1 May 2002

United Nations

Economic and Social Council

Permanent Forum on Indigenous Issues

First Session, 13-24 May 2002, New York

Item 6 of the provisional agenda

INDIGENOUS PEOPLES AND HEALTH

A Briefing Paper For The Permanent Forum On Indigenous Issues

Prepared by the Committee on Indigenous Health[1]

1.        The Committee on Indigenous Health has prepared this briefing paper for the United Nations Permanent Forum on Indigenous Issues, on the occasion of its inaugural session from 13-24 May 2002 at the Headquarters of the United Nations Organisation (UNO) in New York City, USA. The intent of this paper is to inform the members of the Permanent Forum of the current situation, review progress, recommendation and provide an entry point for this august body into the health and survival issues of indigenous peoples and nations from their own perspective and experiences. It is a voice of the indigenous peoples and nations. The paper is not an exhaustive or comprehensive treatment of the health issues among the indigenous peoples and nations of the world nor is it to be viewed as a definitive submission by the Committee on Indigenous Health to the members of the Permanent Forum.

1.        The Committee wishes to take this opportunity to express its satisfaction at the establishment of the Permanent Forum on Indigenous Issues within the International Decade on the World’s Indigenous People; and believes that, with its establishment, the on-going process within the United Nations to address indigenous peoples’ issues concerning their human rights will be further strengthened.

1.        The Permanent Forum on Indigenous Issues is mandated by ECOSOC (resolution 2000/22) to discuss indigenous issues within the mandate of the Council relating to economic and social development, culture, the environment, education, health and human rights. The mandate specifically empowers the Permanent Forum to provide expert advice and recommendations on indigenous issues to the Council as well as to programmes, funds and agencies of the United Nations, through the Council.

1.        It is recognised that health, as perceived by indigenous peoples and nations, is a very broad and holistic concept that is not confined to the narrower conventional health concept or definition. Within the ambit of Permanent Forum’s wide mandate, this paper hopes to review the current status and contribute to the discussions on the health of indigenous peoples so that it may be of assistance to the members of the Permanent Forum’s discussions, expert advice and recommendations in this area. 

1.        The Committee has worked closely with the Working Group on Indigenous populations since 1997 and continues to do so. In this regard, the Committee on Indigenous Health wishes to reiterate its steadfast commitment and full support to the endeavours of the Permanent Forum in fulfilling its important mandate.

1.        We recognise, however, that some progress has been achieved in the standard-setting activities within the United Nations and some regional inter-governmental organizations. The work of the Sub-Commission’s Working Group on Indigenous Populations since 1982 has been an inspiring rallying point for indigenous peoples and nations as well as many international organisations and specialized agencies and bodies of the United Nations. The International Labour Office (ILO) had paved the way in its progressive revision of Convention 107.

1.        Among the areas in which increasing progress on the rights of indigenous peoples and nations in international and regional agendas have been made, mention may be made of inter alia the UN Declaration on the Rights of the Indigenous Peoples, the UN Convention on the Rights of the Child and the work of its monitoring body – the Committee on the Rights of the Child, the Convention on Biological Diversity, OAS Declaration on the Rights of Indigenous Peoples, the Berlin Agenda (5 November 1999), UN Framework on the Convention on Climate Change, the Convention to Combat Desertification and UN Development Programme’s draft policy.

1.        However, there are other areas of work among international organisations where indigenous peoples and nations, from all regions, have expressed deep concern. These include the World Bank’s present conversion process of OD 4.20 and revision of the draft Operational Policy/Bank Procedures 4.10 and Indigenous Peoples policy of the Asian Development Bank. Special mention must be made on the current work being undertaken by the World Intellectual Property Organisation (WIPO) and the Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional Knowledge and Folklore. The issues being dealt with are of special significance to the health of Indigenous Peoples and Nations, and the COIH looks forward to the outcomes of the Committee.

