HEALTH OF THE INDIGENOUS PEOPLES OF THE AMERICAS CONCEPTS, STRATEGIES, PRACTICES AND CHALLENGES

Item

Title
HEALTH OF THE INDIGENOUS PEOPLES
OF THE AMERICAS
CONCEPTS, STRATEGIES, PRACTICES
AND CHALLENGES
extracted text
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CONCEPTS, STRATEGIES, PRACTICES
AND CHALLENGES

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HEALTH OF THE INDIGENOUS PEOPLES
OF THE AMERICAS

EPasB AmeHcasti
Health
Rcg.ona) Office of the

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World Health Organization

Technology, Health Care and Research Area
Health of the Indigenous Peoples Initiative

Jose Luis Di Fabio, MD. PAHO/WHO
Manager Technology, Health Care and Research Area
Rocio Rojas Almeida, MD. PAHO/WHO
Regional Adviser on Health of the Indigenous Peoples
Text Edition
Franklin Quizhpe, Saraguro People, Ecuador
Graphic Design
Franklin Quizhpe, Saraguro People, Ecuador

Cover and Back Cover Design
Franklin Quizhpe, Saraguro People, Ecuador

Photographs Credits
Aldo Lo Curto, Brasil
Rocio Rojas Alnreida, PAFIO/WHO
Armando Waak, PAHO/WHO
Franklin Quizhpe, Saraguro People, Ecuador

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The regional, sub-regional and
national implementation of the
Health of the Indigenous Peopies of the Americas Initiative
has been possible thanks to the
role played by the Ministries of
Health and other government
bodies, Non Governmental
Organizations, academic institutions, different agencies
within the United Nations
system, international coopera­
tion agencies, indigenous organizations, Technical Areas
and Units at the Pan American
Health Organization Headquarters, as well as PAHO/
WHO Country Representative
Offices. All their efforts must

be acknowledged since they
have contributed to generate
conceptual frameworks, strat­
egies and tools that have en­
abled the development of poli­
cies, plans, programs, projects
and cooperation networks to
the benefit of the indigenous
peoples in the Region.

We must particularly acknow­
ledge and thank the members
and representatives of indige­
nous communities themselves,
who have allowed us to work
with them and learn from
them the importance of the
implementation of a holistic ap­
proach in health care, as a syn-

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Hui.ni of rut Inwgenovs Peoples of the Americas: Concepts, Strategies, Practices ano Challenges.

onym of equitable individual
and collective well-being.
This publication has been in­
spired by indigenous peoples'

wisdom and the urgent need
to address the health problems
that affect most of their com­
munities, thus, they deserve
special mention.

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Jose Luis Di Fabio, MD.
Manager Technology, Health Care and Research Area
PAHO/WHO

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Hfaith of nn Indigenous Peoples of the .Americas: Conceits. Strategies, Practices and Challenges.

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dfable of Contents

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The institutional authors
The issues

1
3

i.

CONCEPTS

5

Population and indigenous peoples
Where and in what context do indigenous peoples live?
How are they organized?
World view, health - illness

7
11
12
15

HEALTH STATUS AND LIVING CONDITIONS OF
INDIGENOUS PEOPLES

23

Multidisciplinary approach to indigenous
peoples' problems

26

A CLOSER LOOK INTO A HOLISTIC AND
INTERCULTURAL APPROACH TO HEALTH

29

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1.1.
1.2.
1.3.
1.4.

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2.

2.1.

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3.
3.1.

A socio-cultural analysis that takes into account a holistic
36
approach to health

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THE lXDK.1 SOUS PEOPLES OF T HE AMERlL \s: CONCEPTS, S FRATEGIES, Pr\( TICES AND Cl I Alt ENGEx

3.2. Application of the socio-cultural analysis to health care
systems and services

STRATEGIES

4.

4.1. The Pan American Health Organization
4.2. The International Labour Organization
4.3. The United Nations Permanent Forum
on Indigenous Issues
PRACTICES

5.

5.1. International policies and agreements
5.2. Information, analysis, monitoring and management
5.3. Primary Health Care and an intercultural
approach to health
5.4. Inter-institutional and intersectoral networking
6.

CHALLENGES

38
45

45
48
49
53
53
54

55
56
59

NOTES

64

REFERENCES

66

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Pi cu-sof tiieAmi:«h>.s: Conceits. Stiutecii s. Piucto.sanoCiiaiienc.es.

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The Pan American Health
Organization (PAHO)

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The Pan American Health
Organization (PAHO) is an
international multilateral or­
ganization specialized in pub­
lic health. It is composed of
39 Member States. As a spe­
cialized agency of the Orga­
nization of American States
(OAS), it belongs to the Inter­
American System and, as the
Regional Office of the World
Health Organization (WHO),
it is also a member of the United Nations system.

PAHO's mission is to lead stra­
tegic collaborative efforts among
Member States and other part­
ners to promote equity in
health. This mission must be
accomplished in a rather di­
verse universe determined by
the multilingual, multi-ethnic
and multicultural diversity of
the Region's population and
the presence of different views
on health and health care.

Since 1992 PAHO has made
systematic efforts to improve
the health conditions of indig­
enous peoples in the Americas.
These efforts were made in re-

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Hem.™ w the Inwgenovs Peoples of the Aminox Concepts, Stiutegies, Practices and Challenges.

sponse to calls from the indig­
enous movement for increased
attention to health, education,
environmental issues and hu­
man rights. The actions de­
ployed by PAHO have taken
place within the framework of

five principles and three reso­
lutions signed and ratified by
Member States.

RCD 37.R5 (1993)
RCD 40.R6 (1997)
RCD 47.R18 (2006)

GUIDING PRICIPLES OF THE HEALTH OF THE INDIGENOUS
PEOPLES INTIATIVE
(1)

The need for a holistic approach to health

(2)

The right of indigenous peoples to self-determination

(3)

Respect for and revitalization of indigenous cultures

(4)

Reciprocity in relations

(5)

The right of indigenous peoples to systematic participa­
tion

Hi-al fi >■ oi the Indigenous Peoples oe the. /Americas: Concepts, Strategies, Practices and Challenges.

Gyfee Issues

This publication will examine
the health of indigenous peo­
ples by taking into account
their holistic views of health,
as well as the different factors
that have had an impact on
their well-being. In addition,
this publication will highlight
the experiences of integrating
an intercultural approach by
countries in the egion to the
health of indigenous peoples.
Several concepts will be re­
viewed and data will be pre­

sented to illustrate the hetero­
geneity of the lives and health
conditions of indigenous peo­
ples. PAHO's Strategic Lines
of Action regarding the health
of indigenous peoples will be
detailed, together with a sum­
mary of progress achieved and
the challenges faced.

This information is an oppor­
tunity to deeply reflect on dif­
ferent processes currently un­
derway in the Region.

Suggestions from readers interested in contributing to an improved
understanding of the health of indigenous peoples are welcome. Com­
munications should be addressed to: Rocio Rojas, MD., Regional Ad­
viser on Health of the Indigenous Peoples, PAHO
(rorojas@ecu.ops-oms.org).

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Hem i i! of n it Indigenous Pi.oi i.es or ti ie Americas: Conceits. Strategies, Practic es and Chau enges.

