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The Continuity of Caste: How Caste-Based Hierarchies Impact Healthcare and Law
By Samara Rezwan Edited by Natalie Bouzas
Vol. 1, Issue 2. — May 2025
For over 3,000 years, caste hierarchies in South Asia have restricted lower-caste access to legal and health
services. Despite legal prohibitions in India, caste-based discrimination persists within societal structures and cultural norms, extending beyond Hinduism to impact religious minorities. This continuation even appears in legal disputes in the United States and the United Kingdom, highlighting the portability of caste-based hierarchies and their intersection with systematic inequality, identity and discrimination.
This article asserts that global legal frameworks have failed to dismantle caste hierarchies despite ongoing
legislative and international efforts. Addressing caste-based inequality requires both legal recognition of caste as a protected category in addition to structural reforms within healthcare, law, and employment. Failure to do so will allow caste to persist, weakening the credibility of global efforts toward equity and anti-discrimination.
Introduction
Since its codification in Hindu scriptures, the caste system has established inequalities in South Asia. Despite legal
prohibitions against caste-based discrimination in India, such as Article 17 of the Indian Constitution and the Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act, 1989, caste continues to marginalize individuals who fall outside of the given hierarchical system [1][2].
Initially seen in texts such as the Rig Veda and Manusmriti, the caste system divided society into four
primary “varnas” or classes. Those excluded from this structure were considered impure and relegated to inferior tasks. They came to be known as Dalits or “Untouchables.” This influence extends beyond the religious boundaries of Hinduism, impacting Muslims, Christians, and other minorities in South Asia. The Cisco Systems lawsuit has brought caste into the scope of anti-discrimination laws beyond South Asia, raising questions about the adequacy of existing legal frameworks and highlighting its continuation in present society. Through the evaluation of judicial decisions and international responses, current legal frameworks can be deemed insufficient in abolishing caste-based discrimination. This paper, therefore, argues that legal mechanisms must be strengthened both domestically and globally to address the tenacity of the caste system.
[1] Jai Singh v. Union of India & Ors., AIR 1977 SC 898 (India).
[2] Devarajiah v. B. Padmanna, AIR 1958 Kant. 84 (India).
Caste as a Social and Structural System
The Rig Veda, one of the Hindu scriptures that assigns status and class based on birth, describes the creation of
social order from the body of the divine entity Prusha. According to the hymn, society is divided into four varnas or classes: Brahmins (priests and scholars) came from Prusha’s mouth, Kshatriyas (warriors and rulers) emerged from his arms, Vaishyas (merchants and traders) came from his thighs, and Shudras (laborers and service providers) came from his feet. Those who fell outside of this system were seen as “mixed” varna, also known as the Canadalas. Canadalas were mythically known as violators of the rules of inter-varna relations and, thus, were ostracized and demoted to the most menial social tasks, such as disposing of carcasses and human waste. This mythical group is often suspected to be the basis for the “untouchable” group now known as Dalits [3]. Historically, caste has determined one’s occupation, wealth, and mobility. The upper castes, such as the Brahmins and Kshatriyas, controlled resources and power, while the Shudras and Dalits were consigned labor-intensive and “dirty” tasks. This division laid the groundwork for the term “untouchable,” which became closely associated with Dalits. Initially, the term was used to indicate their perceived social and ritual impurity. Over time, it became formally recognized by Indian courts in cases such as Jai Singh v. Union of India and Devrajiah v. B. Padmana. In these rulings, the courts explicitly acknowledged “untouchable” as a category tied to caste-based discrimination, further entrenching the legal and social marginalization of Dalits [4].
Economic bias also played a key role in linking socioeconomic status to broader political power. As a result, caste
identity became a determinant of one’s occupation in addition to their role in governance, access to education, and degree of political participation. This dynamic mirrors the United States, where racial minorities have been systematically oppressed through segregation, disenfranchisement, and economic exclusion. In both cases, legal and societal frameworks justified hierarchies through ideologies that portrayed certain groups as inherently inferior. Caste in South Asia and race in the United States have thus served as mechanisms of social stratification, preserving the privileges of dominant groups [5].
[3] Jeo Elder, Enduring Stereotypes about South Asia: India’s Caste System 20-22 (1996).
[4] Devarajiah v. B. Padmanna, supra 2
[5] Scott Grinsell, Caste and the Problem of Social Reform in Indian Equality Law, 35 Yale J. Int’l L. 199 (2010).
