The Myth of the Healthy Tribal*

Health Modernity has been defined as scientifically correct information, attitudes and behaviour in relation to physical and mental health, family planning and childcare, personal hygiene and environmental sanitation and such other issues which are essential pre-requisites for healthy living and, therefore, for human and social development. A Health Modernity Scale, in the form of an interview-schedule, was administered on 991 tribals (male and female) in two rural blocks of Ranchi district in South Bihar. Their health status was also measured through health indicators, such as living conditions and food habits, age at marriage of women, fertility and family size, immunization and malnutrition in under-five children, and death and disabilities. The tribal community studied had very low health status and Health Modernity.

PLEASE close your eyes and think of an average tribal person in the native habitat. The mental image, most likely, will be of a healthy, strong, carefree man with a flute on his lips, and of a woman, with flowers in her hair, dancing happily on the wild beats of the drum. This stereotype of a tribal, held by most Indians, alas, is a hollow romantic myth.

This myth has been exposed by the grim facts of a Health Modernity Survey sponsored by the Indian Council of Medical Research in two rural blocks, Kanke and Namkum, of Ranchi district in Chotanagpur region of Bihar.

The present paper describes the sad story of this tribal community, which, after four decades of Independence, deceived by the mirage of political promises and bypassed by modernization and development, continue to be over-whelmingly illiterate (81%), poor (58% having monthly income of Rs. 200 and less and another 31% between Rs. 201 and 400) and unhealthy (29% families reporting illness). Less than 8% of the children were immunized. Two-thirds of the children under five were malnourished, 44% having severe malnutrition. A large majority of the sample (71%) took tobacco, mainly in the form of raw leaves called khaini, chewed with lime. Most of them (89%) drank alcohol, mainly haria, a home brewed rice-beer. The daily consumption of meat, fish, egg and milk was by less than 1%, of pulse by a small 8% and 65% did not eat green vegetable. Two-thirds of them did not take baths daily; the percentage of women being as high as 90. Nor did they wash their personal clothes (91%) or clean their nails (95%) regularly. An average tribal woman married early at the age of fifteen and had six children, two of them dying in her life-time. The average tribal family had seven persons with only about two rooms. Deprived of basic physical facilities they lived in squalor and garbage, with pigs and hens, without electricity, sanitary latrines, ventilation, outlet for smoke, drainage and sewage. Less than 4% had scientifically correct knowledge of, and attitudes to, physical and mental health, diet and nutrition, and family planning and childcare.

Illiteracy	81%
Poverty	58%(< Rs. 200 p.m.)
	31%( Rs. 201 - 400 p.m.)
Unhealthy (Families reporting ill health)	29%
Children immunized	<8%
<5 children, malnourished	75%
Tobacco (Khaini with lime) consumption	71%

A tribal, like anyone else in the world, cannot be healthy living in poverty, ignorance, starvation and garbage. Despite these, if he seems happy to others, or to himself, there is something wrong in the definition of happiness.

I

Health and Human Resource Development in India

Health Status in India

Health has been acknowledged as an essential pre-requisite for human resource development. The Seventh Five Year Plan underlines this in the chapter on Health and Family Welfare (GOI, 1985). It has been argued that low health status and high fertility in India are the main obstructions against human resource development (Singh, A.K. 1986). The health status in India is distressingly low as reflected in numerous dismal statistics on health indicators such as high rates of infant and child mortality, fertility and low birth-weight, low life-expectancy and immunization-coverage, and wide-spread malnutrition (Table 1). The low health status in India is confirmed repeatedly by the high prevalence of easily preventable diseases at low cost, such as blindness, tuberculosis and diarrhoea.

The statistics given in Table 1 give a bird’s eye-view of the gloomy situation of health status in India. A few more studies may be mentioned to supplement these.

