Globally, indigenous health has emerged as a critical frontier in public health. Countries like Australia, Brazil, Chile, and New Zealand with significant indigenous populations have led the way in aligning their national policies with international frameworks such as the United Nations Declaration on the Rights of Indigenous Peoples 2007 (UNDRIP) and the International Labor Organization’s Convention (ILO) 169. These frameworks emphasize the imperative of indigenous self-determination in health governance. India, too, stands at the cusp of this movement, with constitutional protections and recognition for its indigenous populations. However, persistent health disparities among tribal populations underscore the urgent need for a comprehensive and culturally appropriate roadmap. It is imperative to shift from a deficit discourse to one that centers the strengths, resilience, and knowledge of tribal communities.

Status of Indigenous Health in India

In India, the indigenous communities, officially recognized as “Scheduled Tribes,” comprise 8.6% of the nation’s population according to the 2011 census, encompassing 705 different tribes totaling approximately 104 million individuals. However, this demographic endures a stark health disparity compared to their non-tribal counterparts, with poorer health indicators and a higher burden of diseases. .

The high incidence of malnutrition, infectious diseases such as malaria and tuberculosis, and the growing prevalence of chronic illnesses among these communities are indicative of underlying systemic factors. These include racial discrimination, environmental degradation, internal communication barriers, forced displacement, and the erosion of cultural heritage, all of which contribute significantly to their heightened health risks. Moreover, their geographic isolation exacerbates these challenges.

While progress has been made in certain health indicators such as sex ratios, the use of family planning services, and maternal and child health practices, between 2016 and 2021, the landscape is far from equitable. A critical gap in knowledge has been the lack of comprehensive population-level health data for these communities. This data deficiency was partially remedied in 2018 with the publication of India’s first comprehensive tribal health report, led by Dr. Abhay Bang and the Expert Committee on Tribal Health. This seminal report has laid the groundwork for more informed policy initiatives to address health inequities and enhance the well-being of India’s indigenous tribes.

Addressing Indigenous Health Disparities: Progress and Persistent Gaps

The 2018 Tribal Health Report stands as a groundbreaking contribution to understanding the health challenges and disparities faced by India’s indigenous populations. By meticulously mapping out the disease burden, infrastructure deficits, human resources constraints, and financing in tribal areas, the report provided a critical foundation for targeted interventions. Its strategic recommendations, including the establishment of dedicated Tribal Health Councils, Directorates, Action Plans, and Research Cells, offered a blueprint for addressing unique health challenges faced by tribal communities.

While this groundbreaking report illuminated the path forward, its translation into concrete action remains a work in progress. The National Health Mission (NHM) focuses on states to develop their own Program Implementation Plans (PIP) for districts with health indices below the state average- a commendable step towards addressing disparities, yet its impact on tribal health specifically is unclear.

A critical gap persists in the availability of disaggregated health data for tribal communities. The reliance on the existing data from Rural Health Statistics and the National Family Health Survey (NFHS) fall short of providing a clear picture of tribal health status, leaving significant gaps in our understanding and limiting our ability to tailor health interventions that are culturally appropriate and geographically relevant.

Call for Action: Roadmap for India’s tribal health through Inclusive Health Governance

As India strides towards improving public health, it’s crucial that the unique needs of its indigenous populations are not merely acknowledged but actively integrated into health policy frameworks. The health disparities facing these communities are not just a challenge but an urgent call to action for systemic change. To achieve this, a comprehensive approach involving health research, community participation, and institutional reform is essential.

Advancing tribal health requires a foundational shift towards evidence-based governance. This means prioritizing the collection, management, and analysis of health data disaggregated by ethnicity, including determinants of health that uniquely affect these communities. Such data is vital for informed decision-making and crafting public health policies that are not only effective but also equitable.

Strengthen institutional capacities to analyze health data with a focus on ethnic disparities. This involves training and equipping health agencies to understand and address the specific health issues of tribal populations, fostering a healthcare environment that is sensitive to cultural and linguistic diversities. Promoting transparency in how this data is used and disseminated will further ensure that health strategies are both accessible and accountable to the communities they aim to serve.

Furthermore, the involvement of indigenous communities in the planning, delivery, and monitoring of health services is not optional but necessary. Currently, the lack of meaningful participation has led to gaps in communication, misunderstandings, and a general mistrust in the healthcare system.  By involving tribal leaders and community members directly in health governance, we can close these gaps and build a healthcare system that is truly participatory and responsive. Lessons can be drawn from international examples, such as Brazil’s Local Indigenous Councils (CLSI) and State Indigenous Councils (CONDISI), where indigenous community leaders, health service managers, and health workers collaboratively engage in policy evaluation and control. Similarly, in New Zealand, the participation of Māori in the health sector, through robust Māori health service providers and institutions, demonstrates the power of close working relationships between government agencies and indigenous communities. These models can be adapted to our local contexts to create a more inclusive and culturally relevant healthcare system, paving the way for a more equitable and just healthcare system in India.

Conclusion

Addressing indigenous health disparities in India has underscored the critical need for inclusive, evidence-based, and community-driven approaches. By integrating the unique needs of indigenous populations into health policy frameworks and fostering genuine community participation, we can make strides towards equity and improved health outcomes for all. The path ahead requires collective effort, sustained commitment, and a genuine dedication to understanding and addressing the deep-rooted challenges faced by India’s indigenous communities.

References

1. Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, et al. Health conditions and health-policy innovations in Brazil: the way forward. Lancet. 2011 Jun 11;377(9782):2042–53.
2. Ferdinand A, Lambert M, Trad L, Pedrana L, Paradies Y, Kelaher M. Indigenous engagement in health: lessons from Brazil, Chile, Australia and New Zealand. Int J Equity Health. 2020 Jul 31;19(1):47.
3. King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009 Jul 4;374(9683):76–85.
4. Banerji D. Place of the indigenous and the western systems of medicine in the health services of India. Int J Health Serv. 1979;9(3):511–9.
5. Subramanian SV, Joe W. Population, health and nutrition profile of the Scheduled Tribes in India: a comparative perspective, 2016-2021. Lancet Reg Health Southeast Asia. 2024 Jan;20:100266.
6. Tribal Health Report: Bridging the Gap and a Roadmap for the Future [Internet]. Ministry of Health and Family Welfare, GoI & Ministry of Tribal Affairs, GoI; 2018 [cited 2024 Jun 27]. Available from: https://tribalhealthreport.in/
7. Kumar MM, Pathak VK, Ruikar M. Tribal population in India: A public health challenge and road to future. J Family Med Prim Care. 2020 Feb;9(2):508–12.
8. Linda AI, Pal D, Murmu N, Taywade M. Health of Tribal Population in India: A Glimpse of the Current Scenario. Current Medical Issues. 2024 Apr;22(2):114–7.

Author

Jasmine Maringmei

Jasmine Maringmei is a tribal youth belonging to the Rongmei Naga community from Manipur, Northeast India. She is a Policy Analyst specializing in health systems and policy research. Beyond her professional work, Jasmine is actively involved in youth networks focused on education, peacebuilding, and protection. She is also the 2024 Atlantic Fellows for Health Equity. Jasmine holds an MPhil degree in Planning and Development from Indian Institute of Technology Bombay, and a Master of Sociology from Delhi School of Economics.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.