In Chile, the incorporation of Indigenous perspectives of health and wellbeing into mainstream health practices has mainly centred around the concept of ‘intercultural health’; that is, approaches that seek to articulate traditional Indigenous and biomedical health care and practices. However, fulfilling the underlying principles of interculturality—respect for and preservation of cultural knowledge, Indigenous self-sovereignty, and culturally appropriate and accessible care—requires a shift in the balance of power between the State and Indigenous peoples which has not yet been realised. Furthermore, the focus on incorporation of traditional practices into mainstream services leaves ambiguous and conflicted underlying assumptions that drive the continued dominance of biomedicine. That is, there is a lack in the biomedical sector to understand their own cultural and historical roots and dominance. This reflexivity is a key aspect to building a shared understanding and knowledge with Indigenous communities and to develop intercultural models regarding the processes of health, wellbeing and illness.
The majority of intercultural health models in Chile have been driven by the demand and advocacy of communities themselves. However, on the part of the State, there has also been a growing discourse and emphasis on the participation of Indigenous peoples in the health care system as part of the development of intercultural health care. This has manifested in three main ways: expanded consultative processes; the use of intercultural facilitators; and deliberative roundtables attended by both State and community representatives. While these actions represent important advances, there remains a lack of mechanisms allowing for Indigenous communities to undertake shared or autonomous decision-making. Nevertheless, the existence of strong national and international legislative structures, an increase in political will to strengthen representation of Indigenous values and perspectives in health and continued community demand and organisation may provide the basis for further action.
Suggestions to build on existing opportunities to strengthen State recognition of Indigenous cultural and traditional understandings of health, reform current health policy and practice and align Indigenous health research to do so are considered.