Subjective And Objective Health In Indigenous And Non-Indigenous Older Persons In Chile

Abstract

The gradual increase in the population aged over 60 years in Chile has given rise to an increase in research activity focusing on this age segment. However, comparative studies among ethnic minorities are still insufficient. Life pathways in the specific case of the indigenous population tend to be less favourable; this results in an old age involving more social risk, particularly in the context of health. The purpose of the study is to analyse differences in health (subjective and objective) among indigenous and non-indigenous older persons in Chile. The methodology used in this study is quantitative and transversal, with a sample consisting of 800 elderly people and 71% of the sample describing themselves as indigenous (35% Aymara and 65% Mapuche). The most recurrent health problems were evaluated in old age, perceived health, use of medication (number) and average treatment, alcohol and drug consumption, and physical activity (exercise). The data were processed using standard statistical tests (Chi-Square). The findings and results of this study suggest that belonging to an indigenous ethnicity is related with differences in health. Specifically, the indigenous population showed more problems with cataracts and lungs and other health problems, in addition to presenting increased risk factors such as alcohol consumption. However, the results also indicate that the indigenous population engaged in more physical and sporting activities. In contrast, non-indigenous people reported more problems with high cholesterol, diabetes, osteoporosis and cancer, and had higher rates of smoking.

Keywords: Elderlyethnicityhealth; indigenous groups

Introduction

The aging process is constructed over a lifetime, and as such life pathways will determine how a person age. If life experiences have been positive, this may lead to good aging in functional, cognitive, psychological and social terms. Various biological approaches describe aging as “the accumulation of diverse deleterious changes occurring in cells and tissues with advancing age that are responsible for the increased risk of disease and death” (Tosato, Zamboni, Ferrini, & Cesari, 2007, p. 401). However, we may argue along the same lines in the social environment, in that a positive balance of life experiences, circumstances and pathways will mean that we reach old age with a reduced likelihood of psychosocial risk.

In this regard, health becomes a key factor in understanding the aging process. The term health refers to a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1983). This definition, which remains accepted today in scientific and political circles, entails incorporating the construct of overall wellbeing in order to understand health. In other words, good health is associated with a good life, with wellbeing and quality of life during the various life cycles and, particularly, during old age (Fernández-Mayoralas, Rojo-Pérez, Abellán, & Rodríguez-Rodríguez, 2003). In this respect, the empirical evidence confirms that good health at advanced ages is a determinant of successful aging (Cosco, Prina, Perales, Stephan, & Brayne, 2014) and particularly that enjoying high levels of cognitive, mental and physical functioning determines good aging (Kim & Park, 2017).

However, in addition to assessing health, there are contextual and cultural elements that play significant roles in understanding good aging processes. Specifically, we refer here to ethnicity – understood as “a term related to expressions of group identity and the feeling of belonging to a group” (Palenzuela & Olivi, 2011, p. 25). In the particular case of this study, we examine two ethnic issues: being of Mapuche or Aymara indigenous ethnicity and thus belonging to a specifically Andean cosmovision in the current situation of ethnic minority and, on the other hand, declaring oneself non-indigenous but Chilean, with a cosmovision that is also specific and more generalised. In international terms, the empirical evidence shows that belonging to ethnic minorities is associated with higher risk in old age. Specifically, that risk translates into worse health, more illnesses and even multiple comorbidities (Pace & Grenier, 2017).

Problem Statement

As previously noted, there are few studies that examine the implications of ethnic diversity in the aging process. This research is intended to offer a contribution in terms of identifying possible differences in health between indigenous and non-indigenous older persons. The starting point is the premise that there is a duality regarding health in indigenous communities: on one hand, their more adverse life pathways have resulted in greater predisposition to suffer illnesses or health problems in old age, but on the other, indigenous cultural practices act as protective mechanisms against ill-health. This is especially true of their healthy habits, such as a more balanced diet and a more active, less sedentary lifestyle.

Research Questions

The research hypotheses of this study were as follows:

1. There are significant differences between indigenous and non-indigenous older persons in terms of subjective health.

2. There are significant differences between indigenous and non-indigenous older persons in terms of chronic illnesses.

3. There are significant differences between indigenous and non-indigenous older persons in terms of lifestyle.

Purpose of the Study

The purpose of the study was to analyse differences in health (subjective and objective) between indigenous and non-indigenous older persons in Chile. Specifically, self-assessments of physical health were evaluated as the subjective aspect, while the objective aspects evaluated were related with the most commonly occurring health problems, medical treatment for those problems, consumption of medication, frequency of alcohol consumption, frequency of smoking, and frequency of physical activity.

