Traditional Medicine in the Americas

The Region of the Americas is characterized by being multi-ethnic and multicultural. Indigenous peoples (who receive different denominations or conceptualizations according to the countries), Afro-descendants, Romani and members of other ethnic groups coexist in the Region of the Americas. Such diversity implies the recognition of different realities and needs among the countries of the Region, as within them.

In recent decades, important commitments and political initiatives have been developed for the recognition and respect of Human Rights and the Rights of ethnic communities and their members at global, regional and local levels. This has allowed more recognition, participation, visibility and integration of communities; a historically pending task by the states.

In Latin America, and the Caribbean, indigenous peoples population is approximately of 50 million people and reach around 8-10% of the population. While the Afro-descendant population is estimated at around 120 million people.

In the Region of the Americas, there are more than 700 indigenous peoples. Each group with a particular worldview and cosmogony that shape unique universes and therefore ways of being and living in the world in a particular territory. The indigenous peoples of the region speak more than 500 different languages, almost a quarter of which are cross-border languages, being used in two or more countries.

Indigenous people inhabit geographic areas of great diversity such as Patagonia, Chaco Ampliado, Amazonia, Orinoquia, Andes Mountains, Pacific Coastal Plain, Continental Caribbean, Lower Central America, Mesoamerica, and North America, including the Arctic Region. 87% of the indigenous people of Latin America live in Mexico, Bolivia, Guatemala, Peru and Colombia. Brazil is the country with the highest diversity of indigenous peoples with 241 indigenous people who speak 188 different languages. (See List of Indigenous Peoples of the Americas)

This wide diversity is still an underestimated richness. The identity of both ethnic and non-ethnic communities and the quest to understand their past, live their present and to project their future represent challenges and opportunities for governments and citizens in general.

See:

• (CSP29/7 PAHO/WHO 2017) Ethnicity and health policy
• (UNICEF) Sociolinguistic Atlas of Indigenous Peoples in Latin America (Volume 1, Volume 2).
• (WORLD BANK) Indigenous Latin America in the 21st Century
• (CEPAL) Indigenous Peoples in Latin America.
• (CEPAL) Afro-descendants in Latin America and the Caribbean: from statistical recognition to the realization of rights.

Health understood as a process: health – disease­ ­- medical attention – care, is totally interdependent of social, cultural, economic, political, religious and environmental processes. Indigenous and ethnic communities are not alien to these processes and have created their own medical and therapeutic systems that respond to their history, context, region and way of seeing themselves in the world.

On the other hand, health as a Human Right assists all people regardless of their ethnicity, gender, religion, class or race. This implies the opportunity to receive medical attention in all areas of individual and collective life. This has been a challenge for the states, which results, for example, into inaccurate data on the health situation of indigenous peoples, African descents and other ethnic groups.

Although specific detailed health information is not available, it is known that the social and economic conditions of a large part of the ethnic communities of the region are precarious. Many of these populations suffer the consequences of significant health gaps. The available data regarding some indigenous and Afro-descendant populations account for existing inequities compared to the general population.

The health and development indicators of indigenous peoples are precarious and this responds to historical structural problems. For example, in the past decade, the PAHO warned that in the Region of the Americas 400,000 children under the age of five died each year from preventable diseases and that the results were poor in terms of health, especially when they related ethnic groups. To date, maternal and infant mortality is significantly higher in indigenous and Afro-American populations than in other ethnic groups. Similarly, child malnutrition rates are higher in the indigenous population than in the general population. The rates of violence against women and suicide tend to be higher in the indigenous population.

In some countries of the region, indigenous peoples are the majority, such as the Mayas, Quechua or Kichwa, Guarani, Achi or Aymara, who due to economic, social and cultural social factors have precarious life and health conditions. In these cases, the relationship between the variable of poverty and ethnicity is always in direct proportion. Therefore, indigenous populations, in general, have more adverse conditions than other population groups. Health indicators ranging from maternal mortality to hospital deliveries and vaccination coverage have less performance in indigenous populations than in non-indigenous ones.

