Forest neighbourhoods and healthcare access for Adivasi communities in India: A critical interpretive synthesis

Introduction: Environments where people live and work shape resources and opportunities available to them and studying healthcare access in relation to people’s living environments helps in understanding structural factors beyond individual factors. This is especially relevant for many Adivasi communities whose lives are closely connected with forests. Methods: We used the critical interpretive synthesis method, a flexible, critical and iterative approach to literature synthesis. We conceptualised health and healthcare access in relation to neighbourhood environment and used this lens to examine healthcare access in Adivasi communities living in forest neighbourhoods in India. Results: We developed a lens of neighbourhood as a physical and social environment and used it to build a conceptual framework describing forest neighbourhoods in India. We describe forest neighbourhoods in terms of their built and social environment. The availability of mobile networks, condition of roads, flooding of streams during rains and the forms of transport available constitute the built environment. There are two important components of the social environment, first is the connection of the Adivasi people with the forest and second is the institutional environment comprising of different actors working in the forest neighbourhood. The life of Adivasi people is connected with the forest through their livelihood, nutrition, physical and mental well-being and their ecological knowledge about the forest from their lived experience. The institutional environment consists of different actors that shape the built and social environment that comprise the government institutions, private for-profit providers, civil society organisations, traditional healers and the forest department. Conclusion: While working on Adivasi health, it is critical to consider their connection with the forest. Exploring forest neighbourhoods as physical and social environments can help examine distribution of public services and how they are shaped by external policies and actors working in the neighbourhood. This could shift the focus of Adivasi health and healthcare interventions away from the current emphasis on individual-level health interventions.