Why are so many indigenous Pando people dying? Using observations from Chhattisgarh, India, to conduct structural assessment and identify solutions

Figures & data

Figure 1. Structural factors underlying an untimely death of a young labourer from the Pando community.

Table 1. Structures identified while evaluating causes of excess deaths among Pando people along with their determinants, vulnerabilities and violence and proposed solutions.

Structure^1	Structural determinant^2	Structural vulnerability^3	Structural violence^4	What we proposed?
Political	Small population of Pando people in India distributed in multiple electoral districts or constituencies	Poor political representation of the Pando community; not a political priority due to small number of votes	Denial of political voice compared to other larger Adivasi communities	Need for regular outreach by the political leaders and administrative officials to Pando community to understand their problems and help find solutions. Regular outreach by Pando community members to local political representative to acquaint them of the problems faced by the community
Administrative	Ill-prepared healthcare system that can’t respond adequately to local health needs – especially of vulnerable communities Non-issuance of caste/tribal certificate	Inability to define, measure and respond to disease outbreaks in the Pando community Inability to avail of affirmative action policies	Unacknowledged, preventable, and treatable deaths and morbidity Low levels of education and high unemployment among youth	Build administrative capacity to improve disease surveillance and structural competency. Create Adivasi-friendly health facilities Adivasi status documentation needs to be understood and responded at the local, state and the national level
Legal	Unavailability of constitutional protection	Pando community members in uneven power dynamics with other communities of the village. Prone to exploitation. Lack of legal awareness and support	Land grabbing, violence against Pando people by other communities (Mishra, 2021)	Legal support should be provided to these communities. Train community youth in legal matters
Economic	Lack of economic self-sufficiency	Difficulty in escaping poverty due to lack of education, jobs and tribal status certificate. Senior members of the community feel that education is not providing jobs	Can’t seek legal protection against economic exploitation such as land grabbing due to poverty, premature deaths among young members of the community which further worsen poverty	Ensuring that the benefits of the national employment guarantee scheme reach to Pando community members. Improving access to quality education and heath care
Social	Otherization of the Pando community members in the society	Pando community members are labelled as lazy	Pando community members left out of key community decisions	Increasing awareness among other communities regarding the challenges faced by the Pando community members and building allyship
Cultural	Lack of representation of the Pando community in the healthcare system – as a culture or its members	Assumption by the members of other communities that health and healthcare are not the priority of the Pando community	Stereotyping of the Pando community members as lazy, crude, unclean, alcoholics, culturally inferior resulting in undignified treatment	Participation by the public health system members in festivals of Pando community. Greater recruitment of the Pando community members within the health system and as patient navigators. Sensitisation of healthcare workers about their socio-cultural practices through more community engagement such as in festivals
Material	Access to housing, water supply, mobile network and phones, internet, and roads	Risk of persistent ill health and denial of access to healthcare	Infections, deaths due to preventable diseases at young age, delayed healthcare seeking	Improved road and mobile phone access; community-led prevention of illness
Technical	Lack of good quality health data from Pando community, such as birth and death rates and causes of death with public health system or academia	No data to inform response	Health problems among Pando community remain unidentified and thus unsolved	A system to monitor vital events and causes of death among Pando community
Biological	Malnutrition	Nutrition seen as an individual’s responsibility. Stereotyping of eating habits – ‘Pandos drink water from contaminated sources in the forests and eat stale food’	Poor overall nutritional status and health	Improve access to food; more ration for larger families; target government schemes and benefits to vulnerable groups and ensure access
Environmental	Forest-dwelling community In close contact with the mite’s habitat and rising impact of climate change	Ensuring forest rights to Pando community members is not a priority for the state government Scrub typhus is not a priority of public health system as it is not included in the national vector-borne disease programme, poorly researched and corelated with climate change unlike in other parts of east Asia	Lack of sustainable livelihood; poverty and poor healthcare seeking At higher risk of getting the disease in the first place because of disproportionate effect of climate change and the resultant rise in scrub typhus cases	Helping the community in getting such rights Organise a conference on scrub typhus and deliberate on its public health consequences; dedicated funding for research into scrub typhus in forested areas

¹ Structures- The Oxford English dictionary defines structure as an arrangement and organisation of interrelated elements in a material object or system, or the object or system so organised. Thus, a social structure can be defined as a way a society is organised in hierarchies through institutions, policies, economic systems, and cultural or normative belief systems such as caste, tribe, socioeconomic status, gender (Miller, 2019).

² Structural determinants- Context, structural mechanisms and the resultant socioeconomic position of individuals (World Health Organization, 2010).

³ Structural vulnerability- the risk that an individual/ community experiences because of structural violence through their location within the socioeconomic, political, and cultural/normative hierarchies (Bourgois et al., 2017).

⁴ Structural violence- arrangements embedded in the economic and political organisation of our social world, causing injury to people (Farmer et al., 2006).

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Data availability statement

Not applicable.