|
Indian society is highly stratified, with many glaring inequalities among different socio-economic groups. The worst positioned among them are Dalits and tribals. The caste system segregated Dalits from the rest to such an extent that they were denied basic human rights.
Etymologically ‘Dalit’ word stands for the broken, the oppressed, the crushed, the ground down, the helpless, the poor and low, a term employed by rights activists to refer to ‘untouchables’. Mahatma Jotirao Phule and Dr BR Ambedkar used this word to describe the ‘atishudras’ in the traditional Hindu social hierarchy. Dalit does not refer to a caste but suggests a ‘state of being’ in oppression, social disability and who now cherish a hope of emergence. In the socio-political situation of caste-ridden country; the Dalit community stands for the one whose fundamental/human rights are severely violated. More than one-sixth of India’s population (about 160 million) is Dalits, located at the bottom of the caste system and face what “hidden apartheid.”
In an era where new economic policy is adversely affecting the social and economic interests of all weaker sections, depressed and disadvantaged sections, the nomenclature ‘Dalit’ can be applied in a very broad sense to all broken people and disadvantaged people. Traditionally oppressed Dalits and adivasis who are displaced due to development projects in their resource-rich habitats, the other backward communities who all form a social majority “bahujans” can also be called Dalits. Though the caste system of India has been described as the world’s most elaborate and most politically documented system of inherited inequality; the experience and perception of this system as good or oppressive depends on from whose perspective one looks at the society. If one looks at it from the point of those (upper) castes placed at the higher level in the hierarchy, one tends to appreciate the dynamics of dominant castes and privileges they enjoy and the issues of the dominated castes/communities do not get highlighted. On the other hand if one looks at the caste system from the point of view of those who are placed at the lower and the lower-most positions in the hierarchy, one realises the historical injustice and oppression the Dalits have experienced and nothing short of a clarion call for the “annihilation of caste”, as Dr BR Ambedkar did, will be enough to undo the historical injustice. This article looks at the conditions and implications to the health and factors affecting general wellbeing of those communities who have been historically bearing the burden of the traditional caste hierarchy and have been oppressed and discriminated in such inhuman ways which are unprecedented in history. FEUDALISM AND CASTE
Caste is linked fundamentally to the social-economic-political organisation of the Indian society and is essentially is part of the feudalism and class structure in India. The feudalism in the context of caste-created artisans and service workers and also created hierarchy among them. The priests and others at the top and scaling through goldsmiths, barbers down to weavers, washer men, leather workers at the bottom. The bottom level of artisan and service workers were seen as untouchable due to the polluting nature of their particular work such as handling leather, removing dead cattle from village grounds, roles in death and funeral ceremonies etc. The untouchable castes, which were performing the most essential tasks of removing the most polluting elements of the entire society, were considered the most/absolute impurity vis-à-vis the Brahmans’ absolute purity.
CASTE AND ECONOMICS
By assigning different jobs to different castes, it did not result only in division of labour but also the ‘division of labourers’. The effects of the birth-based occupational distribution on different castes were entirely opposite in nature. For upper castes it was a divine privilege enjoying the monopoly of education, industry, trade, commerce and soon; on the other hand, it spelt disaster for the lower castes. This is because they were assigned the tasks involving only low paid/unpaid menial labour which was stigmatised. In the absence of freedom of occupation, low earnings, implicit restriction on needs, and stigma on menial labour destroyed the economy of lower castes. Hence as a result, being dependent on the upper castes for existence they remained socially outcaste, economically dependent, politically powerless and culturally subjugated.
Almost 80% of Dalits live in villages and are still dependent on the others for their livelihood. The caste domination, violation, discrimination, untouchability, physical-mental torture and humiliation, ill treating of women are all still continuing. These lead to poor access to health, education, meagre purchasing power, chronic inadequacy of housing, clothing and primary medical facilities.