1.        Important thematic world conferences during the last century have also focused on the particular problematic of the indigenous peoples, calling on the international community to take urgent and appropriate action. Mention may be made inter alia of the Rio Declaration (1992; principle 22; agenda 21: 26.1), Vienna Declaration and Programme of Action of the World Conference on Human Rights (June 1993, Para 20 section I), the International Conference on Population and Development (Cairo 1994; Para 6.25 and 6.27); the Beijing Platform for Action of the Fourth World Conference on Women (1995, Para 116, 230, 233 and 242), and the Copenhagen Declaration on Social Development of the World Summit for Social Development (Copenhagen 1996, principle and goal 26m; commitment 6g, access to health care; 4f, support indigenous peoples’ aspirations for social justice and to provide an environment that facilitates indigenous peoples’ participation in socio-economic and political life of their country).  Much more need to be done on the ground to make effective and lasting changes to the situation of indigenous peoples and nations, however.

1.        Recently, at the World Conference on Racism, Racial Discrimination, Xenophobia and Related Intolerance (Durban, 2001), the adopted Declaration and Programme of Action have definitively expressed the world’s deep concern for the situation of indigenous peoples. These concerns that include the crucial issues of discrimination, self-determination and exclusion of indigenous peoples have very deep and ramifying implications for indigenous peoples’ survival and health.

1.        In July 2001, during the session of the Working Group on Indigenous Populations, the Committee on Indigenous Health established formal contact with the newly established Special Rapporteur on the situation of human rights and fundamental freedoms of Indigenous People, Mr. Rodolfo Stavenhagen. In his first report to the Commission on Human Rights the Special Rapporteur has referred to the progress made in the area of health through a developing partnership between the World Health Organisation and indigenous peoples (E/CN.4/2002/97 dated 4 February 2002; Para 24). He has outlined the future activities of the Special Rapporteur, which includes particular areas of great significance to the health situation of indigenous peoples (Para 113 [a] to [g]).

1.        The Special Rapporteur on adequate housing as a component of the right to an adequate standard of living, Mr. Miloon Kothari, stated in his first report to the Commission on Human Rights, in (E/CN.4/2001/51) that it was necessary to broaden the interpretation of the right to adequate housing since international legal standards already existed to address these, from a human rights based approach.   Of particular interest the Special Rapporteur included within the framework of his mandate and related to health and well being is that of access to potable water.  In the meanwhile several Indigenous NGO's reminded the Special Rapporteur, and others, that they have an obligation to include indigenous peoples in their reports according to CHR resolution 1993/30 which call on them "to pay special attention, within the framework of their mandates, to the situation of Indigenous Peoples."

The Committee on Indigenous Health

1.        The Committee on Indigenous Health (COIH) an indigenous peoples’ representative independent focal point was established by the Indigenous Peoples’ Caucus prior to the 15th session Working Group on Indigenous Populations in 1997 to:

a.        ensure indigenous representation and participation in development and planning related to health issues, policy and initiatives.

b.       assess the globalisation impact on indigenous health by environment degradation, rights violation and forced relocation.

c.        provide a consistent interface with international and intergovernmental agencies and to ensure the dissemination of information to the widest possible extend among indigenous peoples, national government and other stakeholders.

1.        A Forum on Indigenous Peoples and Health, in conjunction with the WGIP sessions, has been held annually at the Palais des Nations, Geneva by the COIH and WHO since 1998.

1.        During the “International Consultation on the Health of Indigenous Peoples”, (Geneva, 21-22 November 1999) jointly organised by COIH And WHO, COIH organised a Indigenous Peoples’ Health Caucus and drafted, after extended discussions, “The Geneva Declaration on the Health and Survival of Indigenous Peoples” (see Annex 1). This Declaration was adopted during the International Consultation. The International Consultation was organised to progress a global plan of action for addressing and promoting the health of indigenous peoples. A framework for Indigenous Peoples’ Health Policy was also adopted at the Consultation. The framework identified three pre-requisites to address the health of the indigenous peoples; “respect for fundamental human rights; recognition of indigenous peoples; and political will of the states” and the approach to their development is characterized by three inter-related themes of; “interconnectedness, self-determination and Equity”. Each approach has three principles, “interconnectedness is associated with cultural responsiveness, intersectoralism, and vertical integration; self-determination is associated with control, capacity-building and intellectual property and Equity is associated with quality information, accountability and resourcing”.

