Market integration and health: The impact of markets and acculturation on the self -perceived morbidity, diet, and nutritional status of the Tsimane' Amerindians of lowland Bolivia

Scholars have long been interested in the effects of markets and contact on the health of native populations. Greater integration into a market economy and exposure and assimilation into a dominant society can result in shifts in modes of subsistence, decision-making about resource use, and access to health-related goods and services. The clear direction of influence is often elusive. Increased income, material wealth and credit, predicts expanded access to goods and services that may directly and indirectly improve household and individual health. At the same time, greater involvement in market trade can shift economic priorities away from secure subsistence production toward the lure of material gain and novel items. Additionally, exposure to acculturative forces (such as formal education, language skills of the dominant society, and frequency of contact) can result in the adoption or rejection of new values and preferences. The Tsimane' Amerindians of lowland Bolivia have been undergoing varying degrees of integration into the regional economy and society. The organization of their economic and social activities has been influenced by external forces from as early as colonial expansion. The Tsimane' people share many experiences with other native peoples of the Amazon who have responded in myriad ways to the encroachment, expansion, and opportunity of contact and articulation with a larger economy. The Tsimane' provide a suitable population among which to examine the relationship between markets and health.;Research on the health impacts of market integration and acculturation is important because health is a standard indicator of human welfare. This dissertation examines three components of health: illness episodes, household diet, and nutritional status. Using data from a panel study of two Tsimane' communities, I present descriptive and multivariate analyses of each of the three dependent measures of health as they relate to measures of integration into the market economy and acculturation.;Tsimane' household and individual integration into the market economy did not demonstrate strong effects on health status. The absence of statistically significant findings is explained in part by the observation that income and education alone are insufficient to improve health. Even with increased participation in the regional economy and society, constraints such as poor physical infrastructure, lack of political representation, and access to health care and knowledge remain despite increased opportunity for earning income and attaining education.