In 1985-86 the percentage of marginal farmers among the SCs was as high as 71 as against 58 for the population as a whole. Nearly 13% are completely landless. (Source: NSS Round 37, 1982, Table on landholdings and Govt of India, 1990b)
With the abandonment of land reforms in most states, even the prospect of land reform undoing the historical discrimination faced by dalits in access to land has been denied. The burden of caste is not on those who are occupying positions of privilege but those who are on the lower/ lowest rung of the hierarchy.
The socio-economic profile of Scheduled Castes (All India)
1 Population (1981) 10.48 crore
2 Urbanisation 16.00%
3 Literacy 2 1.38%
4 Agricultural Labourers 48.22%
5 Cultivators 28.17%
6 Average Status of Cultivators Marginal
7 Industrial Employment 4.00%
8 Percentage of people BPL 50.00%
9 Bonded Labourers 66.00%
Source: Govt. of india, 1990. Report of the study group
appointed during the Vii FYP to look into the progress of
the SCs and STs. New Delhi: Ministry of Social Welfare (BL Mungekar,291) SOCIAL DETERMINANTS OF HEALTH Of DAUT COMMUNITIES
Discrimination based on caste affects Dalits, the hitherto called ‘untouchables’, adversely in all possible ways thus hampering their growth and denying them access to any opportunity and resources. Caste discrimination affects Dalit’s health in many distinct ways such as health status, access to health care, and quality of health service. Inequality leads to discrimination which in turn leads to denial to resources: a) Physical b) Intellectual c) Emotional/ cultural: v Discrimination also takes the pernicious forms of physical and social segregation of dalit groups
and individuals, and of the continuing and criminal practice of untouchability
d) Economic:
v discrimination in access to employment (in termsof exclusion from employment in specific tasks, the rates of wages paid, and unfree work relationships, including bondage); lack of ownership of the means of production (including, most importantly, land); price and non-price discrimination in access to markets; and lack of access to public services
e) Natural:
v Land, water, rivers, forests etc.
f) Violence:
v Because of their social positioning, discrimination of various kind (psychological, emotional, and physical) continues. No access There is no access to public places like temples, hotels etc. In villages, physical segregation of settlements is part of the village system. More often than not they are made to live in the most unhygienic, water logging, low lying areas of the village. Denial of access to land, good housing, conducive atmosphere... reduced them to a state of constant beggary and expectation from the state
g) Discrimination of health personnel (doctors, nurses, ANMs, Anganwadi workers etc.) is also a matter of grave concern. In the medical fraternity itself there is a lot of discrimination practised the. The recent anti-reservation protests all over the country by the organised upper caste medicos are an indication of this malaise, Medical education needs to understand this unscientific approach and attitude towards Dalits. Social exclusion and discrimination with respect to public health facilities have had profound consequences. At the Census of 2001, the proportion of literate persons (above the age of 7 years) in the dalit population was 67 per cent for males and 42 per cent for females, while for the population as a whole, the corresponding figures were 75 per cent and 54 per cent. There are wide regional differences here: the literacy rate among Scheduled Caste females in Bihar, for example, was an abysmal 14 per cent. With respect to every significant human development and demographic indicator, dalits fare far worse than the general population. Belief in untouchability and the subsequent practice of discrimination. Are justified based on the caste ideology which in turn is based on the acceptance of purity and pollution, herediatary transmission of qualities, and sanctions and legitimization given by religious traditions. POORER HEALTH STATUS
Poorer health status, including higher morbidity lower life expectancy and higher rates of infant mortality based on caste and also sub-caste. In India, efforts are not made to collect data disaggregated by caste:
• In India, the Infant Mortality Rate (IMR) among the Dalits was 91 per 1000 live births, an excess ranging from 22% to 45% over the national average. In Nepal, life expectancy of the Dalits is42 years compared to the national average of 58 years.