Population and
Qmdigenous Peoples

ILO Convention (N° 169)
concerning Indigenous and
Tribal Peoples in Indepen­
dent Countries (1989), under
Article 1, recognizes as indig­
enous, that distinct section
of the national community
which is understood to consist
of "tribal peoples in indepen­
dent countries whose social,
cultural and economic condi­
tions distinguish them from
other sections of the national
community, and whose status
is regulated wholly or par­
tially by their own customs or
traditions or by special laws
or regulations", it also applies
to "peoples in independent

countries who are regarded as
indigenous on account of their
descent from the populations
which inhabited the country,
or a geographical region to
which the country belongs, at
the time of conquest or colo­
nization or the establishment
of present state boundaries
and who, irrespective of their
legal status, retain some or all
of their own social, economic,
cultural, and political institu­
tions". The concept of people
refers to a set of characteristic
features that define and give a
sense of identity to a human
group based on its territory,
history, culture and ethnic origin.

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Health of the Indigenous Peoples of the .Americas: Concepts, Strategies, Practices and Challenges.
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Between 45 and 50 million
indigenous peoples, belong
to more than 600 different
peoples (groups?) and live in
24 countries throughout the
Americas. They are the basis
upon which the plurality of
contemporary multicul tural,
multiethnic and multilingual
societies of the region are
built.
They are currently known, in­
ter alia, as:
Indigenous peoples, indig­
enous populations, original

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peoples, autochthones peo­
ples, native communities,
tribes, nations, Native Ameri­
cans, ethnic groups, first na­
tions, nationalities, peoples,
societies or Amerindians.
Several indigenous peoples
demand to be designated by
their specific names, for in­
stance, the Maya People, the
Garifuna People, and the Ona
People, the Chortt People.
International resolutions, con­
ventions and declarations use
the term indigenous peoples.

Reminder: Wherever reference is made to indigenous peo­
ples, the reader should recall that names may vary from one
country to another, depending on its historical, geographical,
political and cultural context

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Health oi rm. Indigenous Peoples of the /Xmericas: Com epes Strategies, Practices and Challenges

qAmw Are

Afhey Organized?

In their relationship with so­
ciety, indigenous peoples fol­
low traditional and ancestral
patterns of organization in the
pursuit of their goal of estab­
lishing links at local, national
and regional levels Their own
organizations have the same
hierarchical structure. Such
relationships start at the com­
munity level through the roles
played by traditional authori­
ties, formal and informal lead­
ers, and community members
who may not have a specific
function but deserve respect.
There is also an organizational
relationship based on gender
and civil status.

A proper understanding
of these organizational
processes enables a re­
spectful and legitimate
approach to the commu­
nity. This is the level at
which action plans will be
designed, developed and
implemented and where
health projects will be pro­
moted as actions aimed at
the development of indig­
enous peoples.

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Health or the Indigenous Peoples of the /Vmericas; Concepts, Strategies, Practices and Challenges.

Worldview,

Q^ealth - Illness

Culture can be defined as a
pattern of beliefs, thoughts,
values, practices, communi­
cations, behaviours - view of
the world - and institutions
(family, religious, economic
and political institutions)
which are characteristic of
and help to preserve a specific
social group. Ethnicity, race,
tine socioeconomic level and
geographical environment in
various combinations shape
different cultural contexts.
Throughout its own historical
development, each culture has
identified different respons­
es to fundamental problems

such as life, death, sickness
and health. However, these re­
sponses do not depend solely
on internal dynamics; they are
significantly bound by exter­
nal conditioning factors. As
far as the health - illness equa­
tion is concerned, distinctive
categories, models, ideas and
practices have emerged ac­
cording to each culture's fun­
damental view of the world,
their social and economic his­
tory and their geographic or
natural environment. Conse­
quently, these responses are
not necessarily identical or
valid for all cultures (1).

Health of the Indigenous Peoples of the Americas: Concepts, SrR.-vn-.GH-s, Practices and Challenges.

The World Health Organi­
zation defines health as the
biological, psychological and
social well-being of an individ­
ual. For indigenous peoples,
well-being is the harmonious
coexistence of the elements
of health, including the right
to have an understanding of
and control over the lives and
the rights "of human beings to
live in harmony with nature,
with themselves and with each
other, in order to achieve a ho­
listic state of well-being and
fulfilment, as well as spiritual,
individual and social peace".
In other words, by incorporat­
ing several paradigms based
on indigenous perspectives,
the concept of health finds
expression through the bal­
ance between the inseparable
components of the individual
(physical, mental, emotional
and spiritual) and the collec­
tive components (ecological,
political, economic, cultural,
social and - once again, spiri­
tual) . This holistic conception
of health encompasses the
biological, psychological, so­
cial and spiritual well-being
of an individual and of his or

her society/community under
conditions of equity.

The indigenous peoples of
the Region have developed
an extremely complex and
well-structured (both in con­
tents and internal logic) set
of practices and beliefs about
the human body and how to
live in harmony with other
human beings, nature and the
spiritual world. The strength
and survival of indigenous
peoples is significantly linked
to the efficiency of their tradi­
tional health systems, whose
"main conceptual axis" or
view of the world, is based on
equilibrium, harmony and a
holistic approach to ??.
The set practices and knowl­
edge of indigenous peoples of
the Region, referred to as Tra­
ditional Medicine, will also be
labelled as as traditional health
systems or indigenous health
systems (2). Traditional indig­
enous health systems encom­
pass an entire body of ideas,
concepts, beliefs, myths, ritu­
als and procedures, whether
explainable or not, related to

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physical or mental illnesses or
to social imbalances among a
specific group of people. This
knowledge explains the eti­
ology, the nosology (?) and
procedures for the diagnosis,
prognosis, treatment, cure and
prevention of illnesses. Indig­
enous peoples transmit this
knowledge orally and tradi­
tionally from one generation
to another. Thus, medicine is
local, collective, anonymous
and contains a deeply univer­
sal message.
In traditional health systems,
sickness is defined from a so­
cial perspective as the interfer­
ence in an individual's normal
social behaviour and his or her
ability to work. Most indig­
enous peoples divide diseases
into two groups: land diseases,
which stem from supernatural
causes (incantations, winds,
spirits - that act either on their
own or invoked by magic pro­
cedures) and; God's diseases,
of an unknown origin to the
indigenous mythical realm.
Different techniques are used
to establish a diagnosis and
prognosis of an ailment: can­

dles, guinea pigs, eggs or the
patient's urine. In general,
each therapist applies these
techniques according to his or
her training, powers and pref­
erences. Other practitioners
establish their diagnosis and
prognosis while under the ef­
fects of hallucinogenic plants
or dream interpretation. Treat­
ments include rituals, plants,
human substances deriva­
tives, minerals and animals.

Individuals go to traditional
therapists (3) for various rea­
sons; to seek help when con­
fronted with an illness, to pro­
tect themselves from potential
diseases and/or to reassert
their physical condition. Tradi­
tional therapists' care is based
on their knowledge of diseases
and the underlying meaning
of these diseases. The purpose
of treatment is to restore a bal­
ance that has been somehow
lost and the therapist's inter­
vention is effective when,the
unity and harmony of the pa­
tient can be restored, together
with the unity and harmony
between the patient and Inis or
her surroundings (4).