Physical Quality of Life Index

A Study on Physical Quality of Life Index (PQLI) is available for thirteen major states of India. The PQLI is a broad indicator of overall health status as it combines three variables namely, infant mor5tality, life expectancy and adult literacy. A value of 100 points indicates a satisfactory health status. All the states of India have a low PQLI, and in most states the females score lower than males (GOI 1979).

Nutritional Status

Several studies have demonstrated the low nutritional status of the majority of the population. Data for malnutrition in children between 1-5 years are available from 1969 to 1980 collected on large samples in different states by National Institute of Nutrition (NIN, 1981; UNICEF 1984). Though there is evidence that there has been improvement in the nutritional status of children, still only 15% of the children studied in 1980 had normal nutritional status. Majority of the Indian population, both in rural and urban difference in the country is quite high. The percentages of consumers below the level 2800 KCAL are 56.39 for rural and 71.0 for urban population. There are also significant regional variations in under-nutrition (Das Gupta 1984). The states, of Kerala, Tamilnadu and West Bengal have the highest under nutrition, and states of Jammu and Kashmir, Punjab, Himachal Pradesh and Rajastan have the lowest.

Infant Mortality

Though the urban population is more malnourished, it has a lower infant mortality rate than the rural population. This rural-urban difference in infant mortality favouring the urban, has been continuing, without much change, from 1970 to 1982 (GOI 1985; UNICEF 1984). The lower infant mortality in urban areas is perhaps mainly because of the fact that larger proportion of urban population has access to medical facilities at the time of child-birth. During 1979-78, 66.2% births had received institutional and trained medical attention in urban areas; the corresponding percentage for the rural population was only 16.5% (Visaria 1985. P. 1400). There is evidence that the infant and child mortalities in rural as well as urban areas, are lower when child-births are attended by trained medical personnel compared with when attended by untrained ones (UNICEF 1984, p. 29). A greater percentage of rural population (64%) is unaware of available MCH services compared with the urban (54%). As a consequence of this, lesser number of rural population (17.7%) avail of the MCH services than the urban population (20.8%) (Operational Research Group, 1983, p. 55).

ICMR-UNICEF Study of Child Survival

Unhappily, the dark picture of the low health status in India gets a shade darker by each new study. A recent ICMR-UNICEF sponsored study, covering a large sample of 180,000 in three uban slums of Madras, Delhi, and Calcutta and three rural areas near Chandigarh, Varanasi, and Hyderabad, has reported very high perinatal (65.3), neo-natal (57.7) and infant (94.5) mortality rates; 29.3 stillbirths per 1000 deliveries, and low birth-weight of less than 2500 gms in 39.3% of births (ICMR, 1986).

Vaccine-preventable diseases

As is reported in Table 1, there is very high incidence of vaccine-preventable diseases in India. India’s share of total incidence of vaccine-preventable deaths and disabilities in the third world is the highest. For polio, tetanus and measles India’s share is 40% , 31%, and 39% respectively. On the other hand, India contributes only 15% in prevention of paralytic polio and 10% in deaths by other diseases (John 1986). Grant in his annual report on the State of the World’s Children 1987 has recorded that "whether the issue is diarrhoeal deaths or vaccine-preventable diseases, low birth weight or malnutrition, infant death or childhood disability, nearly 30% and sometimes more of those affected live in India" (Grant 1987, p. 62).