Caste and the Law
Articles 15 and 17 of the Indian Constitution repudiate caste-based hierarchies by prohibiting caste-based
discrimination and abolishing the practice of “untouchability” in all forms. Despite these legal safeguards, caste-based discrimination persists overtly and insidiously across various domains of public life, including healthcare, employment, education, and even public gatherings [6]. Despite affirmative action frameworks and statutory protections such as the Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act, the enforcement of these measures remains inconsistent. Empirical evidence underscores the ongoing consequences of inadequate policy implementation. For instance, only about 50% of Dalit children demonstrate basic reading proficiency, compared to 69% of Brahmin children. These statistics reflect persistent structural inequalities in educational access and outcomes [7] .
South Asia’s caste system, however, does not exist in a geographical or cultural vacuum. In the United States, caste
discrimination has also begun to explicitly surface in legal cases, displaying how social hierarchies can adapt to new cultural contexts and institutions. One prominent example is the California Department of Fair Employment and Housing (DFEH) v. Cisco Systems, Inc. case. Filed in 2020 under Title VII of the Civil Rights Act of 1964 and California’s Fair Employment and Housing Act (FEHA), the lawsuit alleged that an Indian-American engineer, anonymized as John Doe, faced caste-based discrimination and harassment from his upper-caste Indian supervisors at Cisco's San Jose headquarters [8].
The two engineers named in the lawsuit, Sundar Iyer and Ramana Kompella, were alleged to have reinforced
caste-based expectations in the workplace after learning that Doe was Dalit, a historically marginalized caste in India. They allegedly denied him leadership opportunities, spread information about his caste background, and responded negatively when he raised concerns. Doe’s caste identity, which was discovered through their shared attendance at the Indian Institute of Technology, was used as the basis for workplace exclusion after he reported discriminatory treatment to Cisco’s human resources department. This case marked the first time a U.S. government agency formally recognized caste discrimination as a civil rights violation, positioning caste as a protected characteristic under existing frameworks of race, ancestry, and national origin discrimination. The claims against Iyer and Kompella were voluntarily dismissed in 2023, but the lawsuit against Cisco Systems, Inc. remains active, as the company is accused of failing to prevent or properly address the discrimination once it was reported [9]. This case is significant both for its legal precedent and for revealing how caste travels and transfers to new institutional structures through South Asian diaspora communities. Cisco’s predominantly Indian workforce, especially in technical roles, is reflective of broader demographic patterns in Silicon Valley, where many Indian immigrants come from upper-caste backgrounds. In this environment, traditional hierarchies can be reestablished subtly and overtly, especially when companies lack cultural awareness or policy frameworks to prevent such biases [10]. The transnational nature of caste discrimination is highlighted through this case, showing how migration can preserve pre-existing hierarchies rather than dismantling them. It also exposes a gap in corporate diversity and inclusion practices that often overlook caste as a category of identity and marginalization. By bringing caste discrimination into the purview of U.S. civil rights law, this lawsuit encourages broader conversations about how American institutions must adjust to recognize and address global forms of inequality.
Human rights organizations have also been at the forefront of advocating for global caste protections. Groups
like the National Campaign on Dalit Human Rights (NCDHR) in India and the Dalit Solidarity Network (DSN) in the UK have raised awareness about the continuity of caste-based discrimination, urging international bodies such as the United Nations to formally recognize and combat caste oppression as part of broader human rights protections [11]. Additionally, treaties like the International Convention on the Elimination of All Forms of Racial Discrimination (CERD) attempt to challenge caste discrimination by including descent in the definition of racial discrimination. However, the absence of specific legal language complicates these protections, as caste discrimination is often nuanced and difficult to prove in court.
