Traditional medicines and their articulation with health systems and services

Since the Declaration of Alma Ata https://www.paho.org/hq/dmdocuments/2012/Alma-Ata-1978Declaracion.pdf (1978), the adoption 1989 of ILO Convention 169 concerning Indigenous and Tribal Peoples in Independent Countries https://www.ohchr.org/SP/ProfessionalInterest/Pages/Indigenous.aspx and the International Covenant on Economic, Social and Cultural Rights– ICESCR (OHCHR) in 1996, which recognise the health of indigenous and Afro-descendant peoples as a fundamental human right that is closely linked to other human rights and for which governments are responsible, international organisations have adopted resolutions, approved strategies and adopted work programmes, adopted strategies and work agendas, urging and recommending that the countries of the Region of the Americas adopt public policies that recognise their ethnic, cultural and health diversity, take into account the specific characteristics of their populations, and incorporate the intercultural approach in their health policies, plans and programmes as part of the primary health care strategy (1), (2), (3), (4), (5). 

In 2007, as part of the revision of the values and principles that inspired the Declaration of Alma Ata on PHC, PAHO prepared a position paper entitled “The Renewal of Primary Health Care in the Americas” The Renewal of Primary Health Care in the Americas (paho.org), whose objective, according to PAHO Director Mirta Roses, then Director of PAHO, is “…to serve as a reference for all countries seeking to strengthen their health systems and bring health care closer to the people in urban and rural areas, regardless of gender, age, ethnic group, social status or religion”. Primary Health Care (PHC) has therefore been adopted by indigenous peoples, Afro-descendants, Roma and other ethnic groups in the countries of the Region as a strategy for the development of their traditional medicines.

In this context, the States of the Region of the Americas have the obligation to respect, protect and fulfil human rights, including the right to health, which, being universal and encompassing all aspects of life, include not only the civil, political, social, economic, and cultural rights of individuals, but also the collective rights of peoples, such as self-determination, equality, development, and peace, among others, and must be applied without discrimination to all persons, regardless of their ethnicity,  origin, religion, language, nationality, age, sexual orientation, disability or any other characteristic. 

This application should take the form of positive action targeted at groups or persons who are traditionally discriminated against (because of their ethnicity, political orientation, etc.) or who are in a situation of vulnerability (due to physical, economic or social conditions), through the adoption of regulations, the application of public policies or legal action. 

For WHO, the State’s responsibility is not limited to solving health problems, but also to preventing different types of risks (natural, economic, violent, etc.) that may affect the health and well-being of individuals and communities. 

Addressing the health of Indigenous, Afro-descendant, Roma and other ethnic populations poses important challenges, not only in terms of providing concrete responses to health problems and the determinants that affect them, but also in terms of recognising the existence of traditional medical systems that respond to their history, context, region and worldview, and that are an essential part of comprehensive responses for the health and common good of humanity.

Thus, in recent decades, the countries of the Americas have begun to make visible in their constitutions and local jurisprudence not only the existence and survival of traditional medicines, but also their recognition as traditional medical systems, together with their knowledge, know-how, practices and practitioners, and their promotion as an alternative and complementary option to modern medicine; Similarly, they have promoted intercultural health processes, which are developing at different rates in response to national social, political and economic realities, in terms of the articulation of traditional medicines with health systems, their implementation in health services and the provision of culturally relevant health services.

In this way, the right to health is defended from an integral and intercultural perspective that articulates not only institutional medical services for the treatment of diseases, but also action on the various environmental, socio-economic and cultural factors that influence health. 

References

1. United Nations. Substantive issues arising in the implementation of the International Covenant on Economic, Social and Cultural Rights. General Comment No. 14 The right to the highest attainable standard of health (article 12 of the International Covenant on Economic, Social and Cultural Rights). [Internet], 2000. Committee on Economic, Social and Cultural Rights. E/C.12/2000/4. Available at: https://undocs.org/es/E/C.12/2000/4
2. Pan American Health Organization PAHO/WHO. Policy on Ethnicity and Health. [Internet]. 2017. CSP29/7. Rev. 1. Available at: https://www.paho.org/es/documentos/politica-sobre-etnicidad-salud 
3. Andean Health Organization, Hipólito Unanue ORAS-CONHU Agreement. Andean Intercultural Health Policy. [Internet]. 2019. 2nd ed. Available at: https://orasconhu.org/sites/default/files/files/003_Politica_SI_490.pdf)
4. Pan American Health Organization PAHO. Resolution CD47.R18 on the Health of the Indigenous Peoples of the Americas [Internet]. 2006. Available at: https://www3.paho.org/spanish/GOV/CD/cd47.r18-s.pdf
5. Pan American Health Organization PAHO. PAHO/WHO Resolution CD53.R14. Strategy for universal access to health and universal health coverage [Internet]. 2014. Available at: https://www.paho.org/hq/dmdocuments/2014/CD53-R14-s.pdf
6. World Health Organization WHO. Resolution A/RES/70/1. 2030 Agenda for Sustainable Development. [Internet]. 2015. Available at: http://www.un.org/sustainabledevelopment/es/2015/09/la-asamblea-general-adopta-la-agenda-2030-para-el-desarrollo-sostenible/,