Social exclusion is both a cause and consequence of poverty. In light of this, examine how residential segregation based on caste and religion perpetuates unequal access to public

GS2 Healthcare
Social exclusion is both a cause and consequence of poverty. In light of this, examine how residential segregation based on caste and religion perpetuates unequal access to public health services in India, with reference to recent evidence on neighbourhood-level inequalities.

Examine

  • 15 marks
  • 8 min
  • 250 words
  • Medium

The Hindu

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Introduction

  • Social exclusion entrenches poverty by limiting access to basic services. In India, caste- and religion-based residential segregation shapes neighbourhoods, leading to unequal public health access and outcomes.

Nature of Residential Segregation

  • Segregated settlements (e.g., Dalit hamlets, Muslim ghettos) arise from historical discrimination and market biases.
  • Studies using IHDS/NFHS and urban mapping show persistent spatial clustering of marginalised groups with poorer civic amenities.

Pathways Linking Segregation to Health Inequality

  • Infrastructure Deficits: Marginalised localities often lack PHCs, anganwadis, sanitation, and clean water, affecting disease burden (NFHS-5 shows higher stunting and anaemia among SC/ST and Muslims).
  • Service Discrimination: Evidence of provider bias and differential treatment reduces utilisation (documented in IHDS-based studies).
  • Distance & Mobility Barriers: Peripheral ghettos face higher travel time/costs, delaying care—critical in maternal and emergency services.
  • Information Gaps: Weak outreach (ASHA/ANM coverage) leads to lower awareness of immunisation and schemes.
  • Environmental Risks: Segregated areas often coincide with polluted or hazard-prone zones, worsening health outcomes.

Recent Evidence on Neighbourhood Inequalities

  • NFHS-5 (2019–21): Stark inter-group gaps in IMR, nutrition, and institutional deliveries.
  • IHDS (2011–12) & subsequent analyses: Show lower access to public facilities in SC/ST-dominated villages.
  • Urban studies (e.g., Sachar Committee, 2006; later municipal audits): Highlight deficits in Muslim-concentrated wards—fewer health centres and poorer sanitation.
  • NITI Aayog SDG Index: Intra-urban disparities persist despite aggregate improvements.

Policy & Legal Context

  • Article 21 (right to health, judicially expanded), Articles 15 & 17 prohibit discrimination.
  • NHM aims for universal access, yet place-based inequities remain under-addressed.

Way Forward

  • Place-based Planning: Map deprivation; allocate need-based PHCs/UPHCs in underserved clusters.
  • Equity-weighted Financing: Higher per-capita spending for segregated localities.
  • Anti-discrimination Protocols: Training, audits, and grievance redress in public facilities.
  • Strengthen Frontline Outreach: Ensure ASHA/ANM saturation and community health workers from local communities.
  • Urban Inclusion: Integrate ghettos into municipal services, transport, and insurance (AB-PMJAY) networks.
  • Data Transparency: Disaggregated, neighbourhood-level health indicators for accountability.

Conclusion

  • Residential segregation converts social identity into spatial disadvantage, perpetuating health inequities. Addressing it requires targeted, rights-based, and place-sensitive interventions to break the poverty–exclusion cycle.