I recently wrote about my visit to the indigenous Xukuru community with a group of Brazilian family doctors. In this post I’m going to share some of my learning from the visit in terms of what we can do to support the health of the Xukuru.
Part of the purpose of our visit to the Xukuru community was to learn about their health needs and to think about how we could best design a health system to serve an indigenous community such as theirs.
Since this was part of our reasons for visiting, I thought I’d better write a bit about what I feel are some the key priorities for improving the health of the Xukuru people:
1) A strong education system, sanitation, roads, ability to earn an income and respect for their culture and their land rights. The health of the Xukuru is intricately linked to all these other issues that the community faces and cannot be considered in isolation.
2) A type of medicine that respects their culture and beliefs and that will be accepted by the local population.
3) A type of doctor who can deliver on the above two points. Although the Cuban doctors are sensitive to the Xukuru’s cultural needs and are widely praised, it would be even better for the Xukuru if they were able to have some nurses and eventually doctors who come from the Xukuru tribe themselves. This will require their local education system to be built upon so that their secondary-school students stand a chance of getting into the very competitive Brazilian university system and then funding so that the students could pay their way through university.
For me, the overriding theme of the meeting was the idea that the health needs of the Xukuru cannot be separated from the other issues their society faces. There is little advantage in having access to the latest and greatest in health technology, if the Xukuru lack the right to land from which to produce food and a stable income. Efforts to improve access to doctors will be in vain they lack the basic sanitation facilities needed to prevent the spread of infectious diseases. And the there is no point in having the most advanced healthcare system in the world if this is not complemented by an education system which equips their future generations with the skills to flourish in a world that is rapidly changing around them.
Healthy people need a healthy society
This idea that individual health is built upon a foundation of a ‘healthy society’ applies just as much to us in high-income countries such as the UK as it does to the Xukuru. Some doctors might consider things such as education, income equality, social mobility to be beyond the usual scope of their practice. However, there is an enormous amount of evidence that these ‘social determinants of health’ make more of a difference to people’s wellbeing than much of what we doctors do in the consulting room.
The importance of the ‘social determinants of health’ is something I was already pretty aware of, but my visit to the Xukuru helped really hammer the message home. More so than ever, I am determined to make it part of my business as a medical professional to engage in public health issues, even if I never end up becoming a public health specialist myself.
Despite all this thought around the importance of building the foundations of a healthy society for the Xukuru, I was surprised to spend even more of my time reflecting about what we could really learn from them, which is what I’ll be writing about in my next blog post.
My blog post explaining a bit more about the plight of indigenous people in Brazil, the Xukuru people and their healthcare system.
For anyone looking to learn more about these ‘social determinants of health’, I’d recommend a book called ‘The Spirit Level: Why More Equal Societies Almost Always Do Better’ as well as the works of Michael Marmot, a public health expert who’s done a lot of research on the social determinants of health. Here’s a talk from Michael Marmot to get you started.