September 28, 2016
In its resolution 30/4, the Human Rights Council requested the Expert Mechanism on the Rights of Indigenous Peoples to prepare a study on the right to health and indigenous peoples with a focus on children and youth and to present it to the Council at its thirty-third session. The present study consists of a critical analysis of the content of the right to health vis-à-vis indigenous peoples and a review of the legal obligations of States and others in terms of fulfilling that right. Expert Mechanism advice No. 9 on the right to health and indigenous peoples is contained in the annex.
Although this is the first study of the Expert Mechanism focusing on the right to health, previous studies have addressed the links between access to justice and the health of indigenous women and indigenous persons with disabilities (A/HRC/27/65), the health implications for indigenous peoples of disaster risk reduction initiatives (A/HRC/27/66) and the importance of indigenous cultures and languages for the health of indigenous peoples (A/HRC/21/53).
The right to health framework: availability, accessibility, acceptability and quality
Availability – Public health and health-care facilities, goods and services should be available in sufficient quantity within a State, depending on its level of development. However, availability is often constrained for indigenous peoples and communities. For example, in certain areas in Africa where indigenous nomadic pastoralists and communities are located, health infrastructure is non-existent.
For facilities, goods and services to be available, they must also be functional. Facilities located in areas inhabited by indigenous peoples are frequently not operational owing to a lack of staff, medicines, supplies and other consumables.
Accessibility – The four primary dimensions of accessibility are non-discrimination, physical accessibility, economic accessibility and information accessibility. For indigenous peoples, these four dimensions often intersect. Indigenous peoples are very likely to experience discrimination when accessing health-care facilities, goods and services. Doctors, nurses and other health-care professionals may refuse to treat indigenous peoples or indigenous peoples undergoing treatment may encounter discriminatory beliefs, practices and experiences, fuelling fear and distrust that further discourages use of health-care facilities. That situation is amplified for indigenous persons with disabilities. Racism may even lead to misdiagnosis and mistreatment for serious illnesses.
Physical accessibility is an issue for indigenous peoples, many of whom live in geographically isolated areas, often because of displacement or the encroachment of non-indigenous peoples on their land.
Economic accessibility is another concern for indigenous peoples, who are frequently among the most socioeconomically marginalized groups in society. This is particularly true in countries without universal health care or with high out-of-pocket costs for consumers. Information accessibility is also constrained for indigenous peoples: this can be attributed to a number of factors, including health information being unavailable in indigenous languages; higher rates of illiteracy among indigenous peoples with limited educational opportunities; a lack of contact with health-care providers owing to unavailability; and discriminatory or paternalistic attitudes among health-care providers.
Acceptability – The Committee on Economic, Social and Cultural Rights has acknowledged that the right to take part in cultural life encompasses cultural appropriateness, which should be taken into account in providing health-care services. Unfortunately, the health-care facilities, goods and services available to indigenous peoples are often unacceptable in nature. Interpersonal and structural racism frequently lead to system-wide policies and practices that marginalize or exclude individuals and minimize access to facilities, goods and services. One example of a basic failure to provide acceptable care is the non-provision of services in indigenous languages (see CEDAW/C/FIN/CO/7), which constitutes structural racism. Such failures can result in indigenous peoples internalizing stigma, creating additional barriers to health care. Moreover, indigenous people are frequently blamed for their illnesses and medical needs, either individually or as a group. Negative attitudes and a lack of cultural sensitivity among health-care providers in some jurisdictions also have an impact on indigenous peoples’ ability to seek health care.
Quality – Health-care facilities, goods and services should be scientifically, medically and culturally appropriate, and of good quality. That requires skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe drinking water and adequate sanitation. Tension often exists between mainstream health-care services, which are generally evidence-based and perceived to be of high quality, and the traditional health-care practices of indigenous peoples, on which there is a paucity of evidence, often owing to a lack of research. That should not be viewed exclusively as a source of tension between indigenous peoples and mainstream health-care providers. Indigenous communities themselves often face challenges internally in seeking to balance traditional and modern approaches to health and in addressing other social issues.