Health of thi Indigenous Peoples of the Americas: Conceits, Strategies, Practicesand Chai , engi s.

Through their close relation­
ship to nature, indigenous
peoples have attained full
knowledge of the classifica­
tion, composition, uses and
protection of plants found in
their habitats. Plants are part
of indigenous peoples' daily
existence and culture; the uses
and categories of plants are
intertwined with the magical
and religious aspects of their
worldview. When we examine
traditional health systems, we
acknowledge that we are deal­
ing with elements that include
far more than potent thera­
peutic substances extracted
from medicinal plants. For
this reason, medicinal plants
deserve a special place with­
in traditional health systems
and, thus, in the culture of in­
digenous peoples.
Although specialized thera­
pists have mastered this medi­
cal knowledge, all community
members know the general
rules and concepts of indig­
enous medicine. Traditional
medical therapies and prac­
tices can be applied at home at
any given moment. Any adult

man or woman could be an
herbalist, cleanser or shadow
caller (5). Parents are often the
first ones to provide care and
initial treatment to their sick
children. This could involve
different herbal teas or concoc­
tions, depending on whether
the ailment is due to excessive
heat or cold; "ill-wind cleans­
ing" with nettle, eggs or guin­
ea pigs; or "spirits call" if the
patient suffers from "fright".
Childbirth attendants are usu­
ally the mother or the motherin-law of the woman in labour,
without the presence of a mid­
wife. Many commonly known
illnesses, if considered minor,
will be treated at home with­
out help from a traditional
therapist or a midwife. In this
context, the core family, the
extended family, neighbours
and close friends become the
main health care providers.
Women play a leading role in
community health care and
in the preservation of its cul­
ture, including traditional
medical knowledge (6). The
magical connotation often as­
sociated to traditional healers
or therapists acts as a catalyst

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in the use of his or her "pow­
ers" by community members.
Depending on the healer's or
therapist's origin, he or she
might have received a call
either from God or from the
mountains. Oftentimes, they
might have felt their "pow­
ers" after bathing in "wild"
lakes or springs or they might
have been blessed with "luck"
, giving them the ability to ex­
ercise their medical art. More­
over, they may have inherited
the art of healing or they may
have been called to become a
therapist as a means to accom­
plish their mission on Earth.
A community's healer is irre­
placeable in so far as he or she
has a profound knowledge of
the laws that regulate balances
and imbalances at the origin of
health and illness. Indigenous
peoples recognize in the heal­
er the indigenous champion

of their identity and the indig­
enous person who reaffirms
their knowledge and values
through their craft.
"If you believe in the Apus
(gods, spirits), they will cure
you" is the symbolic expres­
sion constantly reiterated to
the patient by the altomisayoq,
or traditional therapist, when
treating a disease. This belief
reaffirms the cultural iden­
tity of the Andean patient.
Cultural identity is extremely
important for both the patient
and the Andean traditional
medical practitioner as he or
she must remember the "land
they come from" or "who he
or she is". These elements will
give both the patient and the
healer the necessary faith and
confidence required to ensure
proper healing.

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&fealth Status and

Living Conditions
if (indigenous Peoples
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Indigenous communities have
what is known as epidemiolog­
ical accumulation. This notion
refers to the persistence and
exacerbation of health prob­
lems related to unsatisfied ba­
sic needs (communicable and
deficiency diseases, including
STIs, HIV, AIDS and tubercu­
losis), together with a steady
rise in morbidity and mortal­
ity linked to chronic and de­
generative diseases (cardio­
vascular diseases and cancer).
This is further compounded by
public health problems associ­
ated with urbanization, indus­
trialization and the sprawling
adverse effects of the affluent

society (i.e. violence: suicides,
homicides and accidents; al­
coholism and drug abuse;
pollution, environmental deg­
radation and destruction of
the environment). Indigenous
adolescents and young adults
suffer from a lack of opportu­
nities and inequity. In the case
of young indigenous women,
their health profile is aggra­
vated by problems linked to
their reproductive functions
and tire discrimination they face
being female, indigenous and
oftentimes illiterate and mono­
lingual.
The following chart responds
to the need to apply the con-

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tents of the Millennium De­
velopment Goals to different
realities. It also shows the
burden of disease and ineq­
uity that affect indigenous
peoples in the Americas. Real

solutions to these challenges,
as demanded by indigenous
leaders, will require the in­
corporation of indigenous
peoples' concepts of poverty,
alliance and development.

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Issue
1. Poverty
2. Illiteracy

thi Ami was: Com epts, Siratcgies, Practk i s am) Chai ij.mjis.

Country
Canada
Chile
Bolivia

Indigenous

Not Indigenous

34%
16%
20.1%
32.2%
4.51%
19.61%
Illiteracy among indigenous women
varies between 50% and 90%. Only
43% of them finish elementary school,
5.8% finish high school, and 1% gets a
higher education.

3. Gender Equity
and Women's Au­
tonomy

Guatemala

4. Child Mortality

Panama

5. Maternal Mortality

Honduras

6. Fight against ma­
laria, HIV/AIDS and
other diseases

Nicaragua

90% of malaria cases caused by falci­
parum are
concentrated in 24 municipalities with
indigenous populations.

El Salvador

95% surface water sources are con­
taminated.
Malnutrition in children and adults
is associated with parasites. 40% of
indigenous children suffer from mal­
nutrition, compared to the national
average of 20%.

7. Environmental
Sustainability and
Nutritional Status

8. Foster a Worldwide
Partnership for
Development

\___________________

84/1,000 live
births
255/100,000 live
births (Intibuca)

17/1,000 live
births
147/100,000 live
births

Indigenous peoples share similar
problems (i.e. similar epidemiological
profiles, presence of refugees, changes
in lifestyles, acculturation, advance in
the frontiers of development, loss of
territory), particularly for those living
in border areas. Thus, there is an ur­
gent need to coordinate efforts aimed
at the development and/or the imple­
mentation of international and subre­
gional agreements in the Region.
y

Source: Data provided by the countries participating in the national evaluation of health achieve­
ments within the framework of the International Decade of Indigenous Peoples of the
World. PA HO. 2004

Pan An
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H; ■: tH if i HE |v >igewl - Peoples of the American Costepts, Strat egies. Practices and Challenges.

A Q^ultidisciplinary
(Approach to

Qmdigenous Peoples Problems

Inequity, as faced by indige­
nous populations, requires an
approach that intersects with
a number of issues including
human rights, democracy, de­
velopment, environment and
an understanding of their cul­
tural identity and worldview,
through a new approximation
to their history. In practice,
adequate legal frameworks
must exist and be applied in
order to address these deter­
minant factors of exclusion.
These legal frameworks must
prioritize the development of
indigenous peoples and the
consolidation of multidisci­

plinary as well as intra and
intersectoral joint cooperation
processes.
Multidisciplinary approach to
indigenous peoples problems

Hi? i:.,: iiB. Inmglndi s Peoples ?>r ms Americas; Conceits. Strategies, Pkaot.es and Challenges.

