Why Tribal Health Matters: Addressing the Challenges of India’s Indigenous Communities

India’s tribal communities, officially recognised as Scheduled Tribes, are among the oldest inhabitants of the subcontinent. They live in forests, hills, and remote pockets that the mainstream rarely sees. Yet, despite their rich cultural heritage and constitutional protections, they continue to face some of the worst health outcomes in the country. Understanding why tribal health matters is not just an academic exercise; it is a question of equity, justice, and public health priorities.

Who are India’s tribal populations? 🔗

Scheduled Tribes are constitutionally recognised indigenous communities with distinct social, cultural, and economic identities. According to the 2011 Census, they make up around 8.6% of India’s total population, which translates to over 104 million people. These communities are spread across 700+ groups, each with its own language, customs, and traditional knowledge systems.

Geographically, tribal populations are concentrated in the central and eastern belts of India, including Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha, Maharashtra, and Gujarat. Sizeable populations also live in the Northeast, the Andaman and Nicobar Islands, and pockets of southern India like the Nilgiris and Wayanad. Many tribal groups live in forested areas, where their lives are closely tied to natural resources for food, medicine, and livelihood.

Particularly Vulnerable Tribal Groups (PVTGs) 🔗

Within the broader Scheduled Tribe category lies a sub-group called Particularly Vulnerable Tribal Groups, or PVTGs. These are communities considered the most marginalised, even within tribal society. The category was first created on the recommendation of the Dhebar Commission in the 1970s, originally under the name “Primitive Tribal Groups,” and was renamed PVTGs in 2006 to remove the pejorative label.

Today, there are 75 PVTGs spread across 18 states and the Union Territory of Andaman and Nicobar Islands. The criteria for identification are stringent: a pre-agricultural level of technology, a stagnant or declining population, extremely low literacy, and a subsistence-based economy. Groups such as the Jarawa of the Andaman Islands, the Birhor of Jharkhand, the Koraga of Karnataka, and the Saharia of Madhya Pradesh fall in this category. Their estimated combined population is around 47.5 lakh, with the largest concentrations in Madhya Pradesh, Maharashtra, and Andhra Pradesh.

The socio-economic backdrop 🔗

Tribal communities have historically lived in physically isolated and resource-rich, yet economically backward, regions. Many depend on forest produce, shifting cultivation, daily wage labour, or seasonal migration. Literacy levels are well below the national average, and access to formal education, banking, and government services remains uneven.

This isolation has two consequences. First, mainstream development schemes often fail to reach them in their original form. Second, when development does arrive in the form of mining, dams, or industrial projects, tribal communities frequently bear the cost through displacement and loss of land. The Xaxa Committee report of 2014 highlighted this paradox starkly: tribal lands are rich in minerals and forests, but the communities themselves remain among the poorest.

Health disparities among tribal populations 🔗

The health gap between tribal and non-tribal Indians is wide and persistent. Data from the National Family Health Survey-4 (NFHS-4, 2015-16) and subsequent rounds make this painfully clear.

Infant and child mortality 🔗

Children in tribal households are far more likely to die before their fifth birthday than children in the general population. According to a peer-reviewed analysis using NFHS data, the infant mortality rate for Scheduled Tribes was 62.1 per 1,000 live births, compared to 48.9 for others, and the under-five mortality rate stood at 95.7 versus 59.2. That is a 39% gap in under-five mortality, which signals deep structural inequities in maternal and child health.

Within tribal communities, the PVTGs fare even worse. A study on socioeconomic inequalities in eastern India found that Scheduled Tribes face higher infant mortality rates and shorter life expectancy at birth compared to less disadvantaged groups, with PVTGs being especially vulnerable due to loss of land and livelihood.

Malnutrition and stunting 🔗

Undernutrition is widespread among tribal children. NFHS-4 found that 43.8% of ST children under five were stunted, 27.4% were wasted, and 45.3% were underweight. These figures are higher than the corresponding national averages and reflect chronic food insecurity, poor maternal nutrition, and limited access to supplementary feeding programmes.

Encouragingly, the Press Information Bureau has noted that stunting among tribal children reduced from 43.8% in NFHS-4 to 40.9% in NFHS-5, with wasting and underweight showing similar declines. Progress is real but slow, and the gap with non-tribal children remains.

Anemia 🔗

Anemia is another quiet crisis. A study in tribal villages of Birbhum district in West Bengal found that the expected prevalence of anemia among tribal children aged 6 to 35 months was as high as 75.3%, based on NFHS-4 data. Anemia in children leads to fatigue, reduced cognitive development, and lifelong consequences for productivity. In pregnant tribal women, it raises the risk of low birth weight and maternal complications.