1.        The Consultation made a number of recommendations to WHO’s regional offices, State governments and the office of the Director-General. A summary of the recommendations is annexed for the information of the members of the Permanent Forum on Indigenous Issues. (See Annex 2)

1.        At a short glance, it should be noted that throughout the 20th century and continuing into the 21st century Indigenous Peoples and Nations and their rights to survival and well being faced and continue to face serious threat, with most of the governments of the world refusing to recognize, respect, protect and promote the fundamental human rights to health, to cultural knowledge, practices and identity, to land, to self-determination and to life of the indigenous peoples.

Enduring concerns for indigenous peoples’ survival and health

1.        It is not within the scope of this briefing paper to elaborate or discuss at length the extremely wide scope of the health issues concerning indigenous peoples. However, considering the grave situation of many indigenous peoples and given the fact the “health gap” between indigenous peoples and other population groups living within countries continues to widen rapidly, the members of the Permanent Forum are requested to facilitate a special briefing session on the health of the indigenous peoples during the inaugural session. COIH is committed to cooperate with and support the Permanent Forum conduct such briefings on a regular basis.

1.        The right to health is universally recognized, indivisibly linked to the right to life. It is recognized in article 25 of the Universal Declaration on Human Rights; articles 12 of the International Covenant on Economic, Social and Cultural Rights; articles 25 of the ILO Convention no.169 and articles 8 of the Declaration on the Right to Development. Indigenous peoples perceptions and experience of health is much wider than those of other groups of the population, in a sense that indigenous peoples approach health in holistic terms, which incorporates physical, cultural, emotional, mental and spiritual balance.

1.        The development of indigenous peoples health is inextricably linked to their wider social, cultural, economic and political development. The ways in which indigenous peoples measure the health and vitality of their community is also different from the conventional concept of health. The degree of self-government, the ability to participate in cultural practices and expressions, extent of access to traditional lands, or the numbers of speakers of their language may be considered indicators of equal importance as access to health services or the incidence rates of diabetes, tuberculosis, or malaria, of the health of the indigenous peoples.

1.        As we have reached the last quarter of the International Decade of the World’s Indigenous Peoples, it is a matter of grave concern that no concrete policy on the health of the indigenous peoples is in sight. The continued absence of such a policy or strategy has meant that systematic and organized work even on the preliminary and urgent task of accurately identifying and documenting health disparities between indigenous peoples and other populations is not taking place at the pace expected. Our attention is also drawn at the pace of progress of the specific intergovernmental and other specialized agencies dealing with health-related issues in establishing a comprehensive programme of action. Coordinated efforts must be made at both policy and activity levels. These efforts must be appropriate, integrated and sustainable.

1.        There is the primary concern of indigenous peoples for their survival as a group, the daily threat of ethnic violence, repression and the lack of essential health and welfare services. Armed and civil conflicts and development interventions that cause the displacement of indigenous communities and disturb the social lives aggravate the health problems. There is continuing discrimination of indigenous peoples in national health policies and access to health care. The links between the loss of land, of tradition economic structures, environment degradation and poor health conditions cannot be refuted. Diseases resulted from the loss of cultural identity due to colonization, marginalization, militarization, industrialization, globalization and discrimination are well recognised.

1.        As the major determinants lie outside the direct influence of the conventional health sector, there is an urgent need to directly involve the social, economic, cultural and political sectors including the private sector, whose activities have great impact of the health and survival of indigenous peoples, and evolve new ways of working together and establishing an effective partnership to address the health situation of indigenous peoples. The full participation of indigenous peoples is essential to ensure an integrated and appropriate approach, which is vital to the success of any policy, strategy or programme.

The World Health Organisation

1.        The World Health Assembly, which governs the World Health Organisation responded very positively to the global objectives of the International Decade on the World’s Indigenous Peoples. Its annual resolutions since 1994 (WHA 47.27, 48.24, 49.26, 50.31, 51.24, 53.10 and 54.16) affirm its continuing commitment. Last year, the fifty-fourth World Health Assembly, made its seventh annual resolution urging its member States and requesting its regional bodies and the Director-General of WHO on a number of appropriate actions to address the deplorable health situation of indigenous peoples.