3

Qg/Ctoser Look Into

3

a Q^olistic and

3

Qmtercultural
Approach to QOvealth
Discussions, under various
formats and categories have
enriched a holistic and intercultural approach to health.
This has been translated into
the harmonization of in­
digenous and conventional
health systems and has mate­
rialized in the incorporation
of indigenous perspectives,
medicines and therapies into
primary health care models. As
such, conciliation, concerted
action, mediation, association
and harmonization of tradi­
tional and conventional helth
systems is needed in order to

achieve an efficient health care
system that takes these factors
into consideration.
Intercultural Dynamics

Past and recent developments
in the history of the Region
have determined a number
of relationships between cul­
tures. In most societies, such
relationships are asymmetric,
subordinated or conflictive.
Official history has failed to
consider the vision of many of
the leading characters in these
processes.

Health of the Indigenous Peoples of the Americas: Concepts, Strategies, Practices and Challenges.

In the midst of such a dynam­
ic environment, the search
for joint strategies to address
the health - illness equation
implies revisiting concepts of
practices used by "others" in
order to find a convergence be­
tween two or more visions on
potential solutions to health
problems. These solutions
might stem from different con­
textual frameworks. Further­
more, there is an urgent need
to change paradigms since this
search will lead to an analyti­
cal process that is not based on
a biomedical perspective, but
rather on sensitivity towards
and respect for differences .
The proposal to incorporate
an intercultural approach to
health in the work with mul­
ticultural populations is rel­
evant in so far as it makes it
possible to understand the
place and role played by each
culture within national societ­
ies and the social determinants
that affect their lifestyles and
health status. Furthermore,
it provides an insight into
the daily interaction between
and within non- indigenous
and indigenous cultures. The

challenge in achieving equity
is reaching a common under­
standing from intercultural
dynamics.
The concept of intercultural
interaction involves respectful
and equitable interrelations
in dealing with the political,
economic, social, cultural, age,
linguistic, gender and genera­
tional differences which may
have emerged in a specific
context between cultures, peo­
ples or ethnic groups in order
to build a fair society.
In practice, the intercul­
tural approach to health is
understood as the balance
between different elements
of knowledge, beliefs and
cultural practices related
to health, disease, life and
death, as well as biologic
and social issues which are
perceptible through visible
expressions and through
a cosmic and spiritual di­
mension.

The already precarious living
and health conditions and the
low health coverage in rural

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Health oe the Indigenous Peoples of the Americas: Concepts, Strategies, Practicesand Challenges.

areas, reach critical levels in
areas inhabited by indigenous
populations. The life and cul­
ture of indigenous peoples
are revitalized by a heritage
of collective knowledge, tra­
ditional practices, indigenous
medical therapists and com­
munity resources. Though in­
valuable assets in confronting
such a complex epidemiologic
profile, they just partly cover
indigenous peoples' health
needs.
"... Just as Mother Earth
is exhausted and requires
attention, our health and
the health of our children
has been deteriorated by
malnutrition, scabies, diar­
rhoea and other diseases
and require medicines. We
can no longer rely solely
on the help of midwives
and healers, even if they
are meticulous, respectful,
patient and caring in the
way they heal us."

Therefore, strategies must be
identified to reach this popu­
lation through formal health
systems. But these strategies

must also take into account
their cultural differences, lan­
guage, communication, values,
beliefs, social organization,
lifestyles, time conception as
well as their own community
therapeutic resources.

The creation of a multidisci­
plinary team is of paramount
importance, together with tine
inclusion of community mem­
bers with health knowledge.
The latter will bring an insight
into the social and cultural fac­
tors that have an impact on the
improvement of health care
and access to health services,
thus facilitating the expan­
sion and extended coverage of
health care in areas inhabited
by indigenous populations.
The challenge for public health
services is to translate quan­
titative and qualitative data
into operational information
that could be useful in under­
standing the indigenous per­
spective of health and their ex­
isting resources. As well, this
information could assist in
the development of a cultur­
ally appropriate health model.

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This model should provide
quality health care from both
the technical dimension and
the user's point of view.

Primary health care is es­
sential health care based
on practical, scientifically
sound and socially accept­
able methods and technol­
ogy made universally ac­
cessible to individuals and
families in the community
through their full partici­
pation, and at a cost that
the community and coun­
try can afford to maintain
at every stage of their de­
velopment in the spirit of
self-reliance and self-de­
termination.

Human resources, infrastruc­
ture, equipment and adequate
inputs for specific epidemio­
logical profiles are important
elements in the provision of
public health services. How­
ever, this becomes a matter
of concern if we consider that

such resources have remained
concentrated in urban areas
or areas of easy access, while
indigenous populations and
other ethnic groups have been
faced with shortcomings in the
organization and response to
conventional health services.

Most of the 45 million in­
digenous people living in
the Americas face increas­
ing inequity in health care
and access to basic health
services.

Thus, in the implementation
of the principle of equity:
a) States must reduce as far as
possible all unjust and avoid­
able differences, through the
implementation of intercultural policies;
b) Populations must receive
care according to their needs
and they must contribute
economically according to
their ability to pay;

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Intercultural Interaction: Framework for Policy-Making
with Indigenous Peoples
The framework presented be­
low is based on three principles.
Each principle has a specific
approach that guides cross­
cutting actions and includes
criteria to identify indicators
to assess their effective appli­
cation.
The key principle under this
framework is the overall re­
spect for fundamental human
rights and for the right to life,
in particular. The application
of this principle requires the
development of policies that
promote multidisciplinary and
intersectoral coordination and
cooperation, as well as vertical
integration. In other words, it
ensures consistency between
domestic, regional, interna­
tional and global policies on
the health of indigenous peo­
ples.

Another principle is the rec­
ognition of the existence of in­
digenous peoples. This implies
a steady progress towards the
self-determination of indig­

enous peoples and their right
to control all aspects of their
future, including health. The
strengthening of their techni­
cal, administrative, manage­
rial and political capabilities is
essential for the equitable ex­
ercise of their rights. Similar­
ly, the protection of ancestral
knowledge should be assured
through the respect of intellec­
tual property. Consequently,
policies should promote for­
mal mechanisms to be ap­
plied by agencies and institu­
tions entrusted with the joint
development of health poli­
cies together with indigenous
peoples. This will ensure their
participation in health policymaking bodies and enable
them to gain greater control
over their services, resources
and health.
None of the above will be pos­
sible without the political will
of States that are committed
to the promotion of equity
amongst the peoples and in­
habitants of their countries.

The following components are
required in adequate policymaking: quality information,
responsibility and the avail­
ability of technical and finan­
cial resources. The starting
point of such policies must be
a definition of ethnicity which
should be compatible with the
perception of indigenous peo­
ples, combined with the devel­

opment of both conventional
and supplementary indicators
to measure positive results,
as perceived by indigenous
peoples. Moreover, these poli­
cies must promote joint man­
agement mechanisms to foster
official relationships between
indigenous peoples' organiza­
tions and governmental health
policy-making bodies.

Intercultural Interaction: Framework for policy-making with in­
digenous peoples
Principles
(Standards)

1.

Respect for
fundamental
human rights
(particularly the
right to life)

Approaches
(Cross-cutting actions)

Criteria
(References to develop
indicators)
Multidisciplinary focus

Interconnection

Intersectoral action

Vertical integration
Control

2.

