Carolyn Stephens

Indigenous peoples' health—why are they behind everyone, everywhere?

In December 2004 Health Unlimited a UK based non-governmental organisation and the London School of Hygiene and Tropical Medicine hosted a meeting of experts in indigenous health to mark the end of the International Decade of the World’s Indigenous Peoples. It was clear as 2004 drew to a close that little had been achieved to meet the Decade’s objective of strengthening international cooperation for the solution of problems faced by indigenous people in such areas as human rights the environment development education and health. In their assessment of the Decade the UN Commission on Human Rights observed that indigenous peoples internationally continue to be among the poorest and most marginalised and that “the adoption of a declaration on the rights of indigenous peoples one of the main objectives of the Decade has not been achieved”. (excerpt)

Healthy cities or unhealthy islands? The health and social implications of urban inequality

This paper suggests that governments and international agencies must address the large and often growing levels of inequality within most cities if health is to be improved and poverty reduced. It describes the social and health implications of inequalities within cities and discusses why descriptions of the physical symptoms of poverty (and their health implications) are more common than analyses of the structural systems which produce and perpetuate poverty. It also describes the health problems from which low-income groups in urban areas suffer more than richer groups including those that are not linked to poor sanitary conditions and those that are more linked to relative poverty (and thus the level of inequality) than to absolute poverty.

Exposures and cancer incidence near oil fields in the Amazon basin of Ecuador

OBJECTIVES To examine environmental exposure and incidence and mortality of cancer in the village of San Carlos surrounded by oil fields in the Amazon basin of Ecuador. METHODS Water samples of the local streams were analyzed for total petroleum hydrocarbons (TPHs). A preliminary list of potential cancer cases from 1989 to 1998 was prepared. Cases were compared with expected numbers of cancer morbidity and mortality registrations from a Quito reference population. RESULTS Water analysis showed severe exposure to TPHs by the residents. Ten patients with cancer were diagnosed while resident in the village of San Carlos. An overall excess for all types of cancer was found in the male population (8 observed v 3.5 expected) with a risk 2.26 times higher than expected (95% confidence interval (95% CI) 0.97 to 4.46). There was an overall excess of deaths for all types of cancer (6v 1.6 expected) among the male population 3.6 times higher than the reference population (95% CI 1.31 to 7.81). CONCLUSIONS The observed excess of cancer might be associated with the pollution of the environment by toxic contaminants coming from the oil production.

Outcomes of pregnancy among women living in the proximity of oil fields in the Amazon basin of Ecuador.

Abstract Oil companies have released billions of gallons of untreated wastes and oil directly into the environment of the Ecuadorian Amazon. This cross-sectional study investigated the environmental conditions and reproductive health of women living in rural communities surrounded by oil fields in the Amazon basin and in unexposed communities. Water from local streams was analyzed for total petroleum hydrocarbons (TPH). The women, aged 17 to 45 years, had resided for at least three years in the study communities. Socioeconomic and reproductive histories of the last three pregnancies were obtained from interviews. Information from the questionnaire was available for 365 exposed and 283 non-exposed women. The study was conducted from November 1998 to April 1999. Streams of exposed communities had TPH concentrations above the allowable limit. Mter adjustment for potential confounders, the pregnancies of women in exposed communities were more likely to end in spontaneous abortion (OR: 2.47;95% CI: 1.61–3.79;P < 0.01). No association was found between stillbirth and exposure. An environmental systemto control and eliminate the sources of pollution in the area is needed.

Urban equity and urban health: using existing data to understand inequalities in health and environment in Accra, Ghana and São Paulo, Brazil

This paper describes the methods used to study inequalities in health status and environmental conditions between different groups in the cities of São Paulo and Accra. The studies used existing data, drawn from different sources, and involved staff from different government agencies (from city authorities and higher levels), academics and NGOs in determining how best to use it. The paper also provides a summary of the main findings, including a discussion not only of inequalities in health between the best quality and worst quality zones in each city but also on how health risks differ by age group. The paper begins by considering why information on such inequalities is so important for policy makers and why so little data on this are available in most cities in the South.

Saúde e meio ambiente: uma análise de diferenciais intra-urbanos enfocando o Município de São Paulo, Brasil

Objetivou-se preencher as lacunas no tipo de informacao necessaria sobre mor-talidade para estabelecimento de correlacoes entre saude, urbanizacao e meioambiente. As estatisticas produzidas baseiam-se na analise de dados de regis-tros continuos, dados de pesquisas, relatorios e censos populacionais. Dadossocioeconomicos foram utilizados para construir um indicador composto paracada distrito e subdistrito fornecendo a base para a construcao de quatro zonassocioeconomicas. Sao apresentados diferenciais de mortalidade entre essas zo-nas, distribuidos por quatro grupos de causas e cinco grandes grupos etarios. Ozoneamento urbano mostrou que 43,8% da populacao da cidade de Sao Paulovive em areas com as piores condicoes socioeconomicas. Os dados de saudedemonstraram que pessoas vivendo nessas areas tinham padrao de mortalidademais elevado que aquelas vivendo em areas com melhores condicoes socioeco-nomicas. Analisa-se a sobremortalidade entre as zonas socioeconomicas e su-gere-se este enfoque como instrumento util para a definicao de prioridades naalocacao de recursos de saude.Apresenta-se projeto na area de diferenciais intra-urbanos de saude no Municipio de Sao Paulo, SP, Brasil. Focalizam-se alguns aspectos do problema urbano na cidade, seguindo-se uma revisao bibliografica de trabalhos que abordam a questao dos diferenciais geograficos na literatura paulista. Sao outras tematicas: a desagregacao geografica do territorio a ser estudado e a metodologia de construcao do indice de carencia para definicao de zonas homogeneas no Municipio de Sao Paulo, Brasil. Aponta-se qual seria a aplicacao dos resultados finais obtidos pelo projeto.A project concerned with the study of intra-urban health differentials in S. Paulo city, Brazil, is described. A brief outline of urban problems in the city is presented, followed by a review of the locally published literature on the subject of geographical differentials (stratification by socioeconomic status and environment). Two topics are introduced: geographical subdivision of the area studied and the methods used to choose the socio-environmental indicators for the construction of a deprivation index with to stratify the city. Suggestions are made as to possible applications of results achieved by the project.