SES and Health Modernity

Singh (1984 a, b), on the basis of his study on "Health Modernity and its Correlates in South Bihar", has reported that SES is the most powerful correlate of health status and health modernity. This study was sponsored by the Indian Council of Medical Research to develop a Health Modernity Scale. This served as a pilot project to the Health Modernity Education Project (HMEP) reported in this paper. Therefore, a summary of this study is being reported here. A factorial sample design (4X2X2X2X2) was taken to represent: (i) four religious and ethnic groups, namely, Hindus, Muslim, Tribal Christian and Tribal Hindu/Sarna, (ii) two categories of sex: male and female, (iii) two categories of residence: rural and urban, (iv) two categories of age: 21-30 and 31-40 years, and, (v) two categories of socio-economic status: low and high. The sample consisted of 1280 cases, taking 20 cases in each sample cell from Chotanagpur. A supplementary sample of rural Santhal Pargana of 160 cases was added to the main sample, thus yielding a grand total of 1440 cases. The SES scale was a combination of caste/tribe, income, education, and occupation. Health Modernity was measured by a 50-item scale measuring scientific information and attitudes to mental and physical health. A behavioural measure of Health Modernity was also used, covering such themes as personal hygiene, consumption of alcohol and tobacco, and religious behaviour to avoid and/or cure illness. The analysis of variance had shown that the F-value for SES was the largest compared to those of religion, rural-urban residence and sex. All of these factors had significant independent influence on health modernity. The significant influence of SES was also found in separate ANOVA for all the four religious-ethnic groups. The extent of Health Modernity was only 23% and majority of the persons with health modernity (82%) belonged to the high SES category (Figure 1). The four religious-ethnic groups, on the basis of their Health Modernity Scores, were ranked in this order: Hindu (highest), Tribal Christian, Tribal Sarna/Hindu, and the Muslims (lowest). In each of the four religious-ethnic groups, the high SES, without exception, had higher health modernity score than its counterpart low SES group. The Health Modernity Scale had significant positive correlation with all the four components of SES, namely, caste/tribe, education, income and occupation; education having the highest correlation value. The attitudinal Health Modernity had positive significant correlation with behavioural measures of Health Modernity. A further analysis of the data, taking only the female cases (640), confirmed the findings of the main analysis supporting the strong relationship of SES and Health Modernity(Jayaswal, 1985).

Health and HRD in India

The Health status in India is perhaps even worse than what the governmental statistics reveal, which, as is the common practice, are boosted in the positive direction by the loyal officials. The low health status in India, caused by the combined forces of poverty, illiteracy, ignorance and governmental failure, is clearly a major obstacle in human resource development, health becomes the first foundation stone of human personality. Gopalan (1983) has estimated that because of pervasive malnutrition about 81% of the Indian children fail to develop their genetic potential for their physical and mental development. The Government of India have rightly acknowledged the importance of Human Resource Development by establishing a separate ministry for it, with health as its component. Admittedly, human resource development has many dimensions but health is of primary importance, because it comes first in the development process, and, therefore, performance in other dimensions is importantly influenced by achievement in health.

II

Health Education: Importance and Difficulties

Despite Illiteracy and Poverty

The existing low health status is the rock against which all attempts of human resource development crash and flounder. Poverty and illiteracy are the two main correlates of low health status and these will undoubtedly prove great obstacles in attempts to improve the quality of health. Indeed, it seems difficult to achieve the goal of ‘Health For All’ with the existing poverty and illiteracy levels. The cut-off point of poverty-line has been computed to be Rs. 107 and Rs. 122 per capita per month for rural and urban population respectively. But despite this very low level of cut-off point about 37.40 per cent were below the poverty line in 1983-84. The rates for Scheduled Castes (50.92) and Scheduled Tribes (57.15) are even higher (Singh, P. 1986). The literacy rate is a meager 36 percent, the female literacy is only 18 percent. In the six states of Uttar Pradesh, Bihar, Andhra Pradesh, Madhya Pradesh, Rajastan and Orissa, constituting 52.77 percent of the total Indian population, the female literacy rate varies between 11 (Rajastan) to 21 (Andhra Pradesh/Orissa) percent. It was even lower for women of SCs (11%) and STs (8%). The disappointing poor performance is economic and educational development in the four decades of post-Independence India as likely to continue in the foreseeable future. Thus, it seems certain that we have to cope with the health problems despite poverty and illiteracy.