Recognition of
the existence
of indigenous
peoples

Self-determination

Capacity-building; cul­
tural adaptation

Intellectual property
Quality information

3.

Political will
from States

Equ ity

Accountability; respon­
sibility

Technical and financial
resources
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Health of the Indigenous Peoples or the Americas: Concei ts, Strategies, Practjct'

At other levels, countries should
be accountable for their prog­
ress or lack of progress therein
through the submission of re­
ports on the health of indig­
enous peoples in international
fora.

As far as the allocation of re­
sources is concerned, the role
of policy should be to promote
the availability of additional
resources and other types of
resources, in order to achieve
equitable results. Examples of
these resources include tire ac­
cess of indigenous peoples to
their lands and natural resourc­
es, die availability of therapists
and medicines; the ability to
care for the elderly (die custodi­
ans of traditional knowledge);
access to culturally adequate
health services; and to die op­
portunity to use their own lan­
guages in daily life.
In this sense, intercultural in­
teraction is a political task that
should be geared towards the
legitimate recognition or ac­
knowledged visibility of in­

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digenous populations, their
knowledge, lifestyles and social
organization. It will be neces­
sary to understand the simi­
larities and differences among
equals. In order to achieve this,
policies that respect differences
and promote equity must be
proposed.
Intercultural Interaction shall
generate consensus, as well as
multisectoral and multidisci­
plinary processes. It should
identify clear methods and ac­
tions to achieve real equity; the
type of equity diat values differ­
ences and emphasizes a culture
of health ratlier than disease.
This will legitimize tine knowl­
edge of different health systems
through agreements, dialogue
and consensus in a climate of
mutual respect, reciprocity
and interdependence. Further­
more, it will contribute to the
strengthening, of a bottom-up
exchange of local expressions
and experiences tlnat could con­
tribute to the dissemination of
lessons learnt by different net­
works and audiences.

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A Sociocultural Analysis

that Afakes Into Account a
ttloostlo Aopooooh to P/koozo

At present, general overviews
of health systems are based
on conventional screening pa­
rameters which break down
the population into different
categories and subcatego­
ries. Often parameters such
as the official recognition of
a population remain oblivi­
ous to the existence, realities
and perspectives of indige­
nous peoples. "Filters" used in
conventional analysis classify
people as: poor, marginalized,
vulnerable, fragile, at risk, etc.
These categories marginalize
indigenous and other groups ,
making them "invisible".

A sociocultural analysis pro­
poses the acknowledgement of
the multilingual, multi-ethnic
and multicultural character­
istics of the population of the
Americas and, thus, the rel­
evant presence of indigenous
and black peoples.
This recognition implies a
cross section integration of
indigenous peoples' perspec­
tives, culture and worldview
in both the analysis of living
conditions and health status,
as well as in the development
of strategies to meet these
needs. It has become essential

HtALTI I OF THE INDIGENOUS PEOPLES OF THE AMERICAS: CONCEPTS, STRATEGIES. PRACTICES AND CHALLENGES.

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for both indigenous and nonindigenous populations to un­
derstand indigenous history
and lifestyles and the contributions indigenous peoples have
made to society.
Sociocultural Analysis
Main Axis

In this context, it is of paramount
importance to understand in­
digenous peoples perspectives
of development, health, dis­
ease, social participation, pov­
erty, etc.

For instance:
Wealth is the sum of cultural
and linguistic potential, the
capacity for social control
and leadership, access to land
and to different ecologic stra­
ta, the link with community
power and the adherence to
community principles such
as solidarity and reciprocity.
A person is considered to be
poor if, notwithstanding his
or her material richness, he
or she is deprived of these in­
stances.

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Healthoi the Indigenous Peoples oi the Americas: C incepts, Strategies. Practices and Challenges.

oSpplication of a
Sociocultural Analysis
to Stealth Care

(Systems and Services
The characterization of dif­
ferent population groups, the
understanding of values and
beliefs systems that determine
processes aimed at preserving
and restoring health, together
with the need to tap communi­
ty resources, promote an intercultural and holistic approach
to health based on the harmo­
nization of traditional and con­
ventional health systems.

Conventional analyses tend to
homogenize both population
and health care, while a socio­
cultural approach would seek
to make the population het­
erogeneity visible.

The challenge in an intercultural approach to health is to
generate opportunities for
dialogue and communication
between cultures in order to
empower excluded peoples
and create greater awareness
amongst those that enjoy a
privileged position.
Though traditional, alternative
and complementary therapies
and medicine have gained importance as a source of wealth
in the daily existence in several
countries, only a few of them
mention indigenous therapies
and medicines as an integral
part of their health sector.

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Health or the Indigenous Peoples of rw: Americas: Concepts, Strategies. Practices and Challenges.

The intercultural approach to
health involves the recogni­
tion of human and therapeu­
tic resources, together with
strategies that reach beyond
conventional health systems
paradigms.

Indigenous health systems,
like conventional health sys­
tems, have strategies for treat­
ment, prevention, rehabilita­
tion and health promotion.
Their human resources, infra­
structure and inputs follow
their own structure and ratio­
nale.

Heterogeneity of population

__

For instance:

While the term 'therapists'
in conventional health sys­
tems includes physicians,
nurses, laboratory techni­
cians, dentists, health pro­
moters, etc., in indigenous
health systems only the
yachaks, sukias, pajuyucs,
machis, midwives, boneset­
ters, shadow callers, herb­
alist, etc. appear under the
list of therapists.

Heterogeneity of health
strategies and resources

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Health of the Indigenous Peoples of the Americas: Concepts, Strategies, Practices and Challenges.

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"There are diseases that a
physician cannot cure and
are cured by the shapori;
there are diseases that the
shapori cannot cure and
are cured by the physician.
There are diseases that
cannot be cured neither
by the physician, nor by
the shapori". Diseases and
their cure are not the only
spheres of responsibility of
a shaman; they are just a
part of his or her scope of
action that involves the re­
lation with the cosmos and
with the natural and social
order of his or her commu­
nity.

Mainstreaming indigenous
perspectives, medicines and
therapies require the devel­
opment and implementation
of legal frameworks that pri­
oritize health care for indig­
enous peoples. Similarly, the
practice and application of
indigenous medicines and
therapies must become a pri­
ority, together with the pro­
tection and preservation of
community knowledge and
resources, while understand­

ing the components and re­
sponse capacity of each health
system. This implies the gen­
eration of knowledge and par­
adigms that would broaden
conceptual frameworks and
promote an improved under­
standing of the indigenous
worldview and its incorpo­
ration into human resources
training and development, as
well as in the adaptation of
conventional health programs
to the realities of indigenous
communities.

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The harmonization of indig­
enous and conventional health
systems requires a fostering of
the social, economic, political
and human development of
indigenous peoples in a way
that promotes unity and ac­
knowledges the diversity of
peoples.

This implies the recognition
of the existence of indigenous
peoples and their potential,
their improved comprehension
of organizational processes
and their work to protect their
ecosystems and sacred places.
It also calls for further justice,
legislative review and the cul-

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Health of the Indigenous Peoples of the Americas. Concepts, Strategies. Practices and Challenges.

tural adaptation of health and
welfare programs in order to
strengthen indigenous cultures
and their links with the State.
At managerial and operational
levels, health staff must foster
the empowerment of indig­
enous peoples ensuring the
development of strategies that
combine community and in­
stitutional visions. It is impor­
tant to maintain a respectful
approach to communities and
indigenous peoples through
legitimate channels, and to
establish proper coordination
mechanisms with different

community stakeholders. This
will contribute to ensure the
success and sustainability of
proposed processes.

