Caste Exclusion and Health Discrimination in South Asia: A Systematic Review.

Abstract

The caste system is social stratification system that has been used over the last three millennia. This review aims to investigate caste-based inequity in healthcare utilisation in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR and ASSIA) were searched for relevant articles published before 2019 October, using comprehensive search strategy in accordance with the PRISMA guidance. In total 15,109 papers were found, and from these, nine selected papers were included in the review. The papers focused on studies in both India (n=7) and Nepal (n=2) and utilised a range of methods including qualitative (n=2), quantitative (n=3) and mixed methods (n=4) approaches. The review identified four main themes: stigma, poverty, cultures and beliefs and healthcare. Caste-based inequity impacts upon all aspects of an individual’s well-being including violence and everyday life risks. Caste also impacts upon individuals’ opportunities to access education, employment and healthcare. Dalits appear to experience this more significantly due to both poverty and their caste status which increases their vulnerability to health risks.