Grant (1987) has correctly asked:

Can we really say that we must wait for the return of economic growth when over 3 million children a year are dying of diarrhoeal dehydration which can be prevented by basic family health education and by oral therapies costing less than a dollar? And can we really say that it is too expensive, that we must wait for economic development’ when 3.5 million children a year are dying of diseases which can be prevented by immunisation at an additional yearly cost which is less than the price of five advanced fighter planes.

(Grant 1987, p.9) In an earlier report on The State of the World’s Children, 1982 Grant had very poignantly recorded that: "The cost of immunising third world’s infants works out at approximately five dollars per child. The cost of not doing so works out approximately five million deaths a year" (Grant 1982, p.9)

New Health Messages

Recent developments in medical science has provided information and technologies which are so simple that an illiteracy person can understand them, so inexpensive that a poor person can afford them, so complete that every individual scan self-administer them without the expert guidance of doctors and hospitals, and, most important of all, are so effective that a significant reduction in malnutrition and illness, and death and disability can be achieved. These health information and technologies are related to diarrhoeal diseases and respiratory infections, immunisations and monitoring the growth of the child, diet and nutrition, cleanliness of food and water, personal hygiene and environmental sanitation, birth control and birth-spacing, and breast-feeding and supplementary food for children at the weaning age. These down-to-earth, and what UNICEF has labelled "do-ables", are revolutionary breakthroughs in medical history because of their potentialities to save millions from deaths and disability. The Oral Rehydration Therapy (ORT) is an example of this. An illiterate mother can be taught to prepare a drink at home with a certain proportion of salt and sugar or its substitute, measured with a pinch of fingers and a scoop of hand, and save her child from diarrhoea dehydration, the greatest killer of infants. These new messages make the individual, rather than the doctor, responsible for his health. The informed individual will be his own doctor, always available, motivated and without any cost. In his critique of the industrial western civilisation Illich argues like a Gandhian, that health care may best be left to the individual.

A world of optimal and wide-spread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth, work, healing and dying.

Illich I. (1976): The Limits of Medicine. P. 274).

Importance of Health Education

Health education is importance because it is available right now, in the prevailing conditions of illiteracy, poverty and governmental apathy and failure. Health education is important because it is effective, tested and proven in the experience of the third-world. A significant reduction in the incidence of death, disability and malnutrition in India can be achieved through health education. This reduction possible through immunisation, ORT, balanced, nutritious but inexpensive diet, better child care through growth chart, breast-feeding and supplementary food, improvement in cleanliness of the village and home of the body of the person, of food and water, and above all, by changes in health attitudes and health habits. The annual incidence of death in India by vaccine-preventable diseases (measles, tetanus and pertusis) is 128,000 and polio-related disability is 200,000. About 2500 children die each day because of diarrhoea and 30,000 children become blind annually (Table 1). All this is avoidable tragedy, and avoidable at affordable cost.

The importance of health education has been emphasised by Mahler, the Director General of WHO:

It is not accidental that health education was given the place of pride in the AlmaAta Declaration; not is it accidental that the global strategy constantly refers to educational interventions as the means par excellence for enlisting the involvement of people in all walks of life and for making them true artisans of health and development.

Mahler (1983): World Health April - May, p.4

Difficulties in Health Education

Health education, however, is as difficult as it is important. The apparent simplicity, rationality and feasibility of health educational messages are forcefully and optimistically advocated by Grant, the Executive-Director of UNICEF, in his annual report on the State of the World's Children. This is understandable in view of his moral convictions and international role. Grant is in fact, quite convincing when he is arguing his case, as a possibility. But, he undermines or only hints indirectly and obliquely through inferences, the most important obstacle in the improvement of health status in the third world, including India: the lack of political will and moral commitment of the ruling elite despite their public declarations.

