Disease Burden, Health-Belief and Treatment-Seeking Behaviour Among the Particularly Vulnerable Tribal Groups of India

© SEM 2021 Ethno Med, 15(1-2): 60-73 (2021) PRINT: ISSN 0973-5070 ONLINE: ISSN 2456-6772 DOI: 10.31901/24566772.2021/15.1-2.624 Disease Burden, Health-belief and Treatment-seeking Behaviour among the Particularly Vulnerable Tribal Groups of India C. J. Sonowal1 and Puja Konch2 Tata Institute of Social Sciences, Mumbai 400 088, Maharashtra, India Mobile: 1<9987521466>, 2<9957258097>; E-mail: 1<[email protected], [email protected]>, 2<[email protected]> KEYWORDS Disease and Illness. Health-belief. Particularly Vulnerable Tribal Groups. Treatment-seeking Behaviour. Tribal Health ABSTRACT Widespread health problems are prevalent among the Particularly Vulnerable Tribal Groups (PVTGs) of India, and they tend to incline towards their age-old traditional treatment practices. The PVTGs are relatively reluctant to accept modern bio-medical healthcare and treatment options available to them. The extent of interaction with and the level of exposure to the non-traditional domain directly impact the extent of acceptance of modern healthcare facilities by the tribal people. Based on the review of literature on health aspects of primitive tribal groups of India and some other relevant literature on health issues of indigenous peoples, the author tries to find out the disease burden among the particularly vulnerable tribal groups and perceptions of health, illness, and treatment- seeking behaviour prevalent among them. Further, using a conceptual framework, the author also analyses and discovers the gap in why these people are inclined towards traditional practices. INTRODUCTION over a while. The earlier understanding of health belief emphasised that culture is related to peo- Perception of Health ple’s health perception, and therefore, for effective health education, a change must be induced In the preamble to its Constitution, the World in those cultural features, which stood as sym- Health Organisation states health as “a state of bols or indirect expression of the fundamental complete physical, mental and social well-being moral, religious and social relation code (Fabrega and not merely the absence of disease or infirmi- 1974; Glick 1977; Paul 1955). Beyond this ‘cul- ty.” WHO also states that it is one of every hu- tural belief system’, an ecological framework has man being’s fundamental rights, without distinc- been considered in recent anthropological think- tion of race, religion, political belief, economic ing, emphasising a set of causal elements like or social condition to enjoy the highest attain- environmental features, material or economic con- able standard of health. Huber et al. (2011) define straints, and political considerations, which has health as “a relative state where a person can freed people from being passive followers of cul- function well physically, mentally, socially and tural wisdom, enabling them to choose and de- spiritually and express a full range of unique abil- cide the course of behaviours by selecting vari- ities in the environment in which he or she lives.” ous alternatives. However, the perceptions of health, well be- Napier (2012) and colleagues distinguished ing and illness vary across cultures, territories between narrowly biological notions of health and individuals. For instance, for some people, and disease and the broader socio-cultural con- not experiencing any disease symptoms and text in which people become sick, illness is expe- having the ability to play social roles may indi- rienced and managed, and health services and cate being healthy. The sociological and anthro- systems emerge and evolve. pological understanding of the perception of health and health-related behaviour has changed The Concept of ‘Disease’ and ‘Illness’ Address for correspondence: Scholars on health studies maintain a cate- Dr. C.J. Sonowal gorical conceptual difference between ‘illness’ Centre for Study of Social Exclusion and Inclusive Policies, and ‘disease’ mostly justified through anthro- Tata Institute of Social Sciences Sion-Trombay Road, Deonar, pological and sociological studies, as Fabrega Mumbai 400 088 (1974) mentioned. Kleinman et al. (1978), while Maharashtra, India dealing with the ‘explanatory model’ of disease DISEASE, HEALTH AND TREATMENT AMONG THE PVTGS 61 and illness, have emphasised that perceiving ill- health for a while, including the last two decades ness by an ‘ill’ person varies from person to per- of the 20th century. One can mention the studies son and culture to culture. While one can define conducted by Mahapatra (1994), Singh (1994), a disease as the malfunctioning or maladaptation Bhasin (2008), Nagda (2004), Guite and Acharya of biological and psychological processes in an (2006), Jain and Agrawal (2005), Sonowal and individual, one