Realistic goals must be set
and commitments must
be complied with in or­
der to restore indigenous
peoples' confidence be­
fore any planning effort is
undertaken. The commu­
nity's perception of time
and space, as well as its en­
vironment should be duly
taken into account.

Health systems - models of care

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strategies

The Pan American Health
Organization

The Pan American Health Or­
ganization's (PAHO) initial
systematic actions regard­
ing the health of indigenous
populations date from 1992
when, within the context of
the 500 years of the discovery
of the Americas, it responded
to demands from the indige­
nous movement for increased
health care, education, envi­
ronment conservation and hu­
man rights protection. In 1993,
Member States confirmed this
approach with the approval
of Resolution CD37/R.5, at

the origin of the Health of In­
digenous Peoples Initiative.
This resolution was ratified in
1997 by Resolution CD40R.6
and was adopted within the
framework of the Internation­
al Decade of the World's In­
digenous Peoples. In 2004, af­
ter assessing the results of the
Decade, the delegates from 19
countries recommended the
strengthening of the Health of
Indigenous Peoples Initiative.
In 2006, with the adoption of
Resolution CD47/R.18, PAHO's Member States reassert­
ed their commitment to the
health of indigenous peoples
within the framework of the

Health of the Indigenous Peoples of the Americas: Concepts, Strategies, Practices and Challenges.

implementation of the Millen­
nium Development Goals, the
renewed emphasis on prima­
ry health care and the achieve­
ment of the objectives of the
Second International Decade
of The World's Indigenous
Peoples.
The technical cooperation en­
deavours of the Pan Ameri­
can Health Organization and
Member States actions are
based on the key principles
of the Health of Indigenous
Peoples Initiative. These prin­
ciples call for the permanent
participation of indigenous
peoples and the respect for
and recognition of their ances­
tral wisdom.

The Health of Indigenous Peo­
ples Initiative has been unique
in combining the efforts of
PAHO-promoted
programs
and country proposals. The
Initiative has been effective
not only in advocating for the
well-being of indigenous peo­
ples of the Americas in local,
national and regional fora, but
also in the creation of strate­
gic partnerships and alliances
to promote processes geared

towards the improvement of
indigenous peoples' health
status. Amongst others, the
achievements, policies, strate­
gies, plans, projects and pro­
grams established for human,
community and institutional
capacity building deserve a
special mention.
The conceptual and method­
ological development of the intercultural approach to health
based on individual Member
States concrete experiences has
been an important reference in
the effort to bring health care
closer to indigenous communi­
ties. In addition, it has helped
achieve increased efficiency in
the delivery of health services
by taking into account indig­
enous resources, perspectives,
practices, therapies and medi­
cines. Furthermore, the pro­
duction and dissemination of
technical, scientific and public
information has enabled thesocial exchange of individual
countries experiences and has
provided incidence numbers
on the production and use of
knowledge about indigenous
peoples' health.

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HcTTHIndiginols Peoivs of the Americas: Conceits. Strategies. Practices and (Challenges.

The following strategic lines of action are proposed for the
2006 - 2011 period:

1. To ensure incorporation of indigenous perspectives into the
Millennium Development Goals and national health policies;
2. To improve information and knowledge management on in­
digenous health issues to strengthen regional and national
evidence-based decision-making and monitoring capacities;

3. To integrate an intercultural approach into the national health
systems of the Region as part of the primary health care strat­
egy; and

4. To develop strategic alliances with indigenous peoples and
other key stakeholders to further advance the health of the
indigenous peoples.

Hi•••.!.!H Or THE L'.PiU SOL'S PEOPLES OF DIE AMERICAS: CONCEPTS. SlUATEGlES, PRACTICES AND CHALLENGES.

The International Labour
Organisation
Convention (No. 169) concern­
ing Indigenous and Tribal Peopies in Independent Countries
Part V. Social Security and
Health

Article 24
Social security schemes shall
be extended progressively to
cover the peoples concerned,
and applied without discrimi­
nation against them.

based. These services shall be
planned and administered in
co-operation with the peoples
concerned and take into ac­
count their economic, geo­
graphic, social and cultural
conditions as well as their tra­
ditional preventive care, heal­
ing practices and medicines.
3. The health care system shall
give preference to the training
and employment of local com­
munity health workers, and
focus on primary health care
while maintaining strong links
with other levels of health care
services.

Article 25
4. The provision of such health
services shall be co-ordinated
with other social, economic
and cultural measures in the
country.

1. Governments shall ensure
that adequate health services
are made available to the peo­
ples concerned, or shall pro­
vide them with resources to al­
low them to design and deliver
such services under their own
responsibility and control, so
that they may enjoy the highest
attainable standard of physical
and mental health.

Objectives of the Second Inter­
national Decade of the World's
Indigenous People

2. Health services shall, to the ex­
tent possible, be community­

1. The objectives of the Sec­
ond Decade are as follows:

United Nations Permanent
Forum on Indigenous Issues

n-i 1st

xc, > Pre,i! s or nit Americas: Concepts. Stkailgii.s, I’kaiticesasoChalienges.

Promoting non-discrimina­
tion and inclusion of indig­
enous peoples in the design,
implementation and evalua­
tion of international, region­
al and national processes
regarding laws, policies, re­
sources, programmes and
projects;

2. Promoting full and effective
participation of indigenous
peoples in decisions which
directly or indirectly affect
their lifestyles, traditional
lands and territories, their
cultural integrity as indige­
nous peoples with collective
rights or any other aspect of
their- lives, considering tire
principle of free, prior and
informed consent;

3. Redefining development
policies that depart from a
vision of equity and select­

ing policies that are cultur­
ally appropriate, including
respect for the cultural and
linguistic diversity of in­
digenous peoples;

4. Adopting targeted policies,
programmes, projects and
budgets for the develop­
ment of indigenous peoples,
including concrete bench­
marks with a particular- em­
phasis on indigenous wom­
en, children and youth;
5. Developing strong moni­
toring mechanisms and en­
hancing accountability at tire
international, regional and
particularly tire national lev­
el, regarding the implemen­
tation of legal, policy and
operational frameworks for
tire protection of indigenous
peoples and the improve­
ment of their lives.

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mctices

Progress in PAHO's Technical Cooperation
on Health of the Indigenous Peoples
Strategic Action
Policies and international agreements
Progress
°

o

o

•

•

19 countries have technical units and national initiatives: Ar­
gentina, Bolivia, Brazil, Canada, Colombia, Costa Rica, Chile,
Dominica, Ecuador, El Salvador, Guatemala, Honduras, Mexi­
co, Nicaragua, Panama, Paraguay, Peru, the United States and
Venezuela..
Resolutions CD37.R5 (1993) and CD40.R6 (1997) and plans and
directives of the Health of the Indigenous Peoples Initiative
have served in several countries as the framework for the de­
velopment of initiatives, policies, programs and national proj­
ects.
Permanent participation of indigenous representatives in tech­
nical cooperation activities.
Focal Points: 1 in The World Health Organization (WHO), 5
in specialized centres and 18 in Representative Offices; in 6 of
which this issue is coordinated by a PAHO/WHO Representa­
tive.
National policies that prioritize the health of indigenous peo­
ples (for example, in Bolivia, Brazil, Canada, Chile, Ecuador,
Panama, Peru, the United States and Venezuela).

