Health and Identity: Subcaste Differentiation in Access to Healthcare Services Among Dalits

This chapter explores the often-overlooked health inequalities within Dalits by foregrounding the role of subcaste identity in shaping access to healthcare. Drawing on mixed-methods fieldwork conducted in one of the selected Ambedkar villages of Sonbhadra district, Uttar Pradesh, the study examines how intra-Dalit hierarchies, particularly among subcastes of Chamar and Dharkar castes, translate into differential experiences of illness, treatment, and institutional engagement. Rather than treating Dalits as a monolithic category, the chapter reveals a layered structure of exclusion, where subcaste identity intersects with gender, class, geography, and literacy to influence health-seeking behaviour and outcomes. Framed through identity theory, structural violence, intersectionality, capability, as well as stigma and spoiled identity, the analysis shows how the Dharkars, as a relatively less politically visible and socio-economically deprived subcaste, face greater barriers in utilising public health services, experience deeper institutional neglect, and rely more heavily on informal and non-biomedical care. In contrast, Chamar households demonstrate relatively better engagement with state health mechanisms, though not without caste-based indignities and systemic gaps. The chapter also highlights how critical illness episodes, maternal health risks, and community-level coping mechanisms become sites where caste power is reproduced and resilience strategies emerge. The chapter concludes with a call for more identity-sensitive health policies that recognise subcaste stratification, ensure equitable access, and foreground dignity and recognition in service delivery. By illuminating the intra-Dalit dynamics of health inequality, the chapter contributes to a more nuanced understanding of how caste continues to structure health and life in rural India.