1.        One of the major achievements in the area of international health is the Initiative on the Health of the Indigenous People of the Americas undertaken by the Pan American Health Organisation (PAHO). However, this initiative is limited to two regions of the Western Hemisphere and the initiative by PAHO has not been implemented in other regions of the world.

1.        The progress made by WHO, a technical inter-governmental advisory body, has been important though it has been also characterised by caution, hurdles of institutional arrangements and fixing of responsibilities. While WHO's contribution to the Decadal efforts, and particularly in the Region of the Americas, is commendable, one crucial element needs to be kept in the fore as further steps are contemplated and anticipated - establishment of partnership mechanisms with consistent and close consultation with indigenous peoples' representative organisations. It is encouraging that the WHO Secretariat, in its last report (WHA 54/33), acknowledges the advisory mandate of the Permanent Forum on Indigenous Issues to the bodies of the UN system.

1.        One, constantly cited, constraint to WHO in fulfilling its Decadal commitment is the issue of information. There is very little data, acceptable to WHO and its established partners, on the situation of the health of indigenous peoples from the different regions of the world. The evidence to form the basis of any technical initiative seems to be still ephemeral and beyond the reach of WHO.

1.        Many governments in whose territorial limits indigenous peoples exist have not compiled disaggregated information on their socio-economic or cultural situation. This has been regularly mentioned in WHO’s annual reports with regard to the Decade, and reflects the deeply seated resistance to the recognition of our very existence – a prerequisite to the recognition of our rights. While these lacunae are universally acknowledged, lack of political will has inhibited the adoption of any effective measures to address these.

1.        In this regard, the respected members of the Permanent Forum are invited to give their attention to one of the key recommendations of the Consultation to establish an Indigenous Peoples’ Health Advisory Group as a matter of priority. At the invitation of WHO, in 2000, the co-Chairperson of COIH, Dr. D. Roy Laifungbam, drafted a Terms of Reference for this proposed IPHAG (see Annex 3). Significantly, resolution WHA54.16 of 2001 also acknowledged the recommendations of the "International Consultation on the Health of Indigenous Peoples" (COIH/WHO, Geneva, November 1999), as a point of departure, where appropriate, for the development of regional plans of action. Unfortunately, very little progress has been made in WHO to implement the important recommendations of the International Consultation on the Health of Indigenous Peoples.

1.        It has been repeatedly demonstrated that a close and meaningful partnership with indigenous peoples in addressing national development policies and their implementation is not just desirable but can usher in positive changes that are beneficial to all interests. The recommendations made by indigenous health experts in 1999, reflect our firm belief and commitment to the goals of the Decade.

Global Fund to Fight AIDS, Tuberculosis and Malaria

1.        The Global Fund was set up in 2001 as a joint initiative involving governments, civil society organizations and the private sector as equal partners to increase funding for and fight the overwhelming AIDS, TB and Malaria crisis that we face today across the globe. It is to be seen as an experiment in a novel approach to governance and development decision-making in a “globalising” world. The Global Fund is committed to a transparent and accountable process so that health inequities in the available resources, services and drugs to fight AIDS, TB and Malaria may be better addressed.

1.        AIDS, TB and Malaria have drastically affected indigenous peoples and their communities. The devastation caused by these health problems alone has resulted in dramatic and tragic changes in our social, cultural and survival issues, already greatly compromised by many discriminatory policies, programmes, legislation and acts.

1.        The Committee on Indigenous Health has made many attempts during the past months, through both international NGOs directly cooperating closely with the Global Fund as well as by directly approaching the Global Fund’s Interim Executive Director, Anders Nordstrom, to cooperate actively with the on-going process of administering the fund. (See Annex 4).  Non-governmental organizations are represented in the administration of this Fund but, unfortunately, equitable participation by Indigenous People is not taking place.  Indigenous peoples legitimately demand a place too. To date, we have not received any response from the Global Fund.

