Born to clean? Caste, occupation and health - an exploration among sanitation workers in Dindigul, Tamil Nadu, India.

BACKGROUND: Sanitation work in India remains concentrated among the Scheduled Castes despite constitutional protections and modernisation. Although this concentration is widely recognised, it has not been systematically incorporated into empirical analyses examining the mechanisms through which caste operates. This paper also describes the development of variables that aim to go beyond mainstream descriptive variables. It specifically examines the association between intergenerational occupational continuity and mental health outcomes (depression, anxiety, and stress) among sanitation workers. METHODS: A cross-sectional survey of 243 sanitation workers was conducted in Dindigul Municipal Corporation, Tamil Nadu, January-February 2025. Based on initial meetings and discussions with sanitation workers, as well as a review of the literature, measures were developed to capture the experiences of intergenerational sanitation work and of continuing in sanitation. Structured interviews collected data on parental and grandparental occupations, desire to leave sanitation work, and mental health outcomes assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Bivariate analysis was used to screen covariates; multivariable binary logistic regression was then fitted for each outcome. Full bivariate tables are provided as Supplementary Material. RESULTS: Nearly half (49.8%) reported both parents and grandparents in sanitation work; 64.2% had at least one parent in sanitation. Among those with parents in "other" occupations, employment remained confined to precarious manual labour - wage labour (44.8%), agriculture (21.8%), and casual loading (14.9%) - with no formal employment across generations. While 74.5% cited family tradition as the reason for entering sanitation work, 66.7% expressed a desire to leave if given alternative opportunities, and 69.5% explicitly attributed their entry into the job to their caste "background." Workers from multi-generational sanitation families were significantly more likely to have severe or extremely severe depression (adjusted OR [AOR] = 3.59, 95% CI: 1.95-6.80, p < 0.001, adjusted for tobacco use) and severe or extremely severe anxiety (AOR = 10.8, 95% CI: 3.65-46.4, p < 0.001). For stress, intergenerational occupational status was not an independent predictor in multivariable analysis; stress was significantly and independently predicted by alcohol use (AOR = 20.5, 95% CI: 8.18-58.3) and tobacco use (AOR = 24.5, 95% CI: 10.1-67.9), suggesting its burden is channelled through substance use patterns rather than occupational inheritance directly. CONCLUSIONS: Sanitation work functions as a caste-bound occupation marked by intergenerational continuity and severely constrained intergenerational mobility. Intergenerational occupational status, as measured by a variable developed through a bottom-up process, independently predicts depression and anxiety among sanitation workers. Stress, while prevalent, is driven primarily by substance use rather than occupational inheritance directly. These findings are consistent with anti-caste and structural-violence accounts of occupational segregation and underscore the psychosocial costs of caste-bound intergenerational entrapment, though the cross-sectional design means they should be read as evidence of association rather than causal mechanism.