Towards the development of sustainable indigenous health policy: Insights from a community-based assessment of priority health concerns in the Colombian Amazon

Indigenous groups in various areas of the world face major barriers to access high quality healthcare and health promotion services due to various geographic, financial, and cultural factors. Increased participation of indigenous peoples in healthcare and public health planning and policy is critical to decrease health disparity. Major concerns for indigenous peoples living in tropical environments include basic sanitation, perinatal diseases, and transmissible diseases such as malaria, respiratory, and gastrointestinal infections. However, the provision of adequate healthcare and health promotion services to address these issues is often challenged not only by indigenous peoples' characteristics but also by the characteristics of extrinsic factors including health policy and providers' levels of cultural competency. This paper uses the “vulnerability model” to understand how the confluence of community and external factors places this population at higher risks than other underserved groups. A case study of three rural indigenous villages in the Colombian Amazon is used to illustrate the challenges and opportunities offered by the use of a Community Based Participatory Action Research (CBPAR) approach to identify and address priority health issues in a culturally inclusive and competent manner. Results from a community assessment of perceived barriers to access healthcare, major health concerns, proposed health promotion strategies and use of traditional medicine are presented from both community and providers' perspectives. Results from this study are contrasted with those from the CBPAR experience addressing rural Hispanic health issues in Illinois. Implications for international health policy affecting indigenous peoples and other underserved groups are discussed.