The reasons for dramatic health disparities are varied and complex. But caste discrimination against Dalits which is visible in social, political, economic and cultural forms. Caste discrimination is a major contributing factor to subject millions of people to poverty, unemployment, lack of proper housing and sanitation, greater exposure to unhygienic environment, inadequate nutrition and low quality education. These are all determinants of health status. LESS ACCESS TO HEALTH CARE
Caste-based discrimination directly impedes equal access to health services by way of exclusion. Untouchability is practiced even by the health staff by way of denying access to healthcare: not providing adequate facilities to reach health centers, hospitals, health personnel etc. On the other hand ,Anganwadi karyakarthas, ANMs do not visit their houses nor touch the pregnant women or children.
In a highly privatized healthcare system, it is highly unlikely that Dalits can afford costly medical care.
LOW QUALITY OF HEALTH CARE
In a public health system which is already facing paucity of funds, inadequate supply of medicines etc, Dalits have to endure disparity in health interventions. The practice of irrational diagnostics and treatment, corruption arid only being considered potential population for family planning programme, dalit communities receive low quality health care. The general bias in the minds of health personnel and the atmosphere of the health system both contribute to the low quality of health care that is offered to Dalits. STRUGGLE FOR SURVIVAL AND HEALTH
Dalits are forced to do hard labour for their bare subsistence. They are seasonally employed in agricultural fields with overwork and with no work for most part of the year. Constant increase in prices of essential commodities such as food grains and minimum wage not being in practice (in many parts of the country the daily wages in season are Rs.30/- and lean season it is 15-20 rupees per day!). Most of them being daily wage labourers, they have less access to good food/nutritious food. Very often they come too late treatment and hence either the treatment is not possible or affordable.
IMPACT ON OTHER GROUPS WITHIN DALITS
The impact of caste discrimination and related intolerance are felt more severely by other groups within Dalit communities. People with HTV/AIDS and mental illness are subjected to severe forms of discrimination that denies them access to treatment and prevents them from obtaining jobs and participating in the life of the community. Gender discrimination has an enormous multiplying effect on health. They are subjected to sexual violence, denial of education and work opportunities and discrimination in social and civic life — all of which lead to impaired health status. DALIT WOMEN
Women’s movements have hardly addressed the issue of the gender- related oppression of Dalit women. Even within Dalit movements, the issue of gender violence and patriarchy is not addressed.
The situation of Dalit women is of greater concern due to her multiple identities. A Dalit woman belonging to the oppressed caste:
• Works as a domestic worker, a daily wage labourer, or as an agricultural labourer, and she has
fulfill her role as a woman (wife, mother, sister etc.)
• Burden of triple oppression: Caste, class and gender
• In a caste-conflict situation, women are raped. Rape isused as a political tool to subjugate the
Community and as a medium of oppression and establishing control
• The child marriage, child labour, devadasi system, prostitution as a consequence of trafficking
etc. are the endless problems that Dalit women have to face. ACCESS TO EDUCATION
As access to education is very limited and even if they manage to go to school, the quality of education they get is very substandard. The drop out rate among Dalits and especially girls is very high. Hence what little health knowledge that our educational system provides is not available for them. They are victimised for their social status and develop inferiority complex and this affects their confidence in accessing special education later in life also. GOVERNMENT’S APATHY
The discrimination and denial of health care is hardly recognised as problems deserving attention. By and large, governments do not even collect to identify or to track information health disparities. RESPONSE OF DIFFERENT SECTIONS TO HEALTH OF DALIT COMMUNITIES
Dalit communities is culturally and socially a rich group with thousands of years of tradition and traditional knowledge. The Dalit community is the first in the history who experimented and had the knowledge of tanning and processing leather. Being farm slaves/farm workers, a vast amount of knowledge with regard to agriculture was in the community. Being a community which has survived onslaughts from people, nature (droughts/famine) the community has strong coping mechanisms and survival skills. Many places we find them having knowledge of traditional medicines, crafts, plants, animals etc. Even while being denied access to any resource in the villages such as education, safe living conditions, water, public spaces etc. the community has survived and thrived. However, we find along with other artisan communities, the Dalit community is subjected to the attack of Liberalisation, Privatisation and Globalisation (LPG). WHAT DALITS HAVE DONE FOR THEMSELVES? Dalit communities have organised themselves all over the country into strong people’s organisations to struggle for their rights. This collective bargaining has been always with the state. They have also organised themselves into various cultural groups through which the cultural richness of the Dalit communities has been expressed. Some of the groups that have addressed these concerns among Dalits are: Dalit Sangharsh Samiti (DSS),Human Rights Forum for Dalit Liberation (HRFDL), National Campaign for Dalit Human Rights (NCDHR), Madiga Dandora (A cultural organisation of Dalits), Madiga Reservation Horata Sa?niti (MRHS) which demands the internal reservation among dalits and the like. WHAT OTHERS ARE DOING FOR THEM?
