ABSTRACT
By most measures, the health of indigenous peoples 1 in Latin America's lowlands is terrible. These small ethnic groups of rarely more than 50,000 individuals, and commonly fewer than 5000, live in or near some of the world's last resource frontiers, including the Amazon and Orinoco basins, the Pacific lowlands of the Andes, and the Caribbean littoral. For the past half-century, if not much longer, they have faced a “perfect storm” of epidemiological misery (Coimbra and Santos 2000, 2004). Land-invading colonists bring new diseases (such as dengue and whooping cough), and mining and dam-building create ideal environments for malaria and schistosomiasis vectors (Souza-Santos et al. 2008; Gracey and King 2009). Loss of land and resources intensifies diseases associated with crowding, rapid dietary change, and food insecurity, such as tuberculosis, diarrheal infection, pneumonia, and parasitic infection (Hames and Kuzara 2004; Raich 2004; Coimbra and Basta 2007). Moreover, distance, poverty, discrimination, and government apathy contribute to appalling health service delivery (Nawaz et al. 2001; Gracey and King 2009).