Research Methods

The study was quantitative, with a transversal design. A questionnaire was applied via personal interview, having first obtained the informed consent of participants. Spanish was the main language used for the scales. Qualified social work and psychology professionals administered the questionnaire between August and November 2017. The Ethics Committee of Tarapacá University and the National Council for Science and Technology of Chile approved and monitored the ethical aspects of the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Findings

The hypotheses proposed in this study were contrasted with the χ2 test. Hypothesis 1 (“there are significant differences between indigenous and non-indigenous older persons in terms of subjective health”) was confirmed, as the results show that non-indigenous persons have a worse subjective perception of their health (15%) than indigenous persons (10%) (χ2=9.146; p=.05). In other words, the results show that subjective health is worse among non-indigenous persons.

Hypothesis 2 (“there are significant differences between indigenous and non-indigenous older persons in terms of chronic illnesses”) was also contrasted using the χ2 test. The results were analysed for each health problem. They show that non-indigenous persons have more problems with high cholesterol (25% non-indigenous v/s 16% indigenous), diabetes (26% non-indigenous v/s 19% indigenous), osteoporosis (7% non-indigenous v/s 2% indigenous) and a higher prevalence of cancer (3% non-indigenous v/s 1% indigenous). In contrast, indigenous older persons have more problems with cataracts (14% indigenous v/s 7% non-indigenous) and other health problems (12% indigenous v/s 4% non-indigenous). Included among these other problems are pain from spinal issues, knees, hearing, hernias and so on.Please replace this text with context of your paper.

Finally, hypothesis 3 (“there are significant differences between indigenous and non-indigenous older persons in terms of lifestyle”) was also contrasted using the χ2 test. The results in this respect show that non-indigenous persons smoke more (35% non-indigenous v/s 24% indigenous). However, indigenous persons consume more alcohol (24% indigenous v/s 15% non-indigenous) and engage in more physical activity (36% indigenous v/s 7% non-indigenous).

Conclusion

As suggested above, life pathways impact on the aging process. Among the indigenous communities studied, there are various protective cultural factors that have an influence in terms of improving subjective and objective health. As we have seen, Mapuche and Aymara indigenous older persons have a better subjective perception of their health, have fewer health problems and maintain healthy habits such as smoking less frequently and regularly doing physical exercise.

In this study, we propose that indigenous cultural resources in Chile act as protective mechanisms for physical health in old age. Specifically, we should take into account that the rural residential context may be having a positive impact in terms of the maintenance of certain indigenous practices that promote physical health, such as healthy and natural diet and engaging in regular physical exercise. As we proposed, diet is healthy and natural in rural areas in the north and south of Chile since indigenous communities are responsible for their own agriculture (family economy) and also for tasks relating to the care of animals. The geographical differences between the north (desert and highlands) and south (rainforests) determine diversity as regards type of diet. As such, the Aymara community bases its diet around quinoa, chuño (freeze-dried potato), beans, sweetcorn and various kinds of legumes, alongside proteins such as camelid meat (alpaca and llama). Meanwhile, the Mapuche community has a diet involving the consumption of various vegetables including in particular potatoes, sweetcorn, pine nuts (fruit from the Norfolk Island pine tree), squash, various legumes and yuyo (seaweed), together with high levels of consumption of milk and its derivatives (butter and cheeses) and meat from game birds and cattle. The essence of this traditional indigenous food is far removed from an industrial diet; it is also low in sugar, which explains the low incidence of diabetes and cholesterol. However, alcohol consumption is linked to cultural traditions that are exacerbated by religious ceremonies, making it a practice that is difficult to eradicate.

Another cultural aspect that explains the results obtained is the maintenance of an active lifestyle, which emerges from carrying out domestic activities involving considerable physical activity and is supplemented by a higher frequency of sporting activities among indigenous older persons. The aforementioned domestic activities of indigenous communities include shepherding of animals (Aymara) and sheep shearing (Mapuche). It would appear that the cosmovision among these communities involves an expectation that even when older, persons should remain physically active.

These findings invite further examination of the impact of indigenous cultural practices, life pathways and historical processes in the promotion of successful aging. As affirmed by Pace and Grenier (2017) “in the case pf indigenous people, successful aging takes place at the intersection of individual, social, and cultural contexts across the life course, and against particular historical, economic, and political backdrops” (p. 205). But it is also necessary to open up a space for understanding from the perspective of the indigenous cosmovision of the elements that impact on aging successfully and maintaining wellbeing; in other words, to recover the particular nature of their discourse.

Acknowledgments

This work was supported by the Government of Chile (“Proyecto FONDECYT 1170493”) and University of Tarapacá (“Proyecto UTA MAYOR 3764-18”).

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