Health education is difficult and its effectiveness is uncertain because of five main reasons. Firstly, the factors of poverty and illiteracy will put a limit to the improvement of health status through health education alone. Secondly, health education, to be effective, needs to be supplemented by creating concrete health and health-related facilities, such as facilities for immunization, maternal services, safe d4rinking water, and sanitary latrines. Given the level of prevailing poverty in India, these depend mainly on governmental performance. Thirdly, health education demands the involvement and participation not only of the community, which is loudly publicised in the literature, but also of the health educator. In the absence of a sense of commitment to the cause and emotional involvement of the health educator, health education, with all its newly-acquired glittering audio-visual aids of films and slides and flash cards and flip charts, will only be fashionable gimcracks of urban research scholars, of social workers and governmental agencies. It is necessary that a health educator not only explains how a soak-pit for drainage of bath water or a garbage-pit is made, but he actually works with the villagers in these activities. Fourthly, the health educator must have rapport and empathy with his target-group. This is possible only when he has a commitment to the cause, and the commitment is not only academic and research-oriented but is emotional and moral. Fifthly, health education cannot produce miracles overnight. The age-old unscientific and unhealthy attitudes and habits are reinforced by folklore and customs, are inculcated in the minds from childhood in the process of socialisation, and re-strengthened by poverty and illiteracy.

Not surprisingly, the health messages, with all their apparent rational advantages, meet the resistance of entrenched age-old traditional attitudes and beliefs and of simple ignorance. For example, a very large number of others discard the first breast milk after child-birth in the wrong belief that this is harmful to the baby, not knowing the nutritional and immunisational value of colostrum contained in it. Many unhygienic personal habits, related to taking bath daily, washing personal clothes, washing hands before meals and after toilet, washing of the utensils before serving food in them, cleaning of nails, gargling before sleeping, defecation in the open, and consumption of tobacco and alcohol, have been inculcated in the individual through the process of socialisation. These have become ingrained in the life style and one has developed blind-spots to their adverse aspects. Some of these are reinforced by traditional culture, such as drinking of haria (alcohol) in the tribals. Some others become inescapable because of poverty, lack of resources, and life conditions. Many women do not take bath because of the burden of work, paucity of water, and lack of privacy. Clearly, the life conditions force the poor women to abstain from bath.

Health education is not a fashionable charity-show organised by upper-strata ladies, seeking limelight. It is a serious job demanding a great deal of understanding, patience and hardwork in uncomfortable conditions. Health education is possible, despite odds and difficulties. The greatest ally of health education is the natural desire of every individual to be healthy and of every mother to see her child grow without any disease and disability.

The Importance of the Child in Health Education

The child assumes special importance in the process of health education for two reasons. Firstly, the health of the child is the crux of the health of community (Singh 1983, p. 30). Child-care, therefore, becomes the most important component of health education. The child can be reached through its parents, particularly the mother, who is the logical inescapable target for health education. Secondly, the child is no less important a target for health education. In fact, with long-term perspective he is the target, because the health attitudes and habits begin during childhood. Investing in children is investing in the health of the community argues a Worldwatch Paper :

Child health reflects and determines the human conditions. It results from, contributes to social development. The growth of societies depends on the capabilities of their people and these, in turn, depend on health and education. Child health affects growth, learning and work.

Chandler W. U. (1985): Investing in Children, Worldwatch Paper 64, Washington, p. 5.

III

Health Modernity: Concept and Scale

The Concept of Health Modernity

Health modernity is scientifically correct information, attitudes and behaviour in relation to physical and mental health, family planning and child-care, personal hygiene and environmental sanitation and such other issues which are essential pre-requisites for healthy living and, therefore, for human and social development. The concept of Health Modernity is an extension of the concept of modernity which has been widely used in social science literature to describe a socio-psychological pre-disposition considered to be a prerequisite for economic, social and political development. Thus, it has been argued economic development in India and many third world countries has been handicapped by non-modern attitudes to work and social organisations. The foreign-imported machines have produced far less in third world countries than their output in their native countries. Democracy has failed or has not become a way of life because of the persistence of feudal, non-modern attitudes on such issues as equality of man, respect for dissent, and work-commitment. The non-scientific and non-rational attitudes have proved to be the major obstacles to socio-economic and political development.

