Caste, COVID-19, and Inequalities of Care : Lessons From South Asia

This book explores how social discrimination in South Asia contributes to health disparities and impedes well-being. Specifically, it addresses how marginalization shapes health outcomes, both under normal circumstances and specifically during the COVID-19 pandemic. Coming from diverse backgrounds and representing different academic disciplines, the authors have contributed a range of chapters drawing from quantitative and ethnographic material across South Asia. Chapters address reservation politics, tribal lifeways, Dalit exclusions from governmental institutions, Muslim ghettoization, gendered domestic violence, social determinants of health among migrant workers, and the pandemic fallout across South Asian society, among other subjects. Scholars draw on decades of experience and firsthand ethnographic fieldwork among affected communities. The chapters provide an innovative analysis, often in real time, of the human toll of casteism, classism, patriarchy, and religious intolerance―many set against the spectre of COVID-19. Many authors not only present social critiques but also offer specific policy recommendations. The book is of great interest to social scientists, public health practitioners, and policy advocates interested in addressing systemic inequalities and ensuring that future pandemics are not disproportionately felt by the most vulnerable. Foreword Contents Editors and Contributors 1 Of Prejudice and Pandemics Social Discrimination and Well-being Indian Inequality in a Global Perspective References Part I Institutional Exclusions 2 Exceptional Aryans: State Misrecognition of Himachali Dalits Introduction Halis and Scheduled Caste Gaddis Purification Through the Arya Samaj Chandru’s Arya Problem Caste Correction Woes An Institutional Rejoinder Conclusion References 3 A World Inside a Pig’s Stomach: Alimentary Knots of Tension Around Nutrition, Autonomy and Nationhood Introduction Sixth Schedule, Autonomy and Food Security Caste Hindu Porcine Discourses Complexities of Caste and Hindu Nationalism in Assam ‘We are unable to become Hindu’: Alimentary Paths, Nutrition and Nationhood Medical Discourses About Hygiene and Nutrition Muddiness, Dirt and Disease: Medical Discourse About Porcine Lives Climate Change and Nutrition in Riverine Mising Lives “We do not eat the Mother”: Intimate Human–Animal Relationships Porcine Industrialization as Disrupting Ancestral Connections ‘We ate pork with herbs that cut its fat’: Co-Produced Lifecycles of Pigs and Herbs Conclusion References 4 The Role of Caste Prejudice in Hampering Infection Control Efforts in Government Hospitals Introduction Background Methods Findings Unhygienic Practices and Lacking Infection Control Persistence of Unhygienic Conditions The Role of Caste Prejudice Misperception of the Probability of Infection Lack of Resources Systemic Negligence and Corruption Conclusion References 5 Public and Corporate Health Sector Disparities: Reflections on COVID-19 Experiences in India Introduction Development of Health Care Services in India Three Tier Public Health Care Services Health Care Spending Human Resource Vacancies in Public Health Sector Private and Corporate Health Care Services Public Subsidies to Corporate Hospitals Medical Tourism and Misplaced Priorities Disaster Capitalism: Private Hospitals and Unethical Behaviour Role of Private and Corporate Sector in Disasters Good Practices by Some States Discussion and Recommendations References 6 Knowledge Accumulation During COVID-19: Increasing Digital Divide and Vulnerability Among Indian Students Introduction Digital Divide and Indian Social Inequalities Government Initiatives and Programmes to Address Digital Divide Gender and E-learning Accessibility A Framework to Understand the Digital Divide in India Methodology Case Studies of Student Suicides Analysis of Case Studies Age Gender Economic Status Occupation of Father Geographical Location State of Domicile Causes of Suicide Cases of Institutional Negligence Other Observable Patterns Discussion References 7 Segregation of Muslims: A Reflection on Urban Living Environments and Infrastructure Conditions in Hyderabad Introduction Segregation as Process and Reality Reasons for Segregation of Muslims Methods and Research Questions Contextualizing Segregation and Muslim Neighbourhoods Patterns of Discrimination Muslims, Segregation and Ghettoized Pockets The Muslim Dilemma and Institutional Exclusions Poor Water Drainage Facilities and Health Hazards Amenities Versus Policing Multiple Exclusions and Muslim Urban Poverty Economic Deprivations Life Without Potable Water Sources Households by Availability of Electricity and Latrines Size of Households and the Mean Household Size Apathy of QQUDA Multiple Deprivations of Urban Muslims Concluding Observations References 8 Experiences of and Responses to COVID-19 in a Ho Tribal Village in Jharkhand Introduction Historical Background Nakahasa: A Placid Reception of an ‘Unseen