Health system adaptation to climate change: a Peruvian case study.

Despite mitigation attempts, the trajectory of climate change remains on an accelerated path, with devastating health impacts. As a response to the United Nations Framework Convention on Climate Change call for National Adaptation Plans, Peru has developed a national and decentralized regional adaptation plans. The purpose of this article is to understand the role and priority status of health within the adaptation planning and process. Peru was used as a case study to analyse the policy process in the creation of adaptation plans, encompassing the need to address climate change impacts on health with a particular focus on marginalized people. An actor, content and context policy analyses were conducted to analyse 17 out of 25 regional adaptation plans, which are available. The national adaptation plans (2002, 2015) do not include health as a priority or health adaptation strategies. In a decentralized health care system, regional plans demonstrate an increased improvement of complexity, systematization and structure over time (2009-17). In general, health has not been identified as a priority but as another area of impact. There is no cohesiveness between plans in format, content, planning and execution and only a limited consideration for marginalized populations. In conclusion, the regional departments of Peru stand on unequal footing regarding adapting the health sector to climate change. Findings in the strategies call into question how mitigation and adaption to climate change may be achieved. The lack of local research on health impacts due to climate change and a particular focus on marginalized people creates a policy vacuum. The Peruvian case study resembles global challenges to put health in the centre of national and regional adaptation plans. In-depth cross-country analysis is still missing but urgently needed to learn from other experiences.

[Orthopathy in 19th century Peru: Sebastián Lorente and the Catechism of hygiene]. / Higienismo en el Perú del siglo XIX. Sebastián Lorente y el catecismo de higiene.

Orthopathy appeared in Peru in the 19th century in various guises and different spheres that transcended the activities of doctors. Sebastián Lorente, a doctor and educator, promoted hygiene education for schoolchildren through the publication of a Catechism of Hygiene, which went through multiple editions in the second half of the century. The structure and content of the Catechism is linked to European medical traditions such as the miasmatic interpretation of diseases, but also to local traditions like the medical topography of Hipólito Unanue, both of which had a vision of imposing "healthy" behaviors on the population, which assimilated the work of Johann Peter Frank.

[Cancer etymology and its historical curious course]. / La etimología del cáncer y su curioso curso histórico.

The first cancer descriptions in history are discussed according to recent findings and their interpretation, which show it as a group of unknown diseases until the 18th century, when it started to increase to actual levels. Medical literature shows a variety of what were considered cancer lesions, which are actually different lesions. This is partly due to an etymological misunderstanding of the Greek term karkinos that meant "cancer", in its modern sense, but also ulcerative lesion. This confusion is widely reviewed in the ancient medical literature and the main landmarks of modern cancer conception up to the 18th century are outlined.

[Food in ancient Peru: Haku mikumusum (let's go to eat!)]. / La comida en el antiguo Perú: haku mikumusum (¡vamos a comer!).

The Andean region is one of the eight world centers where plant and animal domestication originated. Given that food is a structural factor of social reality, a description is given of the close relationship that Andean men developed with their geographic surroundings, and the plants and animals they domesticated, giving rise to a remarkable culture that united the extraordinary nutritional richness of their traditional food with a food production, conservation and distribution system that led to a civilization who never experienced hunger. Some foods of ancient Peru are briefly described in the following review.

[The stone of madness: starting points of the history of mental health]. / La piedra de la locura: inicios históricos de la salud mental.

Addressing the relatively recent concern of public health in the issue of mental health problems, the evolution of the concept of mental illness in the occidental pre-modern history is revised, as well as the reasons why it remained outside the mainstream of the professional healing activity. The differences between the naturalist and the supernatural views are explored as well.

Higienismo en el Perú del siglo XIX. Sebastián Lorente y el catecismo de higiene / Orthopathy in 19th century Peru: Sebastián Lorente and the Catechism of hygiene

RESUMEN El higienismo se manifiesta en el Perú del siglo XIX de diversas maneras y en distintas esferas que trascienden la actividad de los médicos. Sebastián Lorente, médico y educador promovió la educación higiénica de los escolares a través de la publicación de un Catecismo de higiene que tuvo múltiples ediciones en la segunda mitad del siglo. La estructura y contenidos del "Catecismo" se vincula a tradiciones médicas europeas como la interpretación miasmática de la enfermedad, pero también locales como la topografía médica de Hipólito Unanue, ambas en el marco de una visión de imposición de comportamientos "saludables" a la población, que lo asimilan a la obra de Johan Peter Frank.

