Socio-cultural epidemiological profiles

In the process of formulating public health policies with an intercultural approach, the countries of the Region of the Americas have demonstrated the need for information on the health situation of the ethnic groups living there, which has led to the development of differentiated epidemiological studies that take into account the history, values, customs, knowledge, and different ways of understanding health and disease of these populations.

These studies are a theoretical-methodological research strategy in which there should be a dialogue between different explanatory models. It is participatory research that analyzes the occurrence of disease in diverse populations, incorporating their own categories and etiologies of disease from the local culture (1) -whether recognized by biomedicine or Western medicine-.

“The health diagnosis and the construction of epidemiological profiles differentiated by ethnicity are the first step towards understanding the determinants of the health status of indigenous, Afro-descendant and mestizo populations and, on this basis, towards making appropriate decisions that guarantee equitable, efficient and adequate access to health care that is appropriate to the particular cultural realities of the native peoples” (2). In addition, the results of these studies contribute to the targeting of interventions and the reduction of equity gaps that disproportionately affect these populations, as well as to relevant and accurate decision-making, and to the design of preventive strategies and public health policies with an intercultural approach.

The main difficulty in developing these socio-cultural epidemiological profiles (intercultural, sociodemographic or with cultural relevance, depending on the country) has been the methodological design to build profiles with reliable data, given that the variable of ethnicity is not included in information systems, censuses, household surveys, vital statistics and/or health records, among others. Moreover, the tools currently used for data collection, the methods of analysis and their interpretation do not take into account the health status of these populations, “…on the contrary, there is a kind of invisibility or a tendency to ignore them or to make them visible only when it is a question of presenting the worst data, in a kind of blaming them for the poor indicators of the country“(3).

Many efforts show progress in basic epidemiologic research, showing gaps in relation to the general population. There has also been some progress in studies using a cross-cultural approach.

“It is called intercultural epidemiology as a component of an intercultural health model, it is a theoretical-methodological research strategy articulated from the analysis of cultural meanings between health teams and indigenous, mestizo, peasant and Roma communities, around health and illness, life and death, healing and care. It is an approach that is specific to each situation and each community, and is the result of an interdisciplinary and intercultural dialogue between medicine, anthropology and the knowledge of people from different health cultures. It is also a dialogue in which the limits of each discipline, theoretical-practical approach or worldview are established” (4).

Studies carried out by PAHO/WHO (5), ORAS CONHU (1) and ECLAC (6), among other international organizations, as well as by some of the region’s Ministries of Health (7) and social organizations (8), have shown a change in the epidemiological profile of ethnic groups, characterized by a high prevalence and incidence of communicable diseases such as Tuberculosis, Malaria, Chagas Disease, Mycoses, Diabetes, Acute Diarrheic Syndrome and Acute Respiratory Infections, as well as deficiency diseases such as malnutrition and anemia, due to their conditions of poverty, lack of opportunities and low income, low levels of education and little access to basic services, such as environmental sanitation.

Links will be made to country experiences in building epidemiological profiles in a participatory manner with ethnic populations.

References:

1. Ministry of Health of Chile. Elementos para un diagnóstico epidemiológico con enfoque sociocultural. Basic guide for health teams. Serie Análisis de la Situación de Salud de los Pueblos Indígenas de Chile. [Internet]. 2006. N. 002. Available in: Elementos de Diagnóstico Epidemiológico Con Enfoque Socicultural – Guía Básica para Equipos de Salu | PDF | Población | Epidemiología (scribd.com).
2. University of Cauca. Estado actual de las condiciones de salud y bienestar y las necesidades de los grupos étnicos en situación de desplazamiento y ubicados en zona de frontera. Unpublished report. 2007.
3. Andean Health Organization ORAS-CONHU (2010). Conceptual guide and methodology for the construction of the Andean Health Situation Analysis. Andean ASIS, with intercultural approach. [Internet]. 2010. Available at: CONCEPTUAL AND METHODOLOGICAL GUIDE FOR THE CONSTRUCTION OF THE ANDEAN HEALTH SITUATION ANALYSIS, ASIS ANDINO, WITH INTERCULTURAL APPROACH (orasconhu.org).
4. Oyarce, A. M. Ibacache J and Neira J. Intercultural Epidemiology. Unpublished. 1996
5. Pan American Health Organization PAHO/WHO. Policy on Ethnicity and Health. [Internet]. 2017. CSP29/7, Rev. 1. Available from: Policy on ethnicity and health (29th Pan American Sanitary Conference) – PAHO/WHO | Pan American Health Organization (paho.org).
6. Del Popolo, Fabiana. Indigenous and Afro-descendant Peoples in Data Sources: Experiences in Latin America. Population Division of the Economic Commission for Latin America and the Caribbean (ECLAC), Project Documents Collection. [Internet] 2008. Available in: Enfoque etnico-DelPopolo (cepal.org).
7. Del Popolo, Fabiana and Oyarce, Ana María (2005). Población indígena de América Latina: Perfil sociodemográfico en el marco de la CIPD y de las Metas del Milenio. Notas de Población Journal No. 79 (LC/G.2284-P/E), CELADE – Population Division of ECLAC. Available at: Notas de Población Vol.31 N° 79 | ECLAC.
8. Oyarce, Ana María. La identificación étnica en los registros de salud: experiencias y percepciones en el pueblo Mapuche de Chile y Argentina. Economic Commission for Latin America and the Caribbean (ECLAC). [Internet] 2008. Available in: Enfoque etnico-Oyarce (cepal.org).
9. Rangel, Marta. The Afrodescendant Population in Latin America and the Millennium Development Goals. An exploratory review in selected countries using census information. [Internet] 2005. Available at: Indigenous peoples and Afro-descendants in Latin America and the Caribbean: sociodemographic information for policies and programs (cepal.org).
10. Ministry of Social Protection and PAHO/WHO. Insumos para la conceptualización y discusión de una política de protección social en salud para los grupos étnicos de Colombia (Inputs for the conceptualization and discussion of a social protection policy in health for ethnic groups in Colombia). [Internet] 2004. Available at: GRUPOS ETHNICOS.pmd (ohchr.org).
11. Association of Promoters and Defenders of Indigenous Rights of Nicaragua. Ancestral knowledge to preserve well-being and harmony in indigenous communities. Diagnosis of traditional medicine, identity base of the indigenous peoples of the Pacific, Central and Northern Nicaragua. [Internet] 2011. APRODIN. 1st ed. Available in: Saberes ancestrales para preservar el bienestar y la armonía de las comunidades indigenas – OPS/OMS | Organización Panamericana de la Salud (paho.org).