Despite these issues, progress is being made at the local level. For example, in February 2023, Seattle became
the first city in the United States to explicitly ban caste discrimination. This legislative act demonstrated movement toward recognizing and addressing caste-based inequities, particularly within communities with large South Asian populations. According to the law, caste now joins race, gender, and other categories in protection from discrimination in Seattle’s workplaces, housing, and public accommodations. An advocate for this legislation, Councilmember Kshama Sawant, emphasized that caste discrimination does not only affect those in South Asia but also impacts immigrant communities in the U.S., especially in the tech sector, where issues of caste inequality are prevalent but often invisible due to the lack of clear physical markers like race or gender [12]. The Seattle law addresses this issue by defining caste as a rigid social hierarchy based on hereditary status, and requiring education and sensitivity training to prevent bias. Nonetheless, the law is only one step towards a larger battle against caste inequality. While it provides a path for redress, effective implementation will require continuous advocacy, education, and cultural change within institutions. Additionally, the international push for caste protections, led by groups like NCDHR and DSN, must continue to address systemic oppression both in South Asia and its diaspora [13]. Ergo, while the Seattle law marks a significant shift in recognizing caste discrimination, continued effort is needed to guarantee that these protections are comprehensive and enforceable; without this effort, legal measures risk being solely performative.
[6] Sagarika Ghose, The Dalit in India, Social Research, 70, 88 (2003), JSTOR.
[7] Sonalde Desai & Amaresh Dubey, Caste in 21st Century India: Competing Narratives, Economic Political Weekly, 11, 10 (2012)
[8] California Department of Fair Employment and Housing v. Cisco Systems, Inc.; Sundar Iyer; Ramana Kompella, No.5:20-cv-04374 (N.D. Cal. filed June 30, 2020).
[9] Associated Press, “California Scraps Caste Bias Case Against Cisco Engineers; Company Still Being Sued,” NBC News (Apr. 12, 2023), https://www.nbcnews.com/news/asian-america/calif-scraps-caste-bias-case-cisco-engineers-company-still-sued-rcna79434.
[10 Paresh Dave, California Accuses Cisco of Job Discrimination Based on Indian Employee’s Caste, Reuters, June 30, 2020.https://www.reuters.com/article/business/california-accuses-cisco-of-job-discrimination-based-on-indian-employees-caste-idUSKBN2423Y8/
[11] David Keane, Caste-based Discrimination in International Human Rights Law, 1st ed., 2007.
[12] Outlook Web Desk, Explained: What’s Seattle Caste Discrimination Ban, What Are The Implications And What Led To It?, Outlook, Mar. 03, 2023, https://www.outlookindia.com/international/explained-what-s-seattle-caste-discrimination-ban-what-are-the-implications-and-what-led-to-it--news-267058
[13] Keane, supra 11
Caste and Healthcare Access
Caste-based discrimination permeates societal systems, influencing healthcare treatment, outcomes, and
professional opportunities in South Asia. Despite constitutional and statutory prohibitions, lower-caste individuals such as Dalits continue to face economic constraints, social stigma, and medical discrimination. These disparities make caste a significant determinant of health, exacerbating inequities in access to care and quality of treatment. Persistent bias from healthcare providers and institutional exclusion further these disadvantages, reinforcing marginalization [14].
The impact of caste-based discrimination on health is indisputable, with studies showing significantly worse
outcomes for Dalits and other disadvantaged caste groups compared to their upper-caste counterparts. Research published in the Asia-Pacific Journal of Public Health highlights higher rates of malnutrition, maternal mortality, and infectious diseases among Dalits [15]. Dalit patients are also seen to face segregation in medical wards, receive substandard care, and report being denied treatment due to their caste identity [16]. In rural areas, where Dalit communities rely heavily on government-run hospitals, caste-based discrimination further exacerbates disparities, with physicians were reported to treat Dalit patients with hostility, delay their care, or refuse physical contact due to notions of “purity” and “pollution.” [17] These forms of exclusion not only harm immediate health outcomes but also perpetuate a cycle of inequality, where caste influences both access to care and the quality of treatment provided, worsening systemic health disparities.
Beyond these direct forms of discrimination, the broader socioeconomic disenfranchisement of Dalits further
exacerbates health disparities. Due to limited financial and educational opportunities, Dalits are disproportionately affected by poverty and insecure employment. Many Dalits also remain unaware of free health services and government health incentives. Even when these barriers are addressed, caste-based bias often forces individuals to travel long distances in search of non-discriminatory healthcare providers, further delaying critical medical interventions [18].
Caste-based exclusion also exists within the medical profession itself. Lower-caste medical students and
professionals face systemic discrimination, including harassment, limited mentorship opportunities, and institutional bias in admissions and hiring processes across India [19]. These structural barriers reinforce caste hierarchies within the healthcare workforce and restrict patient access in general, encouraging inequality throughout the system. While the Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act, 1989, seeks to address caste discrimination, and human rights groups have called for caste-sensitive training and stronger legal safeguards in healthcare, enforcement remains inadequate [20]. Addressing caste-based disparities in healthcare requires the implementation of affirmative action policies, specialized outreach programs, and stronger legal accountability globally. Caste-based health disparities demonstrate the urgent need for comprehensive policy and institutional reforms. Without these changes, caste will continue to dictate access to medical care and health outcomes, undermining the overall goal of universal health equity.
