Inequality in health outcomes in India: the role of caste and religion

The “social gradient to health” - whereby people belonging to groups higher up the social ladder had better health outcomes than those belonging to groups further down - is essentially a Western construct; there has been very little investigation into whether, in developing countries also, people’s state of health is dependent on their social status. The purpose of this paper is to evaluate the relative strengths of economic and social status in determining the health status of persons in India. In other words, even after controlling for non-community factors, did the fact that Indians belonged to different social groups, encapsulating different degrees of social status, exercise a significant influence on the state of their health? The existence of a social group effect would suggest that there was a “social gradient” to health outcomes in India. Furthermore, there was the possibility that the “social gradient” existed with respect to some outcomes but not to others. In investigating this, the paper addresses, in the Indian context, an issue which les at the heart of social epidemiology: estimating the relative strengths of individual and social factors in determining health outcomes.