What Is The Impact On Health Lower Caste System In India?
As described by World Health Organization (WHO), healthcare is a condition of absolute social, mental and physical well being and not just the lack of infirmity or disease. It is a vibrant state ensuing from a body’s continual alteration and acclimatization in reaction to pressures and variations in the environment for preserving an inner balance reffered to as homeostasis (Jylhä, 2009). Social Determinants of Health (SDH) are the circumstances in which individuals grow, live, work, are born to and age in. These conditions are influenced by the allotment of income, authority, and resources at universal, countrywide and regional levels. They are connected to the social and economic circumstances and their circulation within the populace that affects the individual and cluster variations in health condition. Hence, these SDHs influence an individual’s likelihoods of sustaining good health. They are at times known as ‘the causes of the causes’, as it is accepted that health is not just about actions or being exposed to dangers, but how economic and social structures affect the health of populaces. Tackling the social determinants of health is a basic tactic of achieving equality in health (Morteza Abdollahi, et al., 2008). This essay will look at one specific SDH which is the social gradient in the lower caste families in India. It will examine both the positive and negative impact that the social gradient or socioeconomic status has on the health of the families in the lower caste in India. Finally, it will give remedies to the negative impact of this SDH and also look at how the positive aspects of it can be enhanced so that it can better the health of the lower caste families in India.
Some of the Social Determinants of Health include; the social gradient where an individual position in the social ladder acts as a factor in their health and wellbeing. This can be measured using a person’s level of education, employment, and income and they can affect the health of the individual and those depending on them. The next one is stress, this determines the health and well being of an individual in that whatever stressors they face in their everyday life will affect how healthy they are. If they are stressed they will be prone to such conditions like heart attacks. Another determinant is an individual’s early life. Depending on the state of their early lives it will be a factor in how healthy in an individual is in their adulthood. If the individual’s early life was not good they may not get the best healthcare possible hence will be at risk of developing various conditions due to this (Marmot, et al., 2008). Also, social exclusion is another social determinant of health in that people from some part of the society are excluded from the other because of reasons lie class and poverty. Thus when these people are isolated they will not get access to the same healthcare systems as the rest but at the same time, they may not get exposed to the same diseases as those who are isolating them. Next, is the occupation of the individual. When they have a good job with good pay this will enable an individual get access to the best healthcare possible and they will also not be exposed to risks to their health and well being (Chapman, 2009).
Another determinant is unemployment, where if one does not have any source of income they will not be able to provide to themselves and to their families thus this will affect their health and also the quality of health they can access. Also, addiction is another determinant. This affects individuals in that addict are exposed to more risks of developing serious and chronic conditions like liver cirrhosis due to alcohol addiction thus threatening their health and wellbeing. Also, addicts may not get access to the best healthcare because they spend most of their money to support their habits and not to treat themselves or their dependents (Nayar, 2007). Another determinant is the individual’s education. If one is illiterate they may not know the importance of getting medical help or what steps to take so that hey can be healthy and well. Therefore, this will affect them because of their lack of knowledge and the vice versa is true. Food is another social determinant of health for different individuals. Some foods when consumed in large quantities will affect a person’s health whether negatively or positively. Also, access or lack of access to food, which is a source of nutrition, will affect their state of health. Next, social support is another determinant in that when people get sick those around them play a role in them getting well. When they visit and offer their support the individual’s health will be improved greatly (Baru, et al., 2010). Also, those around them will give their help where necessary and the sick individual will focus on getting better. Finally, another social determinant of health is transpor.when individuals get sick they should be able to get access to transport to get them to medical facilities as fast and as safely as possible. This is a huge factor in determining whether an individual will get better or not (Subramanian, Ackerson, Subramanyam, & Sivaramakrishnan, 2008).
