Intercultural Health and the Mapuche: Perceptions and Practice in Santiago, Chile

Background: Intercultural health (IH), defined as the integration of western and indigenous medicine, is a public health approach that aims to reduce the divide between indigenous and biomedical health systems based on mutual respect and equal recognition of both knowledge systems. In Chile, IH has become a national strategy of indigenous health improvement through the Programa Especial de Salud y Pueblos Indígenas. With increasing Mapuche populations in urban centers, it is important to understand how these initiatives are conceptualized in urban settings. Methods: Through a qualitative assessment consisting of 10 in-depth, semi-structured interviews, this project sought to understand how IH is implemented in the La Florida municipality of the Metropolitan Region. Results: Results revealed that the current IH model is inadequate to meet the needs of the urban indigenous population. Constitutional recognition of the Mapuche people and culture was considered a prerequisite to restructure the IH model. Issues such as lack of funding, political favoritism, and a fundamental misunderstanding of Mapuche culture were seen as challenges to improving IH programs and indigenous health outcomes. Conclusion: Efforts to improve IH must take into account the indigenous concept of health and healthcare without forcing it into a biomedical model. A more comprehensive curriculum of indigenous healthcare and culture in general and medical education is critical to improve cross-cultural collaboration. An evaluation framework for funding mechanisms of IH at the regional level is needed to improve transparency and accountability among the Servicios de Salud, or Regional Health Departments, and indigenous associations. More research should be conducted in other urban areas with high indigenous populations to gather more representative data on IH implementation in the Metropolitan Region