Health of indigenous people: a challenge for public health

Washington, DC, August 15, 2002 (PAHO) -- Although the term indigenous people in the Americas is widely used, that generalization encompasses more than 400 different ethnic groups, with different beliefs and different health practices. This diversity presents a challenge for public health in the Americas, where indigenous peoples are among the most excluded.

The response of the Pan American Health Organization is its Health of Indigenous Peoples Initiative, started in 1993, which signifies a commitment by PAHO and its Member States to work with indigenous peoples to improve their health and well being. It is also a recognition of the value and need to conserve indigenous cultural heritage and knowledge.

The initiative for health of indigenous peoples was launched due to the inequalities that existed in health status and in access to basic services between those communities and other social groups. Indigenous communities have higher rates of avoidable mortality and morbidity and lower life expectancy at birth, and many of them do not have regular access to essential health care due to economic, geographical, or cultural barriers.

"Indigenous communities frequently experience higher rates of infectious diseases and maternal and child mortality. In some countries with a different epidemiological profile they have higher rates of accidents and diabetes [within the indigenous communities]. The solution to these problems requires strategies that improve their access to basic services while incorporating community resources (indigenous healers) in local efforts to improve health," said Dr. Land.

Special considerations in the PAHO initiative included the aspirations of indigenous peoples to assume control of their own institutions and ways of life, the need to strengthen their own identities, as well as respect for their rights with regard to health and the environment. There was also a need to recognize the contribution of indigenous peoples to the maintenance of the ethnic and cultural diversity of the Americas, to biodiversity and ecological balance and, especially to the health and nutrition of society.

"In implementation of the initiative, many countries have progressed in three areas: strategic planning and alliances, including designating units in the ministry of health or other ministries to take leadership roles; development of work plans and models of care that accommodate varied cultures, and improvement of the information systems to detect and monitor inequalities," she said.

The spirit of the initiative emphasizes the need to respect the integrity of values and social, cultural, religious and spiritual practices characteristic of the indigenous peoples, including those related to health promotion and maintenance and to treatment of diseases.

According to Dr. Land, "Unfortunately, health sector reform in the majority of the countries has not responded sufficiently to inequalities in health. It is expected that the next generation of reforms will be more successful in this regard."

"Of course, equity is the basis of this initiative," she affirms. So is Panamericanism, Dr. Land adds, since "We have facilitated interchange among countries, periodic consultations, and identification of important lessons learned. Documenting experiences and disseminating information on progress have been successful approaches."

Promotion of the initiative in the Organization has yielded successful projects in water and sanitation, indigenous women, mental health, integrated management of childhood illness, and malaria, she said.

Countries have emphasized different approaches to the initiative, depending on factors such as how indigenous organizations at all levels deal with health. In El Salvador, Ecuador, Honduras, Panama, Bolivia, and Nicaragua, indigenous organizations have been actively involved in the development of projects to serve priority health programs. Chile, Ecuador, Panama, Honduras, and Brazil have units responsible for indigenous health in their ministries of health. Panama and Honduras have published documents on the health of indigenous peoples.

"It's important to emphasize principles that have inspired the initiative from the beginning: the need for a holistic approximation to health, the right to self-determination of indigenous peoples, the right to systematic participation, respect, and rehabilitation of indigenous cultures, and reciprocity in relations," said Dr. Land.

"In fact, the cosmic vision of indigenous peoples with respect to life and health is very similar to the broad health definition of the World Health Organization. Nevertheless, the spiritual dimension and the importance of the community are prominent," added Dr. Land.

PAHO, which serves as the Regional Office for the Americas of the World Health Organization, was established in 1902 and is the oldest health organization in the world. It works with all the countries of the Americas to improve the health and raise living standards.