In India, the societies are separated into different caste systems that were formed a long time ago. People in these different castes are divided using factors such as education, economic status, and employment. All of these factors determine the hierarchy in which the people in India are placed. These caste systems are predetermined hence people are born into their castes and are expected to stay within the confines of these levels. These caste systems have resulted in a difference of outcomes in different domains such as health, employment, education and economic status. These will differ depending on the caste system which an individual belongs. The Dalits and Adivasis are the lowest castes in India. The social determinant of health that I will focus on is the social gradient and how it affects the families in the lower castes in India (Mukherjee, Haddad, & Narayana, 2011).
The social gradient is where individuals are classified in the social ladder depending on their socioeconomic status. Indian families in the lower caste belong to the bottom of the social ladder because their socioeconomic status is low. This determinant covers various factors such as income, employment, education and others. These factors come together to affect the health of these families. Most people who belong to the lower caste system are not competitive and will do little to better themselves due to centuries of conditioning that they are not better or cannot be as good as those in the upper castes. According to research, the health outcomes for those families in the lower caste in India are far worse than those in the upper caste. The outcomes examined were the mortality rates, access to health care and self-rated health (Subramanian, Subramanyam, Selvaraj, & Kawachi, 2009). The economic gap between the different castes in India keeps on growing this affects the health of those families in different ways. People in the lower caste normally do not have access to any source of income for themselves and their families. When they lack access to any income, these individuals will not be able to access the best healthcare services or any services at all because they cannot pay for it. Also, without any income, they will not be able to buy the right food for their nutrition and good health and also they will not afford to take part in activities that are good for their health (Houweling, & Kunst, 2009).
The next factor is education. Families in the lower caste most of the time access poor quality education or are illiterate because they cannot afford to go to school. When they lack proper education they will not have the knowledge required to ensure that they are in good health. As they are low on the social ladder and their socioeconomic status is also low everyone in their caste will have access to the same quality of education. With this lack of information or availability of little education from low-quality education, it can lead to problems for the health status of those belonging in these lower caste systems in India (Marmot, & Allen, 2014). Access to proper infrastructure is another factor in this SDH. Most families in the lower castes in India do not have access to mobile phones thus they cannot call for help when they fall sick and may rely on the one person in the area who has one and this is not convenient. These areas also have poor transportation systems and networks, hence for one to get the help they may have to walk for long distances to hospitals further deteriorating the state they are in (Clougherty, Souza, & Cullen, 2010).
The social gradient has various impacts on those families that belong to the lower caste in India. These impacts can either influence these families positively or negatively. Some of the impacts include; first because they belong low in the social ladder these families usually face discrimination when they go to hospitals. Most individuals in these lower castes are illiterate and school dropouts, hence when they go to the hospital they will not the best care possible because of belonging to this lower caste as most doctors do not believe they are entitled to quality care. Also, they cannot afford it and thus when they go to the hospital most of the hospital workers will turn them away. According to research done, many people in 21.3% of the villages in the lower caste are refused admission to private hospitals because of this discrimination and also as they are considered as untouchables(Conti, Heckman, & Urzua, 2010). The next impact is that because they belong to the lower caste system, they are exposed to poor sanitation in the places that they live in. In India, clean water is supplied preferentially to those in upper castes then after they have enough is it then given to those in the lower caste. Therefore, these families mostly do not have access to clean safe drinking water. Research shows that more than 20% of families in the lower caste cannot access clean safe drinking water. As they have no choice but to use the water, it leads to increased risks of contracting diseases such as malaria, cholera, and diarrhea. These diseases increase child mortality rates especially diarrhea which is the second cause of death in children in the world (Marmot & Wilkinson, 2006).
Another impact of social gradient on the health of families is that individuals are forced to do menial jobs which are most dangerous for them. As most of them lack alternative sources of income and employment, they have no choice but to take up jobs which those in the upper caste do not want. Jobs like working with human waste which is common in the Dalits. This job involves scavenging manually through human excrement and cleaning them from areas like sewers, gutters, drains and septic tanks. They mostly do this without any protective wear and equipment. As a result of lacking this equipment, they suffer consequences such jaundice, vomiting, trachoma, and carbon monoxide poisoning. These conditions require treatment in hospitals but they cannot access it as these menial jobs offer minimal pay (Williams, Mohammed, Leavell, & Collins, 2010). The next impact is that these families lower in the social ladder do not experience some diseases that are related to risk factors associated with people in the higher castes in India. As these families in the lower caste are not exposed to these risk factors, they will not be at risk of developing chronic diseases like hypertension and heart diseases (Lim, et al., 2010).
