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The Health of the Indigenous Population in Mexico

The Health of the Indigenous Population in Mexico. Carlos Zolla COMISIÓN NACIONAL PARA EL DESARROLLO DE LOS PUEBLOS INDÍGENAS – MEXICO, 2004. INDIGENOUS POPULATION IN MEXICO. TOTAL POPULATION IN MEXICO, 2000 97,438,412 Population 5 years and older that speaks

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The Health of the Indigenous Population in Mexico

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  1. The Health of the Indigenous Population in Mexico Carlos Zolla COMISIÓN NACIONAL PARA EL DESARROLLO DE LOS PUEBLOS INDÍGENAS – MEXICO, 2004

  2. INDIGENOUS POPULATION IN MEXICO • TOTAL POPULATION IN MEXICO, 2000 97,438,412 • Population 5 years and older that speaks an Indigenous language (HLI) 6,044,547 • Population ages 0 - 4 in homes where family head or partner speaks an Indigenous language 1,233,455 • Do not speak an Indigenous language but feel they are Indigenous (self-declared)(Sampling) 1,103,312 • TOTAL REGISTERED INDIGENOUS POPULATION 8,381,314 • TOTAL ESTIMATE, INDIGENOUS POPULATION 12,403,000

  3. DISTINCTIVE CHARACTERISTICS OF THE INDIGENOUS POPULATION IN MEXICO • The most numerous population in Latin America: 12,403,000. • Strong cultural and linguistic diversity: 86 languages and dialects are spoken in Mexico. • 80% of the population lives in the Central-South-Southeastern states. • There are big ethno-linguistic groups (nahuas, mayas, mixtecos, zapotecos, otomíes, tzeltales, tzotziles: between 1,400,000 y 300,000), and small groups: kiliwas, paipai, cochimí, kukapás, kikapús, with less than 500 people each.

  4. DISTINCTIVE CHARACTERISTICS OF THE INDIGENOUS POPULATION IN MEXICO • The highest marginalization ratios in the country and a strong territorial dispersion. • They live in regions with important mining, touristic, biological, hydric, forestal, and eolic. Relevant handicrafts and a solid ancient culture. • Notably rich medical flora (the world’s second or third largest) and ample knowledge on traditional and home medicine. • Intense regional, national and international migration in the last years.

  5. RURAL-URBAN DISTRIBUTION OF THE INDIGENOUS POPULATION IN MEXICO, 2000 • 65% of the HLI live in rural areas (locations with less than 2,500 inhabitants) • 19% live in semi-urban areas (locations with more than 2,500 and less than 15,000 inhabitants) • 16% in urban areas (locations with more than 15,000 inhabitants)

  6. THE INDIGENOUS PEOPLES AND THEIR HABITAT • Traditional rural areas • Mexican cities • Agroindustrial areas and their surroundings • Rural areas and cities in the United States of America and Canada

  7. DISTRIBUTION OF THE INDIGENOUS POPULATION.Locations • Locations with 70% and more of indigenous population: 17,436 • Locations with 70% and more of indigenous population and less than 100 inhabitants: 8,263 • Locations with 40% - 69% of indigenous population and less than 100 inhabitants: 1,255 • Locations with less than 40% of indigenous populaton and less than 100 inhabitants: 8,088 • Total of locations with indigenous population and less than 100 inhabitants: 16,351 SOURCES: (CONAPO, 2000. INI, 2000a. ORDPI-INI, 2002. SSa, 2001a. SSa, 2001b. SERRANO CARRETO et al., 2002)

  8. MARGINALIZATION OF THE INDIGENOUS POPULATION IN MEXICO, 2000 • Total of indigenous municipalities or where indigenous population is present: 871 (100%) • Indigenous municipalities with VERY HIGH MARGINALIZATION: 300 (37.4%) • Indigenous municipalities with HIGH MARGINALIZATION: 407 (50.7%) • Indigenous municipalities with MEDIUM MARGINALIZATION: 79 (9.8%) • Indigenous municipalities with LOW MARGINALIZATION: 12 (1.5%) • Indigenous municipalities with VERY LOW MARGINALIZATION: 3 (0.4%)

  9. MARGINACIÓN DE LA POBLACIÓN INDÍGENA.Vivienda • Total of homes: 2,051,444 • Indigenous homes with tap water: 64.0% (National: 84.3%). Durango; 32.3%. Veracruz: 35.1%. San Luis Potosí: 36.2% • Indigenous homes with electricity: 83.1% (National: 95.0%). Durango: 31.6%. Chihuahua: 31.9%. Nayarit: 51.1% • Indigenous homes with dirt floor: 43.7% (National: 13.2%). Guerrero: 75%. Chiapas: 71.0%. San Luis Potosí: 70.9%. • Indigenous homes with exclusive sanitary service: 73.6% (National: 85.9%). Guerrero: 36.8%. Nayarit: 37.5%. Durango: 46.3% • Homes that cook with wood fire: 62.4 (Nacional: 17.2%). San Luis Potosí: 85.8%. Chiapas: 85.7%. Guerrero: 83.8%.

