Dietary transition and emerging NCD risk among Santhal communities in Jharkhand, India: a perspective

The Santhal (also transliterated “Santal” in some cited sources) tribes of Jharkhand have historically relied on forest foods, indigenous millets, and seasonally harvested produce. Research among Santhals in Jharkhand indicates that these indigenous foods have made a meaningful contribution to micronutrient intake, suggesting that this food system has supported nutritional adequacy, though evidence that it specifically confers protection against non-communicable disease is not established. Cross-sectional evidence, discussed below, is consistent with erosion of this food system as cheap, ultra-processed foods become more available in tribal markets. However, longitudinal dietary data confirming this shift among Santhal communities specifically are not yet available. A broadly similar nutrition transition appears to be underway across the Indian population as a whole; among the Santhal, it is layered onto pre-existing undernutrition, poverty, and limited access to healthcare, a combination that may give it a distinct and more consequential trajectory. However, this remains to be demonstrated empirically. Recent cross-sectional, community-level data from Santhal/Santal populations in the neighbouring states of West Bengal and Odisha, which should not be assumed directly generalisable to Jharkhand, show that over 90% of adults reported nutritionally inadequate diets. At the same time, hypertension, diabetes, and hypercholesterolemia among the West Bengal cohort were 13.7%, 11.8%, and 14.7%, respectively. A national Task Force report, drawing on an ICMR multi-district survey, estimated that non-communicable diseases (NCDs) account for 66% of deaths in tribal districts, with cardiovascular disease responsible for close to half of those deaths; these are survey-based cause-of-death estimates rather than vital-registration data. Alongside this, undernutrition has not receded: stunting and anaemia persist alongside apparently rising cardiometabolic risk, a coexistence that conventional health policy, still largely oriented around infectious disease, is poorly equipped to address. This perspective calls for disaggregated NCD surveillance by tribal identity, active protection of indigenous food environments, and culturally grounded primary care that meets these communities where they are.