"Access to healthcare in India is mediated as much by caste and class as by medical infrastructure." Discuss, with reference to regional literature.

Hospitals and drugs make care available, but caste, class and stigma decide whether people actually use it. Tamil social-realist fiction has long examined these socio-economic determinants of access to healthcare [1]. It shows that a cure in the clinic does not always mean acceptance in society.

Caste and class as gatekeepers: the literary evidence

• Sivakami's Pazhayana Kazhithalum shows health through the lens of caste discrimination [1].
• Muthumeenal's Mul shows how leprosy stigma pushes the patient out of family and community life [1].
• Imayam's stories treat the medical condition and the social experience as "each wrapped in the other." Their clinical detail sits alongside commentary on stigma and suffering [1].
• References to Siddha healers, and to people's faith or distrust in them, show that the healthcare people choose depends on what they believe [1].

Literature's insight confirmed by law and policy

• Stigma comes from the deformity leprosy can cause [2]. It sets off a cycle:

Fear of stigma → hidden symptoms → late detection → deformity → deeper stigma

Fig: How stigma blocks access to treatment that already exists

• Law Commission Report No. 256 (2015) found that Indian laws discriminate against persons affected by leprosy, both directly and indirectly [3]. In 2019, the Union Health Minister flagged 108 such laws for amendment [4].
• The Personal Laws (Amendment) Act, 2019 removed leprosy as a ground for divorce [5]. Repeal is therefore partial, not complete.
• The NHRC's 2022 advisory said affected persons must not be denied healthcare, employment or education [6].

Yet infrastructure still matters

• The NLEP provides free diagnosis, multi-drug therapy and preventive treatment for contacts. Prevalence fell from 57.2 per 10,000 in 1981 to 0.57 in 2025 [2].
• Novels with illness as the central plot remain "rather minimal" [1]. Fiction shows how exclusion works, while data shows how much of it there is.

Medical infrastructure provides the cure, but caste, class and stigma decide who can claim it. The way forward is to enact the model anti-discrimination law proposed in Report No. 256 [3]. Campaigns such as Sparsh and awareness work under the Leprosy Case Detection Campaign should be judged by how many early cases they bring in [2]. Doing this would extend the equality and dignity guaranteed by Articles 14 and 21 to every patient, in line with the universal health coverage target of SDG 3.