When "health" is not enough: societal, individual and biomedical assessments of well-being among the Matsigenka of the Peruvian Amazon

Although biomedical indicators of health status show that physical health for the Matsigenka of the Peruvian Amazon has significantly improved over the past 20-30 years, the Matsigenka perceive their health and well-being to have severely declined during this period. This discrepancy between empirical measures and local perceptions of health and well-being points to the central tension inherent in measuring and defining "health." While biomedical parameters of health are generally linked to notions of the body free of illness, measurable by physiological means, the Matsigenka define physical health as only one component of what it means to be healthy and to experience well-being. For the Matsigenka, notions of health and well-being are linked fundamentally to ideals about happiness, productivity and goodness, in addition to biomedical health. The Matsigenka attribute the decrease in their well-being to newly instigated sorcery and stressors resulting from outside influences and morality institutionalized by cultural "outsiders", such as missionaries, school teachers, health personnel, oil company employees and government officials. This article explores the relationships between biomedical, societal and personal assessments of health and well-being among the Matsigenka as they seek to preserve their sense of wellness in spite of their rapidly changing social and economic environment. By using longitudinal qualitative and quantitative ethnographic and health data, this paper shows that, for the Matsigenka, increases in acculturation and permanent settlement result in an alarming decrease in their health and well-being.