Indigenous Peoples encounter numerous challenges in exercising their right to health. Lorna Rothery discussed the importance of collaborative and culturally sensitive approaches with Dr Sandra Del Pino, Advisor on Cultural Diversity at PAHO
What have been some significant milestones in improving the health of Indigenous Peoples in recent years?
The most important aspect to highlight when discussing advances in Indigenous Peoples’ health is the commitments from Member States. The Pan American Health Organization (PAHO) has been a leading agency in this area, conducting significant work since the 1990s; a pivotal moment occurred in 2017 when all Member States in the region unanimously approved the first policy on ethnicity and health. This policy demonstrated a strong commitment to addressing the health needs of these populations. It marked the first time Indigenous Peoples, people of African descent, and members of other ethnic groups collaborated directly with ministries of health to identify their main priorities. This process was not imposed by PAHO or the ministries; rather, it resulted from a complex consultation process. This achievement also opened vital opportunities for promoting technical cooperation to tackle specific health priorities, such as reducing maternal mortality, infant mortality, TB and other communicable diseases.
What challenges do Indigenous Peoples often face when realizing their right to health?
There are numerous challenges to address. Firstly, we must recognize that these populations have historically been excluded from processes related to their health and wellbeing. This lack of participation in initiatives and strategies that concern their health is probably the primary challenge. Top-down approaches within the health sector dictate to Indigenous communities how they should respond to particular health concerns or prioritize issues rather than working collaboratively with them. Many strategies fail to tackle the underlying causes of health issues. For instance, when we consider patterns related to tuberculosis or maternal mortality, we must ask ourselves why an Indigenous woman might be reluctant to visit a health facility.
Indigenous individuals often face discrimination. They are sometimes not allowed to drink herbal tea, which is customary in their communities or be judged based on the way they look or dress. There is a significant lack of acknowledgment for ancestral and traditional medicine and an understanding of how these practices impact their health and wellbeing. While Indigenous Peoples are acknowledged in many countries, recognizing their ethnic diversity has not been implemented consistently. This inconsistency affects the information available regarding the health status of these groups; recognition is crucial for developing effective strategies that support wellbeing.
There is frequently insufficient representation of Indigenous Peoples in the health sector, and many healthcare workers in the general community lack sensitivity and have not received training to address specific cultural needs. To build trust within communities, we should collaborate horizontally and create spaces for cooperation, ensuring that Indigenous Peoples play a key role from the beginning of any project. We need to adopt participatory approaches and facilitate knowledge dialogues to better understand these communities’ needs and experiences. Failing to do so risks implementing strategies that are not culturally appropriate or feasible.
Where are the biggest knowledge gaps in Indigenous health currently?
Data collection is the starting point for understanding the health issues Indigenous populations face. We often lack clarity on why these communities are getting sick or their primary health concerns. This represents a significant gap in our knowledge. We sometimes lack accurate data to guide us toward effective interventions or strategies to address these issues.
Additionally, there is a gap in understanding the causes impacting Indigenous health from their own perspective. While we might attribute health challenges to factors like lack of education or access to safe drinking water, it is essential to consider these causes through their lens and acknowledge their way of life.
The COVID-19 pandemic highlighted these critical situations within Indigenous communities. It served as a wake-up call, emphasizing the need for a deeper understanding of their experiences and concerns. For instance, we need to explore the reasons behind vaccine resistance in these communities, considering their unique viewpoints and historical contexts.
We recognize the importance of addressing the social determinants of health for these communities while valuing the significant role that culture plays in their health and wellbeing. Indigenous Peoples are often referred to as vulnerable groups; however, during our consultations towards the ethnicity and health policy, they have expressed a preference against this label. While they may be susceptible to certain diseases or challenges, this does not define their identity. This perspective is closely connected to the concepts of traditional and ancestral medicine and the complexities involved in protecting their knowledge and practices.
How do the Sustainable Development Goals relate to efforts to establish culturally sensitive healthcare initiatives that support People’s unique needs?
The Sustainable Development Goals (SDGs) are closely aligned with efforts to establish culturally sensitive healthcare initiatives that support people’s unique needs. This alignment is particularly evident in SDG 3, which aims to ensure healthy lives and promote wellbeing for all at all ages. Beyond SDG 3, culturally sensitive healthcare initiatives support other SDGs. For SDG 10: Reduced Inequalities: By addressing cultural differences in healthcare, these initiatives help reduce inequalities within and among countries. SDG 5: Gender Equality: Cultural competence in healthcare can address gender-specific health needs and cultural norms that affect women’s health.
First and foremost, addressing the health of Indigenous Peoples must be grounded in a human rights approach. This is essential. It involves recognizing the various mechanisms that address health and related human rights and acknowledging the broader spectrum of rights pertinent to Indigenous communities. We must respect and promote both individual and collective rights and understand their implications.
Another crucial aspect is ensuring that Indigenous Peoples are actively involved in developing any strategies or initiatives. They should be at the center from the very beginning, serving as the primary actors in matters related to their health and wellbeing rather than having external entities impose solutions on them.
It’s important to recognize that the challenges we face extend beyond linguistic barriers; we must also consider cultural differences. How can we ensure that the initiatives we promote or reinforce truly support diversity?
Additionally, within the framework of the Sustainable Development Goals (SDGs), it’s essential to recognize that each group is unique. We need to adapt our strategies and programs to suit their specific contexts. For example, Indigenous Peoples vary greatly; there is no one-size-fits-all solution to their challenges. This approach takes time. Our perception of time may differ significantly from that of Indigenous communities. Therefore, building trust within these communities based on mutual respect is crucial, as we have seen in various initiatives. It’s vital to keep in mind the many differences between Indigenous groups.
PAHO’s Diseases Elimination Initiative
PAHO launched the Elimination Initiative to eradicate over 30 communicable diseases and related conditions in the Americas by 2030. Building on more than 120 years of public health efforts, the initiative adopts an integrated, multisectoral approach that focuses on:
- Strengthening health systems and service delivery.
- Improving health surveillance and information.
- Addressing social and environmental determinants of health.
- Enhancing governance and financing.
While the COVID-19 pandemic temporarily slowed progress, challenges such as migration, rising non-communicable diseases, health inequities, climate change, and resource constraints remain. However, opportunities exist in technology advancements and increased awareness of health determinants. The Elimination Initiative offers a structured framework for countries to address these issues and prioritize their disease-elimination efforts.