1.        It is very crucial that the Global Fund give indigenous peoples’ representative organisations the opportunity of participation in presenting our critical needs, in decision-making and in benefits from this global initiative.

1.        As the administrative aspects Global Fund are in the process of being stabilized as a “quasi-governmental body”, i.e., a non-governmental entity with a dominant inter-governmental character, the Permanent Forum and the United Nations have a responsibility to ensure that indigenous peoples are fairly represented in all aspects of this fund and its activities.  It would be unfortunate to witness another initiative with commendable goals that fails to achieve the objectives.

1.        Therefore, the COIH request the Permanent Forum examine this initiative and define effective recommendations to the appropriate authorities, institutions and organs that exercise all the powers in this Fund.

Indigenous peoples’ health in other international forums and agencies

1.        Water is Life.  The provision of potable water as an important element for adequate housing is clearly addressed and described by Special Rapporteur, Mr. Miloon Kothari, in his first report mentioned earlier.  In fact, the World Bank along with other development banks is identified as a major offender in supporting privatization of water in low-income communities for over ten years.  The Permanent Forum is encouraged to advance the topic of right to drinking water supply as fundamental to the fulfillment of economic, social and cultural rights as contained in the international human rights instruments.  Furthermore, it is heartening to know the Commission on Human Rights in April 2001, decided, without a vote to request the Sub-Commission on the Promotion and Protection of Human Rights to review the terms of reference for the proposed study on the relationship between the enjoyment of economic, social and cultural rights and the promotion of the realization of the right to drinking water supply and sanitation, and also to review the level of United Nations support requested for such a study.

1.        It is noteworthy to bring to the attention of members of the Permanent Forum of a particular resolution, which passed the 58th session of the Commission on Human Rights. The Commission decided to appoint, for a period of three years, a Special Rapporteur whose mandate will focus on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, as reflected in article 25, paragraph 1, of the Universal Declaration of Human Rights, article 12 of the International Covenant on Economic, Social and Cultural Rights, article 24 of the Convention on the Rights of the Child and article 12 of the Convention on the Elimination of All Forms of Discrimination against Women.   

1.        Since 1995, indigenous peoples and NGO's have been invited as observers to the UNESCO discussions and debates before the International Bioethics Committee (IBC).  The final result of these debates culminated in the Universal Declaration on the Human Genome and Human Rights adopted in 1997 by UNESCO's General Conference, and endorsed by the UN General Assembly in 1998.  In a measure (E/CN.4/Sub.2/2001/L.23) on human rights and bioethics, the Sub-Commission last year decided to entrust Ms. Lulia-Antoanella Motoc with the preparation of a working paper on the Universal Declaration on the Human Genome and Human Rights as its contribution to the reflections of the IBC on their follow-up to the Universal Declaration.   Possible extensions to the Declaration will be considered during this evaluation period 2002-2003.  Indigenous NGO's and this Permanent Forum should be encouraged to submit perspectives, comments and recommendations to Ms. Motoc especially about Indigenous Peoples right to say no to “biopirates”, and to recognize the collective rights of indigenous peoples.  These are two major hurtles the IBC has been unwilling to acknowledge hence there is no mention in the Universal Declaration on the Human Genome and Human Rights.    

1.        The World Intellectual Property Organization (WIPO) General Assembly established the Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional knowledge and Folklore in October 2000.  The purpose of the Committee among others, deals with "intellectual property issues that arise in the context of (I) access to genetic resources and benefit sharing; (ii) protection of traditional knowledge, whether or not associated with those resources; and (iii) the protection of expressions of folklore".  The first meeting of the Committee was in May 2001, and the second in December 2001.  The Committee will have three more sessions within the next two years.  It is encouraging that Indigenous NGO's are being asked to participate and that WIPO announced that some indigenous and local community representatives could be funded in order to ensure their participation in the third session of the Committee scheduled to take place from 17 to 21 June 2002. The fundamental concept is that indigenous peoples’ knowledge is a collective heritage and should not be traded.  The Permanent Forum should examine the progress made in this regard and advise on an alternative system that would serve to protect indigenous knowledge from bio-pirates.

