Cultural Politics and Health: The Development of Intercultural Health Policies in the Atlantic Coast of Nicaragua

Edgardo Ruiz

PhD Thesis 2006

The Autonomous Region of the North Atlantic of Nicaragua (RAAN) gained political autonomy in 1987 after indigenous Miskitu took up arms against the Nicaraguan government. As part of the autonomy process RAAN officials developed a policy document, The Health Model of the RAAN, that guides regional health system reform. The Health Model is guided by the concept of interculturalidad which is meant to simultaneously represent cultural difference, inter-connectedness and inequalities based on ethnic relations as historically constituted in society.

Drawing on fourteen months of participant observation in health meetings and workshops, and interviews with national and RAAN health officials, indigenous leaders, indigenous community members and health providers, this study examines the role of discourses of the indigenous movement, interculturalidad and cultural difference in the development and implementation of health policy in the RAAN. Analysis of interview material, health policy documents and meeting transcripts shows that although both Nicaraguan and RAAN health officials agree that the health system of the region should be guided by the notion of interculturalidad, the concept and process it represents is interpreted differently by the actors involved. For national health officials interculturalidad is simply recognition that culture is an important variable in health and that indigenous medicine should be accepted. For RAAN health officials interculturalidad is a political concept that also refers to the transfer of decision making power to the region. These interpretations lead to different policy propositions and conflicts in the negotiations between the national government and the RAAN. The concept of interculturalidad is broad and vague which makes it open to multiple interpretations, manipulations and degrees of control. The Nicaraguan government can therefore co-opt the discourse of interculturalidad and promote the image of a Nicaragua that recognizes its multi-ethnic character and its inclusiveness without implementing concrete policy changes that deal with resource distribution and political power.