Intervention mapping to address social and economic factors impacting indigenous people’s health in Suriname’s interior region

Abstract

BackgroundPrevious studies found that while internationally financed economic development projects reduced poverty when measured in terms of per capita GDP, they also caused indigenous people to become disassociated, impoverished and alienated minorities whose health status has declined to unacceptable lows when measured in terms of mercury poisoning and the burgeoning rate of suicide. In this study, we developed a needs assessment and a policy-oriented causal diagram to determine whether the impaired health of the people in this region was at least partially due to the role the country has played within the global economy. Specifically, could the health and well-being of indigenous people in Suriname be understood in terms of the foreign investment programs and economic development policies traceable to the Inter-American Development Bank’s Suriname Land Management Project.MethodsInterviews took place from 2004 through 2015 involving stakeholders with an interest in public health and economic development. A policy-oriented causal diagram was created to model a complex community health system and weave together a wide range of ideas and views captured during the interview process.ResultsConverting land and resources held by indigenous people into private ownership has created an active market for land, increased investment and productivity, and reduced poverty when measured in terms of per capita GDP. However, it has also caused indigenous people to become disassociated, impoverished and alienated minorities whose health status has declined to unacceptable lows.While the effects of economic development programs on the health of vulnerable indigenous communities are clear, the governance response is not. The governance response appeared to be determined less by the urgency of the public health issue or by the compelling logic of an appropriate response, and more by competing economic interests and the exercise of power.ConclusionThe health and well-being of the indigenous Wayana in Suriname’s interior region is at least partially due to the role the country has played within the global economy. Specifically, the health and well-being of indigenous people in Suriname can be understood to be a result of foreign development bank-funded projects that drive the government of Suriname to trade land and natural resources on the global market to manage their country’s balance of payments.

Global Health Diplomacy Amid the COVID-19 Pandemic: A Strategic Opportunity for Improving Health, Peace, and Well-Being in the CARICOM Region—A Systematic Review

“…The balance of payments requirements motivate the Suriname government to adopt adjustment policies that dispossess indigenous people of their land and livelihoods. It is an example of how the health and well-being of indigenous people are linked to inequalities generated by a neoliberal approach to economic development (Peplow and Augustine 2017). Perhaps, more "people-centered" policies for economic-development that meets the "balance-of-payment" goals, as outlined in the UNDP 1997-2002, can be developed and adopted.…”

Adaptation of an Evidence-Based Cardiovascular Health Intervention for Rural African Americans in the Southeast

“…The tension between fidelity and adaptation is a recurrent theme in implementation literature and changes to EBIs can pose a threat to internal validity. 7,23,24 We used our collaborative adaptation process to identify intervention core components and consider multiple fidelity and adaptation trade-offs. Primarily, we had to balance community expertise regarding adaptations they felt were necessary to enhance feasibility of implementation with the academic team members' concerns regarding maintaining fidelity.…”

Using Satellite Data to Estimate Risk of Mercury Exposure in the Amazonian Wayana Language Territory between Suriname, French Guiana, and Brazil

“…Acknowledging the extreme nature of the Wayana health crisis, global health practitioners are compelled to address the large-scale social forces at work. While the attention paid to technological and behavioral solutions at the individual level yields important health outcomes, attention should also be paid to structural causes of disease, disability and premature death [13].…”

“…Spatial trends are not obvious and many areas in the Amazon have never been studied. The effects of mercury contamination occur at different scales and levels of biological organization and there are potential opportunities for intervention at each level [12,13]. Since toxicity is a mechanism that operates at the molecular level, the degree to which cause and effect are related (i.e., speci city), the knowledge of the mechanisms of toxicity and apparent opportunities to design and implement appropriate and effective intervention measures is greater at the individual and community level.…”

“…In situations where the contributing factors responsible for exposure lie outside the health sector and are socially, politically and economically formed, they may not be easily identi ed at this level. The examination of Hg risk at multiple levels of social and biological organization are, therefore, needed to identify the full range of mechanisms of exposure and toxicity and to more completely identify apparent opportunities for intervention [12,13].…”