Maternal health and institutional deliveries 🔗

Access to maternal healthcare also lags. A cross-sectional survey across three tiger reserves found that ST communities recorded the lowest institutional delivery rates at 68% compared to the national average of 80%, and the lowest full immunisation rates at 56% versus 62% nationally. Many tribal women still deliver at home, often without a trained birth attendant, increasing the risk of maternal and neonatal complications.

The triple burden of disease 🔗

Tribal communities face what researchers call a triple burden of disease. Apart from high rates of malnutrition and communicable diseases such as tuberculosis, malaria, and sickle cell anaemia, they are now also seeing a rise in non-communicable diseases like diabetes, hypertension, and cancer due to rapid urbanisation and lifestyle changes. This compounds the strain on an already inadequate health system.

The impact of policy neglect and weak infrastructure 🔗

The reasons behind these disparities are not biological. They are historical, structural, and political.

Historical neglect and design flaws 🔗

For decades after independence, tribal health was treated as a sub-set of rural health rather than a distinct concern. The first comprehensive report on tribal health, prepared by the Expert Committee on Tribal Health jointly constituted by the Ministry of Health and Family Welfare and the Ministry of Tribal Affairs in 2013, arrived 66 years after independence and 11 five-year plans. That delay itself tells the story.

The Xaxa Committee, set up in 2013 under Professor Virginius Xaxa, made a sharp observation: healthcare in Scheduled Areas has been inappropriately designed and poorly managed because of the near complete absence of participation of Scheduled Tribes in shaping policies, plans, or implementation. In other words, tribal health programmes are usually designed by people who do not understand tribal lives.

Inadequate healthcare infrastructure 🔗

Physical infrastructure is another major bottleneck. Primary health centres, sub-centres, and community health centres in tribal blocks are often understaffed, poorly equipped, and located far from the villages they serve. Doctors and specialists are reluctant to take up postings in remote forested areas. The result is that even when a tribal patient is willing to seek modern care, the nearest functioning facility may be hours away.

A qualitative study on the Koraga community in coastal Karnataka found that despite the availability of services and schemes, the community encounters significant unnoticed barriers when trying to access healthcare, including distance, language barriers, social discrimination, and stigma. Many tribal patients first turn to traditional healers, partly because of cultural preference and partly because the formal system feels alien or hostile.

Displacement and the social determinants of health 🔗

Large-scale displacement caused by mining, dams, and industrial projects has uprooted entire tribal communities from their traditional habitats. Loss of land means loss of food sources, traditional medicine, and social networks, all of which are critical social determinants of health. Migration to urban fringes exposes them to new health risks like alcoholism, occupational injury, and infectious disease, without the cushion of community support.

Recommendations and the road ahead 🔗

The Expert Committee on Tribal Health set an ambitious goal: bringing tribal health indicators on par with the state average by 2027, supported by a functioning, sustainable healthcare system and a per-capita health allocation of around INR 2,500 at 2015-16 levels. The Xaxa Committee also recommended creating Tribal Health Plans and participatory institutions like Tribal Health Assemblies in Scheduled Areas, alongside a budget allocation proportionate to the ST population.

Initiatives like PM JANMAN, the Pradhan Mantri Janjati Adivasi Nyaya Maha Abhiyan, focused on PVTGs, and the broader Ayushman Bharat scheme are steps in the right direction. But for these to translate into real change, three things must align: better data on tribal health, culturally sensitive service delivery, and meaningful participation of tribal communities in planning and decision-making.

Why this matters beyond statistics 🔗

When 8.6% of India’s population systematically experiences higher mortality, deeper malnutrition, and weaker access to care, it is not just a tribal issue. It is a measure of how inclusive our health system really is. India cannot claim universal health coverage while its indigenous communities are left behind. Tribal health is therefore both a moral question and a practical test of public health policy.

Equally important is recognising that tribal communities are not passive recipients of welfare. They carry deep ecological knowledge, traditional medicine systems, and ways of community living that the wider society can learn from. Bridging the health gap is not about pulling them into the mainstream on someone else’s terms. It is about building a system that respects their context while guaranteeing their right to a healthy life.

What do you think? Should tribal health be treated as a separate vertical within India’s public health system, with its own budget and planning structures, or is it better integrated into the broader rural health mission? And how can the voices of tribal communities themselves be brought to the centre of policy design rather than the margins?

References

1. https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1577166&reg=3&lang=2
2. https://www.drishtiias.com/daily-news-analysis/particularly-vulnerable-tribal-groups
3. https://compass.rauias.com/blog/xaxa-committee-report-tribal-communities-india/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10057368/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9074184/
6. https://www.outlookindia.com/national/children-s-day-india-malnutrition-data-minors-news-236686
7. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1945843
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257594/
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC7116252/
10. https://idronline.org/indias-first-comprehensive-tribal-health-report/
11. https://tribalhealthreport.in/
12. https://www.drishtiias.com/summary-of-important-reports/xaxa-committee-on-tribal-communities-of-india
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12290442/