Excerpts from India's national newspaper, "The Hindu." For the full article, see here: http://www.hindu.com/2009/08/22/stories/2009082255540800.htm
"Caste is a major indicator of health outcomes and mandates the need for interventions that change social structures.
The caste system, with its societal stratification and social restrictions, continues to have a major impact on the country. The system, generally identified with Hinduism, is also prevalent among Christians, Sikhs and Muslims. While some barriers are broken in urban settings, many continue to persist in rural India. While the secular, socialistic and democratic principles enshrined in the Constitution demand equality of outcomes, the inherent caste-related inequality cont inues to dominate reality in Indian society. Much of the debate has focussed on reservation in educational institutions and employment, and rarely highlights the inequalities in health.
Social constructs: Many studies have documented that the caste system is a social construct in the absence of any real genetic differences among castes. Caste, in many ways, is similar to race, which is also a social concept without genetic basis. Nevertheless, these social constructs seem to have a stranglehold on human thought, perpetuating prejudice and propagating unjust societal structures.
It is widely recognised that the determinants of health are social and economic rather than purely medical. The poor health of people from the lower castes, their social exclusion and the steep social gradient are due to the unequal distribution of power, income, goods and services. Caste is inextricably linked to and is a proxy for socio-economic status in India. The restricted access of those from the lower castes to clean water, sanitation, nutrition, housing, education, health care and employment is due to a toxic combination of poor social policies and programmes, unfair economic arrangement and bad politics.
Caste plays out in India just as race plays out in the U.S. and the social class in Britain. Birth seems to determine health, education, employment, social and economic outcomes. Systemic injustice requires much more than a change of heart; it requires changes in social structures. Social injustice is killing people and mandates the ethical imperative of improving the social determinants of health."
The article is written by professor KS Jacob, on faculty at the Christian Medical College in Tamil Nadu.