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APHA Scientific Session and Event Listing

Recorded presentation

Alicia Ely Yamin, JD MPH, Director, Research and Investigations, Physicians for Human Rights, 2 Arrow Street, Suite 301, Cambridge, MA 02138, 617-301-4213, ayamin@phrusa.org, Hector Sanchez Perez, MD, Health, Colegio de la Frontera Sur, Carr. Panamericana y Periferico Sur s/n, San Cristobal de las Casas, Mexico, and Marcos Arana, MD, CAMADDS-CDESC, 5 de febrero, San Cristobal de las Casas, 29200, Mexico.

Background: This presentation discusses the situation regarding health conditions and services in the conflict zone in Chiapas, Mexico and how governmental policies in reaction to the Zapatista uprising have spawned intra- and inter- community tensions, which in turn have affected people's rights to health. It explores how a rights-based approach in the health sector can promote peaceful resolution to the conflict.

Methods: A cross-sectional, population-based household survey was supplemented by semi-structured interviews with community-based governing councils in the three Chiapanecan regions most adversely affected by the conflict with the Zapatistas. 54 communities with under 2500 inhabitants were randomly selected, and surveys were conducted with 17,931 individuals from 2,997 households.

Results Social determinants of health were precarious in all the communities studied and basic public health measures such as vaccination were threatened by continuing low-level conflict and fragmentation of communities. Malnutrition, maternal mortality, and TB rates were alarmingly high. Systematic discrimination was found throughout the health sector.

Discussion The fragmentation of communities and politicization of care since the conflict began has grave implications for the accessibility and use of health services in the region, as well as for health conditions. There are multiple levels of discrimination against the population in the study area, based on political affiliation, religion, gender and ethnicity.

Conclusions Conditional and discriminatory utilization of government programs after the Zapatista uprising, contributed to increased internal polarization in many Chiapanecan communities. A rights-based approach requires devolution of control over health to communities and supports a negotiated solution to the conflict.

Learning Objectives:

• -Identify concrete ways in which low-intensity conflict undermines people’s rights to health, as well as health status.
• -Recognize connections between right to health approach to providing services and resolution of underlying conflict.
• -Articulate rights-based imperatives for providing health services in situations of low-intensity conflict.

Keywords: Indigenous Populations, Human Rights

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation