Objective:

To explore indebtedness dynamics in an Afromexican town by an inclusive epidemiological approach.

Materials and methods:

Qualitative study through 75 questionnaires, 20 interviews to depth and six focal groups in a support process to the Municipal Health Commission in Santiago Tapextla, Oaxaca.

Results:

Catastrophic expenses due to insufficient medical care were the principal causal item. Indebtedness processes with patrimonial loss are dominant, generating dependence spirals of difficult resolution that impact the familiar dynamics and the pathology evolution.

Conclusions:

In spite of its inexistence within sanitary official programs, indebtedness dynamics constitute an epidemiological marker by the uncovering of structural inattention conditions that reflect the imposed, naturalized and pathogenic hierarchization proper of coloniality. To analyze this process at local and global levels is a complex but essential public health task.

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