ABSTRACT Orthopathy appeared in Peru in the 19th century in various guises and different spheres that transcended the activities of doctors. Sebastián Lorente, a doctor and educator, promoted hygiene education for schoolchildren through the publication of a Catechism of Hygiene, which went through multiple editions in the second half of the century. The structure and content of the Catechism is linked to European medical traditions such as the miasmatic interpretation of diseases, but also to local traditions like the medical topography of Hipólito Unanue, both of which had a vision of imposing "healthy" behaviors on the population, which assimilated the work of Johann Peter Frank.

[Interculturality in health]. / Interculturalidad en salud.

Interculturality in health is a recent concept that develops in response to claims of indigenous peoples for their right to their cultural identity, but also correspond to a global trend of incorporating the "right to the difference", which distinguishes and promotes coexistence between different cultural groups in the same territory. The article discusses, from a historical perspective, the original mismatch between Native American populations and European conquerors that marked out their access to health services, and discussed some of the many current issues related to, as the identification of indigenous people and the relationship between human rights and interculturality, to finally present a review of the genesis of the concept of interculturalism in health and their complexity reviewing the concept of cultural syndrome and his adaptation to scientific medicine.

[Tuberculosis in the indigenous population of Peru 2008]. / Tuberculosis en la población indígena del Perú 2008.

OBJECTIVE: To identify the indigenous inhabitants affected by tuberculosis (TB) in Peru during the year 2008. MATERIAL AND METHODS: Descriptive observational study, performed from August to December 2009, including all indigenous patients affected by tuberculosis that were including in the Control Program during the year 2008 in the 25 regions of Peru. RESULTS: We identified 702 indigenous patients with tuberculosis. The ethnical groups that have most patients were the Quechua group (417/702; 59.4%) and the Amazonic indigenous (201/702, 28.6%). Out of the Amazonic, more than 60% belonged to the Ashaninka (Campas), Shipibo and Matsiguenga groups. In third place, we found the Aymara natives, who had 84/702 (11.97%) of cases of tuberculosis. It is important to mention that the distribution of the cases of multidrugresistant tuberculosis (MDR TB) involves five departments (nine cases of MDR TB), being the greater number of cases of MDR TB in patients previously treated (6/9), and only 3 cases were primary MDR TB, belonging to the quechua group. CONCLUSIONS: High incidence rates of tuberculosis in indigenous population have been found, which raises the need of further research in order to guarantee the correct gathering of information in ethnic groups in order to have more and better evidence about the situation of tuberculosis in the indigenous population of Peru.

La etimología del cáncer y su curioso curso histórico / Cancer etymology and its historical curious course

Se discuten las primeras descripciones de cáncer en la historia de acuerdo a recientes hallazgos y sus interpretaciones que lo muestra como un grupo de enfermedades raras hasta el siglo XVIII, cuando comenzó su incremento hasta los niveles actuales. La literatura médica muestra numerosos antecedentes de supuestas lesiones cancerosas que, en realidad, corresponden a otras lesiones. Parte de la explicación se refiere a un malentendido etimológico acerca de la palabra griega karkinos que significaba cáncer, en su sentido moderno, pero también lesión ulcerosa. Se revisa ampliamente esta confusión en la antigua literatura médica y luego se esbozan los principales hitos de la concepción moderna del cáncer hasta el siglo dieciocho.

The first cancer descriptions in history are discussed according to recent findings and their interpretation, which show it as a group of unknown diseases until the 18th century, when it started to increase to actual levels. Medical literature shows a variety of what were considered cancer lesions, which are actually different lesions. This is partly due to an etymological misunderstanding of the Greek term karkinos that, in its modern sense, meant “cancer”, but also ulcerative lesion. This confusion is widely reviewed in the ancient medical literature and the main landmarks of modern cancer conception up to the 18th century are outlined.

La comida en el antiguo Perú: haku mikumusum (¡vamos a comer!) / Food in ancient Peru: haku mikumusum (let’s go to eat!)

La región andina es uno de los ocho centros originarios mundiales de domesticación de plantas y animales. Al ser la alimentación un factor estructurante de la realidad social, se describe la estrecha relación que desarrolló el hombre andino con su medio geográfico, y las plantas y animales que domesticó dando lugar a una cultura singular en la que aunó la extraordinaria riqueza nutricional de sus alimentos tradicionales, con un sistema de producción, conservación y distribución de los alimentos que permitió una civilización en la que no se conoció el hambre. En la siguiente revisión se presenta brevemente algunos alimentos del antiguo Perú.

The Andean region is one of the eight world centers where plant and animal domestication originated. Given that food is a structural factor of social reality, a description is given of the close relationship that Andean men developed with their geographic surroundings, and the plants and animals they domesticated, giving rise to a remarkable culture that united the extraordinary nutritional richness of their traditional food with a food production, conservation and distribution system that led to a civilization who never experienced hunger. Some foods of ancient Peru are briefly described in the following review.