Assessing variation in health status in the Andes: a biocultural model.

Research on health status in the Andes highlands is synthesized to demonstrate that intracultural diversity in the region is greater than often appreciated. Understanding the range of diversity in health status requires a biocultural model of sickness processes. Ecological, sociocultural, political-economic and historical factors, such as altitude, mode of production, labor relations and land reform, are shown to combine to produce varying levels of health as measured at the community level. The model is illustrated both by comparing communities and by the in-depth examination of a single community in the northern Peruvian highlands. A rapid assessment checklist is provided to aid health agents in better assessing the relative health of communities in a potential intervention area.