Understanding Pathways to Health with Legacy of Caste among Sanitation Workers: An Eco-Social Approach

Abstract

High levels of mortality and morbidity in sanitation workers can be attributable to the type of occupations they are engaged in, especially in India. Major diseases such as cardiac disorders, HIV and tuberculosis have an impact on their lives. Bacterial and viral infections are commonly observed among them. The nature of their work leads them towards alcoholism, smoking and unsafe sex. Overall, there is a better understanding of the physical environment to which the sanitation workers are exposed, but the psychosocial exposures to which the workers are thoroughly exposed needs a social approach while investigating social determinants. Thus the patterns of health, disease and well being of sanitation workers in biological sense can be explained in terms of social relations, in our case, caste, social environment and occupation. Caste is an important intrinsic feature which specifies the occupation allied to it. Sanitation workers are mostly ‘Dalits’ who stand in the lowest hierarchy in the Indian caste system. Due to the inter-generational transfer of occupation and stigma associated to the kind of occupation they are socially prohibited. This not only perpetuates into their social status but also in their economic terms of livelihoods. Literature reveals the dreadful nature of their socioeconomic status which further leads to consequences of exclusion and discrimination. The basic understanding of health and well being and how it is socially constructed through pathways influenced by social relations could be explained by the approach of eco-social framework. The eco-social approach explains embodiment, pathways of embodiment and cumulative interplay between exposures, susceptibility and resistance. The comprehending relations of the underlying determinant of caste still persist in the modern era plus the occupational hazards with their impact. This complex relation between caste, social environment and occupation with their pathways to health could be understood by this framework.