Historically, there were little systematic and comprehensive efforts to develop programs that were specifically directed at the indigenous people as such. This fact does not mean that the health problems of the indigenous people were ignored. Rather,<sup>they</sup> were addressed as part of government efforts to improve the health of people in<sup>the rural</sup> and marginalized (disadvantaged) communities. Given that the indigenous people<sup>were</sup> largely located in these communities, they should in principle benefit from these programs. A list of these programs in relation to the evolution of Mexico's health<sup>policy</sup> is presented in "The Health Care System in Mexico."<sup>5</sup> Notable examples of<sup>these</sup> programs currently include IMSS-Solidaridad, PAC (Programa de Ampliaci6n de Cobertura) and, more recently, PROGRESA (now called Oportunidades).<sup>The focusof</sup> those efforts has largely been on the promotion of primary health care such as maternal and child care, control of vector-borne diseases, health education, family planning, nutrition, immunization and other preventive care.

Many of these programs to a considerable extent took into account the indigenous people's particular circumstances, despite the government's lack of explicit targeting. These programs follow in principle a health care strategy that calls for mobilization<sup>of</sup> local resources and greater sensitivity to community constraints and preferences.<sup>Within</sup> this context, government supported initiatives (such as the promotion of traditional medicine and training of birth attendants) that could be expected to facilitate<sup>directlythe</sup> health care of indigenous groups.

Nevertheless, because the indigenous communities _per se_ were not considered as an explicit target population, it has been argued that not enough attention<sup>has been paid to</sup> their social and cultural characteristics. Moreover, not enough resources have been allocated to their health care. A rough estimate by the Subsecretaria de Egresos<sup>de</sup> Hacienda indicates that in 2002 the amount of Federal spending per capita<sup>going tothe</sup> indigenous population was only 128 pesos per year, which is-only about a third of<sup>the</sup> IMSS-Solidaridad average.

In conclusion, it can be argued that the health gap between the general and the indigenous population is due to the economic and social disadvantages suffered by<sup>the</sup> latter. But it can also be argued, as commonly believed, that the health gap<sup>might also be</sup> due to government failure to focus on the need to take more fully into account<sup>the social</sup> and cultural conditions of the indigenous population<sup>6</sup> . More generally, it can<sup>be</sup> hypothesized that demand for modern health services is relatively low among the indigenous people because of the failure of the health system to adapt its health services to their cultural heritage and circumstances. The implication is that there is a<sup>need to</sup> develop a health strategy that directly and explicitly focuses on the health problems<sup>of the</sup> indigenous people and tailors health interventions more adequately to their specific cultural and social conditions. This point of view is supported by the 2001 constitutional reform that now explicitly recognizes the obligation of the state to ensure that these groups have access to effective health care - one that is tailored to their particular conditions and takes advantage of their traditional medicine and cultural heritage.

> 5 Financing Health Care, Volume 22, National Economic Research Associates, 1998. 6(World Bank (2001), Third Basic Health Care Project (PROCEDES), Project Appraisal Document

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