Alcohol use and its consequences in South India: Views from a marginalised tribal population

Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario, Canada K1N 6N5.
Drug and alcohol dependence (Impact Factor: 3.42). 08/2011; 117(1):70-3. DOI: 10.1016/j.drugalcdep.2010.12.021
Source: PubMed


Alcohol consumption in India is disproportionately higher among poorer and socially marginalised groups, notably Scheduled Tribes (STs). We lack an understanding of STs own views with regard to alcohol, which is important for implementing appropriate interventions.
This study was undertaken with the Paniyas (a previously enslaved ST) in a rural community in Kerala, South India. The study, nested in a participatory poverty and health assessment (PPHA). PPHA aims to enable marginalized groups to define, describe, analyze, and express their own perceptions through a combination of qualitative methods and participatory approaches (e.g. participatory mapping and ranking exercises). We worked with 5 Paniya colonies between January and June 2008.
Alcohol is viewed as a problem among the Paniyas who reported that consumption is increasing, notably among younger men. Alcohol is easily available in licensed shops and is produced illicitly in some colonies. There is evidence that local employers are using alcohol to attract Paniyas for work. Male alcohol consumption is associated with a range of social and economic consequences that are rooted in historical oppression and social discrimination.
Future research should examine the views of alcohol use among a variety of marginalised groups in developing countries and the different policy options available for these populations. In addition, there is a need for studies that untangle the potential linkages between both historical and current exploitation of marginalized populations and alcohol use.

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    • "Use of alcohol to cope with the distressing emotions was also found to be reported more often by the tribals than non-tribals. The persisting psychological problems related to low self-esteem in tribals is often noted in the literature; historical oppression and discrimination have had their after effects on their well-being.[5] Use of alcohol when one feels bad about oneself, when one thinks about the bad happenings in the past, when one feels suspicious or discriminated, are the factors significantly quoted more by the tribals. "
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    ABSTRACT: Background: Consumption of alcohol has been attributed to different reasons by consumers. Attitude and knowledge about the substance and addiction can be influenced by the cultural background of the individual. The tribal population, where alcohol intake is culturally accepted, can have different beliefs and attributes causing one to take alcohol. This study attempts to examine the reasons for alcohol intake and the belief about addiction and their effect on the severity of addiction in people with a different ethnic background. Materials and Methods: The study was conducted at a Psychiatric institute with a cross-sectional design. The study population included patients hailing from the Jharkhand state, twenty each, belonging to tribal and non-tribal communities. Patients fulfilling the ICD 10 diagnostic criteria of mental and behavioral disorders due to the alcohol dependence syndrome, with active dependence, were taken, excluding those having any comorbidity or complications. The subjects were assessed with specially designed Sociodemographic-Clinical Performa, modified version of Reasons for Substance Use scale, Addiction Belief scale, and the Alcohol Dependence scale. Statistical Analysis and Results: A significantly high number of tribals cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Addiction was severe in those consuming alcohol to cope with distressing emotions. Belief in the free-will model was noted to be stronger across the cultures, without any correlation with the reason for intake. This cross-sectional study design, which was based on patients, cannot be easily generalized to the community. Conlusion: Societal acceptance and pressure as well as high emotional problems appears to be the major etiology leading to higher prevalce of substance depedence in tribals. Primary prevention should be planned to fit the needs of the ethnics.
    Full-text · Article · Jul 2012 · Indian Journal of Psychological Medicine
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    • "Our second methodological contribution was our approach to the exploration of socially vulnerable and culturally distinct groups such as STs, which involved helping them to express their own voices and to get to the root of a number of sensitive issues, such as alcohol consumption [16]. Participatory approaches, such as those developed by our team, originated in the field of development but are insufficiently used by global health researchers. "
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    ABSTRACT: BACKGROUND: Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women's lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups. THE RESEARCH: The goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1) design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2) strengthen local governance in monitoring and evidence-based decision-making, and 3) develop an evidence base for appropriate health interventions. RESULTS AND OUTCOMES: Health and social inequities have been masked by Kerala's overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group), for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA), under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community-although inclusion of the Paniyas has been a challenge. THE PARTNERSHIP: The Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research. CHALLENGES AND SUCCESSES: Adapting to unanticipated external forces, maintaining a strong team in the rural village, retaining human resources capable of analyzing the data, and encouraging Paniya participation in the health insurance scheme were challenges. Successes were at least partially enabled by the length of the funding (this was a two-phase project over an eight year period).
    Full-text · Article · Nov 2011 · BMC International Health and Human Rights
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    ABSTRACT: Résumé Contexte Les populations pauvres et marginalisées des pays à revenu faible ou intermédiaire voient leur santé contrainte par un engagement public souvent insuffisant. Bien qu'il soit reconu pour ses politiques progressives, l'État du Kérala, dans le sud de l'Inde, ne fait pas exception. Le bien-être des femmes de-meure contraint par les inégalités de genre . Du fait de leur marginalisation, plusieurs groupes autochtones sont au re-gard de leur santé, en position très défavorable comparative-ment aux autres groupes sociaux.
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