{"id":1337,"date":"2026-02-04T09:59:57","date_gmt":"2026-02-04T09:59:57","guid":{"rendered":"https:\/\/ambedkarsociety.org\/assa\/?p=1337"},"modified":"2026-03-18T07:58:05","modified_gmt":"2026-03-18T07:58:05","slug":"world-cancer-day-how-caste-shapes-cancer-outcomes-across-south-asia","status":"publish","type":"post","link":"https:\/\/ambedkarsociety.org\/assa\/world-cancer-day-how-caste-shapes-cancer-outcomes-across-south-asia\/","title":{"rendered":"World Cancer Day: How caste shapes cancer outcomes across South Asia"},"content":{"rendered":"
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As the world observes World Cancer Day on 4 February, one intrinsic factor shapes how the deadly malady is treated in South Asia\u2014caste.<\/p>\n\n\n\n

Caste creates invisible barriers that operates long before a patient even reaches the hospital. Despite legal abolitions and affirmative action policies, the ancient Indian hierarchy system persists in shaping access to screening, diagnosis, and treatment for millions.<\/p>\n\n\n\n

A major new analysis published in The Lancet Global Health warns that cancer outcomes across the region are shaped not just by poverty or weak health systems, but by \u201cthe overlapping effects of caste, gender, religion, language, geography, and social exclusion, creating layered barriers that leave millions without timely diagnosis or treatment,\u201d said the authors.<\/p>\n\n\n\n

The analysis was authored by a multidisciplinary group of clinician-researchers and public health experts based in leading cancer and academic institutions across India, North America, and South Asia. The authors are affiliated with institutions including Virginia Tech Carilion School of Medicine in the United States, MOSC Medical College in Kerala, Memorial Sloan Kettering Cancer Center in New York, Queen\u2019s University in Canada, and Tata Memorial Hospital and the National Cancer Grid in Mumbai.<\/p>\n\n\n\n

The team includes medical doctors, radiation oncologists, surgeons, and epidemiologists with expertise in oncology, global health, and cancer policy, lending clinical and research depth to the findings.<\/p>\n\n\n\n

\u00a0India: Where discrimination follows patients into clinics<\/strong><\/h3>\n\n\n\n

\u201cCaste and ethnic identity are major determinants of access to health care in SAARC countries, resulting in substantial disparities in cancer diagnosis and treatment,\u201d the researchers state.<\/p>\n\n\n\n

In India, marginalised populations such as Dalits\u2014historically referred to as \u201cuntouchables\u201d\u2014\u201dface systemic barriers due to sociopolitical discrimination and the legacy of the caste system.\u201d<\/p>\n\n\n\n

Despite the legal abolition of caste-based discrimination, \u201cthe effects of this hierarchy persist,\u201d said the authors. In India, \u201cDalits have some of the worst health outcomes,\u201d according to the study. Whilst \u201caffirmative action policies have been implemented to reduce these disparities in public services,\u201d their \u201ceffect on health care remains minimal due to poor implementation and use,\u201d the researchers found.<\/p>\n\n\n\n

The researchers explain that \u201cdiscrimination against low-caste communities contributes to their poor socioeconomic status, limits their access to health-care services, and perpetuates intergenerational poor health.\u201d<\/p>\n\n\n\n

The data reveals a troubling paradox. Whilst \u201cparticipation in India\u2019s health insurance programme, Rashtriya Swasthya Bima Yojana, is higher among scheduled tribe households (18\u00b79 percent) and scheduled caste households (14\u00b71 percent) than among high-caste groups (9\u00b73 percent),\u201d the study notes that \u201cthis reliance on government schemes does not fully address the substantial barriers that these groups face in receiving adequate cancer care,\u201d said the authors.<\/p>\n\n\n\n

For Dalit women, the barriers multiply through what researchers call \u201cdouble discrimination.\u201d The study reports that \u201c74\u00b74 percent of Dalit women in India reported difficulties in accessing health care, and only 54\u00b76 percent received professional antenatal care, compared with 70\u00b73 percent of upper-caste women.\u201d<\/p>\n\n\n\n

These gaps have direct implications for cancer screening, as the researchers note that \u201cDalit women face double discrimination due to their caste and gender, further limiting their ability to receive timely cancer care and screenings,\u201d said the authors.\u00a0<\/strong><\/p>\n\n\n\n

 \u2018Invisible\u2019 patients of Nepal<\/strong><\/h3>\n\n\n\n

Nepal presents perhaps the starkest evidence of how caste shapes cancer outcomes. The analysis reveals that \u201cDalits who make up between 13\u00b76 percent and 20 percent of Nepal\u2019s population, yet accounted for only 4\u00b78 percent of cancer diagnoses.\u201d<\/p>\n\n\n\n

By contrast, the study found that \u201cBrahmin and Chhetri castes had the highest proportion of cancers diagnoses (30\u00b78 percent), followed by Newar (22\u00b77 percent), Janajati (19\u00b77 percent), and Terai caste (16 percent).\u201d<\/p>\n\n\n\n

This dramatic under-representation, the researchers suggest, is \u201cpotentially due to selective coverage of the population-based cancer registry, under-reporting, and inadequate access to health-care services,\u201d the authors noted. The numbers suggest that large numbers of Dalit cancer patients never enter the health system at all\u2014remaining invisible, suffering and dying without diagnosis or treatment.<\/p>\n\n\n\n

The study emphasises that \u201ccaste-based discrimination intersects with geographical isolation and poverty, severely restricting health-care access for Dalit and indigenous women and children,\u201d said the authors.<\/p>\n\n\n\n