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Strategic Action
Information, analysis, monitoring, and management
Progress
0

0

0
0
0

Webpage developed.
Indigenous newsletter currently published in English, Portuguese,
Spanish and indigenous languages (e.g. Aymara and Kichwa).
14 titles published under the Series Health of the Indigenous Peo­
ples.
Publications on policies, situation analysis, intercultural models,
traditional indigenous medicine and action networks (28 titles).
Database on the health of indigenous peoples with 919 entries
available on PAHO's webpage.
National documents on situation analysis.

T?’. -] Pan American
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3.

:-.

. . -

Strategic Action
Primary health care and intercultural approach to health

Progress
°

»
•

«

o

3

Legal frameworks on indigenous traditional medicine developed
in Ecuador, Panama and Nicaragua.
Conceptual and methodological progress.
Six case studies on the incorporation of the indigenous peoples'
perspectives, therapies and medicine in primary health care in
the following communities: Mapuche (Chile), Nahualt-Pipil (El
Salvador), Maya (Guatemala), Gan'funa (Honduras), Ngobe Bugle
(Panama) and Kechwa (Peru).
Strategic guidelines for the incorporation of indigenous perspec­
tives, therapies and medicines in primary health care.
Human resources training modules on intercultural approach to
health developed in: Bolivia, Brazil, Ecuador, Guatemala, Hondu­
ras, Mexico and Nicaragua.
Adaptation and development of tools and methodologies on an
intercultural approach to priority problems: Integrated Manage­
ment of Childhood Illness (IMCI), Roll-Back Malaria Initiative,
water and sanitation, H1V/AIDS, tuberculosis, DDT-exempt ma­
laria control (PAHO-GEF Project) and matrixes for quality assess­
ments in the development of intercultural health care models,
among others.

Paa American
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Health .: the Indigenous Peokesot the Americas Conceits. Strategies I’kal ikes and Challenges

4.

Strategic Action
Inter-institutional and intersectoral collaboration networks

Progress

•

°

•

°

®

°

°

Intra-institutional partnerships with 14 PAHO programs: Malaria,
Integrated Management of Childhood Illness (1MCI), Reproduc­
tive Health, Water and Sanitation, Maternal and Child Health,
Virtual Campus, Mental Health, Human Rights, STI/HIV/A1DS,
Social Exclusion, Health of Older Adults, Oral Health, Ocular
Health and Rehabilitation.
Inter-institutional partnerships: Inter-American Development
Bank, the World Bank, the Organization of American States, bi­
lateral cooperation agencies, the Fund for the Development of the
Indigenous Peoples of Latin America and the Caribbean, the Of­
fice of Alternative Medicine of National Health Institutes of the
United States, Health Canada, Indian Health Service and Indig­
enous Parliament.
Intersectoral partnerships: Partnerships to address subjects such
as access to water and sanitation, and disabilities among Miskito
divers on Honduras Atlantic Coast, respectively, with the partici­
pation of the Ministries of Health, Environment and Agriculture,
and with the Ministries of Health, Education, and Labour.
Participation in international fora: United Nations Permanent Fo­
rum on Indigenous Issues, "Healing our Spirits Worldwide" Glob­
al Conference
Tripartite alliances between PAHO/WHO Representatives Coun­
try Offices, Ministries of Health, and national indigenous organi­
zations in Bolivia, Honduras and Panama.
Interagency initiatives within the United Nations system in Co­
lombia, Ecuador, Honduras and Venezuela. All of which include
an intercultural approach to health.
List of institutions that work on issues related to the health of in­
digenous peoples in Central American countries.

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Pi.oi'ii s et nw Americas: Concepts. Strategies. Practices ano Chau.engi

Notwithstanding the progress
and results achieved, certain
challenges remain and must
be addressed. These chal­
lenges will embody important
reference points in the iden­
tification of the Pan Ameri­
can Health Organization and
its Health of the Indigenous
Peoples Program main lines of
action and indicators to mea­
sure the progress and impact
of such interventions. The fol­
lowing can be described as the
most important challenges:

T?.'-? Pon American
r>| Health
/J.-J OrginlraUon

H Indigenous populations epi­
demiological profile is linked
to high levels of poverty, un­
employment, illiteracy, mi­
gration, marginalization, lack
of land and territory, deg­
radation of ecosystems, life
dynamics modification, geo­
graphical isolation, loss of
cultural and linguistic iden­
tity, etc. These structural fac­
tors determine a number of
unsatisfied needs amongst
indigenous peoples. Mother
and child mortality, malar­
ia, tuberculosis, AIDS, prob­
lems associated to the lack

HtAi.ru o: id: Indigenous PeW'LIa « mt Americas: Concerts, Straeegies. Practices ano Challenges.

of access to basic services,
health, water, housing and
basic sanitation, coupled
with food security and men­
tal health problems, to men­
tion a few, are prevalent in
most indigenous communi­
ties and must be adequately
characterized,
prioritized
and addressed. Within this
context, the role of local
and national authorities be­
comes all the more relevant,
as does a greater visualiza­
tion of the administrative
units of a territory (munici­
palities, states, provinces,
departments) that bear the
grunt of inequity.
□ The ethnic, cultural and
geographical location het­
erogeneity of indigenous
peoples calls for the need to
identify innovative health
care formats to satisfy their
health needs, instead of re­
sorting to the adoption of
a single health care model
or program. Problems af­
fecting indigenous people
in urban areas must be in­
cluded in care proposals for
urban marginal populations

in different countries. Bar­
riers that preclude access
to health services due to
economic, geographic and
cultural reasons are com­
pounded by typical urban
problems such as family
and social network disinte­
gration, violence, drug use
and abuse. Gangs are not
an unknown reality in in­
digenous neighbourhoods.
Indigenous children and
adolescents face alarming
vulnerability.
□ The lack of vital statistics or
a breakdown of services by
ethnic group, gender and
age makes it difficult to de­
velop evidence-based man­
agerial processes and, thus,
hinders adequate priority
setting and a proper assess­
ment of indigenous peo­
ples' health status, living
conditions and health ser­
vices coverage at a national
level and within regions of a
country.

□ Like quantitative informa­
tion, it is essential to un­
derstand the social and cul-

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tural factors at the origin of
peoples' knowledge, atti­
tudes and practices regard­
ing ways to preserve and
restore health. Similarly, it
is important to comprehend
the cultural, linguistic and
organizational potential of
indigenous peoples which
is linked to the community
principles of respect, reci­
procity and ancestral wis­
dom. The indigenous peo­
ples of the Americas have
indeed developed a rather
complex - though wellstructured in its contents
and rationale, ensemble of
knowledge and practices re­
lated to the human body, the
coexistence with other hu­
man beings, with nature and
with spiritual beings. Indig­
enous peoples owe much of
their strength and survival
ability to the efficiency of
their traditional health sys­
tems, whose "main concep­
tual axis", or worldview,
is based on the balance be­
tween beings and nature,
harmony and a holistic ap­
proach. The challenge for
public health systems is to

translate this socio-cultural
information into practical
data that can promote in­
digenous peoples individ­
ual and collective holistic
well-being within a context
of equity.

