Intercultural Health and Communicative Justice in Native Chile

Summary:

Intercultural health initiatives in Chile aim at improving health for Native/Indigenous people, but the design and implementation of intercultural programs have also resulted in negative consequences.

Abstract:

Starting in the late twentieth century, the idea of “intercultural health” emerged as a global health model promising to improve health outcomes in Indigenous communities. One of the earliest settings where the intercultural health model was adopted and developed in Latin America was Gulumapu, the traditional territory of the Mapuche nation that lies west of the Andes Mountains in the nation-state of Chile. This chapter offers a case study of Chilean state-subsidized intercultural health and explores both achievements and limitations of the intercultural health model. I argue that a particular imagined problem of cross-cultural miscommunication is foundational in definitions of the intercultural health approach and in the range of programming that has been developed under the model. In fact, three of the cornerstone interventions that characterize intercultural health programming are in place to facilitate better communication between Indigenous patients and non-Indigenous healthcare professionals. I provide analysis of these three interventions, highlighting ways that they simultaneously promote and undermine health equity and health/communicative justice for Mapuche people and communities.

Research questions:

1. How has intercultural health been defined as a public health goal? 
2. What programming has been developed in the interest of advancing intercultural health? 
3. What intercultural health initiatives been implemented in clinical settings? 
4. What are the aims of these initiatives? 
5. How effective have these initiatives been in achieving these aims?

What the research builds on:

In part as a result of growing awareness about and concern for multiculturalism in medicine, public health policy makers began designing and implementing intercultural (sometimes referred to as cross-cultural) health programs across Latin America during the 1990s and early 2000s. Much of the research on these programs has been program assessment, aimed at generating practical findings that can assist in improving existing programs. Other scholarship has focused on illuminating the ways that these programs fit with broader schemes of neoliberalization or the ways that they fail to address concerns that Native/Indigenous communities raise about public healthcare.