In the Shadows of the State: Structural Barriers to Tribal Health in Tamil Nadu

Abstract

In India, Scheduled Tribes still face some of the poorest health conditions across almost every major indicator. This includes infant and maternal deaths, nutrition levels, and even life expectancy. Tamil Nadu is usually praised for its strong social welfare policies and good healthcare system. But the situation looks quite different when we focus on the health of its tribal (Adivasi) communities. This paper examines the deeper structures that shape these health gaps, looking at the role of the state, environmental policies, and the social and political exclusion that tribes continue to experience.

Using a political ecology approach, the paper argues that poor health among tribal groups is not only because they live in remote areas or because health services are weak. It is rooted in long-term marginalization, loss of land, destruction of forests, decline of traditional food systems, and even the criminalization of indigenous healing practices. Drawing from field observations, policy documents, and existing studies from regions like the Nilgiris, Jawadhu Hills, and Kalrayan Hills, we show how environmental damage and the weakening of traditional rights to forests and land increase health risks.

The paper also points out the gap between formal healthcare and Adivasi cultural beliefs. Many times, the biomedical system does not recognise tribal knowledge and treats it as inferior. Our findings challenge the usual idea that Adivasi groups are simply “beneficiaries” waiting for help. Instead, we argue for a shift in health planning, one that respects their land, culture, and ecological knowledge. We suggest a rights-based model where indigenous voices play a central role in designing fair health systems.