Tobacco-related health harms among Indigenous communities in India: Commercial determinants of health perspective

Tobacco use has remained high among Indigenous communities in India over time, compared to other social groups. In this commentary, I use the lens of "commercial determinants of health" to understand commercial drivers of tobacco-related health harms among Indigenous communities, at three levels: the products, industry activities, and structural factors. At the level of products, we need to recognise diverse products and patterns of tobacco use, while differentiating the traditional use of tobacco from commercial tobacco use. Certain industry activities including "sachetisation" of tobacco products, occupational hazards in the bidi sector, and tobacco industry influence on public policy impacting Indigenous community health are examined. Macro-economic factors, not always specific to Indigenous groups/areas, also create the broader environment in which commercial forces operate. Tobacco control efforts need to consider the unique contexts of Indigenous communities, regulate the tobacco industry, and promote policies that provide safer livelihood alternatives alongside supply reduction measures.