How is India’s Healthcare System Plagued by Sociocultural Barriers?

Written By Suhani Wadhwa Designed By Hme Hme Chai

Edited By Ava Tso

The Caste System – three words that may sound ancient to the majority of the Indian populace, but still play a rigid part in the biases of many Indian doctors today. Before diving into its deep roots that extend across history, I first want to ask a simple question. What is bias, and what are its two kinds? The first involves an unintentional/unconscious prejudice that interferes with our decision-making, formally known as implicit bias. The other involves beliefs that we outwardly include as a part of our values and morals, formally known as explicit bias. 

Though healthcare professionals are often equivocated with the divine, they are not immune to the above biases, and therefore such unconscious factors play a role in medical treatment. Due to this, marginalized communities receive poorer healthcare treatment, such as less patient-centeredness, poor provider communication, undertreatment of pain, and other adverse effects. A shocking survey indicates that 48.7% of U.S. medical students reported exposure to negative comments about Black patients by attending or resident physicians, and those students demonstrated significantly greater implicit racial bias in the fourth year than they had in the first year. These practices are what allow such biases to progress through generations.

But what does this bias truly look like? To get a unique perception of this, let’s look at this through the lens of the Indian medical industry. Going back to the 3 not-so-ancient words, for those of you who don’t know, the caste system is an Indian social hierarchy, which features the Brahmins at the top of the ladder and Dalits, also known as the “untouchables”, at the bottom. Although the caste system was abolished decades ago, inequalities and discrimination continue to play out in both urban and rural landscapes.

An unfortunate but real domain of this unfair prejudice is within the medical system: India already suffers from socioeconomic disparities that impact people’s access to health services, and belonging to a particular marginalised caste makes the situation even more dire. Dalits are often considered ‘untouchable’ by dominant castes, which means that their settlements are further away from health care centers and they are not offered the same access, which affects their short and longterm health outcomes. On top of that, for those who managed to reach hospitals, over 20% of Dalits faced caste discrimination when attempting to get Covid-19 vaccines. Furthermore, they often take on hazardous professions such as sanitation of public spaces and manual scavenging without protective gear - and instead of being applauded for their essential services, they are ostracised from society and not offered necessary medical care. This also manifests in the dehumanisation of individuals from marginalised communities in hospital settings: stereotypes, assumption of illiteracy or lack of education, and deprioritization. The biases are compounded by the lack of Dalit representation in healthcare professions, which causes a further ‘othering’ of those oppressed under the caste system. 

The healthcare system in India suffers from several issues, including poor resource allocation, lack of funding, scarcity of healthcare workers; however, the ‘social’ aspect of healthcare access is often overlooked. Socioeconomic status undoubtedly plays a huge role, but so does the social group one belongs to, with Dalits and Adivasis suffering the most in this regard. 

The hierarchical biases are compounded by the lack of Dalit representation in healthcare professions, which causes a further ‘othering’ of those oppressed under the caste system. Amidst concerns such as poor resource allocation, lack of funding, and scarcity of healthcare workers that plague Indian healthcare systems, the ‘social’ aspect of healthcare access is often overlooked. Socioeconomic status undoubtedly plays a huge role, but so does the social group one belongs to, with Dalits and Adivasis suffering the most in this regard. 

As the above insights testify, biases and systemic oppression restrict marginalized communities from accessing safe and secure medical care. As such, the need for inclusive, equitable healthcare without these biases, where each patient receives the care they deserve is imperative. Although it has perpetuated itself in all aspects of life in India throughout the nation’s history, there should be greater action and awareness against these prejudices, and the caste system should be annihilated to mitigate its inhuman repercussions forever.

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