Response to correspondence article on the research protocol titled Towards Health Equity and Transformative Action on tribal health (THETA) studyto describe, explain and act on tribal health inequities in India: A health systems research study protocol.

In this correspondence, we, co-authors and collaborators involved in the Towards Health Equity and Transformative Action on tribal health (THETA) study respond to a recent article published in Wellcome Open Research titled  Correspondence article on the research protocol titled 'Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol' published in Wellcome Open Research in December 2019 In the first part, we provide overall clarifications on the THETA study and in the second part respond to specific comments by the authors of the aforementioned correspondence.

Oil palm cultivation can be expanded while sparing biodiversity in India.

India is the world's largest consumer and importer of palm oil. In an aggressive push towards self-sufficiency in vegetable oils, the Indian government is prioritizing the rapid expansion of domestic oil palm plantations to meet an expected doubling in palm oil consumption in the next 15 years. Yet the current expansion of oil palm in India is occurring at the expense of biodiversity-rich landscapes. Using a spatially explicit model, we show that at the national scale India appears to have viable options to satisfy its projected national demand for palm oil without compromising either its biodiversity or its food security. At finer spatial scales, India's oil palm expansion needs to incorporate region-specific contingencies and account for trade-offs between biodiversity conservation, climate change, agricultural inputs and economic and social security. The policy decisions that India takes with respect to oil palm can substantially reduce future pressures to convert forests to oil palm plantations in the tropics globally.

Examining tribal health inequalities around three forested sites in India: Results of a cross-sectional survey.

BACKGROUND: The data available for the health of Scheduled Tribes (ST) in India are often coarse-scale snapshots at district and state levels and fine-scale comparison within and across site is often not possible. In this paper, we examine the health inequalities between the ST and non-ST populations in two forested sites and compare the healthcare parameters for ST populations across three forested sites. METHODS: We conducted a cross-sectional household survey in three sites in and around three tiger reserves in Karnataka, Madhya Pradesh (MP) and Arunachal Pradesh (AP). In each site, multi-stage sampling and cluster analysis provided a representative sample of households across villages of 859 ST and non-ST households. We examined the sociodemographic and health-related information including self-reported illnesses and healthcare utilisation; from these, we explored the within-site health inequality patterns for the two sites and intersite differences among the ST households of the three sites. RESULTS: In Karnataka, the ST and non-ST differences favoured the latter with regard to socio-economic characteristics with no difference in self-reported illness/injuries or healthcare utilisation. In MP, both groups were similar with regard to socio-economic characteristics and healthcare utilisation. AP ST households reported the highest healthcare utilisation, while MP ST households reported the lowest care seeking at hospitals and relied on home networks and health workers. High tobacco consumption was noted among ST groups in all the sites. CONCLUSIONS: The ST and non-ST inequality patterns at a fine-scale were different between Karnataka and MP. The absence of health inequalities in MP indicates a uniform socio-geographical disadvantage while poor healthcare utilisation by ST people in Karnataka indicates health inequities. The ST households of AP reported the highest utilisation while those of MP reported the lowest. Programmes addressing the health inequalities of STs need to consider site-specific assessments of socio-geographical and health system factors.

Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol.

Background: In India, heterogenous tribal populations are grouped together under a common category, Scheduled Tribe, for affirmative action. Many tribal communities are closely associated with forests and difficult-to-reach areas and have worse-off health and nutrition indicators. However, poor population health outcomes cannot be explained by geography alone. Social determinants of health, especially various social disadvantages, compound the problem of access and utilisation of health services and undermine their health and nutritional status. The Towards Health Equity and Transformative Action on tribal health (THETA) study has three objectives: (1) describe and analyse extent and patterns of health inequalities, (2) generate theoretical explanations, and (3) pilot an intervention to validate the explanation.     Methods: For objective 1, we will conduct household surveys in seven forest areas covering 2722 households in five states across India, along a gradient of socio-geographic disadvantage. For objective 2, we will purposefully select case studies illustrating processes through which socio-geographic disadvantages act at the individual, household/neighbourhood, village or population level, paying careful attention to the interactions across various known axes of inequity. We will use a realist evaluation approach with context-mechanism-outcome configurations generated from the wider literature on tribal health and results of objective 1. For objective 3, we will partner with willing stakeholders to design and pilot an equity-enhancing intervention, drawing on the theoretical explanation generated and evaluate it to further refine our final explanatory theory. Discussion: THETA project seeks to generate site-specific evidence to guide public health policy and programs to better contribute to equitable health in tribal populations. It fulfills the current gap in generating and testing explanatory social theories on the persistent and unfair accumulation of geographical and social disadvantage among tribal populations and finally examines if such approaches could help design equity-enhancing interventions to improve tribal health.