  10. MARGINALIZATION OF THE INDIGENOUS POPULATION.Income Monetary income of the indigenous population as a result of working (SMM: Monthly Minimum Wages)* • Does not get paid for work: 25% • Receives up to 2 SMM: 56% • Receives more than 2 SMM: 19% * 1,298.70 pesos = 113.92 dollars

  11. MARGINALIZATION OF THE INDIGENOUS POPULATION.Illiteracy in municipalities with indigenous population Percentage of illiteracy amongst people 15 years and older: 25% • Women: 32% • Men: 18% • Illiterate HLI women: 43.3% • Non illiterate HLI women: 10.4% • Illiterate HLI men: 23.4% • Non illiterate HLI men: 6.7%

  12. MARGINALIZATION OF THE INDIGENOUS POPULATION.Backwardness in Education

  13. MARGINALIZATION OF THE INDIGENOUS POPULATION.Health • Life expectancy seven years less than the rest of the population (69/76) • High chronic malnutrition ratios • Predominant infectious diseases (intestinal infections, influenza, pneumonia, pulmonary tuberculosis) • General, childhood, preschool, school-age and maternal mortality higher than in national population • Persistence of the so-called residual diseases (for example tracoma, in Chiapas) • Predominant “poverty pathology” (Cholera, malaria, dengue fever, lepra, etc)

  14. INFANT MORTALITY RATE, BY INDIGENOUS LANGUAGE SPEAKERS, 1990-2000 Speaks an indigenous language Does not speak an indigenous language • 1990 60.9 / 1000 36.9 / 1000 • 1995 48.3 / 1000 29.0 / 1000 • 2000 38.5 / 1000 24.9 / 1000 Sources: CONAPO, La situación demográfica en México, 1998 y Programa Nacional de Población, 2001-2006

  15. INFANT MORTALITY BY ETHNOLINGUISTIC GROUP (Deaths for each 1000) • Maya 37.9 • Otomí 40.1 • Zapoteco 40.4 • Mazahua 44.7 • Chol 47.2 • Náhuatl 48.3 • Tzoltzil 52.6 • Other 53.3 • Tzeltal 53.4 • Huasteco 53.6 • Mazateco 55.6 • Mixteco 56.2 • Totonaca 57.0 • NATIONAL 24.9 (Between 21.0 and 22.0, for 2002) Sources: CONAPO, La situación demográfica en México, 1998 y Programa Nacional de Población, 2001-2006

  16. PRESCHOOL AND SCHOOL-AGE MORTALITY IN THE INDIGENOUS POPULATION.Relative weight of deaths • Pre-school mortality (1 - 5 years) National: 12% Indigenous: 19% • School age mortality (6 - 14 years) National: 1.8% Indigenous: 3.3% • Source: SSa, 2001

  17. MALNUTRITION IN INDIGENOUS POPULATIONS • Chronic malnutrition in girls and boys: delay in growth (small for their age) in almost half (44%) of the population (17.7% national) • Micronutrient deficiency and anaemia (36% indigenous; 27% non indigenous) • Important deficiencies in iron, zinc, vitamins C and A (between 12 and 50% of the indigenous children) • Four of ten pregnant women have anaemia (almost twice as many than in the general population)

  18. MORTALITY BY SELECTED CAUSES.*NATIONAL AND INDIGENOUS CAUSE NATIONAL INDIGENOUS _______________________________________________________ • Diabetes mellitus 36 16 • Tumors 53 33 • Heart disease 69 46 • Cirrhosis 24 23 • Pneumonias 22 29 • Tuberculosis 4 9 • Maternal 4 14 • Diarrhea 11 34 *Rate for each 100,000 inhabitants Source: SSa, 2001

  19. The ten main causes of health care needs referred by traditional therapists from traditional medicine in the 3,025 areas covered by the Program IMSS-COPLAMAR Cause of health care need % • 1. “Mal de ojo” (witchcraft) 55.03 • 2. Digestive disorders 49.26 • 3. Scare-Ghost 33.81 • 4. “Caída de mollera” 30.75 • 5. Dysentery 22.57 • 6. Air 20.95 • 7. Diarrhea 18.72 • 8. Sprains (musculoskeletal) 18.41 • 9. Harm (witchcraft) 14.04 • 10. Anginas 9.98 Source: ZOLLA, Carlos et al. Diccionario enciclopédico de la medicina tradicional mexicana, México, INI, 2000, 2 vols.

  20. THE NATIONAL HEALTH SYSTEM - MEXICO • Secretariat of Health (SSa)* • Instituto Mexicano del Seguro Social (IMSS)* • Instituto de Salud y Seguridad Social para los Trabajadores del Estado (ISSSTE) • Secretariat of National Defense (SEDENA) • Marine Secretariat (SEDEMAR) • Petróleos Mexicanos (PEMEX) * They have care schemes for “open population”, not affiliated to social security schemes. IN the case of IMSS, a through the program IMSS-Oportunidades

  21. THE HEALTH SYSTEM AS AN ORGANIZED SOCIAL RESPONSE We perceive the health system as a kind of organized social response to face the impact of disease, accidents, imbalance or death.