Another impact is that the women in the lower caste system face the worst brunt of the discrimination. They are women, poor and poor women, and this makes them vulnerable to discrimination from those in the higher castes. They cannot get access to health facilities when they get sexually violated as these cases are not taken seriously because of their social class. Hence they mostly do not report these cases or seek help when they get sexually violated which runs the risk of exposing them and their partners to sexually transmitted diseases gotten from the sexual abuse. They also risk the lives of their children because most of them cannot afford maternity care and they resort to getting the services of inexperienced midwives. This has led to increased mortality in both mothers and children. The final impact is that as a result of them being low in the social gradient they are prone to suffering from mental health issues. These families face discrimination, bullying, reducing and snobbery by those in the upper castes. These situations act as stressors and they could suffer from suicidal tendencies as a way of dealing with the depression caused because they feel worthless (Currie, 2009).
As a result, the negative impacts of the social gradient on the health of families in the lower caste in India require remedies. These remedies will provide a solution to issues that this social determinant has on the health of these families. The first remedy is that India should find a way of scrapping the caste system and people living freely without any classification. It will ensure that individuals are not denied access to quality healthcare just because they were born in a lower caste which was not their choice (Jeemon, & Reddy, 2010). The next remedy is that the Indian government should make it compulsory form everyone especially in the lower caste to go to school. They can aid this by providing subsidies to or free education and ensuring that the education provided is of good quality. By doing this it ensures that those in the lower caste system have the same opportunities as those in the upper caste to gain information on health and their well being. Another solution is that healthcare providers in public and private institutions should liaise and provide education to their staff on how to handle patients. They should be educated on how they should treat each patient with respect without discriminating against them because of the caste they belong to. By doing this it will allay the fears of the those who are in the lower caste as they know that they will not be turned away when they are sick and go to the hospital (Wolf, Feinglass, Thompson, & Baker, 2010).
The next remedy is that laws should be put in place that stipulates the punishments on people who discriminate and stigmatize people based on the caste system that they belong to. These laws will make people know that they will face consequences and that they do not have the right to be discriminatory towards people they feel are below them. Thus this will ensure that those in the lower caste feel free to access healthcare without fear of being turned away or facing ridicule from the healthcare providers (Navarro, 2009). Next, policies should be put in place to protect minimal wage workers who mostly fall under the lower caste. These policies should ensure that while they are working in dangerous situations like in human excrement are provided with protective equipment which will prevent them from developing consequences as a result of being exposed to them. Also, the policies will ensure that all people are paid the minimum wage which will make it possible to live not as well or comfortably but they can access basic needs like healthcare (Phelan, Link, & Tehranifar, 2010). For the positive impact, studies should be done on the lifestyle that those in the lower caste families have and how it differs from those in the upper caste. Once they find these dissimilarities, they should determine if these are the risk factors that expose those in the upper caste to the chronic illnesses they develop. Once they find out the differences the researchers should recommend that everyone in the upper caste adopt these practices to reduce the risk factors that they are exposed to (Berkman, Davis, & McCormack, 2010).
Conclusion.
In conclusion, social gradient plays a huge part as a social determinant of health in families in the lower caste in India. This determinant affects these families in various ways mostly negative but also a little bit in a positive way. These impacts have various remedies as mentioned in the above essay. The remedies should be implemented by the Indian government for the wellbeing of the health of the families in the lower caste. As this is an inbuilt system that has been ongoing for a long time, it will take a long period to implement the remedies. Also, more research needs to be done on the subject so that more information can be found. Once further data is got, more remedies can be formulated and thus this will result in the health of every Indian, regardless of the caste they belong to, to be the top priority.
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