Multicultural approach to health needed for well-being of indigenous people

Respect for cultural diversity and a deep understanding of the needs of different communities are key to achieving health equity among indigenous peoples, says the Pan American Health Organization (PAHO).

August 9 marks the celebration of the International Day of the World's Indigenous People. It is a day to look at ways to improve the lot for the indigenous so they can enjoy greater well-being.

The indigenous population of the Americas represents 6.7 percent of the total population. PAHO's publication Health in the Americas estimates the indigenous population between 45 million and 50 million. This diverse population speaks 745 different languages. Some 90 percent of them are in Central America and the Andean region. In the United States, the indigenous population is 1.6 million people, and in Canada less than half a million.

The countries with greatest indigenous population are Bolivia, Guatemala, Peru, and Ecuador, with proportions that go from 40 percent to 70 percent.

The biggest challenge, according to PAHO documents, is addressing the historical health problems within a cultural perspective. Some indicators collected for the evaluation of the International Decade of the World's Indigenous People, which culminates in 2005, reflect this reality:

• The indigenous population in general is scattered, sometimes mobile, and tends to live in rural areas or borders. Several indigenous peoples are multinational, such as the Miskito of Nicaragua and Honduras or the Quechuas of Colombia, Ecuador, Peru, Bolivia, and Argentina.
• The majority of health professionals are not prepared to deal with the cultural diversity.
• In the rural areas of Ecuador, where the indigenous population live, 76 percent of the children are poor.
• In El Salvador, unemployment among the indigenous population is 24 percent Some 91 percent of the families consume river water.
• In Mexico, the mortality among the indigenous children in 1997 was 59 per 1,000 live births, twice as high as the national rate.
• In Honduras, the maternal mortality rate at the national level is 147 per 100,000 live births. However, in Columbus, Copán, Intibucá, Lempira and La Paz, where most of the indigenous population live, it ranges between 190 and 255 per 100,000.
• In Guatemala, the rate of chronic malnutrition among the indigenous population is 67.8 percent while it stands at 36.7 percent among the non-indigenous.
• In the United States, indigenous populations have higher rates of alcoholism, obesity, and diabetes.

In order to overcome these inequities successfully, PAHO's "Health Initiative for Indigenous People" proposes to address these problems taking into account five principles:

• A holistic approach.
• The right to self-determination of indigenous peoples.
• The right to systematic participation of these peoples.
• Respect for and revitalization of indigenous cultures.
• Reciprocity in the relationship.

The Aymara indigenous leader Marta González de Paco, from El Alto, Bolivia, summarized these needs during a meeting on maternal mortality carried out at PAHO headquarters last February. She said: "Indigenous women have had to learn Spanish to be understood. But when we arrive at a hospital, not a single health professional knows at least to ask 'how do you feel' in Aymara. We need care with a human quality."

For more information, go to: www.paho.org/English/AD/THS/OS/Indig-home.htm.

PAHO was established in 1902 and works with all the countries of the Americas to improve the health and the quality of life of people of the Americas. It also serves as the Regional Office for the Americas of the World Health Organization (WHO). PAHO Member States today include all 35 countries in the Americas. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States. Portugal and Spain are Observer States, and Puerto Rico is an Associate Member.