may perceive an illness as ‘the Praharaj (2007), Roy at el. (2010) and Sonowal personal, interpersonal, and cultural reactions to (2010, 2018). The findings generally agree that the disease or discomfort’. Therefore, Fabrega people’s socio-cultural and religious beliefs and (1972) and Litman (1974) see illness as a cultural- their immediate ecology influence the percep- ly constructed phenomenon shaped by cultural tions of health and treatment-seeking behaviour. factors that influence or regulate perception, la- These scholars explain the prevalence of tradi- belling, explanation and valuation of the discom- forting experience. The cultural construction of tional healthcare practices and the extent to illness is the crucial determinant that explains which India’s tribal people have been accepting why researchers and scholars of tribal health modern healthcare practices. Moreover, these observe a disagreement or mismatch of under- studies reveal that accessibility and affordabili- standing between physicians’ stated rationale ty are the causes of non-reporting for modern for their action (treatment) and the rationale of healthcare in some cases. the ‘ill’ person for the same, leading to a failure to assure healing, despite effective pharmaco- The Particularly Vulnerable Tribal Groups logic action (Stimson 1974). In a similar line of in India thinking, Mechanic (1972), Waxler (1974), and Yap (1974) maintain that these influence one’s expec- In India, after attaining independence, there tations and perceptions of symptoms, the way was an effort to identify the more backward com- one attaches particular sickness labels to them, munities within and outside the scheduled tribe and the valuations and responses that flow from communities to prepare and implement welfare those labels and further the exhibition of the ‘ap- and development schemes for them. These com- proved’ way of ‘illness behaviour’. Here, Klein- munities were named the “Primitive Tribal man’s (1980) ‘explanatory model’ is relevant to Groups” (PTGs). The specific criteria used to understand perception and action regarding identify these communities were as follows: health aspects, which talks of ‘notions about an i. Pre-agricultural level of technology episode of sickness and its treatment employed ii. Very low literacy by those engaged in the clinical process’. Mana- si et al. (2011) opine that people’s social and cul- iii. Stagnant and diminishing population tural contexts and prior experiences influence Considering the definitional contention people’s explanatory model. The type of explana- (primitive) and their vulnerability to various risk tory model held by a patient influences receptiv- factors, in 2006, these tribal groups got renamed ity to health promotion messages and health be- as ‘Particularly Vulnerable Tribal Groups’ haviours, both preventive and treatment seek- (PVTGs) in the place of ‘Primitive Tribal Groups’. ing. Studies have shown that EMs affect what At present, there are 75 tribal groups in India type of healer or doctor patients will visit and recognised as ‘Particularly Vulnerable Tribal what course of treatment they will follow. Napier Groups’. These groups live in 18 States and one et al. (2014) distinguished between health and Union Territory of India. disease notions based on a narrow biological notion and the broader socio-cultural context in Objective of the Paper which people become sick, illness is experienced and managed, and health services and systems The objective of the paper is to find out the emerge and evolve. gap of information regarding health beliefs and treatment-seeking behaviour among the PVTGs Health Issues of Tribal People in India and the reason for the continuation of traditional healthcare practices and their reluctance in Social scientists have extensively studied the accepting modern healthcare practices and fa- socio-cultural and ecological aspects of tribal cilities considering their extent of exposure to Ethno Med, 15(1-2): 60-73 (2021) 62 C. J. SONOWAL AND PUJA KONCH the non-traditional domain and level of the i. The tribal societies have been in transi- transition of their society. tion due to their exposure to the non-tribal and non-traditional domains and chang- MATERIAL AND METHODS es in social and geophysical conditions around them. Tools and Technique ii. Transition leads to a change in the extent of their attachment to traditional health Since this is a review paper, the materials are belief and treatment-seeking behaviour. the research reports, research articles and other iii. Changes manifest in nature and extent ac- literature. The researchers have used online ar- ceptance of modern or bio-medical health- ticles, reports and print journals and books as care facilities and practices. resource materials. While library

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