Aligning conservation efforts with resource use around protected areas.

A large number of economically disadvantaged people live around protected areas. Conservation efforts that focus on poverty alleviation, work on the premise that an increase in household wealth decreases use of forest resources. We surveyed 1222 households across four tiger reserves to test the paradigm that an increase in assets leads to reduced forest use and we also assess the effects of other socio-economic factors. We find that increase in assets may reduce Non-timber Forest Product (NTFP) collection, but may not necessarily reduce livestock numbers or use of wood as a cooking fuel. Households that faced more economic setbacks were more likely to state that they wanted more livestock in the future. Education is positively associated with choosing Liquefied Petroleum Gas as a cooking fuel in the future. We find site and resource-specific variation. Fifty percent of all households (range across sites: 6-98) want to collect NTFP while 91% (range: 87-96) want to retain or own more livestock over the next 5-10 years. Understanding current and future resource use will help plan context-specific conservation efforts that are better aligned with reducing specific pressures around protected areas.

Impacts of hunting on tropical forests in Southeast Asia.

Although deforestation and forest degradation have long been considered the most significant threats to tropical biodiversity, across Southeast Asia (Northeast India, Indochina, Sundaland, Philippines) substantial areas of natural habitat have few wild animals (>1 kg), bar a few hunting-tolerant species. To document hunting impacts on vertebrate populations regionally, we conducted an extensive literature review, including papers in local journals and reports of governmental and nongovernmental agencies. Evidence from multiple sites indicated animal populations declined precipitously across the region since approximately 1980, and many species are now extirpated from substantial portions of their former ranges. Hunting is by far the greatest immediate threat to the survival of most of the region's endangered vertebrates. Causes of recent overhunting include improved access to forests and markets, improved hunting technology, and escalating demand for wild meat, wildlife-derived medicinal products, and wild animals as pets. Although hunters often take common species, such as pigs or rats, for their own consumption, they take rarer species opportunistically and sell surplus meat and commercially valuable products. There is also widespread targeted hunting of high-value species. Consequently, as currently practiced, hunting cannot be considered sustainable anywhere in the region, and in most places enforcement of protected-area and protected-species legislation is weak. The international community's focus on cross-border trade fails to address overexploitation of wildlife because hunting and the sale of wild meat is largely a local issue and most of the harvest is consumed in villages, rural towns, and nearby cities. In addition to improved enforcement, efforts to engage hunters and manage wildlife populations through sustainable hunting practices are urgently needed. Unless there is a step change in efforts to reduce wildlife exploitation to sustainable levels, the region will likely lose most of its iconic species, and many others besides, within the next few years.

Rodent seed predation: effects on seed survival, recruitment, abundance, and dispersion of bird-dispersed tropical trees.

Tropical tree species vary widely in their pattern of spatial dispersion. We focus on how seed predation may modify seed deposition patterns and affect the abundance and dispersion of adult trees in a tropical forest in India. Using plots across a range of seed densities, we examined whether seed predation levels by terrestrial rodents varied across six large-seeded, bird-dispersed tree species. Since inter-specific variation in density-dependent seed mortality may have downstream effects on recruitment and adult tree stages, we determined recruitment patterns close to and away from parent trees, along with adult tree abundance and dispersion patterns. Four species (Canarium resiniferum, Dysoxylum binectariferum, Horsfieldia kingii, and Prunus ceylanica) showed high predation levels (78.5-98.7%) and increased mortality with increasing seed density, while two species, Chisocheton cumingianus and Polyalthia simiarum, showed significantly lower seed predation levels and weak density-dependent mortality. The latter two species also had the highest recruitment near parent trees, with most abundant and aggregated adults. The four species that had high seed mortality had low recruitment under parent trees, were rare, and had more spaced adult tree dispersion. Biotic dispersal may be vital for species that suffer density-dependent mortality factors under parent trees. In tropical forests where large vertebrate seed dispersers but not seed predators are hunted, differences in seed vulnerability to rodent seed predation and density-dependent mortality can affect forest structure and composition.