Many social action groups, citizens groups, human rights groups, people’s movements, such a People’s Union for Civil Liberties (PUCL), National Alliance of Peoples Movements (NAPM), People’s Union for Democratic Rights (PUDR) and others have taken up the issues of discrimination of Dalits, violence against Dalit women, etc.
WHAT GOVERNMENT IS DOING FOR THEM?
Government has chalked out number of welfare schemes for the development of Scheduled Caste communities. The SC/ST Commission has taken proactive role at the national level and state levels to implement these schemes. However, the usual malaise of corruption has again taken the toll of these schemes in their effective implementation and reaching to the deserving sections. ACTION REQUIRED
While speaking of Health for Dalit communities, nothing short of considering health as a basic human right will be enough to make health accessible to Dalit communities. Dalit communities are those whose all rights are violated, even the right to live as dignified human beings. All the violations are linked to the violation of health right.
Different sections and political groups have placed the agenda of Dalits in their scheme of debates, discussions and action. However, besides the usual demands that are already placed before the various constitutional bodies such as land reforms, assertive action for employing Dalits in the private sector (including health), access to private educational institutions, the state machinery assuring the access to safe drinking water (from rivers, wells, water tanks etc.), housing, freedom from intimidating and coercive atmosphere of the dominant classes and castes etc. the following are specified: ICMRJICSSR has suggested the following: · Integrated overall development
· Improvement in nutrition, environment and health education
· The provision of adequate bealthcare services for all and especially the poor and underprivileged: The aim of the programmes should be to reduce poverty and inequality and also to improve the status of the poor and deprived social groups
· Government should provide disaggregated data for Dalits and Dalit women in the indicators of IMR, MMR, malnutrition, hunger deaths, anaemia etc., as it does for education. Then only we shall be able to really assess the gravity of the situation of Dalits.
· Bring the existing movements for Dalit human rights, campaigns for different issues on Dalit issues, campaigns against atrocities into the larger canvas of health (human dignity as the basic component of wellbeing)
· All kinds of practices of untouchability and discrimination like barring entry into hotels/temples/public spaces etc., manual scavenging, night soil carrying, atrocities and manifest violence in terms of physical torture, rape, molestation etc., should be taken up as the denial of health care and violation of health rights.
· Manifest efforts should be made for the representation of Dalit movements, Dalit social action groups or collective working for Dalit rights into the canvas of People’s health movement.
· While recording access to denial to health care and all the unconstitutional practices, discrimination shown to Dalits in the health systems, the oppression meted out to them by the dominant classes in societies, anti-dalit policies etc, should be condemned and suitable protection measures should be enforced.
· Universal access to health care to all Dalits for their health problems in the state institutions should be pressed for.
· Ensure access to water, housing facility, freedom from all kinds of atrocities, etc. (Excerpts from the booklet, “Health of Dalit Communities” by Mr E Premdas, lana Arogya Andolana-Karnataka UAAK). JAA-K is the Karnataka chapter of People’s Health Movement India. The author is one of the conveners ofJAA-K and works with Community Health Cell which is one of the national coordination committee members of Jan Swastbya Abhiyan. He has earlier worked with a group of volunteers in Raichur district of Karnataka to set up the union of Dalit women now known as Jagrutha Mahila Sanghatan. Dalit women ofJMS trained as community health workers are now known to be very good community healers and have revived a lot of traditional health knowledge)
|
Resources 