Intercultural health, a decolonial proposal09/04/2018 - Juan F. Bacigalupo
In recent decades a new theoretical approach has emerged in South America, academics in different countries have begun to talk about another paradigm, another knowledge: decoloniality, that is, thinking from the south, from our reality as former European colonies and recognizing the effects of that process. Therefore, A. Quijano, Peruvian philosopher, employs for the first time the term “coloniality of knowledge”, thus defining the social relations marked by the concept of race and that prevail until today in our countries. These authors state there is a difference between colonialism (a political and economic relationship of power in which one people is subordinated to another) and coloniality (the result of colonialism, that is, ways of thinking, living, working, authority and relationships that are articulated according to the colonial past and to the idea of race), as well as what they represent in our “south of the world” context.
This coloniality is present in contemporary society, which tries to recognize a homogeneous form of values and cultures, leaving no space for singularities of peoples who have knowledge and experiences that differs from the dominant way of life. Thus, we find different cultures in the world, such as indigenous peoples, Afro-descendants, romani and migrants, who have their own valid explanations of reality that need to be considered in the health field. Following this, the Argentine professor W. Mignolo points out that we must claim the Latin American particularities recognizing the importance of creativity, of contextualized socio-historical and geographical thought; promoting a cultural, political and social project that favor the overcoming with centuries of coloniality and Eurocentrism, what in health we would call “intercultural health”.
Hence, the decolonial proposal in the health area is to disclose the cultural differences that exist in the health care of peoples with knowledge and ways of life that do not fit into the Western standard. According to Professor C. Walsh, interculturality “refers to relationships, negotiations and cultural exchanges, seeking to develop an interaction between people, knowledge, practices, logics, rationalities and culturally different principles of life; an interaction that allows and starts in the social, economic, political and power asymmetries”.
Thus, interculturality is a counterhegemonic concept that emerges in the political discussions of Latin American social movements and that fights to transform problems, with a local and contextualized view. This intercultural nature has also been included in the political definitions of some States, even at the constitutional level, although essentially related to indigenous peoples. These mentions are clear indications of the importance of interculturality for health policies in the region.
In the words of the Pan American Health Organization (PAHO/WHO), the intercultural approach in health promotes coexistence, the relationship of respect and mutual acceptance between the culture of the conventional health system and diverse cultures through collaboration between human resources in health, the community, the family and social leaders. The intercultural approach makes possible that the medical institutional culture and the different autochthonous cultures coexist with respect and mutual acceptance, with close collaboration among social actors, health personnel, the family, the community and community leaders.
Therefore, the ethno-cultural wealth of South America represents both a challenge and an opportunity for the design and implementation of public health policies, especially in a region where, generally speaking, around 31% of the population identifies themselves as indigenous or Afro-descendant (5% and 26% respectively), a percentage should not be disregarded when establishing agreements and policies on ethnicity and health.
Beyond thinking about health for indigenous peoples, Afro-descendants, romani and many other cultural groups in our region, we should start looking for mechanisms that ensure culturally appropriate health care. Countries that declare themselves to be multicultural (Bolivia, Ecuador and Peru) have advanced along these lines, promoting intercultural health policies, including indigenous and Afro-descendent populations. On the other hand, almost all countries of the region propose indigenous health policies, which is a great advance if we think that the worst health indicators are found in these groups.
South America moves forward and begins to give voice to those who were silenced in the colonial process of knowledge production. Health is not left behind: the intercultural model is here to stay and advance in the construction of more egalitarian, just and plural societies.
ISAGS concluded in 2017 a mapping of Intercultural Health policies in South America, which reflects the situation in the region and presents proposals for joint development.