Is the “good” self-reported health of Paniya tribes (Wayanad, Kerala, India) misleading?

Background: It is known that the most deprived groups have the poorest health. However, in India, the Paniya tribes, known as the lowest social groups, report a better health.

Objective: To assess if the “good” self-reported health of the Paniyas is misleading.

Methods: A cross-sectional survey (N=3352 households) was conducted in Kottathara Panchayat (Kerala, India) during April-June 2003. Basic health (self-reported) and socio-economic information was collected. A panel survey (N= 543 households) was also conducted from October 2003-September 2004 in order to measure episodes of illness over time through a health diary. Additionally, a small Participatory Poverty Assessment was done in a Paniya community.

Results: A significantly lower proportion of Paniyas reported a poor perceived health compared to the other social groups (19% vs 24%, OR=1.3; 95%CI:1.2, 1.5). Similarly, Paniyas also report less episodes of illness during a year than others (6.6 ±5.6 vs 8.5±6.7). However, more households of Paniyas are classified as Below Poverty Level (83.7% vs 38%), have no toilet facilities (52.2% vs 6.0%), are not electrified (73% vs 40%), etc. In addition, during the Participatory Poverty Assessment, members of the Paniya community rated that most (90.6%) households wellbeing was miserable.

Conclusions: Evidence demonstrate that most determinants of health of the Paniyas are poor and that the good self-reported health is misleading and probably biased by the perception that they have of their own health. Care should be taken by researchers and decision-makers in using such measures to assess the health status of extremely deprived communities.