Realizing the right to health for minorities and indigenous peoples
‘What I think is that well-being is living better, living well. Because … “well-being” means being well in the family, being well in the home, in good health, not ill, and another thing is eating, or having food in the home – there’s beans, corn, food; it means not suffering hunger, not suffering illness, not suffering in your thinking either, because if you’re bad in your mind, that means not living well. That’s what well-being is about.’Gaspar Castro Uz, 68 years old, K´iche´ Maya indigenous group, Santa Lucia la Reforma Municipality, Totonicapán Department, Guatemala.
Many minority and indigenous groups have a concept of health that is close to the idealized World Health Organization (WHO) description of ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. It is important to realize that for many minorities and indigenous communities, ‘health’ is a concept linked to the community not the individual, has an important spiritual element and relates strongly to the well-being of the ecosystem and planet. This has important implications for how we measure and treat health in minorities and indigenous peoples. Western medical models treat symptoms of individuals, and measure ‘health’ with statistics of individual illness and mortality. This is important when we discuss minority and indigenous health as it influences how and what we measure to evaluate the health context of these groups. Critically, the ways in which minorities and indigenous peoples conceptualize health contrast with the ways in which most governments measure health. Their understanding of health also contrasts with the majority of health indicators collected internationally, and with the Millennium Development Goals (MDGs), and their standard indicators of disease and death rates. But even using these more standard indicators the picture of minority and indigenous health is alarming.
This briefing summarizes MRG’s State of the World’s Minorities and Indigenous Peoples 2013 report, which looks at the health situation faced by minorities and indigenous groups worldwide. Improving minorities’ and indigenous peoples’ health is a critical, but complex, challenge. In some regions, indigenous peoples are unrecognized and uncounted in government data. In every setting, where evidence is available, minority and indigenous health indicators lag behind indicators for the majority and nonindigenous populations. And in almost every setting, this health inequality is rooted in discrimination and marginalization of minority and indigenous groups.
It is important to realize that discrimination against minorities and indigenous peoples has a long history. Policy approaches have to address centuries of prejudice, which in many settings has been accompanied by the ethnically-motivated killing of minorities and indigenous peoples. Five hundred years ago in Latin America, millions of indigenous peoples were displaced or killed, or lost their lives to diseases introduced during the Spanish and Portuguese invasions. In Asia, Africa and the Middle East, the situation of minorities and indigenous peoples is linked to their historical relationship with majority ethnic or religious groups. In India, indigenous groups, known as tribal peoples, are often seen by scientists and policy-makers from the majority culture as backward, and their health problems are blamed on their culture and bad habits.
To an extent, the policy support and attention minorities and indigenous peoples receive in their countries relates to the size of their populations. In some countries, for example Bolivia, indigenous peoples are the majority population, and there is an indigenous president. However, in most countries indigenous peoples are a minority of the population, and often culturally diverse in terms of both the majority population and other minorities, with very different ways of looking at health and their own health systems. For example, according to the 2000 Census, China has 55 different indigenous populations, totalling 104.49 million people, but comprising only 8.1 per cent of the country’s total population. Each of these groups has their own language and culture, highly different from each other and from the majority culture.
Different regions and countries have very different approaches to revealing the health situation of their minority and indigenous populations. As we know globally from scientific studies and government reports, indigenous health data is better documented in Australia, North America and New Zealand, where approximately 1.1 per cent of the world’s indigenous populations live. The health of minorities and indigenous peoples in lower income regions, including Latin America, South Asia and Africa, has received significantly less scientific and policy attention. Key themes in MRG’s State of the World’s Minorities and Indigenous Peoples 2013 report include:
- Lack of data: minority and indigenous identity is not recognized by some national governments, and where it is recognised, data is rarely routinely collected or disaggregated.
- Some governments actively resist disaggregation of data which might reveal the health effects of political discrimination and marginalization on minorities and indigenous peoples.
- Where data exists, evidence suggests that, in all settings, minority and indigenous peoples suffer extreme illhealth, and many population groups are at risk of demographic extinction.
- Minorities’ and indigenous peoples’ concepts of health differ from western biomedical models. For example, indigenous peoples see their personal health as intimately linked to that of the wider community and ecosystem in which they live – rarely focusing on individual well-being.
- Socio-political factors linked to marginalization and colonialism, and relationships with land and environment, are seen as fundamental determinants of minority and indigenous health.
In this briefing we outline the ways in which policymakers can address the health inequalities experienced by minorities and indigenous groups, focusing on the post- 2015 framework. These recommendations itself build on years of activism by minorities and indigenous groups, which led to the adoption by the United Nations General Assembly of the UN Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities in 1992 and the Declaration on the Rights of Indigenous Peoples in 2007 (UNDRIP). The two Declarations finally put the rights of minorities and indigenous peoples explicitly onto the agendas of the nation states of the world.
At the time of UNDRIP’s adoption, Victoria Tauli-Corpuz, Chair of the UN Permanent Forum on Indigenous Issues, released a statement to the United Nations General Assembly, which outlined that this ‘will be remembered as a day when the United Nations and its Member States, together with indigenous peoples, reconciled with past painful histories and decided to march into the future on the path of human rights’. She went on ‘The challenge to ensure the respect, protection and fulfillment of indigenous peoples’ rights has just begun. We foresee that there will be great difficulties in implementing this Declaration because of lack of political will on the part of the governments, lack of resources and because of the vested interests of rich and powerful’.
UNDRIP is particularly detailed when it comes to the right to health; all of the articles of this Declaration have an importance for the health and well-being of indigenous peoples. Box 1 shows specific Articles which refer directly to the indigenous health right. Perhaps one of the most promising ways forward is in the development of intercultural health programmes for both minorities and indigenous peoples. This can include programmes where allopathic, or western-trained, medical staff learn about indigenous health practices and remedies; training of indigenous and minority community members in allopathic medicine; incorporation of traditional healers from minority and indigenous communities into allopathic health services; and the incorporation of traditional medicines and practices into health services. There are now many examples of inter-cultural health programmes today – with notable and extensive programmes in Canada, New Zealand and Australia, and new laws and programmes in Bolivia, Ecuador, and Brazil.
It is important to remember Victoria Tauli-Corpuz’s words on the difficulty of achieving the right to health for minorities and indigenous peoples. This is a right we still need to call for in the context of the post-2015 development framework, and a right that we will continue to fight for in the years to come.