Traditional medicines and their articulation with health systems and services
Health as a human right covers all people regardless of ethnicity, gender, religion, class or race, this implies the opportunity to receive medical care in all areas of individual and collective life.
On the other hand, health, understood as a process of health – disease – assistance – care, is totally interdependent with social, cultural, economic, political, religious and environmental processes. Indigenous, Afro-descendant, Roma and other ethnic populations are no strangers to these processes and have created their own medical and therapeutic systems that respond to their history, context, region and ways of seeing themselves in the world.
The Alma-Ata Declaration (1978) defines health as physical, mental and social well-being and as a fundamental human right for which governments are responsible; it affirms the decisive role of primary health care to achieve a level of health that allows all people to lead a socially and economically productive life (art. V) and to contribute to the enjoyment of the highest attainable standard of health. Primary Health Care (PHC) has been assumed by part of the indigenous, Afro-descendant, Roma and other ethnic populations of the countries of the Region as a strategy for the development of their traditional medicines (See https://www3.paho.org/english/dd/pin/alma-ata_declaration.htm).
In 1989, the International Labor Organization issued Convention 169 concerning Indigenous and Tribal Peoples in Independent Countries, where in Article 24 it states that: “Social security schemes shall be extended progressively to cover the peoples concerned, and applied without discrimination against them.”. Article 25 of convention 169 states that it must be ensured “that adequate health services are made available to the peoples concerned, or shall provide them with resources to allow them to design and deliver such services under their own responsibility and control, so that they may enjoy the highest attainable standard of physical and mental health.”, i.e. that they be organized on a communal basis, be planned and managed in cooperation with these peoples, taking into account their economic, geographical, social and cultural conditions as well as their methods of prevention, healing practices and traditional medicines, or that these peoples be provided with the means to deliver such services, and that preference be given to the training and employment of health personnel from the local community and focus on primary health care, while maintaining close links with the other levels of health care (See https://www.ohchr.org/en/instruments-mechanisms/instruments/indigenous-and-tribal-peoples-convention-1989-no-169).
In 2000, the United Nations Committee on Economic, Social and Cultural Rights (CESCR), in General Comment 14, analyzed the content, scope and obligations of Member States under Article 12 (the right to health) of the ICESCR, and established not only that the right to health is closely related to and dependent on the exercise of other human rights, such as the rights to life, to be free from discrimination, to equality, to personal liberty, to personal integrity, to association, to assembly and movement, to food, to housing, to employment and to education, but also considered it appropriate to identify the elements of the right to health that should be included in the right to health, to equality, to personal liberty, to personal integrity, to association, to freedom of assembly and movement, to food, to housing, to employment and to education, but also considers it appropriate to identify the elements that would help define the right to health of indigenous peoples and Afro-descendants, so that States with such populations can more adequately implement the provisions contained in Article 12 of the Covenant. (See https://www.refworld.org/pdfid/4538838d0.pdf).
In 2006, PAHO issued Resolution CD47.R18, which urges Member States, among other things, to incorporate the ethnic perspective in the achievement of the Millennium Development Goals and the intercultural approach in the Region’s national health systems as part of the primary health care strategy (See https://iris.paho.org/handle/10665.2/366).
Subsequently, in 2007, PAHO, at the request of its member countries, decided to review the values and principles that had inspired the Alma-Ata Declaration on Primary Health Care (PHC) and prepared a position paper called “The Renewal of Primary Health Care in the Americas”, whose objective, according to the then Director of PAHO Mirta Roses is “…. to serve as a reference for all countries seeking to strengthen their health care systems, bringing health care closer to people living in urban and rural areas, regardless of their gender, age, ethnic group, social status or religion” (See https://iris.paho.org/handle/10665.2/31083).
In 2014, PAHO/WHO member countries approved the Strategy for Universal Access to Health and Universal Health Coverage and stated that they are aware that “… universal access to health and universal health coverage imply that all individuals and communities have access, without discrimination, to adequate, timely, quality, comprehensive health services, determined at the national level, according to need…” (See https://www.paho.org/en/documents/strategy-universal-access-health-and-universal-health-coverage).
In 2015, the United Nations General Assembly adopts the 2030 Agenda for Sustainable Development, along with an action plan for the next fifteen years, containing 17 goals with 169 targets in the economic, social and environmental spheres that seek to end poverty and improve people’s lives. The Agenda also aspires to “…universal respect for human rights and human dignity, the rule of law, justice, equality and non-discrimination; where race, ethnicity and cultural diversity are respected…” and recognizes “…the natural and cultural diversity of the world, and also that all cultures and civilizations can contribute to and play a crucial role in facilitating sustainable development” (See UN 2023 SDG Summit).
