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Research studies conducted worldwide reveal the disadvantaged health conditions among sanitation workers. Higher disease burden is prominent among Mumbai municipal corporation sanitation workers who mainly belong to Scheduled Castes, the lowest point in the hierarchical social structure. Sanitary work is affixed to these caste groups. This study deciphered the mechanisms and pathways where caste, occupation and social environment affect and modulate workers’ health, imbibing the eco-social approach to health. We analysed in-depth interviews of 15 sanitation workers from three sanitation posts, one from three wards. Five volunteers with a contract-based non-governmental organisation and two supervisors as key informants were included in the sample ( N = 22). The findings explain mechanisms and pathways to embodiment through eco-social approach where the biology of workers is shaped by historical life trajectories of their castes and decent-based occupation, the ecology and the susceptibilities, cumulating and impacting their health and overall well-being.