■ The problems shared by in­
digenous peoples, particu­
larly those located in border
areas (similar epidemio­
logical profiles, presence of
refugees, changes in life dy­
namics, acculturation, loss
of land, etc.) urgently call
for the coordinated effort of
al! countries in the Region,
and for the development
and/or implementation of
sub-regional and interna­
tional agreements.
□ Both at a national health level
and within regions in each
country (7), little health staff
training for the delivery of
adequate services has been
adapted to the sociocultural
realities of users.

□ Although PAHO Member
States have signed and rati­
fied different international

H: i.i He: in I'.;1: iinovs Pimisoi inr. .\Misine: Com ms, Snunuft. Practices am> Ciiauengiis.

worldview. This requires
the political commitment
and responsibility of the
countries in the Americas,
international
cooperation
agencies and indigenous or­

ganizations, to foster mul­
tisectoral and multidisci­
plinary working processes
with the full participation
of indigenous peoples as so­
cial stakeholders.

Hem ih or the Indigenous Pk i-li.s or tin Americas: Conceits. Strategies, Practices and Challenges.

NOTES

1. Few societies today are limited to a single mechanism for procur­
ing and preserving their health status. A community may have
a number of traditional and alternative therapeutic approaches
that offer different treatments, costs and benefits; however, de­
spite the fact that cross-cultural surveys of therapeutic systems
have revealed the existence of multiple health care options in
the community, only a few of them have detailed the vast choice
of alternatives in available treatments. The existence of a “pop­
ular" sector amongst multiple health systems, which contrasts
with traditional and Western or conventional health systems,
has gained interest in current anthropologic medical literature.

2. Local health systems are considered to be a complex set of process­
es that represent the totality of social health actions undertaken at
the local level which include, but are not limited to the delivery of
health services. In contrast, traditional health systems are a par­
ticular type of local health systems characterized by a holistic ap­
proach and the concept of all-inclusiveness and holistic approach
that have been ever-present among indigenous peoples.
3. Traditional medical therapists receive different names according
to their specialty. These names may vary from people to people
depending on their history. For example, in the Nicaraguan At­
lantic Coast, elements of indigenous culture have been combined
with elements of Afro-Caribbean black culture as in the case of
the obiainan and the sukias, the ciopi and the spirits. In the Ama­
zon Region, the shaman is the spiritual leader of the community
and for the mapuche people, the machi is the spirtual leader. In
the Andes, indigenous therapists have names that distinguish
them from one another such as herbalist, bonesetters, ill-wind
cleansers, shadow callers, great healers, midwives, suckers, etc.
4. In traditional health systems, as in Western medical systems,
each disease has an etiology, an anamnesis and a set of symp-

Health of n-i. Im'Mlnoi > Peoius or the Americas: Concepts. Strategies, Practices and Chai.li.nces.

toms. There is also a physical instrumental examination of the
patient, a diagnosis and a differential diagnosis, a prognosis and
a therapy in both health systems. Furthermore, in traditional as
in Western medicine, there are preventive and health promotion
practices. The existence of adverse practices, for instance the use
of contaminated substances or "instruments" in open wounds,
medical mal praxis, side-effects of medicines, iathrogenic and
others, are aspects that require awareness in traditional and con­
ventional medical systems alike. Research on the effectiveness
of practices and codes of ethics applied in traditional and con­
ventional medical systems would be useful for users of both sys­
tems.

ZH

5. Community members attain the knowledge of traditional health
practices from an early age. For example, children know the
properties of the medicinal plants most commonly used in the
community, as they are usually the ones who have to search and
collect the plants to cure sick people in their household.

6. A survey carried out in the Snraguro community in Ecuador,
showed that in 140 households where illnesses occurred through­
out the year, women's advice was sought in 86% of cases and
that they were the only resource persons in 76% of these cases.
These women were mostly mothers and grandmothers.

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7. Multiculturalism is defined by social realities and consists of
the presence, within a society, of several cultures, indigenous
peoples, and ethnic communities, as groups with distinct cul­
tural codes, who have different customs and habits to start with.
(Cunningham, 1999).

Hf.'j.ru a nn IswglsW': ltow.Es or rm Amlkh 's: Comims. Strategies, I’m this wo Ciiaili.m.fs.

REFERENCES

1.

United Nations Permanent Forum on Indigenous Issues. Second Decade
of the World's Indigenous Peoples. Resolution 59/174, New York, 2005.

2.

Hall G, Patrinos AH. Indigenous Peoples, Poverty and Human Develop­
ment in Latin America: 1994-2004. Washington, DC: World Bank, 2005.

3.

Montenegro R, Stephens C. Indigenous health in Latin America and the
Caribbean [Indigenous Health 2]. Lancet 2006; 367:1859-69.

4.

United Nations High Commissioner for Human Rights, United Nations
Staff College Project, A Basic Handbook for UN Staff", New York 2004.

5.

Pan American Health Organization. Strengthening and Development of
Traditional Health Systems: Organization and Delivery of Health Servic­
es in Multicultural Populations. Washington, DC: Pan American Health
Organization; 1997.

6.

Pan American Health Organization. Harmonization of Indigenous and
Conventional Health System in the Americas. Strategies for Incorporating
Indigenous Perspectives, Medicines, and Therapies into Primary Health
Care Washington, DC: Pan American Health Organization; 2003.

7.

Pan American Health Organization. Evaluaci6n del Deceilio Interna­
tional de los Pueblos Indi'genas del Mundo: Salud de los pueblos
indi'genas de las Americas. Washington, DC: Pan American Health Or­

ganization; 2004.

8. Pan American Health Organization. Abya-Yala Kuyarinakui: Promo­

tion de la salud sexual y prevention del VIH/sida y de las ITS en
los pueblos indi'genas de las Americas. Pan American Health Organi­
zation. Washington, DC: 2005.
9. Pan American Health Organization. 47th Session of the Directing Coun­
cil. Health of the Indigenous Peoples of the Americas. Washington DC:
OPS; 2006 (Official Document CE138/13; CD47.R18).

10.International Labour Organization. Convention (N°169) concerning In­
digenous and Tribal Peoples in Independent Countries. ILOLEX: http://
www.ilo.org/ilolex/english/

ll.Tauli-Corpuz V. Indigenous peoples and the Millennium Development
Goals. Paper submitted to the 4th Session of the UN Permanent Forum on
Indigenous Issues, New York, 16-27 May 2005, Item 3 of the provisional
agenda. Economic and Social Council, Dist.:GENERAL. New York: 2005.

$

Health of the Indigenous Peoples of the Americas Initiative
PAHO/WHO Ecuador
Av. Amazonas 2889 y Mariana de Jesus
P.O. Box 17-07-8982, Quito Ecuador
Tel: (593-2) 2460330 / 2460332 Ext.1811
Fax: (593-2) 2460-325 rorojas@ecu.ops-oms.org

www.paho.org/indigenous
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Health
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