Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, San Martín de Porres, Peru.
The Priestley Center for Climate Futures, University of Leeds, Leeds, UK.
BMJ Glob Health. 2024 Sep 7;8(Suppl 3):e014391. doi: 10.1136/bmjgh-2023-014391.
Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems.
This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks.
Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses.
Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment.
在 COVID-19 大流行期间，土著知识和应对措施被付诸实施，以保护健康，展示了土著社区参与卫生系统如何成为增强对气候变化等突发危害的复原力的途径。本研究旨在通过以下方式为加强卫生领域的气候变化适应能力提供信息：（1） 检查秘鲁亚马逊地区卫生系统是否以及如何适应气候变化，（2） 了解土著社区和领导人对气候危害的应对措施如何在正式卫生系统中得到阐述，（3） 提出增加亚马逊卫生系统适应气候变化能力的建议。
本研究在秘鲁亚马逊地区的胡宁和洛雷托两个医疗保健网络中进行。采用混合方法设计，使用横断面调查（13 个医疗设施）、半结构化访谈（27 名正式卫生系统参与者和 17 名土著参与者）和两次面对面研讨会来验证和选择重点（32 名参与者）。我们使用与世界卫生组织卫生系统组成部分相关联的具有气候弹性的卫生系统框架。
秘鲁亚马逊地区的土著和正式卫生系统正在适应气候变化。土著应对措施包括利用关于天气变化的土著知识、植物药来管理健康风险以及建立网络来分享食物和资源。正式卫生系统的应对措施包括气候变化战略和应对平台，这些主要是在发生气候灾害之后才采取的。将土著和正式卫生系统联系起来的关键途径包括将土著代表纳入气候和卫生治理、培训卫生工作队伍、改善服务提供和获取、加强支持土著应对措施的证据以及增加气候紧急情况应对的预算。
关键的复原力途径要求卫生系统发生更广泛的范式转变，承认土著复原力对健康适应的价值，朝着更具参与性的卫生系统发展，并扩大健康作为与环境内在相关的维度的视野。
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