Ricardo Ventura Santos

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.

Saúde, minorias e desigualdade: algumas teias de inter-relações, com ênfase nos povos indígenas no Brasil

No Brasil, nao ha uma producao sistematica acerca do peso da dimensao etnico-racial na expressao diferenciada dos agravos a saude. No cotidiano, minorias vivenciam situacoes de exclusao, marginalidade e discriminacao que as colocam em posicao de maior vulnerabilidade frente a agravos a saude. Neste texto e enfocada, em particular, a situacao dos povos indigenas. Coeficientes de morbi-mortalidade mais altos do que os registrados em nivel nacional, fome e desnutricao, riscos ocupacionais e violencia social sao apenas alguns dos multiplos reflexos sobre a saude decorrentes da persistencia de desigualdades. E importante que sejam realizados esforcos no sentido de reverter uma preocupante invisibilidade demografica e epidemiologica resultante da ausencia de informacoes confiaveis para as populacoes indigenas nas bases de dados oficiais. Isso possibilitara compreender melhor a genese, determinantes e formas de reproducao das desigualdades em saude no Brasil. Tais conhecimentos sao fundamentais para o embasamento tanto de atuacoes politicas, inclusive por parte de liderancas indigenas, como de intervencoes com vistas a promocao da equidade em saude.

Nutrition Transition in Amazonia: Obesity and Socioeconomic Change in the Suruí Indians from Brazil

The purpose of this study was to assess the nutritional status of the adult Suruí population, an indigenous society from the Brazilian Amazon, as it relates to socioeconomic conditions. Fieldwork was carried out in February–March 2005, including 252 individuals (88.1% of the total eligible subjects older than 20 years of age in the villages surveyed). Anthropometric measurements were performed following standard procedures, and percentage of body fat (%BF) was measured by bioimpedance. To classify the Suruí according to socioeconomic status (SES), an index was constructed based on a group of variables to characterize socioeconomic differentiation. Evaluated by body mass index (BMI), the majority of Suruí 20–49.9 years of age were overweight (42.3%) or obese (18.2%). The frequency of obesity for women (24.5%) was twice that recorded for men. Subjects classified as overweight or obese also showed high %BF and waist circumference (WC). Women in the high SES category showed higher anthropometric values (including weight, BMI, arm fat area, and WC) and %BF than those of lower SES. This study shows that the Suruí are undergoing a rapid process of nutrition transition. This transition is closely associated with the emergence of intragroup differences in SES which have impacted diet and physical activity patterns. In research in indigenous peoples in Amazonia, greater attention should be paid to the human biological outcomes of socioeconomic transformations related to the growing involvement of native societies in the market economy. Am. J. Hum. Biol., 2008.

Color, Race, and Genomic Ancestry in Brazil Dialogues between Anthropology and Genetics

In the contemporary world, “race” narratives are so multifaceted that at times, different views of the concept appear mutually incompatible. In recent decades biologists, especially geneticists, have repeatedly stated that the notion of race does not apply to the human species. On the other hand, social scientists claim that race is highly significant in cultural, historical, and socioeconomic terms because it molds everyday social relations and because it is a powerful motivator for social and political movements based on race differences. In this paper we present the results of an interdisciplinary research project incorporating approaches from genetics and anthropology. Our objective is to explore the interface between information about biology/genetics and perceptions about color/race in Rio de Janeiro, Brazil. We argue that the data and interpretation of our research resonate far beyond the local level, stimulating discussion about methodological, theoretical, and political issues of wider national and international relevance. Topics addressed include the complex terminology of color/race classification in Brazil, perceptions about ancestry in the context of ideologies of Brazilian national identity, and the relationship between genetic information about the Brazilian population and a sociopolitical agenda that turns on questions of race and racism.

Avaliação do estado nutricional num contexto de mudança sócio-econômica: o grupo indígena Suruí do estado de Rondônia, Brasil

This paper details the results of a nutritional assessment conducted with 147 Suruí Amerindian children 0-8.9 years of age from the Aripuanã Indian Park, Rondônia, Brazil. The data include anthropometry, hemoglobin concentration levels, and stool examinations. The Suruí reservation is located in an area which experienced intensive government-oriented colonization and immigration over the past three decades. The group was contacted by the Brazilian Indian Foundation (FUNAI) in 1969 and, recently, became more involved in the regional market economy, which led to partial abandonment of traditional subsistence strategies. Compared to international reference curves (NCHS), the results indicate high levels of low height for age (46.3%), weight for age (31.9%) and weight for height (6.6%). Anemia (71.2%) and intestinal parasitism (over 75%) are also common. The authors argue that the precarious nutritional status of the Suruí children reflects nutritional problems due to a reduction in the Suruí food production system as well as inadequate sanitary conditions of the various villages.

Mortalidade infantil segundo raça/cor no Brasil: o que dizem os sistemas nacionais de informação?

This study analyzes the consistency of the Brazilian national information systems on mortality (SIM) and live births (SINASC) as data sources for evaluating health inequalities according to race/color. Infant mortality rates (IMRs) were obtained according to race/color from death and live birth certificates for the country as a whole and its regions, for the years 1999-2002. The IMR was also estimated according to race/ color, based on the incorporation of deaths and live births with race/color not reported by two criteria. The study compared the IMRs obtained in the study with those estimated by indirect methods. The IMR ratios were also calculated between race/color categories. A substantial reduction was observed during the period in the number of deaths and live births with race/color not recorded. In 2002, infant mortality in black children was 30.0% to 80.0% higher than that of white children and 40.0% to 80.0% higher than that of brown or mixed-race children (pardas); infant mortality in indigenous children was 40.0% to 90.0% higher than that of white or brown children. It is hoped that improved recording in the SIM and SINASC databases will allow a more in-depth discussion of health inequalities according to race, color, and ethnicity in Brazil.

