Coloniality of care: Indigenous autonomy and the structuring of contemporary health regimes in Chile

Abstract

Abstract

This article analyses intercultural health in Chile as a contested institutional regime through which colonial relations are reorganised rather than dismantled. Drawing on long-term, multi-sited ethnographic research conducted between 2016 and 2025, and informed by sociological approaches to governance, coloniality and the politics of recognition, it examines how Mapuche-Indigenous actors engage with state-led intercultural health programmes and how these arrangements structure relations of knowledge, authority and care. The analysis suggests that while institutionalised interculturality has seemingly reduced overt discrimination and expanded access to services, it has also subordinated Indigenous knowledge within bureaucratic and biomedical frameworks. At the same time, the Makewe Intercultural Hospital illustrates how interculturality can be reworked as an Indigenous-led project of institutional autonomy grounded in territorial governance, collective organisation and epistemic plurality. Although materially constrained and exceptional, Makewe illuminates the conditions under which alternative regimes of care can emerge within, yet in tension with, state health systems.