Some figures according to the Ethnicity and Health Policy:

• Although indigenous peoples constitute between 8-10% of the population, they currently represent 17% of the population living in extreme poverty in Latin America.
• The fertility rate of indigenous and Afro-descendant women is approximately 10% higher than the rate of the general population, and yet they receive less quality care during pregnancy, delivery and post-partum.
• In Guatemala, 58% of indigenous children suffer from chronic malnutrition and 23% suffer from severe malnutrition. While in the case of children who are not indigenous, 34% suffer chronic malnutrition and 10% suffer severe malnutrition.
• In Panama and Peru, infant mortality is three times higher in indigenous populations than in non-indigenous.
• In Chile, the mortality of the young indigenous population is almost four times higher than in the general population.
• It is estimated that 62.6% of indigenous children in the Region suffer some degree of deprivation of drinking water, compared to 36.5% of children who are not indigenous.
• In some countries, the fertility rate of Afro-descendant adolescents is 40% above other populations; in indigenous adolescents, this rate can be twice as high compared to the fertility rate in the non-indigenous population.

The coverage of health care, already low in rural areas, reaches the most critical levels in the settlement areas of indigenous peoples. The collective knowledge, local practices, therapists of indigenous medicine and community resources are very necessary, together with the resources of biomedicine, to address the health problems of indigenous communities, African-Americans and the diverse ethnic groups that are affected by health problems.

Taking into account health in the indigenous populations of the Americas involves important challenges (benefits). It can provide concrete answers to health problems and the determinants that act over them, It also recognizes the existence of traditional medical systems that have benefited the whole humanity, and that form a fundamental part of the integral responses to health and the common good.

For several decades and fundamentally framed in the recognition of rights through the ILO Convention 169 the nations are making progress in intercultural health processes, whose developments are of different magnitude, as they respond to national realities, in terms of systems of health, a breakthrough in rights, etc. This implies that each country has developments, integration of health systems and data about their ethnic communities.

At the end of the 1970s, the PAHO proposed understanding traditional medicine as: “the set of all theoretical and practical knowledge, explainable or not, used for diagnosis, prevention and suppression of physical, mental or social disorders, based exclusively on the experience and observation, and transmitted verbally or written from one generation to another. It can also be considered as a firm amalgam of active medical practice and ancestral experience “(IIDH, PAHO, 2006). In this sense, traditional medicine is recognized as a system that has a complex of knowledges, traditions, practices and beliefs that is structured through its own agents: shamans, mamos, traditional doctors, pulseers, midwives, bonesetters, promoters, etc., which has its own methods of diagnosis, treatment, care, and prevention, and whose therapeutic resources include “medicinal” plants, animals, minerals, rituals, diets, among others, which are recognized by a population that requests them and practice them.

This broad concept covers a wide diversity of medical traditions, which through time and cultural encounters have syncretized, or not, diverse elements. But which remains anchored to the ancestral history pillar of the communities and which allows denominating this knowledge and practice as indigenous traditional medicine.

In this section, we will soon be developing a summary of the different medical traditions of the indigenous peoples, Afro-descendants and other ethnic diversities of the American continent.

The knowledge associated with traditional medicine has been developed for millennia and is a fundamental aspect of the culture of each people and especially of the indigenous peoples, African-Americans and the different ethnic diversity of the continent. This knowledge has a wide range of manifestations and practical uses which results, for example, in the knowledge of medicinal plants. It also includes the understanding of the relationship between health and disease, life and death, or in a general way, the vision of the world that has a close relationship with health, therapeutic, ritual and symbolic procedures as holistic systems for the recovery of health.

This knowledge has often been threatened by changes in the cultural base of the peoples or by different ethnic groups and by the misappropriation of such knowledge, mainly related to phytotherapy.

In this section, you will find soon a review of the different international and national strategies, agreements, and protocols designed for the protection of traditional knowledge, and traditional medicines of the various ethnic groups of the region of the Americas

4.1 International instruments related to the protection of traditional medicine and collective rights

Globally, international agreements have been created to pursue the protection of collective rights, traditional medicine, and knowledge of indigenous peoples, Afro- descendants and other ethnic groups.

