Understanding violence as a health determinant among ethnic communities in Colombia's Pacific region: a qualitative analysis.

This study sought to understand the manifestations of violence affecting Indigenous and Afro-descendant communities in the Nariño Pacific region, Colombia, through the framework of the social determinants of health. A qualitative research design was implemented with 60 purposively selected participants, ensuring variation by ethnicity (49 Afro-descendant and 11 Indigenous), gender (34 women and 26 men), and role (institutional and community). All participants were adults affected by the armed conflict and registered in the National Victims Registry (RUV). Data were collected through in-depth interviews and the analysis of paradigmatic cases, complemented by field notes documenting contextual aspects of the data collection process. An inductive thematic analysis was conducted using the social determinants of health as the analytical framework. The findings reveal that violence affecting communities in the Nariño Pacific region operates as a structural determinant of health, characterized by systemic, symbolic, and historical configurations embedded within multiple social determinants (sociocultural, economic, political, environmental, and health service-related). These dynamics are reinforced by persistent symbols of domination, structural institutional crises, restricted access to fundamental rights, mistrust in the State, corruption, and the territorial control exercised by armed groups in these collective ethnic territories.