UN Declaration on the Rights of Indigenous Peoples

This thesis examines the development of the right of indigenous peoples to natural resources on their lands and territories in international law. It examines international treaties, the jurisprudence of international courts and other international bodies, as well as the practice of international actors. A special focus is on the UN General Assembly Declaration on the Rights of Indigenous Peoples. The thesis describes the drafting process and the discussions that took place around the issue of land rights and natural resources, and uses this to draw conclusions on the development of a new international customary law of an indigenous right to free, prior and informed consent with regard to natural resources.

Revisiting urban health and social inequalities: the devil is in the detail and the solution is in all of us

This paper considers how the subject of urban inequalities has come to be given more consideration within the discussions of urban poverty and urban health. It suggests a need for more precision in understanding and acting on such inequalities — and discusses how measurement and policy response are influenced by whether the focus is on urban poverty, differentials, inequality or inequity. Many authors fail to clarify the difference between a differential, an unequal and an unjust distribution of services or resources, or health outcomes. This paper discusses what aspects of inequality can and cannot be addressed through conventional local government interventions (for instance, in upgrading informal settlements or public transport, or water pricing). It argues that to change urban inequalities at root, we have to recognize and address unjust distributions of power and control of resources.

Utz Wachil: Findings from an International Study of Indigenous Perspectives on Health and Environment

This article reports previously unpublished results of a collaborative study undertaken in 2003 by health workers of the UK-based organisation Health Unlimited, and by researchers of the London School of Hygiene and Tropical Medicine. This study marked the first of a series of collaborative activities aimed at highlighting the situation of Indigenous peoples, some in the most isolated ecosystems of the planet. While many researchers focus on quantitative analysis of the health and environmental conditions of Indigenous peoples, our 2003 study aimed at exploring the views of Indigenous peoples in isolated communities in five countries on their environment and their health. In this article we look closely at the web of knowledge and belief that underpins Indigenous peoples’ concepts of health and well-being, and their relationship to land and the environment. Although many Indigenous people have been forced off their traditional lands and live in rural settlements, towns, and cities, there are still a large number of people living in very small Indigenous communities in remote areas. This article focuses on 20 such communities in six countries. We explore traditional knowledge and practice and its relationship to Western medicine and services. The research findings highlight the importance of Indigenous knowledge systems for the emerging ecohealth community and suggest that we have much to learn from Indigenous peoples in our pursuit of a more holistic science.

Indigenous Perspectives on Ecosystem Sustainability and Health

Indigenous peoples have been guardians of our global envi-ronment and its medicines for millennia—built on a com-munal view of humanity and its links to the ecosystem. Yet asthe new millennium rolls out, Indigenous peoples are amongthose most marginalized within many nation states, theyhave the worst health indicators, and their knowledge con-tinues to be threatened asthe land and resources they dependon are appropriated, developed, degraded, or destroyed.During the United Nations Decade of the WorldsIndigenous Peoples (1995–2005), one response to theseconcerning trends was increased scholarly and policyattention to fields such as traditional ecological knowledge,indigenous health, traditional medicines, and biopro-specting (Janes, 1999; Berkes et al., 2000; Merson, 2000;Subramanian et al., 2006). Yet at the end of this UN decade,an invited Lancet series offered a sobering reminder of justhow much more needs to be done to improve and promotethe health status of Indigenous people worldwide (seeStephens et al., 2006). A significant obstacle to meeting thischallenge has been the predictable tendency to study andanalyze indigenous perspectives and priorities along tradi-tional disciplinary lines, in effect disaggregating holisticunderstanding into academic or thematic silos with mini-mal interaction and a disconnect from pressing, intercon-nected realities of health, culture, and ecology.This edition of EcoHealth has been put together withexplicit interest in (re)integrating indigenous perspectiveson ecosystem sustainability and health. It is timely that theissue was finalized the same week that the United NationsGeneral Assembly adopted the Declaration on the Rights ofIndigenous People, after almost 13 years since the draftdeclaration was proposed in 1994 (United Nations, 2007).The nonbinding declaration passed despite objections fromAustralia, Canada, New Zealand, and the United States,who cited inconsistencies with existing national laws.The controversies and lengthy negotiations to pass theUnited Nations Declaration on the Rights of IndigenousPeoples exemplify the challenges of diversity and contextwhich characterize indigenous issues and demand ongoingattention. The notion of indigeneity is complex and highlycontested. The term Indigenous is used in some contexts torefer to the aboriginal population of a nation or area—-those who were the first-recorded human inhabitants. InAustralasia, North America, and to a large extent LatinAmerica, this interpretation is clearer, drawing a distinctionbetween native peoples and European colonial settlers. Inother areas, including Asia and the Middle East, distinc-tions are less clear. Colonization took place between ethnicgroups within and between countries, and in some casesnative populations were almost entirely eradicated. In othercontexts, social hierarchies such as the Indian caste systemestablish categories of social position at birth, with somegroups recognized as Indigenous or tribal on a sociocul-