• Convention on Indigenous and Tribal Peoples, number 169 (International Labor Organization)
• United Nations Declaration on the Rights of Indigenous Peoples
• Convention on Biological Diversity (CBD)
• Nagoya Protocol
• American Declaration on the Rights of Indigenous Peoples – Organization of American States.
• Executive Decree of the National Regulation of the Common Regime on Access to Genetic Resources in Application of Decision 391 of the Andean Community of Nations.

World and regional consensus relevant to the health context of indigenous peoples, people of African descent, Romani and members of other ethnic groups (Source: Ethnicity and Health Policy, PAHO, Non-exhaustive list)

• World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance (2001)
• Rio Declaration on the Social Determinants of Health (World Health Organization, 2011)
• World Summit of Afro-descendants (2011)
• International Decade for People of African Descent 2015-2024 (2013)
• World Conference on Indigenous Peoples (2014)
• 2030 Agenda for Sustainable Development (2015)
• Plan of Action for the Decade of Afro-Descendants in the Americas (2016)

4.2 Public policy linked to Traditional Medicine in the Americas

In this section, you will soon find a summary of public policies on Traditional Medicine in the countries of the Americas. For now, we invite you to visit the Regulations and Policies in TCIM.

Many of the knowledge of biomedicine (medicines, vaccines and bioresources) are based on natural resources that at the same time are intimately connected with traditional knowledge and traditional medicine. This knowledge, in turn, has social, cultural and scientific value and is important for many indigenous peoples and local communities, as well as for genetic resources and for scientific knowledge. Historically, traditional knowledge has been the basis for the development of scientific thought and knowledge.

To cite some examples, medications such as aspirin, morphine, quinine, artemisinin, digoxin, vincristine, taxol, ergotamine, pilocarpine, ephedrine, atropine, certain corticosteroids, are medicines derived from medicinal plants, and several of them have been used since ancient times for treat various situations of health and disease as part of the knowledge of traditional medicine. Approximately 50% of drugs currently used are derived from medicinal plants.

More than 80% of the world population has made use of some form of traditional knowledge in health, as a form of self-care in health. In some countries, 70% of the population uses traditional medicines as a primary health care strategy.

In this section, you will find detailed information about the contributions made and continue to make traditional practices and traditional medicines to other medical systems.

In this section, you can access the different strategies, policies and spaces created by PAHO / WHO for the protection of indigenous peoples and diverse ethnic groups, the maintenance of their health, and the promotion of traditional medicines.

6.1 WHO Strategy on Traditional Medicine 2014-2023: Strategy published in 2013, updating the WHO Strategy on Traditional Medicine 2002-2005, with the objective of “helping Member States to develop dynamic policies and implement action plans that reinforce the role of the [MTCI] in maintaining people’s health, “taking advantage of” the potential contribution of [MTCI] to health, well-being and people-centered health care “, promoting” the use safe and effective [MTCI] through regulation and research, as well as through the incorporation of products, professionals and practices in health systems, as appropriate. ”

6.2 Policy on Ethnicity and Health: Approved by the Ministries of Health in 2017, promotes an intercultural approach that contributes, among other things, to eliminate barriers to access to services, and to improve the health outcomes of different ethnic groups. This Policy highlights five strategic lines for technical cooperation in addressing the health of different ethnic groups. Among them, the recognition of ancestral knowledge and traditional and complementary medicine. With this, it seeks to enhance the dialogue of knowledge that facilitates the development and strengthening of intercultural health models as a way to achieve care focused on the needs of individuals and communities.

6.3 Universal Health Strategy: Access and Coverage for All: The universal health strategy promotes universal access to health and universal health coverage, which “implies that all people and communities have access, without any discrimination, to health services that are integral, appropriate, opportune, quality, determined at national level, fitting the needs; as well as access to medicines that are good quality, safe, effective and affordable. All these, while, ensuring that the use of these services does not expose users to financial difficulties, particularly vulnerable groups. “(CD53/5, Rev. 2 and CD53/R14 PAHO / WHO, 2014).

6.4 Agenda for Sustainable Health for the Americas 2018-2030 (CSP29/6): represents the response of the health sector to the commitments assumed by the Member States of PAHO in the 2030 Agenda for Sustainable Development, together with the unfinished issues of the Millennium Development Goals (MDGs) and the Health Agenda for the Americas 2008-2017, as well as emerging regional public health challenges. The Agenda is operationalized through the strategic plans and strategies of PAHO, as well as through subregional and national health plans.

