According to the World Health Organization (WHO), the definition of health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The health status of any community is influenced by the interplay of health consciousness of the people, socio-cultural, demographic, economic, educational and political factors. The common beliefs, traditional customs, myths, practices related to health and disease in turn influence the health seeking behaviour of autochthonous people.
The health status of tribal populations is very poor and worst of primitive tribes because of the isolation, remoteness and being largely unaffected by the developmental process going on in India.
The health conditions of the tribals are not in a good condition. Most of the tribal people in India are illiterates. They believe in faith cure and ageold methods. And also depends on local herbal medicines.
Diseases are common between the tribal and non-tribal population. However, there are some diseases peculiarly prevalent in the hill areas. Malaria has been recently reduced, of not altogether eliminated. But there are certain social customs which facilitate propogation of diseases in the tribals. Diseases of the lungs are common among the tribesmen, even in the hills. Nutritional problems are also faced by tribals. Due to lack of balanced diet, tribals suffer various vitamin deficiency diseases. Ex: Night Blindness.
The diseases prevalent in tribal areas can be broadly classified into following categories.
- Malnutrition – Low birth weight, under-nutrition of children, lower body size of adults, anemia, iron and vitamin A and B deficiency.
- Maternal and child health problems – higher IMR, <5MR, neonatal mortality, acute respiratory infections, diarrhea,
- Communicable diseases – malaria, filaria, tuberculosis, leprosy, skin infections, sexually transmitted diseases, HIV, typhoid, cholera, diarrheal diseases, hepatitis, viral fevers etc.
- Accidents and injuries – including the burns, falls, animal bites, snake bites, violence due to conflicts, and more recently motor cycle accidents.
- Addictions – especially to alcohol and tobacco generally and to drugs in the North East region.
- Hereditary diseases such as the Hemoglobinopathies (Sickle Cell) and G-6 PD deficiency.
- Mental health problems – especially in the areas affected by conflicts.
- Speciality problems – especially the orthopedic and surgical problems, gynecological problems, oro-dental problems and eye problems.
- Non-communicable illnesses – Hypertension, stroke, diabetes, cancers.
Tribal communities in general and primitive tribal groups in particular are highly disease prone. Also they do not have required access to basic health facilities. They are most exploited, neglected, and highly vulnerable to diseases with high degree of malnutrition, morbidity and mortality (Balgir, 2004). Their misery is compounded by poverty, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water and blind beliefs, etc. The chief causes of high maternal mortality rate are found to be poor nutritional status, low hemoglobin (anemia), unhygienic and primitive practices for parturition. Average calorie as well as protein consumption is found is below the recommended level for the pregnant as well as lactating women.
Some of the preventable diseases such as tuberculosis, malaria, gastroenteritis, filariasis, measles, tetanus, whooping cough, skin diseases (scabies), etc. are also high among the tribals. Some of the diseases of genetic origin reported to be occurring in the Indian tribal population are sickle cell anemia, alpha- and beta-thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, etc. (Balgir, 2004b). Night blindness, sexually transmitted diseases are well known public health problems of tribals in India.
Tribal communities are mostly forest dwellers. Their health system and medical knowledge over ages known as ‘Traditional Health Care System’ depend both on the herbal and the psychosomatic lines of treatment. While plants, flowers, seeds, animals and other naturally available substances formed the major basis of treatment, this practice always had a touch of mysticism, supernatural and magic, often resulting in specific magico-religious rites. Faith healing has always been a part of the traditional treatment in the Tribal Health Care System, which can be equated with rapport or confidencebuilding in the modern treatment procedure. For example, the doctor priests of the Saora tribe utilize several herbs and roots in conjunction with their magico-religious rites in Orissa. Health problems and health practices of tribal communities have been profoundly influenced by the interplay of complex social, cultural, educational, economic and political practices. The study of health culture of tribal communities belonging to the poorest strata of society is highly desirable and essential to determine their access to different health services available in a social set up. The common beliefs, customs, traditions, values and practices connected with health and disease have been closely associated with the treatment of diseases. In most of tribal communities, there is a wealth of folklore associated with health beliefs. Knowledge of folklore of different socio-cultural systems of tribals may have positive impact, which could provide the model for appropriate health and sanitary practices in agiven eco-system. The health culture of a community does not change so easily with changes in the access to various health services (Balgir, 2004a). Hence, it is required to change the health services to conform to health culture of tribal communities for optimal utilization of health services.
The health care services and challenges in rural and tribal areas are a complicated phenomenon such as:
- Concept of health and disease is rather traditional which results in their not seeking
treatment at an early stage of physical maladjustment and frequent refusal of preventive measures in rural areas and their idea of medical care is some treatment not easily accessible and available. Lack of motivation of people for availing medical care at the initial stage of the disease.
- Limited paying capacity or habit of getting treatment always free of cost.
Comparative inaccessibility of medical care services due to under-developed communication and transport facilities.
- Nonavailability of qualified medical practitioner in the village.
- Qualified health workers and professional medical and paramedical staff do not want to work in rural and tribal areas because of professional, personal and social reasons.
- Nonavailability of private or governmental doctor as and when need arises.
Lack of medical facility is another problem for them. Hygiene problem is very common in rural as well as in tribal areas. Tribal populations are affected by various social, economic and developmental constraints that potentially expose them to high rates of malnutrition and health problems which is correlated with the lower percentage of higher education of the community. The tribal of India are heterogeneous. Although scheduled tribes are accorded special status under the fifth/sixth schedules of the Indian Constitution, their status on the whole, especially their health still remains unsatisfactory. Hence, the methods to tackle their health problems should not only be multi-fold, but also specific to the individual groups as feasible as possible.
Though Modern medicine has largely replaced the traditional practices of healers and belief in such magicians has considerably declined. A comprehensive control strategy with specific interventional measures needs to be evolved and implemented specially in tribals with serious efforts for their overall development.
There are several challenges for policy makers, planners, administrators, implementers, doctors, social workers and nongovernmental organizations (NGOs) for the amelioration of tribal communities . Some of the suggestions are :
1. A complete Mini Mobile Hospital or Health Unit
2. A mass awareness and preventive programme a
3. Mass screening for genetically transmitted diseases such as hemoglobino-pathies,
b-thalassemia syndrome, G6PD deficiency, hemophilia, colour blindness, etc.
4. Providing Genetic/Marriage Counsellor
5. Providing social and economic incentives and support for
6. Maintenance of registry of common prevalent diseases
7. For nutritional deficiencies provide necessary nutrients with change of dietary practice
8. To achieve operational efficiency, to involve local tribals
9. Constraints and bottlenecks should be identified, strategies in consonance with the felt needs of the local tribal population.