Context

• There has been an increase in the incidence of diabetes amongst the tribal population in India.

Tribal communities

• Tribal communities in India constitute approximately 8.9% of the country’s population.
• According to a study by the Ministry of Tribal Affairs, newborn mortality in tribal communities is 63 % higher than the national average.
• Tribal people are at higher risk of getting chronic diseases such as diabetes, hypertension, cardiovascular diseases, cancer, and mental disorders.

Diabetes

• Diabetes is a metabolic disorder in which the body has high sugar levels for prolonged periods of time.
• The lack of insulin causes a form of diabetes.
• Type I Diabetes is a medical condition that is caused due to insufficient production and secretion of insulin from the pancreas.
• Type II Diabetes occurs when the body is unable to use insulin effectively and can’t keep blood sugar at normal levels.

Diabetes in Tribal population

• • According to a study, about 13% of tribal adults have diabetes and 25% have high blood pressure.
  • A study revealed that the mean age for the onset of diabetes was slightly earlier for tribal population as compared to non-tribals.
  • Some tribal population suffer from fibrocalculous pancreatic diabetes, an uncommon but severe form of diabetes.
    • Fibrocalculous pancreatic diabetes (FCPD) is an uncommon form of diabetes that occurs as a result of chronic calcific pancreatitis. 
    • The disease is restricted to tropical regions of the world, and southern India has the highest known prevalence of FCPD. 
    • The typical patient with FCPD is a lean adolescent or young adult of either sex, presenting with history of recurrent bouts of abdominal pain and steatorrhea.

• Chronic pancreatitis is an inflammation of your pancreas that impairs your body’s ability to digest food and regulate blood sugar.

Lean diabetes

• Most tribals also suffer from lean diabetes (patients with low-normal body mass index).
• It is a medical condition that involves dual stress of intermittent starvation and overload of carbohydrate metabolism. 
• A study revealed that lean diabetes in India is as high as 23 percent. Cases of lean diabetes are seen spreading among tribals in Chhattisgarh.

Reasons for Diabetes amongst tribal population

• Poor socio-economic status, history of childhood malnutrition and rural origin are important factors for a rise in diabetes in tribal population.
• Over reliance on rice distributed through Targeted Public Distribution System (TPDS) is attributed to the sudden rise of diabetes in the tribal population.
• Traditionally, the tribal population would cultivate millets, grow vegetables and fruits. This practice has vanished over the years.
• There has been a shift in food consumption in tribal population. The traditional platter consisting of millets like jowar, bajra, meat, green leafy vegetables and seasonal fruits has been replaced with higher consumption of white rice, rotis, dal, etc. 

Report by Expert Committee on Tribal Health

• In 2018, an expert committee, constituted jointly by the Ministry of Health and Family Welfare and Ministry of Tribal Affairs released the first comprehensive report on Tribal Health in India.
• Recommendations of the Report:
  • Introduce ST Health Cards for tribal people living outside scheduled areas to facilitate access to benefits at any healthcare institution.
  • Enhance food security and strengthen Integrated Child Development Services (ICDS) to address malnutrition.
  • Publish a State of tribal health report every three years. 
  • Establish a Tribal Health Index (THI) to monitor tribal health.

Way Forward

• Government must invest in proper data management systems for disease control, training of ASHA and healthcare workers, hospitals infrastructure etc.
• Decentralised care and establishment of other non-medical approaches like peer support groups etc to create awareness and inclusivity.
• The situation can be improved by nutritional rehabilitation of mixed food types, including egg, millets and nuts which can be distributed through TPDS.