James R. Welch

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING The Lowitja Institute.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BackgroundAnemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the Country. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil.MethodsThe survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.ResultsEvaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.ConclusionsThe prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

Tuberculosis among the Xavante Indians of the Brazilian Amazon: an epidemiological and ethnographic assessment.

Abstract Background: Despite broad availability of a national tuberculosis (TB) control program that has proved effective in Brazil, TB remains a major cause of morbidity and mortality among indigenous peoples. Aim: We report the results of an interdisciplinary investigation of TB epidemiology, healthcare services, and ethnomedicine among the Xavante Indians of Central Brazil. Subjects and methods: Fieldwork components included clinical assessment of TB (479 subjects, 89.3% of the population = 1 year of age), analysis of medical health records, and ethnographic research. Results: We found TB to constitute a major health risk, with moderately high annual risk of infection (0.94%), moderate prevalence of infection, high percentage of X-ray images suggestive of TB (14.2% in subjects ≥ 10 years of age), and a relatively low percentage of individuals with reactive TB skin tests (16.6% of reactions ≥ 10 mm) despite high BCG vaccine coverage. We also found a high rate of TB patients showing no evidence of prior infection. Ethnographic interviews show that Xavante and biomedical health perspectives are simultaneously divergent in their etiologies but pragmatically compatible. Conclusion: Ineffective diagnosis procedures compromise the efficacy of existing TB prevention efforts and threaten to undermine otherwise favorable institutional and cultural conditions.

Indigenous Burning as Conservation Practice: Neotropical Savanna Recovery amid Agribusiness Deforestation in Central Brazil

International efforts to address climate change by reducing tropical deforestation increasingly rely on indigenous reserves as conservation units and indigenous peoples as strategic partners. Considered win-win situations where global conservation measures also contribute to cultural preservation, such alliances also frame indigenous peoples in diverse ecological settings with the responsibility to offset global carbon budgets through fire suppression based on the presumed positive value of non-alteration of tropical landscapes. Anthropogenic fire associated with indigenous ceremonial and collective hunting practices in the Neotropical savannas (cerrado) of Central Brazil is routinely represented in public and scientific conservation discourse as a cause of deforestation and increased CO2 emissions despite a lack of supporting evidence. We evaluate this claim for the Xavante people of Pimentel Barbosa Indigenous Reserve, Brazil. Building upon 23 years of longitudinal interdisciplinary research in the area, we used multi-temporal spatial analyses to compare land cover change under indigenous and agribusiness management over the last four decades (1973–2010) and quantify the contemporary Xavante burning regime contributing to observed patterns based on a four year sample at the end of this sequence (2007–2010). The overall proportion of deforested land remained stable inside the reserve (0.6%) but increased sharply outside (1.5% to 26.0%). Vegetation recovery occurred where reserve boundary adjustments transferred lands previously deforested by agribusiness to indigenous management. Periodic traditional burning by the Xavante had a large spatial distribution but repeated burning in consecutive years was restricted. Our results suggest a need to reassess overreaching conservation narratives about the purported destructiveness of indigenous anthropogenic fire in the cerrado. The real challenge to conservation in the fire-adapted cerrado biome is the long-term sustainability of indigenous lands and other tropical conservation islands increasingly subsumed by agribusiness expansion rather than the localized subsistence practices of indigenous and other traditional peoples.

A Half-Century Portrait: Health Transition in the Xavante Indians from Central Brazil

This chapter discusses some of the most recent studies that have been conducted among the indigenous Xavante people in Central Brazil by members of the research group Health, Epidemiology and Anthropology of Indigenous Peoples, coordinated by Ricardo Ventura Santos and Carlos E. A. Coimbra Jr., from the Oswaldo Cruz Foundation, Rio de Janeiro. Members of this research group first studied the Xavante in 1990 and have since published on such diverse topics such as nutrition, subsistence, demography, epidemiology of infectious and parasitic diseases, and social organization. Recently, the group has focused on the relationship between health profiles and emergent forms of socioeconomic differentiation internal to specific Xavante communities. Additionally, they have begun publishing the results of longitudinal studies that document phenomena that had not yet been evident in cross-sectional approaches. In this chapter, they illustrate these new directions with examples of recent research on dental health, demography, and nutrition transition. These examples demonstrate the interrelatedness of health and various ecological, political, economic, and sociocultural transformations of different temporal scales.

Physical growth curves of indigenous Xavante children in Central Brazil: results from a longitudinal study (2009–2012)

Abstract Background: The nutritional profile of Indigenous children in Brazil is comparable to those observed in some of the least developed regions of the world. Aim: Weight and height growth curves were characterised based on longitudinal data from a local Indigenous population experiencing the double burden of child under-nutrition and adult obesity. Subjects and methods: Anthropometric data were collected in six waves from 2009–2011 for children <10 in two proximate Xavante villages in Central Brazil. Prevalence rates for stunting, wasting and thinness were calculated using WHO references. Weight and height data were adjusted for generalised additive mixed models to generate growth curves. Results: Prevalence rates of stunting and wasting were high, but cases of thinness and excess weight were negligible. Weight and height began close to WHO medians, but fell substantially before 12 months. Boys but not girls were able to catch-up in weight before age 10. From 3–10 years, height for both sexes remained between −2 and 0 z-scores. Conclusion: Impaired Xavante growth before 1 year followed by inconsistent recovery before 10 years reflects health and wellbeing disparities with regard to the Brazilian national population and a complex epidemiology of growth involving rapid nutritional change.

