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the preparation of the
2014 World Conference on
Indigenous Peoples
JUNE 2014
Thematic Paper on the Health of Indigenous Peoples
The United Nations Inter-Agency Support Group (IASG) on Indigenous Issues aims to strengthen
cooperation and coordination among UN agencies, funds, entities and programmes on indigenous
peoples’ issues and to support the UN Permanent Forum on Indigenous Issues. It also seeks to
promote the effective participation of indigenous peoples in relevant international processes.
At its annual meeting held in October 2013, the IASG decided to develop a set of collaborative
thematic papers to serve as background information and analysis on key issues to contribute to the
process and preparations for the World Conference on Indigenous Peoples.
The preparation of each paper was led by one or more agencies with inputs from other IASG
members. The papers do not present or represent formal, official UN policy positions. Rather, they
reflect the collective efforts of the Inter-Agency Support Group to highlight selected key issues and to
provide substantive materials to inform the Conference, with a view to contributing to the realization
of the rights of indigenous peoples.
*The chair of the IASG rotates annually amongst the participating agencies. The Support Group has
been chaired by the United Nations Children’s Fund (UNICEF) until the end of the 13th session of
the Permanent Forum on Indigenous Issues in May 2014. The Office of the High Commissioner for
Human Rights (OHCHR) is currently holding the chair of the Group. The Secretariat of the
Permanent Forum on Indigenous Issues acts as co-chair of the Support Group.
Key messages ……………………………………………………………………………………………………………. 1
Background ………………………………………………………………………………………………………………. 2
Analysis …………………………………………………………………………………………………………………….. 3
Conclusion ………………………………………………………………………………………………………………. 10
Acronyms ………………………………………………………………………………………………………………… 10
Key messages
 Globally, indigenous peoples suffer from poorer health, are more likely to experience
disability, and reduced quality of life and ultimately die younger than their nonindigenous counterparts.
 Indigenous women experience health problems with particular severity, as they are
disproportionately affected by natural disasters and armed conflicts, and are often
denied access to education, land property, and other economic resources.
 Differences in infant mortality between indigenous and non-indigenous populations
reflect the structural inequalities of these groups on an international level. Many of the
most widespread causes of mortality among indigenous children are preventable, such
as malnutrition, diarrhea, parasitic infections, and tuberculosis.
 Indigenous youth and adolescents face particular challenges in the realization of their
right to health that are often not adequately addressed, including sexual and
reproductive health and rights, and mental health.
 Statistical and health data collection is a key challenge in addressing Indigenous health
disparities across the world and within regions.
The United Nations has estimated that there are approximately 370 million indigenous peoples
in the world, living across all regions in at least 70 countries.1 There is an enormous diversity of
languages and cultures amongst indigenous peoples. However, an unfortunate commonality
across much of the world’s indigenous peoples is persisting inequities in health status in
comparison to non-indigenous populations. Gaps are not only in health status, but also in many
determinants of health. Data indicates that circumstances of extreme poverty are significantly
more prevalent among indigenous peoples than non-indigenous groups, and are rooted in other
factors, such as a lack of access to education and social services, destruction of indigenous
economies and socio-political structures, forced displacement, armed conflict, and the loss and
degradation of their customary lands and resources. These forces are determined and
compounded by structural racism and discrimination, and make indigenous women and children
particularly vulnerable to poor health. Because of these phenomena, indigenous peoples
experience high levels of maternal and infant mortality, malnutrition, cardiovascular illnesses,
HIV/AIDS and other infectious diseases such as malaria and tuberculosis.
These health inequities are of grave concern from a public health perspective, but also from a
human rights perspective. All peoples have the right to the highest attainable standard of
physical and mental health, and states have the responsibility to promote, protect, and fulfil all
human rights. In addition to being recognized in many international conventions, the right to
health for indigenous peoples is further stipulated in the UN Declaration on the Rights of
Indigenous Peoples, which also recognizes their right to traditional medicines and the
maintenance of their traditional health practices.2 WHO Regional Office for the Americas
(PAHO/WHO)i promotes the rights of indigenous peoples in line with the UN Declaration on the
Rights of Indigenous Peoples. There is a need to increase indigenous participation in the
planning and delivery of health services because “[t]here is a strong correlation between the
health of individuals and communities and the exercise or denial of the right of selfdetermination”ii.
