A saúde indígena no Brasil
Ruben Schindler Maggi
Revista Brasileira de Saúde Materno Infantil
The 'official' indigenous population of Brazil, according to the 2010 Census of the Brazilian Institute of Geography and Statistics (IBGE) is 896,917, a little under 0.5 % of the population of the country as a whole. In addition to the surprisingly exact figure, our attention is drawn to the significant rise in numbers of this group in recent years, which appears to be a result more from changes in the criteria used to identify indigenous individuals, than from demographic factors.
... this is a considerable portion of the population, which some deemed to be on the path to extinction between the 1950s and 1970s, when official figures estimated around 120,000 survivors of the nearly one thousand nations and five million individuals who the Portuguese conquistadors found on these lands in 1500. The history of European colonization of these Amerindian peoples shows that, in many countries, they were virtually decimated, partly through outright extermination in the course of long wars, but especially because of infectious diseases introduced by the colonists, sometimes unwittingly, as was the case with measles, influenza and tuberculosis, but also intentionally, as is reported in the case of some outbreaks of smallpox, when the forms of contagion by the disease were already known. All of this was exacerbated by slavery and poor nutrition. Largely caused by constant conflicts over land rights, the latter afflicts many ethnic groups, with grave nutritional consequences, especially among mothers and children and is one of the causes of the high morbidity and mortality índices among women and children, with rates and coefficients far higher than the Brazilian average. These indigenous populations, like those brought from Africa, were always treated unfairly and viewed with contempt by the ruling classes during colonization, with little in the way of moral constraints. It was only with the Enlightenment in the 18 th and 19 th centuries that the concepts of equality, fraternity and liberty gained ground and, in almost the whole of the American continent, including Brazil, the Independence movements then developed often provided policies that benefited less privileged groups. Brazil had to wait until 1910 for the emergence of the Indian Protection Service (SPI), although, since it was linked to the Ministry of Agriculture, it obviously gave priority to land rights issues. It was only in the 1950s that the Aerial Sanitary Units Service (SUSA), linked to the Ministry of Health emerged, with the aim of providing care in remote areas. The most important event in recent history was the creation of the National Indian Foundation (FUNAI) in 1967, although the extensive shortcomings of this organization led lawmakers to draw up a care model specifically for indigenous people in the 1988 constitution, which brought into existence the National Health System (SUS), and in 1991 that responsibility for indigenous health passed from FUNAI to the Ministry of Health. Special Indigenous Sanitary Districts (DSEIs) were set up as an "operational basis for SUS health care policy for indigenous populations", coordinated by the National Health Foundation (FUNASA). The technical inexperience of the latter, which was the cause of constant conflicts indigenous communities and health service providers alike, led the Ministry of Health to set up the Special Indigenous Health Department (SESAI) in 2010, which passed responsibility for management of the DSEIs over to social organizations, including the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in Pernambuco.