1.        The Convention on Biological Diversity (CBD), Conference of Parties VI adopted several resolutions regarding indigenous peoples.  The fundamental need for clear and binding frameworks to support and strengthen the protection of traditional knowledge is still elusive.  The work of the CBD and of the WIPO need to be mutually supportive.

1.        The Food Agricultural Organization (FAO) is central to the CBD, particularly article 8(j).  Indeed, traditional and local communities including farmers were key stakeholders in all FAO policies and activities.  In November 2001 the FAO Conference adopted the new International Treaty on Plant Genetic Resources for Food and Agriculture.  The Treaty provides for Farmer's rights, equitable sharing of benefits arising from their sue, in harmony with the CBD.  The Treaty will succeed the International Undertaking on Plant Genetic Resources.  The 19th session of the Working Group on Indigenous Populations has "requested the High Commissioner on Human Rights to encourage studies with respect to the rights to food and adequate nutrition of Indigenous peoples and Indigenous peoples and poverty, stressing the linkage between their present general situation and their land rights, and to develop further cooperation with the Food and Agriculture Organization and the World Food Program on Indigenous issues.  In support of these endeavors the FAO helped finance the Indigenous Peoples International Consultations on the Right to Food.  The report and Declaration of Atitlan, Guatemala is now an official document where the participants reached a consensus on the priority issues faced by indigenous peoples with regard to food security; and Develop a document with a plan of action addressing these priority issues, with positions and demands from the perspectives of Indigenous Peoples, on their right to development and their right to food.

1.        In resolution (E/CN.4/Sub.2/2001/L.14) the Working Group on Indigenous Populations recommended that the Commission on Human Rights invite the UNDP and the World Bank to present their new policy guidelines on indigenous peoples at its twentieth session.  Many indigenous peoples did not respond to the invitation by the World Bank to review and comment on changes to O.D. 4.20 (1991) to the new revised version O.D. 4.10 which is much weaker and a disadvantage to Indigenous Peoples.  It was felt that by participating in the policy changes indigenous organizations would be in agreement to the changes.  Indigenous organizations are pleased that the World Bank representative in Geneva has stated he will include indigenous representatives in the GEF/NGO/UNEP and World Bank consultations as first steps for more direct participation.

Recommendations

1.        The Permanent Forum is requested under its mandate to take the following recommendations into consideration in its inaugural session. 

1.        Examine, with utmost priority and greatest attention, all developments in various international agencies and UN bodies and develop a protocol and permanent mechanism under its authority whereby all economic, cultural and political sectors of specialized agencies and bodies of the UN dealing with health-related issues, or have relevance to health according to the perspective of indigenous peoples, work in partnership with indigenous peoples own experts and representatives and work towards coordinating their policies and programmes of action to ensure that the health of indigenous peoples is maintained as a cross-cutting priority.

1.        Facilitate the establishment of an Indigenous Peoples’ Health Advisory Group by WHO as a matter of priority according to the Terms of Reference recommended by the COIH, and request WHO to urgently implement the recommendations of the International Consultation on the Health of Indigenous Peoples.

1.        Establish the means to examine the role and functions of the Global Fund for AIDS, Tuberculosis and Malaria and all other similar international initiatives to ensure indigenous peoples’ representative organisations the opportunity of meaningful participation in presenting their critical needs, in decision-making and in benefits from GFATM.

1.        Establish a continuing and constructive relationship between the Permanent Forum and the Committee on Indigenous Health, as an indigenous peoples’ independent and representative focal point on indigenous health issues.

Annex 1  The Geneva Declaration On The Health And Survival Of Indigenous Peoples

Annex 2  Summary Recommendations Of The International Consultation On The Health Of Indigenous Peoples, Geneva, 23-26 November 1999 (WHO/HSD/00.1)

Annex 3  WHO Advisory Group On Indigenous Peoples’ Health: Draft Terms Of Reference

Annex 4  COIH Letter to the Global Fund to Fights AIDS, Tuberculosis and Malaria

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Copyright Natalie Drache 1999