Hierarchy, symmetry, and the xavante spiritual life cycle

Xavante society, well-known for its dual structural aspects, provides the best documented example of a formal age-group system in South America. Although the basic features of the Xavante secular age-group system were previously described, a second age-group system in the spiritual domain is presented here for the fi rst time. In this paper, I describe the Xavante spiritual life cycle, including a structural dyna- mic whereby age sets pass through age grades in alternate fashion, allocating them between two moieties. That basic morphology is shared with the secular age-group system and attests to a Xavante logic of hierarchy and symmetry as mutually construc- ted and non-contradictory. Interactions between the spiritual and secular age-group systems manifest in the daily experience of spiritual participants in ways that suggest plurality and contingency are essential features of Xavante social organization.

Transição alimentar e diversidade cultural: desafios à política de saúde indígena no Brasil

A seguranca alimentar e um importante tema da vida contemporânea, ganhando contor-nos ainda mais relevantes no cenario atual da globalizacao em economias emergentes. No Brasil, a politica oficial de seguranca alimentar se anuncia como iniciativa intersetorial que busca garantir o acesso sustentavel a uma alimentacao saudavel, pautada pelo respei-to as diversidades culturais. Apesar dessa recomendacao, a implementacao das atividades neste campo e aqui – como em outras realidades – marcada pela padronizacao na oferta de alimentos, com implicacoes negativas na variabilidade cultural das praticas alimentares humanas.A transicao alimentar e inerente aos processos de industrializacao e de urbanizacao que hoje regulam o acesso aos alimentos. Tais eventos assumiram escala planetaria, alcan-cando aqueles cujas vidas situam-se em polos mais distantes da linha principal da globali-zacao, como os povos indigenas.No Brasil, os discursos cientificos e institucionais sobre a saude indigena tem alertado sobre o rapido incremento de doencas cronicas associadas ao crescente consumo de ali-mentos industrializados e as mudancas nos padroes de atividade fisica. Como ocorre em outros grupos populacionais, essa transicao alimentar redunda em sobrepeso e obesidade em adolescentes e adultos, associando-se a doencas cardiocirculatorias, hipertensao e dia-betes e coexistindo, nao raro, com desnutricao infantil. Solucoes para o problema deman-dariam transformacoes individuais e coletivas de comportamentos, de extrema complexi-dade, que transcendem os atuais modos de indigenas de vida. Nessa otica, a mudanca da alimentacao deve ser entendida como um fenomeno simultaneamente local e global.Numa perspectiva antropologica, a alimentacao deve ser vista como uma dimensao da cultura em interacao dinâmica com o meio ambiente, a economia e os valores e crencas de cada grupo social. Assim, o empobrecimento das dietas indigenas consequente a aflu-encia de um grupo restrito de alimentos industrializados adquiridos de moto proprio ou priorizados nas acoes de seguranca alimentar, implica risco a diversidade sociocultural do Brasil indigena. A perspectiva mais estreitamente biologica na area de nutricao nao leva em consideracao as dimensoes simbolicas e afetivas intrinsecas ao consumo alimentar das etnias atendidas. Parte do problema esta ligada ao desconhecimento das ricas e variadas culturas alimentares indigenas e de suas implicacoes na manutencao de niveis nutricio-nais adequados.Os comportamentos alimentares de indigenas, como os de quaisquer outras pessoas, sao determinados por suas visoes de mundo. Visoes de mundo diversas implicam multipli-cidade de tradicoes alimentares, que deveriam ser conhecidas para subsidiar a proposicao de estrategias de saude participativas, com vistas a integralidade e humanizacao da politi-ca de seguranca alimentar.Abordar a transicao alimentar ora em curso entre os povos indigenas requer o reco-nhecimento da diversidade cultural dos grupos envolvidos. Trata-se de importante desafio para a ampliacao da reflexao da academia e dos servicos de saude com vistas a prover fer-ramentas de apoio a geracao de politicas publicas culturalmente sensiveis. Nesse labor, o conhecimento antropologico representa uma via privilegiada para estimular a colaboracao interdisciplinar e intercultural necessaria a efetiva promocao a saude que o tema requer.

