Indigenous health in Latin America and the Caribbean

Summary

This review is the second in a series on Indigenous health, covering different regions and issues. We look briefly at the current state of Indigenous health in Latin America and the Caribbean, a region with over 400 different indigenous groups and a total population of 45 to 48 million people. We describe the complex history and current reality of Indigenous peoples' situation within the American continent. We discuss the importance of Indigenous health systems and medicines, and look at changing political environments in the region. The paper concludes with a discussion of the changing political and legislative environment in Latin American countries.

Introduction

Latin America and the Caribbean have vibrant and politically active Indigenous populations. Over 400 different Indigenous groups are estimated to live within the region—roughly 10% of the total population.1, 2 Recent data suggest that Indigenous peoples remain some of the most marginalised in every country in the region.³ We describe the complex history of Indigenous peoples' situation within the American continent and the severe effects of European invasion, which still continue today. However, we cannot cover all 43 Latin American and Caribbean countries and dependencies of the continent. As with the other papers in this series, information was drawn from a range of sources, including peer-reviewed papers, and government and non-governmental sources. We draw on classic anthropological studies and on grey literature from international agencies and Indigenous organisations.

We noted some publication bias of data for this region. Some countries are well represented in the published work (such as Brazil) despite their small Indigenous populations. However, data are scarce for particular groups and particular countries. Although our review includes Caribbean countries, we can present few data for their situation. The political nature of indigeneity also determines availability of data—in many countries indigeneity is a complex sociopolitical form of identity, which might or might not be recognised. Even if indigeneity is measured, data are not always disaggregated by ethnicity.

Indigeneity is a complex notion with varying definitions. The UN Permanent Forum on Indigenous Issues does not have a universal definition of indigeneity. However, for the purposes of obtaining important data for Indigenous peoples and their wellbeing, a definition does exist, built on a study by Martinez-Cobo.⁴ Indigenous peoples are the original inhabitants of an area, the descendants of the original inhabitants who are colonised, and those who live in an Indigenous way and are accepted by the Indigenous community. Indigenous people could also be those who are successful in maintaining ancestral behaviours over specific territories with or without traditional lands. Indigeneity in Latin America and the Caribbean is, as in many parts of the world, most clearly defined as those who predated European conquistadores. Despite the huge diversity of peoples and cultures, there also seems to be some societal commonalities in Indigenous communities in the region: these are cultural (shared knowledge, identity, and wellbeing strategies), political (self-determination, internal hierarchies, territorialism), spiritual (ideology, belief system, religion), and ecological (use of natural resources, ecological cycles, carrying capacity of ecosystems). Few of these criteria are used practically to define indigeneity—a reality that has great implications for measurement of health and wellbeing in the region.

Indigenous languages in Latin America and the Caribbean are an important means of self-identification and group-identification, and belong to 34 language families and two special language groups.¹ This diversity equates to roughly 400 different Indigenous languages throughout Latin America, and as a World Bank report suggests, “every country has from 7 to 200 languages. Uruguay is the only country in the continent that is Spanish-monolingual.”⁵ Language is fundamentally important to Indigenous health, both in terms of its use as a predictor of all things Indigenous and as a medium for transmission of knowledge within cultures and health systems.

Demographic estimates of Indigenous populations within the region vary, and depend fundamentally on the way in which indigeneity is defined and measured.⁶ Language has been the most common means of defining indigeneity in most census counts.⁶ More sophisticated measures of indigeneity have also been included, most incorporating more subtle indicators of self-definition, such as ethnic self-identification, evidence of an Indigenous language spoken, and even, as in Guatemala, the use of cultural clothing (in this case Mayan). These variations in measurement have a great effect on estimates of population size.⁷ Mexico has used language to define Indigenous populations in many of its census counts. Schmal⁸ reports that in 1895, 27% of people aged 5 years or older in the Mexican Republic spoke Indigenous languages. By 2001, this figure had dropped to 7·1%. By this measure, Indigenous populations would disappear when their language does, and in fact population estimates in 1990 matched estimates of Indigenous language speakers.⁶ In 2000, Mexico used three criteria: language, living in an Indigenous household, and “Persons who consider themselves Indian but do not speak an Indigenous language”.⁶

The proportion and distribution of Indigenous peoples vary widely in every country in the region and across the continent (table 1, figure 1). Although only 14% of Mexico's population is Indigenous, the country still has the largest number of Indigenous people—more than 13 million. 89% of Indigenous peoples in Latin America and the Caribbean live in only five countries: Bolivia, Guatemala, Peru, Ecuador, and Mexico, all of which have between 5 and 13 million Indigenous citizens.

Different definitions of indigeneity in different countries determine the estimates of Indigenous populations (table 1), although to what extent is not known. Self-definition as Indigenous can have social and cultural ramifications. At various times in Mexico, some people did not want to report their languages or self-identify as Indigenous.⁸ A recent Brazilian study analysed different estimates of Indigenous populations living in the Amazon, which varied by up to 21 000 between data from the census, the national Indigenous organisation of the government (FUNAI), and a national non-governmental source.¹⁹ The investigators suspected that one discrepancy was due to the self-identification as Indigenous of urban peoples, who feature in the census but not in other databases.²⁰ To understand current distributions of Indigenous peoples in the region, we need to understand the demographic history.