Research on healthcare use in Nepal showed that \u201cchildren from marginalised communities, such as Dalit and Madhesi groups, face substantial barriers in accessing health care due to caste-based discrimination and remoteness of health-care facilities.\u201d<\/p>\n\n\n\n

\u00a0Pakistan: Unacknowledged hierarchy<\/strong><\/h3>\n\n\n\n

Even where caste systems are less openly acknowledged, they continue to shape health outcomes. The researchers note that \u201cin countries such as Pakistan, where the caste-like system (zaat or qaum) is less openly acknowledged, it still plays a substantial role in perpetuating health-care inequities,\u201d said the authors.<\/p>\n\n\n\n

A study cited in the research \u201crevealed that 49\u00b75 percent of respondents identified as low-caste groups, including Kammi and its sub-castes, and these groups faced greater barriers in accessing essential health services than high-caste groups.\u201d<\/p>\n\n\n\n

The disparities begin at birth. The study found that \u201c34\u00b75 percent of low-caste women said they had unskilled attendants during childbirth, compared with 16\u00b71 percent in high-caste groups.\u201d These inequities in maternal care, the researchers argue, have \u201cimplications for early cancer detection and treatment,\u201d said the authors.<\/p>\n\n\n\n

An ethnographic study on maternal deaths in Pakistan, referenced in the analysis, \u201chighlighted how caste and poverty intersect to prevent lower-caste women from accessing life-saving maternal health care, even when services are physically available.\u201d<\/p>\n\n\n\n

\u00a0Bangladesh: Ethnic minorities left behind<\/strong><\/h3>\n\n\n\n

In Bangladesh, \u201cethnic minorities, such as the Rohingya and tribal communities in the Chittagong Hill Tracts, face severe barriers to health care.\u201d For the Rohingya, \u201cover 1 million displaced people live in camps in Cox\u2019s Bazar,\u201d where \u201ccancer care is almost non-existent.\u201d<\/p>\n\n\n\n

The study notes that \u201cRohingya refugees face multiple layers of exclusion due to their displaced refugee status, ethnicity, poverty, and compromised social identity,\u201d and \u201cthese combined factors prevent this population from accessing cancer care and other key health services,\u201d said the authors.<\/p>\n\n\n\n

Tribal groups \u201csuch as the Chakma and Marma, are affected by health-care inequities due to geographical isolation.\u201d The research explains that \u201cthese communities often rely on traditional healers, such as the Badi, and delay formal medical care,\u201d whilst \u201cyears of conflict and underdevelopment in the Chittagong Hill Tracts have further worsened these disparities,\u201d said the authors.
How caste operates as a barrier to cancer care<\/p>\n\n\n\n

The researchers highlight that \u201ccancer awareness is often minimal\u201d across the region. In rural north India, their review found that \u201conly 20\u00b76 percent of participants in a study knew that breast cancer was the most common type in the country, and over half were unaware of key warning signs that should prompt medical attention.\u201d<\/p>\n\n\n\n

Amongst marginalised communities, awareness is even lower. In tribal regions of southern India, a study found that whilst \u201cover 80 percent had heard of cervical cancer, only 2\u00b73 percent knew it could be detected early, and none had ever been screened.\u201d<\/p>\n\n\n\n

The study emphasises how \u201cgeographical isolation can also compound these barriers, particularly where health care facilities are sparse,\u201d said the authors. Researchers found that rural Dalit women \u201cface highest screening barriers,\u201d illustrating how \u201cfactors such as caste, education, and rural residency influence cancer screening access in India.\u201d<\/p>\n\n\n\n

The broader pattern across South Asia shows that \u201curban centres concentrate cancer hospitals and specialists, while rural patients often travel hundreds of kilometres for diagnosis or treatment.\u201d The researchers note that whilst \u201ccities report higher cancer incidence due to better detection, rural areas bear higher mortality because patients arrive late or abandon care altogether.\u201d<\/p>\n\n\n\n

\u00a0When caste compounds other identities<\/strong><\/h3>\n\n\n\n

The research stressed that \u201ccaste, ethnicity, gender, and other marginalised identities intersect in complex ways, multiplying barriers to healthcare access across SAARC countries,\u201d said the authors.<\/p>\n\n\n\n

For Dalit women specifically, \u201cthese compounded identities not only affect access to health care but also exacerbate suboptimal outcomes due to neglect and discrimination within the system,\u201d the researchers noted. The study stresses that interventions must recognise \u201chow overlapping identities (caste, gender, and sexuality) create unique barriers.\u201d<\/p>\n\n\n\n

The study provides concrete evidence: \u201c74\u00b74 percent of Dalit women in India reported difficulties in accessing health care, and only 54\u00b76 percent received professional antenatal care, compared with 70\u00b73 percent of upper caste women.\u201d Additionally, researchers note that \u201ccancer stigma and gender roles limit timely care, especially for Dalit and rural women,\u201d said the authors.<\/p>\n\n\n\n

Religious identity adds complexity to caste-based discrimination. The analysis points out that \u201cDalit Christians and Muslims in India, while facing caste-based marginalisation, are excluded from government affirmative action programmes designed to uplift the scheduled castes.\u201d<\/p>\n\n\n\n

The researchers emphasise that \u201cthese intersecting factors of caste, religion, and socioeconomic status create a widening gap in health-care outcomes for patients with cancer from marginalised communities,\u201d said the authors.<\/p>\n\n\n\n

The study makes clear that \u201csocial stigma, cultural and religious beliefs, and financial toxicity often lead to avoidance of health-care facilities, further perpetuating inequitable access,\u201d said the authors. These barriers operate simultaneously, creating what researchers describe as \u201ccompounded layers of oppression that drive inequitable health outcomes.\u201d<\/p>\n\n\n\n

Source: The South First<\/a><\/strong><\/p>\n\n\n\n

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