Anemia e níveis de hemoglobina em crianças indígenas Xavante, Brasil Central

RESUMO: Objetivo: Avaliar a prevalencia de anemia, os niveis medios de hemoglobina e os principais fatores nutricionais, demograficos e socioeconomicos associados em criancas Xavante, em Mato Grosso, Brasil. Metodos: Realizou-se inquerito em duas comunidades indigenas Xavante na Terra Indigena Pimentel Barbosa visando avaliar todas as criancas com menos de dez anos. Foram coletados dados de concentracao de hemoglobina, antropometria e aspectos socioeconomicos/demograficos por meio de avaliacao clinica e questionario estruturado. Utilizaram-se os pontos de corte recomendados pela Organizacao Mundial da Saude (OMS) para a classificacao de anemia. Analises de regressao linear com hemoglobina como desfecho e regressao de Poisson com variância robusta com presenca ou nao de anemia como desfechos foram realizadas (intervalo de confianca de 95% -IC95%). Resultados: Os menores valores medios de hemoglobina ocorreram nas criancas com menos de dois anos, sem diferenca significativa entre os sexos. A anemia atingiu 50,8% das criancas, prevalecendo aquelas com menos de dois anos 2 anos (77,8%). A idade associou-se inversamente a ocorrencia de anemia (razao de prevalencia - RP - ajustada = 0,60; IC95% 0,38 - 0,95) e os valores medios de hemoglobina aumentaram significativamente conforme o incremento da idade. Os maiores valores de escores z de estatura-para-idade reduziam em 1,8 vez a chance de ter anemia (RP ajustada = 0,59; IC95% 0,34 - 1,00). A presenca de outra crianca com anemia no domicilio aumentou em 52,9% a probabilidade de ocorrencia de anemia (RP ajustada = 1,89; IC95% 1,16 - 3,09). Conclusao: Elevados niveis de anemia nas criancas Xavante sinalizam a disparidade entre esses indigenas e a populacao brasileira geral. Os resultados sugerem que a anemia e determinada por relacoes complexas e variaveis entre fatores socioeconomicos, sociodemograficos e biologicos.Objective: To evaluate the prevalence of anemia, mean hemoglobin levels, and the main nutritional, demographic, and socioeconomic factors among Xavante children in Mato Grosso State, Brazil. Methods: A survey was conducted with children under 10 years of age in two indigenous Xavante communities within the Pimentel Barbosa Indigenous Reserve. Hemoglobin concentration levels, anthropometric measurements, and socioeconomic/demographic data were collected by means of clinical measurements and structured interviews. The cut-off points recommended by the World Health Organization were used for anemia classification. Linear regression analyses with hemoglobin as the outcome and Poisson regression with robust variance and with the presence or absence of anemia as outcomes were performed (95%CI). Results: Lower mean hemoglobin values were observed in children under 2 years of age, without a significant difference between sexes. Anemia was observed among 50.8% of children overall, with the highest prevalence among children under 2 years of age (77.8%). Age of the child was inversely associated with the occurrence of anemia (adjusted PR = 0.60; 95%CI 0.38-0.95) and mean hemoglobin values increased significantly with age. Greater height-for-age z-score values reduced the probability of having anemia by 1.8 times (adjusted PR = 0.59; 95%CI 0.34-1.00). Presence of another child with anemia within the household increased the probability of the occurrence of anemia by 52.9% (adjusted PR = 1.89; 95%CI 1.16-3.09). Conclusion: Elevated levels of anemia among Xavante children reveal a disparity between this Indigenous population and the national Brazilian population. Results suggest that anemia is determined by complex and variable relationships between socioeconomic, sociodemographic, and biological factors.

Introduction: Special Issue on Fire Ecology and Ethnobiology

Anthropologists have been studying fire’s evolutionary and cultural significance for over a century (e.g., Burton 2009; Pausas and Keeley 2009; Wrangham 2009). For several decades ethnobiologists (e.g., Anderson 2005) have addressed why and how people use fire to manage resources and studied the effects of anthropogenic burning. Attention to fire ecology has blossomed during the last decade within anthropology and ecology, as well as in other academic disciplines such as history (e.g., Pyne 1998) and applied fields such as conservation science (Driscoll et al. 2010). This burgeoning interest in fire ecology coincides with explosive growth in climate change science (Oreskes 2004) and therefore presents a strategic opportunity for contributions by ethnobiologists. In May 2013, we launched a conversation about fire ecology and global change at the 36th Annual Conference of the Society of Ethnobiology, and now amplify this debate about the biological and cultural impacts of fires in this special issue on fire ecology and ethnobiology. Authors of the papers in this collection present recent research addressing ecological, social, and political processes in settings where anthropogenic fire is or was central to cultural landscape dynamics. The papers that comprise this issue are ethnographically thick and scientifically rigorous, exemplifying the strengths of applying transdisciplinary scholarship to complex problems. The methodological tools they draw on—such as archaeobotany, geospatial analysis, and ethnography— are diverse. Nevertheless, they speak similarly to crucial issues about how anthropogenic fires link to multi-scale, multi-species processes. Theoretically, they seek to explore the relationships between fire ecology and human ecology in ways that are relevant for biological conservation and cultural diversity. The issue is organized in three sections. The first includes three contributions on prehistoric burning and vegetation change in North America that apply ethnographic and archaeological evidence to reevaluate widely accepted models of human influences on past vegetative landscapes. The second section includes two articles drawing on geospatial analysis, census data, and ethnographic observation to address the ecological dynamics of anthropogenic fire regimes. The final section is comprised of three papers on the use of fire by Indigenous peoples within conservation lands in Australia and Brazil. In the first section, Anderson and Rosenthal draw on extensive demographic, historical, and ethnographic evidence to argue that prehistoric Indigenous