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This article investigates the lived experiences of health inequalities and inequities among tea garden laborers in Assam, India. By employing decolonial ethnographic research, this study explored long-standing health inequalities and inequities in the tea industry and workers’ illnesses and injuries due to inadequate occupational, environmental, and health care policies. Neither the state nor the management of the tea garden, according to the interviews, has taken the essential actions to safeguard the health and safety of the workers in tea gardens either during the pandemic or at any other time. Instead, hearing gaalis (verbal abuses) from babus (the tea garden managers) is a part of their everyday life. We argue that even after 7 decades of post-colonial rule, tea garden workers are subject to a ghettoized economy characterized by closure and control. Thus, we need to reexamine how the tea industry is structured in order to rectify existing health inequities.

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The 'tea tribes' in Assam have a unique socio-cultural history. They were the prime labour force of tea plantations in colonial Assam. Originally, they were migrants brought in by British tea planters in different phases during the eighteenth to mid-nineteenth centuries from different parts of India. Colonial engagements with these labourers in tea gardens were akin to slavery. Construction of the 'coolies' community in colonial India had broader implications for the community in post-colonial India. Constitutional provisions and state mechanisms to uplift the community from the margins have never borne fruits on the ground. This underdevelopment, coupled with the colonial legacy of an 'outsider within', catalysed the larger 'Adivasi consciousness' among the tea tribes in Assam. In this article, we argue that attributing every problem faced by tea tribes to the colonial system is an elitist attempt to undermine the role of the post-colonial state and society in excluding and reproducing these community as the 'other' in the wider social structure. Seven decades of post-colonial experience have not changed the sociabilities of these tea tribes who still live in the margins of Assam's social landscape, causing them to unify within the 'Adivasi' consciousness.

This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: ( a) dynamic and flexible, ( b) intersectional and backed up by sufficient grassroots research, and ( c) equitable at every stage of policy formulation, implementation, and evaluation.