Urban Migration as a Social Determinant of Health for Wounaan Indigenous People Residing in Bogotá, Colombia

ABSTRACT The absence of State enforcement and the incursion of violent armed groups into rural Chocó, Colombia, has forcibly displaced the Wounaan indigenous people from their ancestral lands to Bogotá. As migration is recognized as a social determinant of health, this study employed a qualitative phenomenological approach to describe effects of social determinants of health, including migration, on access to health among displaced Wounaan members of the “Cabildo Indígena Wounaan nonam de Bogotá DC”. We conducted focus groups, individual interviews, and participatory workshops with Wounaan adults residing in Bogotá. One main consequence of migration was the shift in the Wounaan conceptualization of health. The new territory transformed both their social organization and the Wounaan bodies themselves. Participants noted the adverse effects of social determinants, including changes in social risk factors, unfamiliar or different types of food, environmental pollution, and safety concerns. In response to discrimination and barriers in access to Western healthcare, the Wounaan endeavored to incorporate traditional medicine practices, despite difficulties finding medicinal plants or traditional healers. The forced displacement reinforced the generational trauma for the Wounaan people, continuing years of exclusion, mistreatment, and discrimination from colonial times to recent armed conflicts. The adverse effects of migration on the health of Wounaan people are compounded by negative changes in the social determinants of Indigenous health, including language difficulties and limitations on traditional medicine practices. Incorporating migration as a social determinant prompts researchers to consider broader upstream structural factors and move beyond behavioral interventions to improve health and wellbeing of migrants.