[14] Kiran Kumbhar, The Medical Profession Must Urgently Act on Caste-based Discrimination and Harassment in their Midst, Indian Journal of Medical Ethics, 6 (2021)
[15] Anant Kumar, Health Inequality and Women’s Self-Help Groups in India: The Role of Caste and Class, Health Sociology Review, 16, 160-168, (2007), SSRN.
[16] Nilamber Chhetri, A Difficult Transition: The Nepal Papers, Contemporary South Asia, 27, 305-306 (2019), ResearchGate.
[17] Kumbhar, supra 14
[18] Raksha Thapa, Edwin van Teijlingen, Pramod Raj Regmi, & Vanessa Heaslip, Caste Exclusion and Health Discrimination in South Asia: A Systematic Review, Asia Pacific Journal of Public Health, 33 (2021)
[19] Kumbhar, supra 14
[20] Id.
Modern-Day Caste Discrimination and Its Global Reach
Caste-based discrimination, which has long existed in South Asia, has become present in communities
worldwide. In nations such as the United States and the United Kingdom, South Asian immigrants have carried caste distinctions with them, resulting in continued exclusion within their new communities. One blatant example of this is a case in Milton Keynes, England, where a woman from India’s lowest caste was awarded over 200,000 euros after undergoing deplorable conditions, comparable to servitude, by an upper-caste couple [21]. These caste-based divisions can also be seen manifesting in corporate, educational, and legal contexts, where lower-caste individuals face discrimination in hiring practices, academic opportunities, and access to justice [22].
Despite the clear existence of such discrimination, institutional and corporate structures have inadequately
addressed these issues, as seen with the ineffective implementation of the 2013 Equality Act [23] .While this Act was amended to include caste as a protected category, its provisions remain largely unenforced, and caste-based discrimination continues to persist. To combat these injustices on a global scale, international governing bodies, including the United Nations, need to take a stronger stand by recognizing caste-based discrimination as a human rights violation. Advocacy for its inclusion in anti-discrimination legislation worldwide is vital to ensure the protection of these marginalized groups from ongoing exclusion and violence.
[21] Nick Chester, Why Hasn’t the Government Banned Caste Discrimination in the UK?, Vice, Jan. 5, 2017, https://www.vice.com/en/article/why-hasnt-the-government-banned-caste-discrimination-in-the-uk/
[22] United Kingdom, Global Forum of Communities Discriminated on Work and Descent, Accessed on April 24, 2025, https://globalforumcdwd.org/united-kingdom/
[23] Hugo Gorringe, Surinder S. Jodhka, & Opinderjit Kaur Takhar, Caste: Experiences in South Asia and Beyond, Contemporary South Asia, 25, 231 (2017), Taylor & Francis.
Conclusion
Caste-based discrimination continues to manifest in healthcare disparities, legal disenfranchisement, and narrowed
academic and occupational prospects for individuals and institutions, even over 3,000 years later. Despite constitutional protections and legal frameworks designed to oppose these injustices, these structures have failed to eradicate hierarchies that sustain caste-based exclusion. Litigations such as the Cisco Systems case in California and the exploitation in Milton Keynes illustrate the transnational nature of caste-based oppression and its continued impact on contemporary society.
The most effective strategy to confront caste-based discrimination lies in the explicit recognition of caste as a
protected category under both domestic and international anti-discrimination laws. Future efforts must refine legal frameworks and policy interventions to address the specific nuances of caste discrimination across global contexts. Affirmative action policies, along with stronger legal protections and targeted interventions in healthcare and employment, are essential for dismantling the systemic barriers that maintain caste.
Judicial systems must reject the accommodation of caste, rather than merely respond to its effects. Genuine
progress requires greater accountability in enforcing anti-caste discrimination laws and comprehensive education for relevant parties. Global legal systems must be strengthened to guarantee that all individuals, regardless of caste, have equal access to opportunities, rights, and protections. Only through intentional structural reform across jurisdictions can the legal system move from its current state complacency to a place of justice.