Indigenous Peoples’ United Nations access to Health Services state of the world’s indigenous peoples Indigenous Peoples’ access to Health Services United Nations State of the World’s Indigenous Peoples DESA The Department of Economic and Social Affairs of the United Nations is a vital interface between global policies in the economic, social and environmental spheres and national action. The De- partment works in three main interlinked areas: (i) it compiles, generates and analyses a wide range of economic, social and environmental data and information on which Member States of the United Nations draw to review common problems and to take stock of policy options; (ii) it facilitates the negotiations of Member States in many intergovernmental bodies on joint course of action to address ongoing or emerging global challenges; and (iii) it advises interested Govern- ments on ways and means of translating policy frameworks developed in United Nations confer- ences and summits into programmes at the country level and, through technical assistance, helps build national capacities. Note The views expressed in this publication do not necessarily reflect those of the United Nations. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country or territory or of its authorities, or concerning the de- limitations of its frontiers. The designations of country groups in the text and the tables are intended solely for statistical or analytical convenience and do not necessarily express a judgement about the stage reached by a particular country or area in the development process. Mention of the names of firms and commercial products does not imply the endorsement of the United Nations. Symbols of United Nations documents are composed of capital letters combined with figures. ii ξ Indigenous Peoples’ access to Health Services Acknowledgements The State of the World’s Indigenous Peoples has been a collaborative effort of experts and orga- nizations. The introduction was written by the secretariat of the Permanent Forum on Indigenous Issues within the Division for Social Policy and Development of the Department of Economic and Social Affairs. The thematic chapters were written by Ms. Oksana Buranbaeva, Dr. Myriam Conejo Maldonado, Dr. Ketil Lenert Hansen, Dr. Mukta S. Lama, Dr. Priscilla S. Migiro and Dr. Collin Tukui- tonga. The Secretariat of the Permanent Forum on Indigenous Issues oversaw the preparation of the publication. Special acknowledgements go to the editor, Jeffrey Reading, translator Raul Molina, and also the UN Graphic Design Unit, Department of Public Information. Ms. Shamshad Akhtar, Assistant-Secretary-General for Economic Development and Senior Ad- visor on Economic Development and Finance, of the Department of Economic and Social Affairs provided invaluable comments. ξ iii Indigenous Peoples’ access to Health Services Foreword to the State of the World’s Indigenous Peoples By Mr. Wu Hongbo, Under-Secretary-General for Economic and Social Affairs Over the past two decades, international efforts have been made to improve the rights of indige- nous peoples, to bring awareness to their issues, including their engagement in developing policy and programmes in order to improve their livelihoods. In the First Decade of the World’s Indig- enous People (1995-2004) the United Nations created the United Nations Permanent Forum on Indigenous Issues as well as the Special Rapporteur on the rights of indigenous peoples. During the Second Decade of the World’s Indigenous People (2005-2015), there have been further initia- tives such as the creation of Expert Mechanism on the Rights of Indigenous Peoples. The adoption of the United Nations Declaration on the Rights of Indigenous Peoples in September 2007 was a major step for the United Nations as the Declaration had been debated for over 20 years. The United Nations Permanent Forum on Indigenous Issues is an advisory body to the Economic and Social Council with a mandate to discuss indigenous issues related to economic and social development, culture, the environment, education, health and human rights. At its twelfth ses- sion, the Permanent Forum on Indigenous Issues reviewed health as one of its mandated areas and stated the right to health materializes through the well-being of an individual as well as the social, emotional, spiritual and cultural well-being of the whole community.1 The United Nations Declaration on the Rights of Indigenous Peoples states that indigenous peo- ples have the right to be actively involved in developing and determining their health programmes; the right to their traditional medicines, maintain their health practices, and the equal right to the enjoyment of the highest attainable standard of physical and mental health. Unfortunately, indig- enous peoples suffer higher rates of ill health and have dramatically shorter life expectancy than other groups living in the same countries. This inequity results in indigenous peoples suffering unacceptable health problems and they are more likely to experience disabilities and dying at a younger age than their non-indigenous counterparts. Indigenous peoples’ health status is severely affected by their living conditions, income levels, employment rates, access to safe water, sanitation, health services and food availability. Indige- nous peoples are facing destruction to their lands, territories and resources, which are essential to their very survival. Other threats include climate change and environmental contamination (heavy metals, industrial gases and effluent wastes). Indigenous peoples also experience major structural barriers in accessing health care. These in- clude geographical isolation and poverty which results in not having the means to pay the high cost for transport or treatment. This is further compounded by discrimination, racism and a lack of cultural understanding and sensitivity. Many health systems do not reflect the social and cultural practices and beliefs of indigenous peoples. 1 E/2013/43 p. 2. ξ v State of the World’s Indigenous Peoples At the same time, it is often difficult to obtain a global assessment of indigenous peoples’ health status because of the lack of data. There has to be more work undertaken towards building on existing data collection systems to include data on indigenous peoples and their communities. This publication sets out to examine the major challenges for indigenous peoples to obtain ad- equate access to and utilization of quality health care services. It provides an important back- ground to many of the health issues that indigenous peoples are currently facing. Improving indigenous peoples’ health remains a critical challenge for indigenous peoples, States and the United Nations. vi ξ Indigenous Peoples’ access to Health Services Contents Foreword to the State of the World’s Indigenous Peoples by Mr. Wu Hongbo, Under-Secretary-General for Economic and Social Affairs ............. iv Introduction ............................................................... 002 The concept of indigenous peoples .......................................... 003 Article 33 ............................................................... 005 About this publication .................................................... 006 Overview of major international responses to indigenous peoples .................. 008 Chapter One Access to Health Services by Indigenous Peoples in the African Region by Dr. Priscilla Santau Migiro . 010 Introduction .............................................................. 011 Conclusion .............................................................. 028 References: ............................................................. 028 Chapter Two Access to Health Services by Indigenous Peoples in Asia by Dr. Mukta Lama .......................................................... 032 Introduction ............................................................. 033 Conclusion .............................................................. 054 References .............................................................. 055 Chapter Three Access to Health Services by Indigenous Peoples in the Arctic Region by Ketil Lenert Hansen, PhD .................................................. 058 Introduction ............................................................. 059 Conclusion .............................................................. 077 References ............................................................. 077 Chapter Four Access to Health Services by Indigenous Peoples in Central, South America and the Caribbean Region by Dr. Myriam de Rocio Conejo Maldonado ........................................ 081 Introduction ............................................................. 082 Conclusion .............................................................. 098 Bibliography ............................................................ 099 Internet sites ............................................................. 101 Special documents ........................................................ 101 ξ vii State of the World’s Indigenous Peoples Chapter Five Access to Health Services by Indigenous Peoples in North America .................... 103 Introduction ............................................................. 104 Conclusion ............................................................... 126 Bibliography