Identifying Marginalised Groups and Their Unique Health Challenges

In any society, some communities sit further from the centre than others – not by accident, but because of long-standing social, economic, and political structures. In India, these groups face the sharpest end of inequality when it comes to one of the most basic human needs: health. From a tribal child in central India who is twice as likely to die before her first birthday, to a Dalit patient asked to wait outside a clinic, marginalisation translates directly into illness, disability, and shorter lives. Understanding who these groups are and what they face is the first step towards designing healthcare that actually reaches everyone.

What does marginalisation really mean? 🔗

Marginalisation is the process by which certain groups are pushed to the edges of society, denied full participation in its economic, social, political, and cultural life. It is not the same as being poor, although poverty often follows. A community can be wealthy in cultural heritage yet marginalised because the dominant system refuses to recognise its rights, language, or way of life. The key feature is structural disadvantage – disadvantage built into laws, institutions, and everyday practices, not just individual misfortune.

In the context of health, marginalisation shows up as disparities in availability, accessibility, affordability, quality, and utilisation of healthcare services. A hospital may exist on paper a few kilometres away, but if the road is broken, the staff is rude, or the costs are unaffordable, it might as well be on another planet for a marginalised family.

Key marginalised groups in India 🔗

Indian society officially recognises several categories of disadvantaged communities, each with its own history of exclusion. While the boundaries sometimes overlap, six broad groups deserve particular attention.

Scheduled Castes (SCs) 🔗

Historically labelled “untouchables” and today often self-identifying as Dalits, Scheduled Castes comprise roughly 17% of India’s population and have for centuries faced discrimination, exploitation, and social exclusion. Even after constitutional protection through Article 17 (which abolishes untouchability) and decades of affirmative action, structural discrimination persists.

For Dalits, marginalisation has very physical consequences. Many still live in segregated hamlets with poor sanitation, contaminated water sources, and minimal health infrastructure. Many work in hazardous occupations like manual scavenging, sanitation, and leather tanning, exposing them to infections, respiratory illness, and injury. Studies have documented healthcare workers refusing to touch Dalit patients or providing less information about health services and programs once they learn a patient’s caste status.

Scheduled Tribes (STs) 🔗

Scheduled Tribes constitute approximately 8.6% of the population and include hundreds of indigenous communities – from the Gond and Santhal of central India to the Bhil of the west and the Naga tribes of the northeast. Unlike SCs, their marginalisation stems primarily from ethnicity, geographical isolation, and a long history of displacement due to mining, dams, and forest policies. Problems of tribes are mainly related to forest rights, land alienation, exploitation by money lenders, and displacement in tribal areas.

Tribal health challenges are unique. Communities often live in remote terrain where the nearest primary health centre may be hours away on foot. Many continue to depend on traditional medicine, partly out of preference and partly because formal healthcare feels alien or hostile. Malnutrition, malaria, sickle-cell disease, and tuberculosis remain stubbornly high.

Other Backward Classes (OBCs) 🔗

OBCs are a constitutionally recognised category of socially and educationally backward communities, distinct from SCs and STs. They make up the largest single bloc of India’s population – estimated at over 40% – and include a wide range of occupational and agrarian castes. While generally better placed than SCs and STs, several OBC sub-groups, especially nomadic and de-notified tribes, remain severely deprived.

Health-wise, OBCs sit in the middle of most indicators. They often have better access than SCs/STs but still lag behind upper-caste groups in maternal care, child nutrition, and insurance coverage. The diversity within OBCs means that a few sub-castes do well while many others continue to struggle.

Women 🔗

Women cut across every other category and form what is perhaps the most pervasive marginalised group. Patriarchy, son preference, restricted mobility, and economic dependence combine to limit women’s access to healthcare throughout their lives. According to NFHS-5 (2019-21), approximately three-fifths of women surveyed reported facing problems in obtaining medical care, including lack of money, distance from health facilities, lack of female healthcare workers, and lack of medicines.

The health insurance picture tells a similar story. Although coverage has improved, only 30% of women aged 15-49 are covered by any health insurance or scheme, compared to 33% of men. Anaemia, malnutrition, maternal mortality, unsafe abortion, and mental health stigma all bear down disproportionately on women.

Persons with disabilities 🔗

Differently-abled individuals form an estimated 2.2% of India’s population according to the 2011 Census, though disability rights advocates argue the real figure is much higher. The Rights of Persons with Disabilities (RPwD) Act, 2016 mandates accessibility in all public buildings, transportation systems, and information and communication technology services, including healthcare facilities. Yet implementation remains patchy.

Physical inaccessibility is only part of the problem. Attitudinal barriers – staff who speak about, rather than to, a disabled patient – are equally damaging. For invisible disabilities like mental illness, the picture is even bleaker. According to India’s National Mental Health Survey, the treatment gap for mental health disorders ranges from 76% to 85%, meaning approximately four out of five people with conditions such as depression or anxiety receive no treatment.