The component of health has been missing in the concept of modernity. Since modernity is considered as a means of development, which, in turn, means the well being of the common man, the component of health logically becomes the most eligible component of modernity. Singh has argued that:

If modernity is a pre-requisite for social, economic and political development, Health Modernity is the pre-requisite for human development, which undoubtedly is the summum bonnum of all development. The individual must be alive and cognitively competent to be economically productive, socially liberal, and politically democratic. Admittedly, Health Modernity does not ensure and guarantee social, economic and political modernity, but nonetheless, it is a fundamental precondition of all development

Singh, A. K. 1984b, pp.7-8

Health Modernity Scale

Health Modernity has three components: information, attitudes and behaviour. A fourth component may be added, that of Health Indicators. The data on informational-attitudinal and behavioural components of health modernity can be obtained from the individual. The health indicators are environmental, social and demographic factors, data for which can be obtained from the individual (e.g. physical living conditions) as well as from the societal sources (e.g. health facilities). The health indicators are the correlates of health modernity which influence it and are also influenced by it. Therefore the component of Health Indicators has been kept separate from the Health Modernity Scale.

The Health Modernity Scale (HMS) covers seven main dimensions, namely: (i) Physical Health (PH), (ii) Mental Health (MH), (iii) Diet and Nutrition (DN), (iv) Family Planning (FP), (v) Child Care (CC), (vi) Breast-Feeding (BF), (vii) Health Habits Behaviour (HMB). The first Six are combined to make a total Health Modernity Attitudinal Scale.

The main themes covered in each of the seven dimensions have been listed in Table 2, which also lists the themes on Health Indicators. The coding of all the seven dimensions have been done in a way that each of them has a range of 0-50 scores. There are 10 Likert-type items in PH, MH, DN, FP, and BF, each on a five point scale. The CC has seven Likert-type and remaining non-Likert type items, whereas the HMB has all non-Likert type items. The mixture of Likert and non-Likert type questions was necessary because of the nature of the topic covered in the themes.

The seven dimensions of the Health Modernity have statistically significant positive inter-correlations, indicating that the seven sub-scales can be combined to make an overall Health Modernity Scale. The split-half reliability of the seven dimensions have been calculated and the correlations are statistically significant. The correlation of Health Modernity Attitudinal and Behaviour Scales is also statistically significant (269). This can be considered as a criterion of validity for the attitudinal scale.

V

Health Modernity Education Project (HMEP)

In view of the importance of health education as a means of improving the health status, particularly in the illiterate and poor population, the ICMR has sponsored a Health Modernity Education Project (HMEP) in rural tribals in Ranchi district of Chotanagpur region in south Bihar. An earlier survey had shown that the tribal population in South Bibar had poor health status and very low health modernity (Singh 1984, a, b). The present paper is a summary of the bench-mark study of the HMEP, which not only provides base-line data for the evaluation of educational intervention programme, but is also a complete survey in itself.

Tribals in South Bihar

The 1981 census had counted 51,628,638 tribals in India constituting 7.53 per cent of the total Indian population. Bihar accounted for 5,810,867 of them, constituting 11.26% of the total tribal

population of India and 8.31% of the, total population of Bihar. The tribals are mainly concentrated in Chotanagpur and Santhal Parganas. The districts of Ranchi (56.41%), Singhbhum (44%) and Santhal Parganas (36.8%) have large tribal populations.