Ecologia humana e antropometria nutricional de adultos Xavánte, Mato Grosso, Brasil

This study compares anthropometric and ecological profiles of two Xavante indigenous communities in Mato Grosso, Central Brazil. The research describes time allocation patterns and involves an anthropometric survey (including body mass, stature, and BMI) in adults over 20 years of age. Data from Etenitepa (also known as Pimentel Barbosa) were collected in 1994. Field work at Sao Jose was conducted in 1998 and 1999. Compared with the Sao Jose group, Xavante in Etenitepa do more subsistence activities like farming, fishing, hunting, and gathering. The Sao Jose Xavante do more paid work and generally engage in less physical activity. Average stature in the two communities is similar, but there are major differences in mean body mass and BMI. The Sao Jose group has average BMI values well over those of the Etenitepa group in practically all age brackets. Obesity prevalence rates were high in both men (24.6%) and women (41.3%) in Sao Jose, while in Etenitepa the rates were only 2.5% and 4.8%, respectively. The authors conclude that the different nutritional profiles in the two communities result from specific patterns of social, political, and economic interactions with Brazilian society.

Supraspinal influences on the penile reflexes of the male rat: A comparison of the effects of copulation, spinal transection, and cortical spreading depression ☆

Abstract The penile reflexes of the rat were observed on interruption of the copulatory behavior sequence after intromission and ejaculation in the initial ejaculatory series, after the penultimate series, during sexual exhaustion, and during recovery from sexual exhaustion 24 and 72 hr later. These were compared to the reflexes of the normal rat in control conditions, to those of the male rat after spinal transection, and to those of the sexually rested and sexually exhausted male rat under cortical spreading depression (CSD). It was concluded that (1) the stimuli associated with copulation evoke disinhibition of the penile reflexes, these showing the short reflex latencies observed in the spinal animal. The release of the spinal mechanisms is lost within 30 min of the last copulatory event. CSD further inhibits reflex responsivity. (2) Stimuli associated with intromission provoke acceleration of the normal rhythmic presentation of reflexes seen in the normal and spinal rat, resulting in a decrease in the duration of intervals between reflex clusters and an increase in reflex number. This excitation decays within about 15 min after intromission. (3) The increase in degree of penile extension and percentage of penile flips after spinal transection suggests tonic inhibition of reflex intensity in the normal rat. The decrease in capacity to attain full erection with the approach of sexual exhaustion suggests an increase in this inhibition. This does not recover during a rest period but instead intensifies. CSD effects did not mimic the effects of spinal transection but instead depressed reflex excitability. The relationship of these changes to the copulatory behavior pattern is discussed.

Estado nutricional e anemia em crianças Suruí, Amazônia, Brasil

OBJETIVO: Analisar o perfil nutricional de criancas indigenas Surui menores de 10 anos atraves da antropometria e da dosagem de hemoglobina. METODOS: A pesquisa foi conduzida em fevereiro-marco de 2005 na Terra Indigena Sete de Setembro, na fronteira de Rondonia com Mato Grosso. Estatura e peso foram obtidos segundo tecnicas padronizadas e comparados a referencia do National Center for Health Statistics (n = 284). A concentracao da hemoglobina foi determinada utilizando b-hemoglobinometro portatil (Hemocue) (n = 268). RESULTADOS: As porcentagens de criancas com deficit (escore z < -2) nos indices estatura para idade, peso para idade e peso para estatura foram 25,4, 8,1 e 0%, respectivamente. Nas menores de 5 anos, foram 31,4, 12,4 e 0%, respectivamente. A ampla maioria das criancas estava anemica (80,6%), alcancando 84,0% naquelas de 6 a 59 meses de idade. CONCLUSOES: Os resultados apontam para um quadro de alta prevalencia de desnutricao e anemia nas criancas Surui. A comparacao com resultados de inquerito anterior indica que houve reducao expressiva na prevalencia de baixa estatura para idade entre 1987 e 2005 (de 46,3 para 26,7% nas criancas menores de 9 anos). Por sua vez, 3,9% das criancas apresentaram sobrepeso em 2005, o que nao foi observado em 1987. As prevalencias de anemia nao se modificaram substancialmente entre os dois periodos. Apesar das melhoras observadas no perfil antropometrico, as prevalencias de deficits nutricionais ainda permanecem muito mais elevadas que as observadas na populacao brasileira em geral. Impoe-se a necessidade da implantacao de atividades sistematicas e regulares de monitoramento do crescimento e desenvolvimento das criancas indigenas, com enfase na vigilância nutricional.

Crescimento físico e estado nutricional de populações indígenas brasileiras

This paper reviews the literature on the physical growth of native populations from Brazil. Studies aiming at relating the physical growth patterns of these populations to their nutritional status are relatively recent and still do not provide a comprehensive picture of the situation. Compared to non-indigenous Brazilian children and international reference populations (NCHS), indigenous children are short and light for their age, although they maintain their body proportionality, as evaluated by weight for height. These findings could be interpreted as an indication of high rates of chronic protein-energy undernutrition. At least for some groups, data derived from health surveys provide further indication of the existence of marginal nutrition. It is pointed out, however, that international reference curves may not be appropriate for evaluating the physical growth of specific populations, which may be the case of Brazilian indigenous children. It is also pointed out that changes in subsistence practices and in health profiles due to the acculturation process may contribute to the deterioration of nutritional status of indigenous peoples.