6.5 “Advanced Regional Meeting towards Universal Health, contributions of traditional and complementary medicine”: In June 2017, Nicaragua hosted the Regional Meeting “Advancing towards Universal Health, Contributions of Traditional and Complementary Medicine”. In this meeting, the experiences of 21 countries of the Region of the Americas, related to the implementation of traditional and complementary medicine in health systems, academic and research spaces, were exchanged.

In this section, you will find links to different academic institutions, research groups, collaboration networks, associations and international organizations, which include in their agenda and objectives intercultural health and traditional medicines.

7.1 Groups, Research Centers, and Observatories in Traditional Indigenous, African American, and Ethnic Diversity Medicines

• Master in Intercultural Health (University of the Autonomous Regions of the Nicaraguan Caribbean Coast -URACCAN): http://www.uraccan.edu.ni/tesis-campusvirtual.
• Observatory of Multiethnic Regional Autonomy (Nicaragua): http://observatorio.uraccan.edu.ni/contenido/medicina-tradicional.
• University Program of Studies on Cultural Diversity and Interculturality: http://www.nacionmulticultural.unam.mx/.
• A vision of intercultural health for the indigenous peoples of the Americas http://apps.who.int/iris/handle/10665/166086.

7.2 Research networks in Traditional Medicine of the Indigenous, Afro-descendant and Ethnic Diversity peoples

• National Native Health Research Training (NNHRT) http://nnhrti.org/about.html.
• National Indigenous Research and Knowledges Network http://www.nirakn.edu.au/.
• National Native Health Research Training Conference https://www.nativeresearchnetwork.org/.
• Center for World Indigenous Studies https://cwis.org/center-for-traditional-medicine/people/.

7.3 Repositories related to Traditional Medicine

• VHL of Indigenous Peoples: http://pueblosindigenas.bvsp.org.bo.
• Digital Library Traditional Mexican Medicine (UNAM): http://www.medicinatradicionalmexicana.unam.mx/index.php.
• Tebtebba Virtual Repository (Indigenous Peoples’ International Center for Policy Research and Education) http://www.tebtebba.org/index.php/resource-center.

7.4 Alliances, Networks, Associations of Indigenous Peoples

• Alliance of Indigenous Women of Central America and Mexico (AMICAM): http://alianzademujeresindigenas.org.mx.
• Andean Coordinator of Indigenous Organizations (CAOI): http://www.coordinadoracaoi.org.
• Indigenous Council of Central America (CICA): http://consejocica.org/.
• Mesoamerican Indigenous Council (CIMA).
• Coordinator of the Indigenous Organizations of the Amazon Basin (COICA): www.coica.org.ec.
• Continental Liaison for Indigenous Women of the Americas (ECMIA): www.ecmia.org.
• Network of Indigenous Women on Biodiversity in Latin America (RMIB-LA): http://reddemujeresindgenas.blogspot.com/.

7.5. International organizations

• Permanent Forum of the United Nations for Indigenous Issues https://www.un.org/development/desa/indigenous-peoples-es/sesiones-del-foro-permanente.html.
• Fund for the Development of the Indigenous Peoples of Latin America and the Caribbean: http://www.filac.org.
• Andean Health Organization (ORAS-CONHU): http://www.orasconhu.org/home.
• Publications of the Gender and Cultural Diversity Unit (PAHO): http://www.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=3340&Itemid=3582&lang=en.
• Expert Mechanism on the Rights of Indigenous Peoples UN http://www.ohchr.org/SP/Issues/IPeoples/EMRIP/Pages/EMRIPIndex.aspx.
• Indigenous Program Spanish Cooperation Agency http://www.aecid.es/ES/d%C3%B3nde-cooperamos/alc/programas-horizontales/programa-indigena.
• Organization of the Amazon Cooperation Treaty (ACTO): http://www.otca-oficial.info/.
• South American Institute of Government in Health (ISAGS / UNASUR): http://www.isags-unasur.org.