The tribals are overwhelmingly rural. About 94% of them live in villages in Bihar as well as in India. They are also illiterate. The illiteracy rate in India is 76% for the males and 92% for the females; the corresponding percentages for Bihar are 74 and 92. The rural illiteracy for both males and females, is even higher. The tribals are poor. About 57.15% of the tribals were below the poverty-line in 1983-84, the percentage in rural area being slightly higher (58.40) (Singh P., 1986). Because of the economic, social and educational backwardness of the tribals, the Constitution of India has given them special protection. Seven percent of State Legislature and Parliament seats and an equal percentage for admission in educational institutions and appointment in governmental jobs are reserved for them. The Constitution also provides them protection against social and economic exploitation. Despite these safeguards, the atrocities against the scheduled tribes have been increasing. There were 3340 cases in 1981 against 843 in 1967 and 2134 in 1979. (GOI, 1983; Singh, A.K. in press).

The tribals are non-Aryans. They are called Adivasi, meaning original inhabitants. They are described as aboriginals and primitives, often derogatorily, as they existed early in the development of mankind. They are called Vanvasi and Girijan because they live in forests and mountains. The tribals are racially, linguistically and culturally different from the non-tribals. However, the tribals are not a single homogenous group; there are about 427 groups in India. Together they share their closeness to nature, poverty, illiteracy and exploitation by the ruling elite of the non-tribals, who are called Dikus in Bihar, literally meaning one harasses.

The tribal groups are different in many ways: in physical appearance and skin colour, dress and decoration, huts and household things, geographical terrain agricultural crops, food and drink, flora and fauna, festivals and customs, and language and folk-lores. These differences are not only among the tribals in different parts in India, but they also exist between tribals of the same region. These differences have important implications for the preparation of health education materials. Clearly, the audio-visual materials appropriate to one will not be suitable for the other.

In Bihar, the 1971 census had recorded 29 tribal groups, the four most numerous being santhal (18,00,764), Oraon (8,76,218), Munda (7,28,106), and Ho (5,05,172). The Oraon and the Munda live in Ranchi district. They have two different languages, Kuruk (Oraon) and Mundari. But, they also speak a common language called Nagpuria or Sadri, a simple bazar Hindi. They have common customs and festivals. They inter-marry. They live in the same villages. The sample of the present study has included mainly Mundas and Oraons.

Sample Location

The sample has been taken from Kanke and Namkum blocks of Ranchi district. The two blocks are adjoining Ranchi town. The villages selected are at a distance of about 20 to 25 kilometers from Ranchi.

Sample Stratification

The basis of sample stratification has been sex (male/female) and four age-categories, that is, 15-24, 25-34, 35-44 and 45+ years. In the sample selection an interval of five years was taken, which was later increased to ten to organise and facilitate data analysis. Each age-category in the sample has approximately the same percentage, sex-wise, of the total sample size as is its representation in the total adult population of the village. The sample consists of 991 cases, with 498 males and 493 females (Table 3).

Sample Demographic Characteristics

The demographic characteristics of the sample in relation to education, income men age at marriage a woman, family size and number of children born to a woman, family size of women, average number of children born to and number of depicted by the Project data of rooms are given in Table 4 A & Table 4B.

The demographic profile this tribal community highlights the following facts:

1. The tribals are illiterate. About 81% of the total population is illiterate, the percentage for women is as high as 95.
2. The tribals are poor. Fifty-eight percent have no income or have income upto only rupees two hundred per month. Another 31% have monthly income between rupees 201 and 400.
3. The tribal women marry at an early age. The mean age at marriage is 15 years which is lower than the national average of rural women (17 years).
4. The tribal women have higher fertility than national average. The average number of children born to a tribal woman is about six, higher by two than the national average.

HMEP: Main Findings

The main findings of the HMEP are reported in relation to Health Indicators and Health Modernity.

Health Indicators

In Health indicators we are reporting the data on living conditions, prevalence of illness and disabilities, and malnutrition in children under five years.

Living Conditions

It has been already noted that the mean age at marriage of women is 15 years, and a woman has, on an average, about six children. The family size is 6.78 with just about two rooms. As the data on living conditions (Table 5) show not even 1% had bath room, septic latrine and electricity. Only 23% had separate kitchen but just about 2% had provision for the outlet for smote. About 83% did not have ventilation in the sleeping room, 73% did not have cot, 81% had no blankets or quilts, and 89% did not have even mosquito nets. Only 22% had wells and only 6% had drainage for waste-water disposal.

