Significant health inequalities exist between different castes and ethnic communities in India, and identifying the roots of these inequalities is of interest to public health research and policy. Research on caste-based health inequalities in India has historically focused on general, government-defined categories, such as “Scheduled Castes,” “Scheduled Tribes,” and “Other Backward Classes.” This method obscures the diversity of experiences, indicators of well-being, and health outcomes between castes, tribes, and other communities in the “scheduled” category. This study analyzes data on 699,686 women from 4,260 castes, tribes and communities in the 2015-2016 Demographic and Health Survey of India to: (1) examine the diversity within and overlap between general, government-defined community categories in both wealth, infant mortality, and education, and (2) analyze how infant mortality is related to community category membership and socioeconomic status (measured using highest level of education and household wealth). While there are significant differences between general, government-defined community categories (e.g., scheduled caste, backward class) in both wealth and infant mortality, the vast majority of variation between communities occurs within these categories. Moreover, when other socioeconomic factors like wealth and education are taken into account, the difference between general, government-defined categories reduces or disappears. These findings suggest that focusing on measures of education and wealth at the household level, rather than general caste categories, may more accurately target those individuals and households most at risk for poor health outcomes. Further research is needed to explain the mechanisms by which discrimination affects health in these populations, and to identify sources of resilience, which may inform more effective policies.

Diabetes affects millions of people globally and can lead to other severe health complications when undiagnosed or not properly managed. The incidence of diabetes has rapidly increased over the past several years, however, not all individuals have access to affordable or convenient healthcare. We hypothesize that wastewater-based epidemiology (WBE) has the potential to assess community health status by analyzing biomarkers indicative of human health and disease, including diabetes. Used in tandem with current methods, monitoring indicators of diabetes in community wastewater could provide a comprehensive assessment tool for disease prevalence in large and small populations. Specifically, the proposed targeted biomarker evaluated in this study to indicate population-wide diabetes prevalence was 8-hydroxy-2’-deoxyguanosine (8-OHdG). This work combines a rigorous literature review and initial laboratory studies to explore the possibility of diabetes monitoring at the community level using WBE. Here, 24-hour composite wastewater samples were collected from within two wastewater sub-catchments of Greater Tempe, AZ. Overall goals of this study were to: i) Determine the feasibility to detect endogenous markers of diabetes in community wastewater; ii) Assess the potential impact of confounding factors, such as smoking, cancer, and atherosclerosis, through a literature analysis; and iii) Evaluate the socioeconomic status and demographics of the study population. Preliminary results of the experiments suggest this methodology to be feasible, as indicated by the observation of detectable signals of 8-OHdG in community wastewater collected from the sewer infrastructure; however, future work and continued experimentation will be required to address low signal intensity and assay precision and accuracy. Thus, the work presented here provides valuable proof-of-concept data, with detailed information on the method employed and identified opportunities to further determine the relationship between 8-OHdG concentrations in municipal wastewater and diabetes prevalence at the community level.