For India's marginalised, the precarity of health
Paying attention to life expectancy disparities in India shows that inequality in health outcomes is relevant even today.
In India, Scheduled Castes (SCs), Scheduled Tribes (STs), and Muslims account for a combined population of 450 million, making them some of the largest marginalised social groups in the world. This cohort routinely suffers marginalisation, violence, exclusion, and discrimination. While inequality in terms of education and mobility has received attention from researchers and policymakers, inequality in health outcomes is less explored. BR Ambedkar once said, “The health of the untouchable is the care of nobody. Indeed, the death of an untouchable is regarded as a good riddance”. Paying attention to life expectancy disparities in India shows the statement is relevant even today.
Life expectancy is defined as the average number of years a newborn is expected to live if prevailing mortality patterns remain constant. Life expectancy at birth is one of the most fundamental measures of health and well-being. India’s Sample Registration System (SRS), which started empirical measurement of life expectancy in the 1970s, estimated it to be 49.7 years for 1970-75, and 69.4 years for 2014-18. But this improvement was not the same for all segments. Recent research by demographers Sangita Vyas, Payal Hathi, and Aashish Gupta (2022) and Aashish Gupta and Nikkil Sudharsanan (2022), show large and persistent disparities in life expectancy for SCs, STs, and Muslims, compared to caste Hindus.
Vyas et al, using the Annual Health Survey 2010-11 data from nine large and poor states representing about half of India’s population, show that compared to caste Hindus, life expectancy at birth is over three years less for SCs and over four years less for STs. Muslims’ life expectancy is about one year lower. One belief is that this reflects the poorer economic status of SC, STs, and Muslims compared to caste Hindus. Vyas et al create a wealth index using household assets such as washing machines, motorcycles, and cars, and household infrastructure such as the number of rooms to document the distribution of social groups across wealth categories. Caste Hindus are richer than marginalised social groups, on average, and richer people are also less likely to die. But they found class and economic status explain less than half of the life expectancy disparities. At all levels of wealth, SCs and STs experience higher mortality.
Gupta and Sudharsanan compare trends in life expectancy at the national level between the late-1990s to mid-2010s for these social groups using the National Family Health Survey 2 and 4. In this period of robust economic growth, while the life expectancy difference between caste Hindu women and ST women declined, the difference remained the same for caste Hindu men and ST men. Alarmingly, for SC men, the absolute differences in life expectancy increased, putting them at a six years disadvantage compared to caste Hindu men. For Muslims, life expectancy was comparable in the late 1990s with caste Hindus, but by the mid-2010s, a Muslim’s life expectancy was three years lower. They further show that these disparities are observed at all ages and not just driven by differences in infant, child, or older age mortality.
Gupta and Sudharsanan report that SCs and Muslims have the lowest life expectancy at birth in the Hindi belt, comprising Bihar, Uttar Pradesh, Jharkhand, and Rajasthan. STs have the highest life expectancy in the Northeast region and lowest in central states, such as Madhya Pradesh, Chhattisgarh and Odisha.
The two research papers reveal the value of large-scale and independent surveys, which can be used to understand inequality in life expectancy. It brings to attention the dire need in India to collect caste-based data. India’s civil registration system, which is incomplete, also does not collect information on caste. These findings suggest a need to focus on addressing caste discrimination and focusing on the health of marginalised populations. Economic growth alone has not reduced these large gaps, and social disparities in life expectancy are not just because of economic differences.
These inequalities are also prevalent in accessing health care to various health outcomes such as nutritional status and morbidity. They have likely worsened due to the pandemic and growing prejudices against marginalised groups. If India is committed to improving welfare, it is imperative that they devise a strategy to better measure and address these inequalities.
Aditi Priya is a senior research associate and the founder of Bahujan Economists. Vipul Paikra is research fellow with Rice Institute
The views expressed are personal