Worlds Transformed Indigenous Peoples' Health in Changing Rainforests


It is said that one of the great ironies of conservation is that what has been preserved by a thousand wise men for athousand years may be destroyed by a few fools in an hour.

Indigenous populations have lived in rainforests for millennia and have adapted lifestyles intimately connected with nature and having relatively low environmental impact. In addition, they have maintained low population densities (for example, one Mbuti Pygmy per four square kilometers in the Congo basin). The result has been long-term conservation of the fundamental quality of the environment.

Over the past century and at an accelerating pace, outsiders and their activities have had enormous impacts on the rainforest homes and the societies of most rainforest indigenous peoples. Today, it is estimated that less than half a million indigenous hunter-gatherers and shifting agriculturalists remain in tropical rainforests worldwide. The three great remaining tropical rainforests are located in the Amazon River basin in South America, the Congo River basin in Africa, and the Malaysian peninsula and across Indonesia to Papua New Guinea, a region referred to as Malesia. Smaller rainforests remain scattered across South and Southeast Asia and southern China as well as northeastern Australia, islands in the Pacific, parts of Africa and Madagascar, and South and Central America. Rainforest-dwelling peoples include the Pygmies and Bantu in the Congo region, the Penan and Dayak peoples in Borneo, and multiple tribes and linguistic groups in New Guinea and Amazonia.

Indigenous people may be harmed by deforestation because they depend completely on the rainforest for their way of life. For this reason, they are often seen as natural allies for conservation. Yet some will argue that indigenous people would be better off if they gave up their traditional existence and joined local mainstream society with its material benefits and available services.

In most areas, indigenous peoples are indeed coming out of the rainforest and into the larger societies that surround them. Once they make this move, they often lead marginalized lives, losing traditional family and community, and experiencing a sense of their own irrelevance within the mainstream culture, low status, menial work, frequent landlessness and migration to the poorest sections of urban areas, rampant drug and alcohol problems, exposures to new diseases to which they are susceptible, and so on. It is far from apparent that their lives are truly improved by deforestation and the socioeconomic disruptions it creates.

The populations of indigenous peoples are small compared to those of other local peoples and until recently they have had little decision-making power regarding deforestation issues, although there are continuing efforts to give them a voice in the decision-making process. In this issue of Cultural Survival Quarterly, contributors working in each of the major rainforest areas of the world explore the effects of ecological and social change on the health and well-being of rainforest indigenous peoples. This exploration is done with the hope that it will lead to greater public understanding of these issues and contribute to the empowerment of rainforest indigenous peoples as they struggle to improve their lives in a world out of balance.

Nicolás Bermúdez-Vélez describes the multiple dimensions of indigenous life and health shaped by the Colombian rainforest. Turipi (Uldarico Matapí), a shaman of the Matapí tribal people, provides an insightful perspective on these issues in his description of the traditional Matapí healing practices.

In contrast to Bermúdez’s and Turipi’s contributions, Patricia Webster of the Rainforest Health Project demostrates the role Western medicine can play in helping indigenous communities maintain their health in the face of transition through her first-hand account of providing health care among the Achuar in a remote area of the Peruvian Amazon.

Alain Froment explores the complex links among health, environment, culture, and politics based on his long experience working with the Pygmies and other groups in Central Africa. Thomas Headland, who has worked with the Agta of the Phillipines for more than 40 years, offers a powerful photo-essay of the enormous changes he has seen in their lives as the rainforest around them has disappeared. Edmond Dounias and his colleagues at the Center for International Forestry Research describe their careful study of nutrition among the Punan, traditional hunter-gatherers of East Kalimantan (Borneo) Indonesia. Also in East Kalimantan, I discuss my own work in partnership with The Nature Conservancy to bring a health program to local people, largely Punan, in a rainforest area adjacent to a recently discovered population of endangered orangutans.

Rainforests and Health

Tropical rainforests are areas of abundant rainfall and dense, extremely diverse plant and animal life situated between the Tropics of Cancer and Capricorn. One hundred years ago tropical rainforests covered almost continuous tracts of land over much of South America, Africa, and Southeast Asia, in all about 14 percent of the land surface of the earth. According to the World Wildlife Fund, during the course of the 20th century, about 50 percent of the world’s rainforests have been lost due to human activity. Deforestation, fragmentation, and degradation of the remaining rainforests continues in all regions, with worldwide yearly rates of loss estimated between one and two percent. Although there is widespread concern in developed countries, this rate has not appreciably slowed.

Rainforests are the irreplaceable habitat of half of all known species on Earth. Due in large part to tropical deforestation, a mass extinction is now occurring on this planet wherein more species are being lost than at any time since the end of the dinosaurs. Biodiversity is important to humanity, for example, as a source of foods, drugs, and potential new medicines. Tropical rainforests are also important economically as natural capital, providing ecosystem services such as erosion prevention, watershed protection, and carbon storage.

The three major tropical rainforests are situated entirely in developing countries. An appraisal of their relationship to human health must therefore consider these ecosystems within the demographic, social, political, and economic contexts of development. Rainforest environments are generally in rapid transition to a more homogeneous, less diverse environment that the local human population has attempted to tailor to its needs. This local population, moreover, is also subject to geophysical, sociocultural, and politico-economic forces outside itself, at the regional, national, and international level. These outside forces often play a dominant role in determining local health.

