Policymakers' concerns linking tobacco and Indigenous communities in India: A qualitative analysis of parliamentary questions (1952-2022).

Tobacco use and associated disease burden remain high among Indigenous communities in India. Despite an overall decline in tobacco consumption over the last few decades, the social disparities in tobacco use have widened, with Indigenous communities experiencing the least decline. Existing tobacco control policies lack specific considerations for Indigenous communities. Hence, as part of a broader research initiative focusing on the health of Indigenous communities, we explored how parliamentarians in India have framed their concerns about tobacco in reference to Indigenous communities over time. We sourced digital transcripts of exchanges (parliamentarians asking questions and ministers responding to them) as part of the Question Hour sessions in the lower- and upper-houses of the Indian parliament between 1952 and 2022. We used thematic content analysis for 301 transcripts that linked tobacco and Indigenous communities. Overall representation of Indigenous communities in the Indian parliament remains very limited. The major concerns expressed by parliamentarians included (1) occupational health hazards and inadequate access to healthcare services faced by members from Indigenous communities working as bidi makers and tendu leaf collectors;(2) unfair wages and exploitative work conditions for these workers; and (3) perceived negative impact on tobacco-linked livelihoods resulting from trade and investment-related policies in the tobacco sector. Parliamentarians did not raise issues related to high tobacco use and tobacco-related harms among Indigenous communities in general, nor did they talk about the negative impact of tobacco on forests that are central to the lives of Indigenous communities. Public health research and advocacy efforts need to acknowledge the complex and multiple intertwining links between tobacco (industry) and Indigenous communities. There is a need to sensitise policymakers on the health and environmental impacts of tobacco while addressing the prevailing exploitation of workers from Indigenous communities in precarious tobacco supply chains and providing viable alternative livelihoods.