Parliamentarians’ concerns about tobacco and Indigenous communities in India: a qualitative analysis of parliamentary questions (1952-2022)

Abstract Tobacco use and associated disease burden remains 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 with 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 discuss about the negative impact of commercial tobacco production on forests that are central to the lives of Indigenous communities. Public health research and policy engagement efforts need to acknowledge the complex and multiple intertwining links between tobacco (industry) and Indigenous communities. There is a need to sensitise elected representatives 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. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work is supported by the DBT Wellcome Trust India Alliance CRC grant Grant No. IA/CRC/20/1/600007 awarded to Prashanth NS, Suresh Shapeti, Deepa Bhat, and Upendra Bhojani. Upendra Bhojani was also supported through the DBT Wellcome Trust India Alliance (clinical and public health) Senior Fellowship awarded to him (Grant No. IA/CPH/22/1/506533). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This article does not contain any studies involving human participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Apart from the data contained in the manuscript, the transcripts of parliamentary questions (and answers) are available in public domain through web portals of the lower house (https://sansad.in/ls/questions/questions-and-answers) and the upper house (https://sansad.in/rs/questions/questions-and-answers) of Indian parliament.