Jungles are, almost by definition, undeveloped. Yet today the world’s remaining pristine rainforest and the relatively small populations of indigenous peoples who live within them cannot be thought of as ecosystems in isolation. They are bounded by and interact with not only other ecosystems in their natural state (such as mountain, savanna, and seashore zones), but also with other areas of rainforest in various stages of disruption, larger numbers of indigenous peoples in various stages of assimilation, and altered environments used by both local and translocated human populations for settlement, agriculture, infrastructure, and industry. This interconnectedness is seen in the following articles through descriptions of differing land uses and inter-group relationships among nomadic and settled groups. Agta live among homesteaders in the Philippines; Pygmies in central Africa interact so closely with Bantu that many speak the Bantu language; and Punan, Kenyah, and transmigrants in Borneo face many of the same conservation challenges. Yet because their physical and social conditions, and their diets, habits, and health risk factors are so different, the peoples living within the rainforest and those living around it may have entirely different health profiles and health care needs.

Humans may cause ecological change, but as a result, human conditions and health may change as well. Moreover, initial changes often lead to other, often unforeseen changes.

In its unaltered state, a jungle is often quite unwelcoming to most human beings. It is full of hazards: heat, humidity, infectious diseases, insects, poisonous snakes, and dangerous animals. As tropical forests are transformed to other types of environments, some hazards are eliminated, while others are created or unleashed. Human exposure to these hazards increases during this process, due both to increases in local population and to new types of local human activity. With development of former forestland, exposures to environmental toxins from industry and agriculture may also increase, as may road and industrial accidents. The articles in this issue of Cultural Survival Quarterly show an application of this web of causality as they discuss the causes of tropical deforestation and its effects on human physical, social, economic, and mental well-being.

In developing countries, infectious and nutritional diseases constitute the greatest threat to health among both forest nomads and settled peoples. Factors that affect the ecology of pathogenic viruses, bacteria, and parasites, as well as insect vectors and animal reservoirs of infection, will thus also affect human health. Human demographics also play a key role, determining the transmissibility of infection.

Ecological factors such as climate, particularly rainfall, are critical for crop production and food supply. Lack of a clean water supply may lead to increases in rates of waterborne infection, especially diarrheal disease in children. As population density increases, hygiene and sanitation play a vital role in preventing infection.

Public health and preventive medical care measures, in particular vaccinations, especially help to protect maternal and child health. The availability and quality of curative medical care also plays an increasingly important role.

As development proceeds in a country, personal choices and factors of the personal environment (dietary excesses of salt, sugar, and fat; sexual lifestyle; and smoking, alcohol, and drug use) typically become dominant causes of disease. The well-known epidemiological transition occurs from the “diseases of poverty” (nutritional deficiencies and infectious diseases) to the “diseases of excess” (heart disease, stroke, and cancers). Examples of this transition among indigenous peoples of all tropical rainforest regions are noted by this issue’s contributors.

Poverty and ill health are typically intimately linked, especially in the developing world. The impact of deforestation on health is thus often transmitted via its effects on economics. Education is also closely tied to health. The level of education attained by women in developing countries has been shown to have a high degree of correlation with health indicators. Disruption of the social fabric that accompanies environmental change may also lead to many new health risks.

Surviving the Destruction

In developing countries, the economic benefits of deforestation may include a supply of fuel wood; an increase in living space and land available for crops, range, or industry; greater ease of transportation; and cash from the production of exportable items such as beef, bananas, timber, ores, and oil. The result may be more personal wealth, more comfortable living space, more available services and material goods, and more convenience. Many people want these things, and so most people in these countries will choose this type of development. A trade-off is made. Deforestation nearly always occurs because it produces greater benefit than costs in the short run for those who have the power. Like many complex social problems, deforestation is largely a question of collective human values. The natural capital of tropical forests has historically not been given proper consideration in the relevant decision-making processes, and so deforestation continues.

In the face of this reality, several themes emerge from the articles featured in this issue. First, the benefits of access are often mixed. Limited access to indigenous lands is in fact a major reason why the world’s remaining rainforests and indigenous societies still exist, but this isolation also results in limited health care and other services for indigenous peoples. Although there were certainly many unmet needs for health care among rainforest groups when they lived in isolation, contact with outsiders and environmental destruction has in many cases brought them new diseases and new health problems that require more health care needs than ever before.

Secondly, the question arises not of how to stop development but how to find less ecologically and socially destructive development trajectories that maximize the benefits of civilization for local people. The health of local people should form a central consideration in planning economic development and conservation that touches their communities. Development planning must find ways to avoid trading off one set of health risks for another.

Finally, despite the many obstacles involved, continuing efforts to integrate rainforest people into the political process, especially around land-use issues, will be critical to ensuring their future well-being. Indigenous peoples themselves are most likely to justly represent their own needs, concerns, and desires in the political decision-making that impacts their lives.

Robbie Ali ( teaches at the Graduate School of Public Health at University of Pittsburgh. His interest is in communities and environments, especially as they relate to conservation.

References and further reading

Goldsmith, F., Ed. (1998). Tropical Rain Forest: A Wider Perspective. London: Chapman and Hall.

Head, S. & Heinzman, R., Eds. (1990) Lessons of the Rainforest. San Francisco: Sierra Club.

Jenkins, C., et al. (1989). Culture change and epidemiological patterns among the Hagahai, Papua New Guinea. Human Ecol. 17:1.

Lodenius, M. & Malm, O. (1998). Mercury in the Amazon. Review of Environmental Contamination and Toxicology 157.

Whitmore, T. (1998). An Introduction to Tropical Rain Forests, 2nd ed., Oxford: Oxford University Press.

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