In this context, the member states of the United Nations have the obligation to respect, protect and fulfill human rights -including the right to health – which being universal and encompassing all aspects of life, include not only the civil, political, social, economic and cultural rights of individuals, but also the collective rights of peoples, such as self-determination, equality, development and peace, among others, but also the collective rights of peoples such as self-determination, equality, development and peace, among others, and must be applied indiscriminately to all persons regardless of race, sex, ethnic or social origin, religion, language, nationality, age, sexual orientation, disability or any other distinguishing characteristic.
It is also the responsibility of States to respect and guarantee the individual and collective rights of their inhabitants, materialized in positive actions focused on certain groups or persons who have been traditionally discriminated against (because of their ethnicity, political orientation, etc.) or who are in a situation of vulnerability (due to physical, economic or social conditions) and through the issuance of regulations, the application of public policies, or through judicial actions. Likewise, to provide its citizens with optimal conditions for the effective enjoyment of their rights, through the creation of mechanisms that allow their enforceability in case of threats of violations to them.
For the WHO, the responsibility of the State is not limited to solving health problems but also to preventing the different types of risks (natural, economic, violence, etc.) that can affect the health and well-being of individuals and communities, regardless of the beneficiaries’ ability to pay. For this reason, some governments around the world have adopted social security and assistance programs that seek to counteract, prevent, mitigate or overcome the effects of the risks affecting the most vulnerable populations (including indigenous peoples, people with disabilities and other special populations).
For some decades now, and fundamentally framed in the recognition of the individual and collective rights of indigenous, Afro-descendant, Roma and other ethnic peoples, as well as the processes of vindication of their rights and the recognition and valuation of their cultures, the countries of the Americas have begun to make visible in their Constitutions and local jurisprudence, not only the existence and survival of ancestral traditional medicines, but also their recognition as traditional medical systems, together with their knowledge, know-how, practices and practitioners, and their promotion as an alternative and complementary option to traditional medicines; Likewise, they have been advancing intercultural health processes, whose developments are of varying magnitude, as they respond to national social, political and economic realities, in terms of the articulation and integration of traditional medicines with health systems, the implementation of traditional medicines in health services and the provision of health services with cultural relevance.
In this way, the right to health is reclaimed from an integral and intercultural perspective that articulates not only institutional medical services for the treatment of illnesses, but also action on the different environmental, socioeconomic and cultural factors that influence health.
Thus, in the countries of the region – both from the institutional framework and from the populations themselves and jointly, technical guidelines, guides, protocols, norms and regulations are being developed. In the same way, they are working on the design and implementation of intercultural health models, sociocultural adaptations in institutional health systems, exercises to analyze the health-disease situation from the perspective of cultural diversity, elaboration of intercultural epidemiological profiles, systematization and exchange of information, knowledge, know-how and good practices among traditional medicines, education and training of their own and institutional human talent in health, and articulation and coordination with other sectors that have an impact on health – intersectionality – within the framework of the social determinants of health, among other processes.
These actions are reinforced by international organizations that issue resolutions urging the countries of the Americas region to adopt public policies that recognize their cultural and health diversity, address the particularities of their population and mainstream the intercultural approach in their health policies, plans and programs (See Policy on Ethnicity and Health (29th Pan American Sanitary Conference); Política andina de salud intercultural).
Taking into account the health of indigenous, Afro-descendant, Roma and other ethnic populations in the Americas poses important challenges not only in terms of providing concrete responses to health problems and the determinants that affect them, but also in recognizing the existence of traditional medical systems that have benefited humanity as a whole and that form a fundamental part of comprehensive responses for health and the common good.
In this section you will soon find a review of the processes and developments advanced by the countries of the Americas region, both for the protection of traditional knowledge and traditional medicines of the various ethnic groups, and for the design and implementation – in a participative manner with these populations – of public policies, plans, programs, projects and health models with an intercultural, intersectoral and socioculturally appropriate approach. You will find as well the articulation carried out with other institutions or sectors in the search for solutions to the problems that affect the integral health well-being of these populations.
Also, you will soon find information on the sociocultural epidemiological profiles that have been developed and the actions to make the intercultural approach transversal in health services. You will find content on the processes of sensitization, training, education and capacity building of institutional and ethnic health personnel, health research processes and traditional medicines. Finally, it will include the forms of analysis and dissemination of the knowledge and know-how of these medicines in the information systems of the countries of the region.