The tribal population of the sample did not have the bare basic physical facilities necessary for healthy living.

Prevalence of Illness and Disabilities

About 29% of the families reported some kind of illness or disability at the time of the survey (Table 6). About 10% of the families had some kind of eye-ailment; about 7% had physical disability and 3% had chronic illness.

Contrary to popular notion, a large number of the rural tribals are afflicted by illness and physical disability.

Malnutrition in Children Under Five

The malnutrition of children was measured in relation to the arm-circumference by the coloured strip (Table 7, Figure 2). Only a quarter of the children had normal nutrition, and shockingly 44% had severe malnutrition. A greater percentage of girls (47%) had severe malnutrition than the boys (42%). The high prevalence of malnutrition can be seen in relation to the food habits (Table 8). The daily consumption of meat/fish/egg and milk was less than 1%, even though many families keep a few chickens and 76% actually had milch animals. But they cannot afford to consume these; they sell these to earn a few rupees to support their bare existence.

A majority of tribal children, like all poor children, are malnourished.

Extent of Health Modernity

The extent of health modernity has been reported in relation to: (i) percentages of the ‘modern’ scorers, and (ii) mean scores of each of its seven dimensions. A ‘modern’ response is a scientifically correct answer representing information, attitudes and behaviour. In the scales of Physical Health (PH) Mental Health (MH), Diet and Nutrition (DN), Family Planning (FP), and Breast Feeding (BF) a modern scorer is one who obtains a score of 40 or more, because there are ten items and a moderns response will get a score of 4 or 5 in each score in 4 or 5 in each item. The range of modern score in CC has been computed item same way for the seven Likert-type items; for other items the scoring is in terms of the degree of correctness of the answer. The items of Health Modernity Behaviour (HMB) have also been coded similarly. As already stated all scales have a range of 0-50 scores.

Overall Health Modernity

A very small, almost negligible, number of persons have qualified on this test of overall health modernity (Table 9, Figure 3). The percentage of persons with health modernity varies from 0 to 5 in the seven dimensions. Not even a single male, out of 498, had health modernity in relation to Child Care; the percentage for the female was also less than 1. Less than 1% males and females had health modernity in Physical Health, Diet and Nutrition, and Child Care. The women, understandably, scored higher (5.3%) than men (1.8%) on Breast Feeding, but, the important fact remained that 95% women did not have scientifically correct information and attitudes in relation to breast-feeding.

The low overall health modernity reflected in the small percentage of modern scorers in the seven sub-scales of health modernity is confirmed by their mean scores computed separately for 8 sample sub-groups based on four age-groups and two sexes. (Table 10). The low health modernity remains approximately the same in all the 8 sample sub-groups with very little variation. Naturally, therefore, this trend is also reflected in the aggregate scales of Health Modernity Attitudinal and Health Modernity Attitudinal Behavioural.

Overall Conclusions

The health modernity survey in two tribal rural blocks in Ranchi district has shown unhygienic living conditions, overcrowding, inadequate and imbalanced food habits, pervasive malnutrition, early marriage, high fertility, non-adoption of contraception, high prevalence of illness, and wide-spread misconceptions and ignorance of physical and mental health, diet and nutrition and family planning and childcare.

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    * This paper is an abridge version of Singh, A.K. (1997): The Myth of the Healthy Tribal : Health Modernity in Two Rural Blocks of Chotanagpur, Bihar. Report on ICMR Task Force Health Modernity Education Project, Post, Graduate Department of Psychology, Ranchi University.

    ** Post-Graduate Department of Psychology, Ranchi University, RANCHI- 8344001

    *** COUNCIL FOR Social Development, 53 Lodi Estate, NEW DELHI-110003