Health to poverty: Tribals scrape bottom of barrel

A comprehensive assessment of tribal health, by an expert committee appointed five years ago by the Ministry of Health and Family Welfare and Ministry of Tribal Development, shows that tribal populations in the country were lagging on almost every health parameter.

Tribal populations in India live at least three years less than non-tribal population groups, have higher malnutrition, a
significantly lower immunisation coverage, substantially higher low-birth-weight children, and were much more susceptible to communicable diseases like malaria, tuberculosis and leprosy.

A comprehensive assessment of tribal health, by an expert committee, appointed five years ago by the Ministry of Health and Family Welfare and Ministry of Tribal Development, shows that tribal populations in the country were lagging on almost every health parameter.

Tribal communities in India had “poorer health indicators, a greater burden of morbidity and mortality, and very limited access to health care services”, the report says.

For example, tribal people account for almost 30 per cent of all malaria cases in the country and 50 per cent of deaths due to malaria, despite forming less than 9 per cent of the country’s population. Similarly, the prevalence of tuberculosis in the tribal population was 703 per one lakh compared to 256 per lakh in the rest of the country.

Life expectancy amongst tribals, as assessed by a Lancet study in 2016, was 63.9 years while it was 67 years for the general population, the committee’s report points out. The committee says even this was likely to be an ‘overestimate’ considering that child deaths are under reported amongst tribal populations as compared to rest of the groups.

The infant mortality rate amongst tribal populations, according to the fourth National Family Health Survey (2015-16) was 44.4 per 1000 live births, significantly higher than the national average of 34. The 12-member expert committee, headed by Gadchiroli-based doctor and activist Abhay Bang, included experts from Tata Institute of Social Sciences, Mumbai; Tribal Research Institute, New Delhi; Indian Institute of Public Health, Gandhinagar; Indian Institute of Population Sciences, Mumbai; and National Institute of Research on Tribal Health, Jabalpur, amongst others.

The committee was asked in October 2013 to assess the gaps and special health needs of the 705 Scheduled Tribes in India and suggest measures to improve the quality and access of health services. Scheduled Tribes have a combined population of approximately 104 million, about 8.6 per cent of the country’s population, and are concentrated mainly in central and eastern Indian states and the north-eastern region.

The expert committee relied on different studies done in the past to make the medical assessment of these population groups to create the first of its kind status report on tribal health. It also identified ten “special health problems” that affect tribal populations disproportionately.

These include: malaria control, malnutrition, infant mortality, family planning, maternal health, de-addiction and health literacy. “It was challenging work to generate data as the institutional mechanism either did not exist or did not function… The darkness of information was astounding. Nobody knew what the Infant Mortality Rate was in the tribal population or how much money was spent on tribal health,” Bang said.

Their report points out that there were no recent estimates of maternal mortality amongst tribal women. But almost 50 per cent of adolescent girls, between 15 and 19 years of age, were underweight with a body mass index of less than 18.5. “At 70.1 per cent, the rate of institutional (child) delivery is the lowest among tribal women,” it says, while noting that this was a substantial increase from 18 per cent recorded by the third National Family Health Survey in 2005-06.

The expert committee said it was unable to create a country-wide disease burden profile of tribal populations in the absence of adequate data, but noted that even supposedly urban diseases like hypertension, cancer and diabetes was widespread in tribal populations.

The committee noted that only 10.7 per cent of the tribal population had access to tap water compared to 28.5 per cent of non-tribal groups, while three out of four tribal people (74.7 percent) continue to defecate in the open. Overall, 40.6 per cent of the ST population lived below the poverty line compared to 20.5 per cent of non-tribal population.

The disease pattern amongst the tribal communities living in the north-eastern region was found to be slightly different from those in other parts of the country. They reported higher incidences of non-communicable diseases, cancer, mental health problems, drug abuse, consumption of tobacco and alcohol, and also higher rates of HIV/AIDS and malaria.

The committee also noted that the poor quality of health amongst tribal communities was still a substantial improvement from the abysmal conditions a few decades ago.

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