Academic journal article Health Sociology Review

Facilitating Indigenous Women's Community Participation in Healthcare: A Critical Review from the Social Capital Theory

Academic journal article Health Sociology Review

Facilitating Indigenous Women's Community Participation in Healthcare: A Critical Review from the Social Capital Theory

Article excerpt

Historically, the model of 'modern-western' healthcare has been characterized by its excessive emphasis on the psycho-physical aspects of the healthcare process (Menéndez, 2005). However, since the end of the 1980s, academia and policy makers have moved away from an inter- pretation of healthcare based on merely physical elements to provide more room for social aspects, based on the belief that social determinants have a major impact on people's health and on healthcare inequalities (Marmot, 2005). Since then,' commu- nity participation' has been identified as the key to primary health care and has been expected to bring about the following benefits for the people: better use of existing health services and increased sustainability of new services by being involved in decisions about the development of the services; and change in their poor health behaviors after being involved in exploring the consequences of these behaviors (Rifkin, 1990, p. 11). From this perspective, healthcare no longer depends exclu- sively on the actions of healthcare agents or pro- gram providers, but on the beneficiaries as well (Heritage & Dooris, 2009; Morgan, 2001; Rifkin, 1996; Smithies & Webster, 1998; World Health Organisation, 1986).

The concern regarding active commu- nity participation in health programing was embraced by the mtemiltural healthcare approach when it emerged in the 1990s as a response to the specific challenge of reaching Indigenous populations in Latin America (Deruyttere, 1997; Griffiths, 2005). Intercultural healthcare has been defined as an approach in health that aims to reduce the gap between Indigenous and west- ern health systems, on the basis of mutual respect and equal recognition of these knowledge sys- tems (Torri, 2012, p. 31). In this sense, the inter- cukural healthcare approach to public pokcies has been seen as a way to guarantee Indigenous peoples' right to health according to their own customs and traditions (O'Neill, Bartlett, & Mignone, 2006). The intercultural approach has been considered a key strategy to improve the health of the Indigenous peoples. But this has especially been recognized as a unique opportu- nity for women, who are recognized as the most vulnerable group of the Indigenous population because of poor sexual and reproductive health indicators and gender inequality (Bant & Girard, 2008; Camacho, Castro, & Kaufman, 2006; Pan American Health Organisation, 2009).

Interest in Indigenous health has been related to local politics and to a global demand of major development organizations. Since mid-1990s, development organizations have added the pro- tection of Indigenous peoples' rights to their operational guidelines, allocating specific funds to the development of Indigenous populations, and financing actions from a standpoint of cultural adaptation (Hall & Patrinos, 2006). Interest in the needs of the Indigenous communities com- ing from development organizations was not just happenstance. Neoliberal health reforms common in low and middle-income countries worldwide beginning in the 1980s-showed poor health outcomes in the majority of cases and, in particular, a large gap in indicators between the Indigenous and non-Indigenous popula- tion (Hall & Patrinos, 2006). For example, in order to improve Indigenous health outcomes, in 1994, the Inter-American Development Bank created an Operational Policy on Indigenous Peoples (OP-765), which mandates the Bank to mainstream Indigenous peoples specificity into its programs and to support 'development with identity' initiatives. With regard to health proj- ects, the policy requires the Bank to support the articulation of public health services, taking into account Indigenous knowledge, practices and values, and also the preservation and strengthen- ing of traditional Indigenous systems of health and healing (O'Neill et al., 2006, p. 1). At the end of the 1990s, Latin American governments1 had made significant efforts to create special- ized institutions that manage intercultural health policy, especially when promoting the inclu- sion and participation of Indigenous people in their design, as a way to guarantee Indigenous peoples' right to health according to their own culture (Torri, 2012). …

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