Pandemic’ Return of Migrants: Longing, Anxiety and Reunion Narratives from Migrant Workers: The Pandemic and Beyond Conclusion References Part II COVID-19 Disparities 9 Disability, Access to Food and COVID-19: An Intersectional Analysis Introduction Disability Through theTimes Disability and Food Insecurity Disability and Poverty Poverty, Malnutrition and Disability Neoliberalism: Disability and Access to Food Disability, COVID-19 and Food Insecurity Conclusion References 10 Inequality in Access to Healthcare for Persons with Disability During COVID-19: An Illustration from Bangladesh Introduction Background Scope of the Study Rationale Methodology Literature Review Analysis of Primary Data Discussions with Key Stakeholders COVID-19 and the Problem of Women in Accessing Healthcare Conclusion References 11 How Do Pandemics Affect Frontline Health Interventions? Insights from the National Tuberculosis Elimination Programme in Bengaluru, India Introduction Methods Limitations Findings Balancing Treatment, Work and Family: DOTS Regimens for Female Patients Challenges of Frontline TB Interventions for Health Workers Discussion Pandemic Exacerbation of Tuberculous and Poverty Cycles Unmet Needs of Patients at Multiple Intersections Slowing Down of Frontline TB Interventions Conclusion References 12 Lone Warriors in the COVID-19 Lockdown: Impediments and Resilience of Women in Allahabad District, India Introduction Roadmap Literature Review Theoretical Perspective Research Methodology Findings Case Study-1 Case Study-2 Case Study-3 Case Analysis and Discussion Burden of All Responsibilities of Household and Non-Household Chores Loss of Purchasing Power Parity and Difficulty Getting Enough Food Inability to Afford Children’s Fees and Online Education Inability to Pay Rent and High Indebtedness Failed Public Health System Loss of Social Cohesions Conclusion Policy Implications References 13 COVID-19 and Violence Against Women in India Conceptualizing Violence Intersectional Determinants of Violence Pandemic Forms of Exclusion and Impediments Towards Inclusion COVID-19 and Gender Violence Complaints Right to Live with Dignity Domestic Violence Lockdown Gendered Violence Cybercrime Against Women Statewide Analysis Impact of Gender Violence Strategies for Helping Victims of Gender Violence Discussion Conclusion References Part III Health Inequalities 14 Inequality and Exclusion in Access to HealthCare: Learning from the Pandemic Introduction: Recognizing an Unequal World Understanding Inequality as Privilege and Disadvantage Wealth and Income Inequality Inequality and Health: The Interconnect Social Exclusions and the Health Gap Poverty, Social Exclusion and Ill-Health Government Efforts to Reduce Health Inequalities Ensuring Healthy Lives? Pandemic Lessons for Health Equity Migrant Workers in the Informal Sector Cleaners ‘Masaan’ Workers Terminological Inequalities: ‘Social Distance’ and ‘Infection Safe’ Containment Measures Nudges and Boosts Conclusion References 15 Caste Disparities in Health Care Utilization in India Introduction Present Study Data and Methods Sampling Independent Variables Dependent Variables Statistical Analysis Blinder-Oaxaca Decomposition Results Decomposition Analysis Discussion Conclusion References 16 Reflections on Gendered Health Inequalities within Households Introduction Household as the Fountainhead of Gender Discrimination Gender Inequality in Health: An Overview The Study Methodology Findings Receivers’ Perspectives Deliverers’ Perspectives Conclusion References 17 Tea Plantation Workers and the Human Cost of Darjeeling Tea Introduction Key Organizational Features of the Tea Industry From Garden to Cup Social Realities of Tea Workers Social Hierarchy Level of Education Workers’ Ages Caste Wages Housing Water and Sanitation Education and Occupational Mobility Health Concerns of Workers, Patterns of Provisioning and Utilization Tea Gardens Through a Gender Lens The Way Forward References 18 Socioeconomic Disparities in Access and Utilization of Health Care Services in Nepal Introduction Caste and Ethnicity in Nepal Method and Material Village Setting Wellbeing Ranking Findings Identity and Well-Being Utilization of Health Post Services Based on Caste/Ethnicity The Use of Herbs and Healers Disparity in Health-Seeking and the Use of Medicine Discussion Family and Folk Sector of Health Policy Rhetoric and Reality COVID-19 and Inequality The Use of Herbs During COVID-19 Pandemic Conclusion References 19 Social Epidemiology of Chronic Kidney Disease with Uncertain Etiology (CKDu) in Sri Lanka: Persistent Inequalities Among Agricultural Communities in a Dry Zone Introduction Setting Methodology Socioeconomic Backgrounds of CKDu Patients CKDu Local Discourses Economic Impact of CKDu on Affected Communities Psychosocial Impact of CKDu Social Impact of CKDu Impact of CKDu on Livelihood Impact of CKDu on Patients’ Families Impact of CKDu on the Community Healthcare-Seeking Behaviour State Response Discussion and Conclusion References