Examining fine-scale tribal health inequalities around three forested sites in India: Results of a cross-sectional survey

Background The data available for the health of Scheduled Tribes (ST) in India are often coarse-scale snapshots of health status and healthcare access showing poorer indicators when compared to others but do not allow fine-scale analysis. In this paper, we examined health inequalities between ST and non-ST populations in two forested sites and compare healthcare parameters for ST populations across three forested sites in India. Methods We conducted a cross-sectional household survey in sites in and around Biligiri Ranganathaswamy Temple (BRT), Kanha and Pakke tiger reserves in the south, central and northeast regions of India respectively. In each site, multi-stage sampling and cluster analysis provided a representative sample of households across villages of 859 ST and non-ST households. We examined sociodemographic and health-related information including self-reported illnesses and healthcare utilisation; from these we explored within-site health inequality patterns for two sites and inter-site differences among ST households in the three sites. Results In BRT, ST-non-ST differences favoured the latter for socio-economic characteristics with no difference in self-reported illness/injuries or healthcare utilisation. In Kanha, both groups were similar for socio-economic characteristics and healthcare utilisation. Pakke ST households reported highest healthcare utilisation, while Kanha ST households reported lowest care seeking at hospitals and relied on home networks and health workers. High tobacco consumption prevalence was noted among ST households in all sites. Conclusions ST-non-ST inequality patterns at a fine-scale were different between BRT and Kanha. Absence of health inequalities between both groups in Kanha indicates uniform socio-geographical disadvantage while poor healthcare utilisation by ST in BRT indicates health inequities within the state. Pakke ST households reported highest utilisation while Kanha reported the lowest. Thus, programmes addressing health inequalities of STs need to consider site-specific assessments in socio-geographical and health system factors.