The tribal population of West Bengal, which constitutes 5.8% of the population of the state, experiences severe inequity in health because of their marginalization over history, geographic seclusion, and the lack of social services in the form of the public health system. The empirical data used in this paper is a cross-sectional study of 36,128 tribal patients receiving services in five Mobile Medical Clinics (MMCs) in 2018-2019, along with a historical analysis of the responses of colonial cholera epidemics to the COVID-19 one. The results indicate that there is a triple disease burden; infectious diseases (44.5% primary registrations), non-communicable diseases (NCDs; 33.2% repeat visits) and injuries/pain (28.3%). The cases of infectious (54.1) and non-communicable disease (NCD) repeats were higher among younger groups (1-25 years) and older adults (Cramer V = 0.29, p <.001), respectively. The lack of attention to such problems is highlighted in historical analysis, where the colonial policies increased the number of epidemics and the post-independence interventions such as the National Health Mission (NHM) failed because of cultural and logistic obstacles. Multinomial logistic regression was used to determine the district specific risks, including 3.97 times of increased odds of NCD in Garbeta II MMC (95% CI [3.05, 5.17]). Seasonal peaks during the monsoons and female dominance (55.9) are some of the areas of vulnerability. It is recommended to use culturally specific MMC expansions, engage community health workers, and reform the policy in order to achieve equity. This synthesis is not only informative of interventions targeted in the face of epidemiological transition in India, but it also informs interventions.
tribal health, West Bengal, morbidity patterns, health disparities, mobile medical clinics, pandemics.
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