Three Thousand Years of Caste: Its Impact on Healthcare and Law — And the Limits of Formal Equality

By Samara Rezwan   Edited by Natalie Bouzas

Vol. 1, Issue 2. — May 2025

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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. Caste appears in legal disputes in the United States and the United Kingdom, highlighting the portability of these hierarchies and their intersection with systemic inequality, identity, and discrimination. 

This article asserts that global legal frameworks have failed to dismantle caste hierarchies despite ongoing

legislative and international efforts. Although formal equality laws are intended to ensure equal treatment by applying the same standard to all individuals, they often fail to account for historical inequalities. As a result, by not explicitly recognizing caste as a distinct category of discrimination, these laws leave the issue vague and allow caste-based exclusion to persist. Addressing this specific form of inequality requires both legal recognition of caste as a protected category and structural reforms, especially within healthcare and the law. Failure to do so will both allow caste to persist and weaken the credibility of global efforts toward equity and anti-discrimination. 

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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 purview of anti-discrimination laws beyond South Asia, raising questions about the adequacy of existing legal frameworks and highlighting caste's continued existence. 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 persistance of the caste system.

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[1] Jai Singh v. Union of India & Ors., AIR 1977 SC 898 (India).
[2] Devarajiah v. B. Padmanna, AIR 1958 Kant. 84 (India).

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Caste as a Social and Structural System

The Rig Veda, one of the Hindu scriptures that assigns status and class based on birth, states that the creation of

social order comes 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 were thus 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 assigned 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, but 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 [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 that of the United States, where racial minorities have been systematically oppressed through segregation, disenfranchisement, and economic exclusion. In both instances, 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 therefore both 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).

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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 in public life, including in healthcare, employment, education, and even at public gatherings [6]. Despite affirmative action frameworks and statutory protections such as the Scheduled Castes and Scheduled Tribes (Prevention of Atrocities) Act, the actual enforcement of these measures remains inconsistent. Empirical evidence displays the ongoing consequences of inadequate policy implementation. For instance, only about 50% of Dalit children demonstrate basic reading proficiency, compared to 69% of Brahmin upper-caste children. These statistics show the effect of structural inequalities in regards to educational access and outcomes [7] .

South Asia's caste system, however, does not exist within a geographical or cultural vacuum. In the United States, caste

discrimination has also explicitly appeared 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 said to have reinforced

caste-based expectations in the workplace after learning that Doe was Dalit. 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 institutions 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 actually preserve pre-existing hierarchies, rather than dismantling them. It also exposes a gap in corporate diversity and inclusion practices. Caste is often overlooked as a category of identity and marginalization, but 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. The absence of specific legal language, however, 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 hidden 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, requiring education and sensitivity training to prevent bias. But 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 efforts are needed to guarantee that these protections are comprehensive and enforceable. Without this, legal measures risk being solely performative.

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[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

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Caste and Healthcare Access

Caste-based discrimination impacts 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 [14]. 

The impact of caste-based discrimination on health is indisputable. Studies show 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 reportedly also 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 worsened disparities. 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 harm immediate health outcomes and allow for caste to influence 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 also

furthers health disparities. Due to limited financial and educational opportunities, Dalits are disproportionately affected by poverty and insecure employment. Many Dalits 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, which further delays critical medical care [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, maintaining 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 is still 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. 

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[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. 

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Modern-Day Caste Discrimination and Formal Equality 

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. A blatant example of this is a case in Milton Keynes, England, where a woman from India's lowest caste experienced 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]. 

Although this discrimination is clear, institutional and corporate structures have inadequately addressed these issues,

as seen with the ineffective implementation of the 2013 Equality Act. While this Act was amended to include caste as a protected category, its provisions remain largely unenforced, allowing caste-based discrimination to persist. This emphasizes how caste is often "culturalized" by dominant groups, framing it as an issue of identity rather than hierarchy, to downplay its true structural advantages. This reflects what Du Bois termed the "psychological wage" of whiteness, highlighting how dominant castes retain covert privileges by denying the existence of caste even as they strategically mobilize it for social capital—particularly within multicultural societies. Therefore, to effectively confront caste inequality on a global scale, international bodies such as the United Nations must move beyond formal legal inclusion and actively recognize caste as a distinct form of structural oppression, similar to race, gender, and ethnicity, each with their own protected categories. Without this recognition, global equality efforts will continue to fall short due to the issue's complexity and the insufficient distinction in current formal equality laws [23].​

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[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.

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Conclusion

Caste-based discrimination continues to manifest in healthcare disparities, legal disenfranchisement, and narrowed

academic and occupational prospects for individuals and institutions over 3,000 years later. Despite constitutional protections and legal frameworks designed to oppose these injustices, 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 recognize caste as a specific entity, 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 ensure that all individuals, regardless of caste, have equal access to opportunities, rights, and protections. Caste is no longer confined to South Asia—its impact is global. Therefore, only through deliberate and coordinated structural reforms can legal systems move beyond their current state of complacency and achieve a system that is truly just.