Examining Explicit and Implicit Caste Bias Among Healthcare Providers in India.

Healthcare provisioning reflects the social context in which it operates, where caste-based identities and hierarchies continue to shape institutional behaviour and care delivery. Drawing on social identity theory and research on implicit bias, this study examines how caste - a rigid, hereditary, and endogamous status hierarchy, structures explicit and implicit attitudes among public healthcare providers in India. Using structured survey measures, open-ended responses, and the Implicit Association Test (IAT), we collected data from 106 providers across public health facilities in Uttar Pradesh. Results indicate widespread caste bias: over 60% of providers expressed explicit opposition to affirmative action policies benefiting Scheduled Castes (SC), and 75% of IAT participants demonstrated an automatic preference for Forward Castes. These attitudes were more pronounced among non-SC providers, while SC participants showed greater awareness and sensitivity towards caste discrimination. Beyond documenting prejudice, the study demonstrates how structural inequality and professional discretion interact in resource-constrained institutional settings. The findings highlight how implicit and explicit caste attitudes may operate as micro-level mechanisms reproducing health inequities, even in formally egalitarian public systems. Policy implications include integrating caste-sensitivity training in medical education, strengthening institutional accountability, and diversifying the healthcare workforce to mitigate bias in clinical interactions.