The excerpts from a paper, “Challenges in closing gaps of health inequities, inequalities and disparities in the new era of Nepal”, which Dr DP Rasali presented at the Conference “Unfolding Futures: Nepalese Economy, Society and Politics” organized by Canada Forum for Nepal in Ottawa from 5th to 7th October 2007.

Citatation for this paper:

The Excerpts:

Caste based discrimination and health disparity

Despite the fact that several population health indicators such as infant mortality rate, under-5 year mortality rate, total fertility rate and life expectancy rate have shown substantial improvement nationally over the past decade, a study of BP Koirala Institute of Health Sciences (BPKIHS) in Nepal indicated that health services utilization by marginalized groups within the population is low, and health disparity is evident among various groups(1). Dalits are the most marginalized group of people who are estimated to be about 15% of the country’s population, and continue to be the victims of caste discrimination impacting negatively on their socio-economic lives including their health status. As they have been pushed down to the lowest stratum in the society due to still rampant age-old societal practice of caste discrimination as well as the statutory provision of caste based “high” and “low” treatments meted to them in the eyes of law ever since the promulgation of Mulki Ain (Civil Code) in 1854 until 1992(2). Health and well-being of this segment of the population have been hit hardest as shown by various indicators of health status, most likely due to the manifold socio-economic drivers that remained against them for centuries. The Word Bank admits low health status among Dalits as compared to the whole population or any other groups of Nepal(3). The World Bank/DFID(3) reported the following 2001 Nepal Census data: the under-5 mortality rate per 1,000 live births was 171 in Dalit population, while the national average figure is 105 per 1,000 live births; the infant mortality per 1,000 live births was 171 in Dalits as opposed to 105 in the total population; and Life expectancy rate in Dalit population is 51 years, while the national average rate is 59 years.

Table 1 shows the situation in 1996 that Brahman and Newar caste groups ranked the best in under-5 mortality rate, infant mortality rate and life expectancy, while the Dalit group remains at the bottom of the list in all three indicators. Therefore, a special attention to the current plight of this segment of the population has been warranted.

Table 1. Disparities in mortality rates and life expectancy by caste/ethnic groups, Nepal, 1996.

Data Source: UNDP 2001: Nepal Human Development Report (NHDR) as cited by The World Bank/ DFID(3).
* Disaggregated data by gender and caste is unavailable.

References

(1) BPKIHS. Health Situation in Nepal. BP Koirala Institute of Health Sciences, Dharan, Nepal, 2008. Available at: http://sph.bpkihs.edu/health.php

(2) Nepaldalitinfo. Nepal Dalit Information Resources Website: http://www.nepaldalitinfo.net

(3) The World Bank/ DFID. Unequal Citizens: Gender, Caste and Ethnic Exclusion in Nepal- Summary. The World Bank/Deparment of International Development, UK, Kathmandu Nepal. 2006.