  22. THE HEALTH SYSTEM - MEXICO • ACADEMIC, MODERN OR ALLOPATHIC MEDICINE (Institutional and private) • DOMESTIC OR HOME MEDICINE • TRADITIONAL MEXICAN MEDICINE (Traditional Indigenous Medicine) • HOMEOPATHIC MEDICINE • ALTERNATIVE OR COMPLEMENTARY MEDICINE (Acupuncture, Naturopathy, Digitopuncture, Iridiology, etc)

  23. H MTCH A - D MA MT N MD THE HEALTH SYSTEM IN MEXICO

  24. THE REAL HEALTH SYSTEM IN THE INDIGENOUS REGIONS IN MEXICO • ACADEMIC INSTITUTIONAL OR PRIVATE MEDICINE (Secretaría de Salud, Programa IMSS-OPORTUNIDADES) • TRADITIONAL INDIGENOUS MEDICINE (Healers, midwives, herbal healers, bone healers, prayers, snake people, etc) • HOME OR DOMESTIC MEDICINE (mainly housewives)

  25. THE HEALTH SYSTEM IN THE INDIGENOUS REGIONS WITH INSTITUTIONAL SERVICES Academic Medicine (MA) Traditional Medicine (MT) Home or Domestic Medicine (MT)

  26. IT IS IMPORTANT TO OBSERVE THE RELATIONSHIP BETWEEN DOMESTIC OR HOME MEDICINE, TRADITIONAL MEDICINE AND ACADEMIC OR ALLOPATHIC MEDICINE WITHIN THE REAL HEALTH SYSTEM MT MA MD

  27. It is the population that associates the different health models in reality and uses them as a complement. MA MT MD

  28. PERCENTAGE OF DISTRIBUTION OF LOCATIONS AND POPULATION IN THE RURAL INDIGENOUS LOCATIONS* BY ACCESS TO HEALTH SERVICES**, 2000 Locations (17,859) • Have health services: 2,064 (11.6%) • Have access to health services: 6,227 (34.9%) • Do not have access to health services: 9,559 (53.6%) Population (4,403,986) • Have health services: (1,721,032): 39.1% • Have access to health services: 1,205,884 (27.4%) • Do not have access to health services: 1,477,070 (33.5%) *Locations with 40% and more HLI **Unidades de la SSa e IMSS-Oportunidades. Se tiene acceso cuando la unidad está a menos de 2,500 m. de la localidad.

  29. PERCENTAGES OF DISTRIBUTION OF THE LAST CHILDREN BORN ALIVE BY AGENT WHO ASSISTED THE MOTHER DURING DELIVERY, BY CONDITION OF INDIGENOUS LANGUAGE1994-1999 Speaks an Indigenous Language Does not speak an I. L. • Doctor: 25.4% 64.6% • Nurses: 2.2% 2.8% • Midwife: 57.2% 28.7% • Others: 2.0% 1.3% • Family or friend: 8.5% 1.4% • Nobody: 4.7% 1.2% Source: Encuesta de Salud Reproductiva en el Ámbito de IMSS-Solidaridad, 1999, CONAPO, 2004.

  30. THE REAL HEALTH SYSTEM IN INDIGENOUS REGIONS WITHOUT INSTITUTIONAL SERVICES DOMESTIC OR HOME MEDICINE TRADITIONAL MEDICINE

  31. FACTORS THAT HAVE FOSTERED EMIGRATION OF THE INDIGENOUS POPULATION IN THE LAST 20 YEARS (I)

  32. FACTORS THAT HAVE FOSTERED EMIGRATION OF THE INDIGENOUS POPULATION IN THE LAST 20 YEARS (II)

  33. FACTORS THAT HAVE FOSTERED EMIGRATION OF THE INDIGENOUS POPULATION IN THE LAST 20 YEARS (III)

  34. STRATEGIC GUIDELINES FOR HEALTH CARE FOR AND WITH INDIGENOUS POPULATION • Foster the tasks of designing, promotion and implementation of a NEW STATE POLICY specifically oriented towards improving the health situation and the living conditions of the indigenous population • Promote the implementation of an INTER-CULTURAL HEALTH CARE MODEL (MIAS) for the indigenous population • Promote the creation of an INFORMATION SYSTEM that allows periodic health diagnoses of the indigenous population

  35. STRATEGIC GUIDELINES FOR HEALTH CARE FOR AND WITH INDIGENOUS POPULATION • Guarantee full access to health care services for all the indigenous population (mainly SSa [Sistema de Protección Social en Salud/Seguro Popular de Salud], IMSS-Oportunidades). • Promote and develop local resources for health, especially traditional indigenous medicine. • Formulate a MONITORING SCHEME of health actions as part of the evaluation and follow-up tasks of public action with the indigenous population, assigned by law to the Comisión Nacional para el Desarrollo de los Pueblos Indígenas.

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