Religious and linguistic minorities 🔗

Religious minorities – Muslims, Christians, Sikhs, Buddhists, Jains, and Parsis – together make up about 20% of India’s population. Muslims, the largest minority, often face concentrated disadvantage in education, employment, and housing. Linguistic minorities, including migrant workers who speak different languages from the local population, struggle to communicate with health staff and navigate paperwork.

A particularly striking finding from recent research is that Dalit Muslim and Christian women were more likely to have hypertension and diabetes compared to Hindu Dalit women, suggesting that the intersection of religion and caste can deepen health disparities. Constitutional benefits available to Hindu Dalits are not extended to Dalit Muslims and Christians, leaving them in a particularly vulnerable position.

Social and economic barriers to healthcare 🔗

The groups above face different histories, but the mechanisms that block them from healthcare share common threads.

Geography and infrastructure 🔗

Tribal areas, urban slums, and remote rural pockets often lack functional primary health centres, ambulances, or specialist services. Distance is not just a matter of kilometres – it includes broken roads, unreliable transport, and the hidden cost of a day’s lost wages.

Affordability and out-of-pocket spending 🔗

Indian households still bear an enormous share of health costs themselves. Out-of-pocket healthcare expenditures consume over 60% of household health spending, and a single hospitalisation can push a marginalised family into debt for years. Schemes like Ayushman Bharat-PMJAY aim to help, but enrolment, awareness, and informal payments continue to dilute their impact.

Discrimination and stigma 🔗

Discrimination is perhaps the most painful barrier because it does not show up on any infrastructure audit. Patients from marginalised groups report being made to wait longer, spoken to harshly, given less information, or denied attention altogether. For women, the absence of female staff can mean foregoing reproductive care entirely. For disabled patients, the sigh of a busy receptionist can be enough to discourage a return visit.

Literacy, language, and information 🔗

Health systems run on forms, prescriptions, and instructions. When a patient cannot read Hindi or English, when consent forms are in unfamiliar legal language, or when public health messaging skips tribal dialects entirely, marginalised groups are excluded by design.

Real-world consequences: what marginalisation looks like in health data 🔗

Numbers can feel abstract, but a few sharp comparisons make the cost of marginalisation visible.

Child mortality among Scheduled Tribes 🔗

One of the starkest gaps in Indian public health is in child survival. The SC/ST population frequently experiences higher rates of preventable diseases, lower life expectancy, and higher maternal and infant mortality rates than other population groups. In several states, tribal infant and under-five mortality rates remain significantly above the national average, despite overall improvement in the country’s health indicators.

The reasons are layered: poor antenatal care coverage, low institutional delivery rates, malnutrition, and limited access to immunisation. A tribal mother giving birth at home, hours from a health centre, faces risks that an urban middle-class mother has not faced in a generation.

Maternal health and the intersection of caste and gender 🔗

Adolescent mothers from SC and ST communities face compounded disadvantage. Studies tracking antenatal care coverage among them reveal lower rates of four or more ANC visits, lower iron-folic acid supplementation, and lower institutional delivery – three of the most basic interventions for safe motherhood. When caste, gender, and age combine, the protective net thins out dramatically.

Disability and the missing middle 🔗

Despite the RPwD Act’s promises, disability certification itself remains a hurdle. Many entitlements require a 40% benchmark disability certificate from a government chief medical officer – a process that often demands repeated visits, travel, and bribes. A critical barrier is the insufficient number of State Commissioners for Persons with Disabilities and the scarcity of Special Courts at the state level, which has weakened accountability. The result is a paper-rich, practice-poor system.

Why a public health lens matters 🔗

Treating marginalisation as a health issue, not just a social or political one, changes how policies are designed. It pushes attention towards community health workers like ASHAs and ANMs, mobile clinics for tribal hamlets, sign-language interpreters at hospitals, gender-sensitive counselling, and caste-blind triage protocols. It also forces medical education to confront its own biases – because health workers carry the prejudices of the society they come from unless trained otherwise.

The goal is not charity. It is the basic constitutional promise of equality before law and equal protection of the law, translated into the corridors of every public hospital, the rounds of every village health worker, and the design of every health scheme.

What do you think? If you were asked to redesign one feature of your nearest government hospital to make it more welcoming for a marginalised patient – say, a Dalit woman with a disability – what would you change first, and why? And how might your own family’s caste, gender, or class position shape the kind of healthcare you have always taken for granted?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9237626/
2. https://www.re-solveglobalhealth.com/post/how-caste-is-a-major-barrier-to-health-equity-in-india
3. https://www.thinkglobalhealth.org/article/caste-out
4. https://www.longdom.org/open-access/contemporary-problems-of-scheduled-castes-and-scheduled-tribes-in-india-82223.html
5. https://ruralindiaonline.org/en/library/resource/national-family-health-survey-nfhs-5-2019-21-india/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696875/
7. https://depwd.gov.in/en/faqs-4/
8. https://idronline.org/article/diversity-inclusion/removing-barriers-for-persons-with-invisible-disabilities/
9. https://www.sciencedirect.com/science/article/pii/S2772653324000224
10. https://arxiv.org/pdf/2506.08206
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150462/
12. https://psychology.town/disability-rehabilitation/disability-rights-india-legal-safeguards/