Ibacache Burgos J. La salud, el desarrollo y la equidad en un contexto intercultural. [Health, development and equity in an intercultural context.] Salud y Cambio [Health and Change] (Santiago, Chile) 1997; 23:32-36.

Objectives: Compare the concepts of equity and development in western medical culture with those in the culture of the Mapuches, a native Indian population concentrated in the southern regions of Chile and Argentina . Formulate an intercultural epidemiology capable of incorporating these different world-views in understanding and approaching the problems of health and disease.

Methodology: Descriptive-ethnographic analysis.

Results: Chilean society is multi-ethnic, with a majority population of Hispanic andmestizo origin, and with groups of native Aymara, Quechua, Atacameño, Rapanui, Coya, Mapuche, and Kawaskar. These indigenous groups manifest socio-cultural differences and a special world-view in comprehending the problems of health and illness.

The study verifies major differences in conditions of life and health between the indigenous groups and the rest of the population. Some indigenous territories register a rate of infant mortality that is twice the national average; similar rates occur with other pathologies such as tuberculosis, bronchopneumonia, and hepatitis.

In the Mapuche world-view, there exists a fullness, a whole, made up of man, the environment, and a collection of beings and forces which rule over the first two. In this holistic conception of the world, illness displays a double aspect: objective and moral. The Mapuche comprehend illness as a disequilibrium or transgression of not only the individual who is ill but of the family group and, in the last analysis, of the community. Development in turn is conceived as the fulfillment of a destiny predetermined at birth. This individual destiny in turn forms part of the destiny of the family, or Rukache, in the mapuche village. Development manifests itself in a frame of mind or behavior that neither harms the future nor destroys the present, attainable through a constant learning about the past. Required of development, orkelluwam, for the Mapuche is knowledge transmitted in oral form, handed down from ancestors through the oldest members of the community. This knowledge must be respected and learned by the young.

From this holistic vision the concepts of equity, health, and development find their expression in the termKüme Mongñen, referring to the concept of equilibrium between the individual, nature, and the supernatural.

The author notes the usefulness of tools such as Epi-Info and Epi-Map (computer-based epidemiological programs) in planning participatory activities suited to socio-cultural realities.

Conclusions: Interculturality in health implies an equilibrium between different beliefs and practices with respect to health and illness, life and death, and the biological, social, and relational self, even if at times these beliefs and practices contain elements that exist in opposition. Heightened valuation of traditional indigenous medical cultures conveys a view of equity as open to different learning systems, to sharing knowledge, to accepting diversity, and to fostering participation. This process requires the development of an epidemiological outlook with a social, territorial, and cultural focus, which generates solutions in those spaces where people live and involves their participation.