Abstract This article concerns public health policies for the Indigenous peoples of Brazil, focusing on relations of violence observed by the authors during their research. We draw attention to different types of violence through an analysis that articulates fieldwork on primary health care in Indigenous Areas with observations of political negotiations concerning health issues involving Indigenous leaders and government workers. There is, on the one hand, the habitual symbolic violence that can be observed in daily interactions between health workers and Indigenous patients, and, on the other, the contradictions of an official political rhetoric that assents to Indigenous authority and then systematically dismisses it when decisions that involve public health are put into practice. The research combines different methodological strategies (intensive fieldwork, research on public policy documents, participant observation of political meetings, interview with indigenes and managers, etc.) to establish correlations between interpersonal violence and structural violence along democratic processes of public policies building in Indigenous health. From this perspective, the paper addresses the violence in health sector beyond the individuals and their intentions; it proposes that violence in health must be interpreted against the backdrop of a broader discussion on the construction of Indigenous citizenship that articulates tutelage and political participation in the politics of health practices in Brazil.