Intergenerational occupational continuity in sanitation work independently predicts severe depression and anxiety among sanitation workers, consistent with 'anti-caste and structural-violence accounts of occupational segregation' and 'the psychosocial costs of caste-bound intergenerational entrapment.'
Key Findings
Results
Nearly half of sanitation workers surveyed came from multi-generational sanitation families, with 49.8% reporting both parents and grandparents in sanitation work.
Cross-sectional survey of 243 sanitation workers conducted in Dindigul Municipal Corporation, Tamil Nadu, January-February 2025.
64.2% had at least one parent in sanitation work.
Among workers whose parents were in 'other' occupations, employment was confined to precarious manual labour: wage labour (44.8%), agriculture (21.8%), and casual loading (14.9%), with no formal employment across generations.
Results
The majority of sanitation workers attributed their entry into the profession to caste background and family tradition, while most expressed a desire to leave if given alternatives.
74.5% cited family tradition as the reason for entering sanitation work.
69.5% explicitly attributed their entry into the job to their caste 'background.'
66.7% expressed a desire to leave if given alternative opportunities.
Results
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.
The association was adjusted for tobacco use in the multivariable binary logistic regression model.
Depression was assessed using the Depression, Anxiety, and Stress Scale (DASS-21).
Results
Workers from multi-generational sanitation families had dramatically higher odds of severe or extremely severe anxiety.
AOR = 10.8, 95% CI: 3.65–46.4, p < 0.001.
This was the strongest association observed across all three mental health outcomes.
Anxiety was assessed using the DASS-21.
Results
Stress among sanitation workers was not independently predicted by intergenerational occupational status but was strongly predicted by substance use.
Alcohol use independently predicted stress with AOR = 20.5, 95% CI: 8.18–58.3.
Tobacco use independently predicted stress with AOR = 24.5, 95% CI: 10.1–67.9.
The authors interpret this as suggesting stress 'is channelled through substance use patterns rather than occupational inheritance directly.'
Methods
The study developed novel bottom-up variables to capture intergenerational sanitation work experiences, going beyond mainstream descriptive variables.
Variables were developed based on initial meetings and discussions with sanitation workers as well as a review of the literature.
Measures captured parental and grandparental occupations, desire to leave sanitation work, and reasons for entering the occupation.
Structured interviews collected data on these variables alongside DASS-21 mental health assessments.
Full bivariate tables were provided as supplementary material, and bivariate analysis was used to screen covariates before multivariable logistic regression.
Conclusions
Sanitation work in India functions as a caste-bound occupation with severely constrained intergenerational mobility, concentrated among Scheduled Castes despite constitutional protections.
The paper notes this concentration is 'widely recognised' but 'has not been systematically incorporated into empirical analyses examining the mechanisms through which caste operates.'
The cross-sectional design limits causal inference; findings 'should be read as evidence of association rather than causal mechanism.'
Findings are described as consistent with 'anti-caste and structural-violence accounts of occupational segregation.'
What This Means
This research suggests that sanitation work in India is not simply a job people choose — it is deeply tied to caste identity and family history. In a survey of 243 sanitation workers in Dindigul, Tamil Nadu, nearly half reported that both their parents and grandparents had also worked in sanitation. Most workers said they entered the profession because of family tradition or explicitly because of their caste background, and two-thirds said they would leave if they had other options. Even among workers whose parents were not in sanitation, the alternatives were limited to precarious, informal work like wage labour or agriculture — no worker came from a family with formal employment.
The study found that workers from multi-generational sanitation families had strikingly higher rates of severe depression and anxiety compared to those without this family history. The odds of severe anxiety were more than ten times higher for workers from families where sanitation work had persisted across generations. Stress levels were high overall, but stress was more strongly linked to alcohol and tobacco use rather than to occupational inheritance directly — which the researchers interpret as suggesting that stress may be expressed or managed through substance use in this population. These findings held up even after accounting for other factors in statistical models.
This research matters because it provides empirical evidence that the mental health burden of sanitation workers is not just about the physical demands of the job — it reflects the psychological cost of being trapped in a stigmatised occupation across generations due to caste. The authors developed their measurement tools in direct consultation with sanitation workers themselves, which helps ensure the variables captured what actually matters to those affected. While the study's cross-sectional design means it cannot prove causation, the findings support the idea that caste-based occupational segregation carries serious and measurable mental health consequences.
Vigneshwaran K, Krishnendhu C, Gaitonde R. (2026). Born to clean? Caste, occupation and health - an exploration among sanitation workers in Dindigul, Tamil Nadu, India.. International journal for equity in health. https://doi.org/10.1186/s12939-026-02963-3