to granting status and resources to someone based on their position in a hierarchy. Isabel Wilkerson notably argued the United States contains a caste system that ranks people based on race. [3,4] This system values some categories of people over others, with racism being only one manifestation of the caste system. [3] 

Casteism: Casteism refers to efforts to maintain the caste hierarchy. It encompasses social structures and individual actions that function to keep people in lower castes. [3] 

Why does caste matter in healthcare?

Much of the research related to the impact of caste in health care comes from India. Caste heavily correlates with factors such as socioeconomic status and education, with 90% of poor Indians and 95% of illiterate Indians being Dalits. [2] In turn, there are caste disparities in access to and ability to afford health care [5]. However, inequities in health persist even after adjusting for socioeconomic differences among castes, and there are marked caste-based disparities in health outcomes like risk of death and infant and mother mortality. [6,1] 

Beyond structural factors, individual biases contribute to casteism in health care. For instance, there may be bias against health care workers of lower castes. [1] Patients may be unwilling to be seen by Dalit doctors, and Dalit health care workers may face caste discrimination and harassment in the workplace. [7, 1] Caste-based disparities also impact US health care workers, with Indian-American health care professionals reporting experiences of casteism both in the workplace and as patients themselves. [8]

What do we know about caste in medical and health professions education?

There are caste-based inequities in access to medical education in India. This issue can be attributed to a lack of access and acceptance in medical education, such as experiences of harassment. [1] Structural factors compound these problems–for instance, inequities in education and differences in who can afford medical education. [9] Inequities in medical education in the US can be analyzed through the lens of caste as well: one caste-based analysis discusses continuing racial inequities in the dental profession due to historic discrimination in medical education. [3]

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References

  1. Pol, A. (2020). Casteism Among Indian Doctors: A Critical Review. World Journal of Public Health. 5(4), 99–104. https://www.researchgate.net/profile/Arindaam-Pol-2/publication/348356339_Casteism_Among_Indian_Doctors_A_Critical_Review/links/5ff9d45e45851553a032ece0/Casteism-Among-Indian-Doctors-A-Critical-Review.pdf

  2. Mayell, H. (2003). India’s “Untouchables” Face Violence, Discrimination. National Geographic. Retrieved January 3, 2023, from https://www.nationalgeographic.com/pages/article/indias-untouchables-face-violence-discrimination 

  3. Kearns, C., Taylor, G., Oberoi, S., Mertz, E. (2022). Dominant Power and the Concept of Caste: Implications for Dentistry and Oral Health Inequality. Community Dental Health. 39(2), 137–142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9156562/ 

  4. Sivashanker, K., Couillard, C., Goldsmith, J., Walker, N., Eappen, S. (2020). Addressing the caste system in the U.S. healthcare in the era of COVID-19. International Journal for Equity in Health. 19(184). https://link.springer.com/content/pdf/10.1186/s12939-020-01298-x.pdf

  5. Baru, R.., Acharya, A., Acharya, S., Kumar, A.R.S., Nagaraj, K. (2010). Inequities in Access to Health Services in India: Caste, Class and Region. Economic & Political Weekly. 45(3), 49–58. https://hsrii.org/wp-content/uploads/2014/04/access20to20health_epw.pdf 

  6. Coelho, K.R., Belden, C. (2016). A Systematic Review of the Literature on the Relationship between Caste Membership and Health-Related Risk Factors in India. Int J Med. Public Health. 6(2), 61–68. https://escholarship.org/content/qt9xd9v5gz/qt9xd9v5gz_noSplash_2ebb3e848a203fe52cfee9fe8d2c4b36.pdf

  7. Kishore, K. (2016). When caste outdoes a medical degree: Dalit doctors face discrimination in TN. Hindustan Times. Retrieved January 3, 2024, from https://www.hindustantimes.com/india-news/when-caste-outdoes-a-medical-degree-dalit-doctors-face-discrimination-in-tn/story-Jv9yQpsNrLFnCQJBiqbEFK.html 

  8. (2020). Casteism as I saw it: Dalit healthcare professionals from the US speak out [Audio podcast]. Caste in the USA. Retrieved January 3, 2024, from https://podtail.com/fr/podcast/caste-in-the-usa/8-casteism-as-i-saw-it-dalit-healthcare-profession/ 

  9. Karpagam, S. (2014). Medical education in India and its discontents. In J. Chacko (Ed.), Higher Education in India. Raj Publication. https://drsylviakarpagam.wordpress.com/2014/07/02/medical-education-in-india-and-its-discontents-book-chapter-higher-studies-in-india/

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Contributing writer(s)

Sophie Pollack-Milgate, BA