UN Permanent Forum on Indigenous Issues, 2009.
United Nations Declaration on Rights of Indigenous Peoples, especially Articles 23 and 24. Found online at:
The situation described above regarding indigenous peoples has at least three direct
implications for public health: (1) a pervasive violation of the human rights of indigenous peoples
in the countries where they are found, including the rights to self-determination, to nondiscrimination, to health, to life, to education, to food, to culture, to land, and to water, among
others; (2) widespread structural inequalities impact multiple rights and social determinants of
health, creating vulnerability and differing levels of risk exposure in indigenous communities;
and (3) health programs have not had the hoped-for effect in these groups, resulting in the
challenge to understand the local socio-cultural contexts in which heightened mortality and
morbidity occur, and with the aim of designing programs and interventions with the full
participation of the populations concerned that are culturally sensitive and epidemiologically
effective.iii Indigenous peoples’ health is an issue of concern in all countries, independently of
their income. For example, in the Western Pacific Region, Australia and New Zealand are
struggling to close substantial gaps between indigenous and non-indigenous populations in life
expectancy and access to health care.
A comprehensive discussion of health inequities experienced by indigenous peoples around the
world is beyond the scope of this paper. However, discussed herein are (1) some selected
issues regarding the health and well-being of indigenous peoples around the world, with a
particular emphasis on Latin America, (2) ongoing challenges for building health care systems
for indigenous peoples and (3) key messages for further action to enhance the health of
indigenous peoples. The issues discussed here are areas in which PAHO/WHO and other WHO
Regional Offices are conducting relevant work.
1. Selected Heath-Related Issues
1.1 Women’s Health: sexual and reproductive health (SRH), maternal health and other
health issues indigenous women face
Data from demographic and health surveys have highlighted the detrimental situation and failure
to respect the right to health and to life for indigenous women and youth. There are gaps in
equity in comparison with non-indigenous peoples in terms of access to family planning
services, delivery care for pregnant indigenous women as well as immunization coverage and
the prevalence of illnesses associated with higher mortality rates for their children.iv
In addition, as the incidence of other public health issues (such as alcohol and substance
abuse, depression, and suicide) increases, urgent and concerted efforts are needed to improve
the health of indigenous peoples. The growing problem of alcohol consumption in Latin
American countries, especially among women and young people, is recognized and specifically
addressed by PAHO/WHO in the Plan of Action to Reduce the Harmful Use of Alcohol (2011).
In terms of information, it is essential to improve record systems for maternal-infant health in
general, and maternal mortality in particular, by incorporating an ethnic focus in all data sources
and during all stages of information gathering. It is also essential to reinterpret standard
indicators through the right to cultural wholeness, ensuring the full participation of indigenous
communities and peoples in these processes.v vi
Indigenous populations are growing rapidly in many countries, and there is a higher child to
adult dependency ration compared to non-indigenous populations.vii
Sexual health is of especially great relevance to indigenous youth and adolescents. The United
Nations Population Fund (UNFPA) notes, “A special mention needs to be made with respect to
indigenous adolescents, given the higher proportion of adolescent maternity that reveals ethnicrelated unequal access to reproductive rights.”viii In Latin America, the proportion of young
mothers in the indigenous population is higher than that of the non-indigenous population. The
countries in this region with the greatest disparity between indigenous and non-indigenous
adolescent mothers are Brazil (27 percent versus 12 percent), Costa Rica (30 percent versus 12
percent), Panama (37 percent versus 15 percent), and Paraguay (45 percent versus 11
percent), respectively.ix This evidences the unequal access to the right to sexual and
reproductive health due to a variety of structural causes: that statistically girls have less
education than boys, a great number live in rural areas with restricted access to health care,
and the lack of culturally appropriate health services, which make it difficult for these young
people to access family planning services.x
The rate of pregnancies for adolescent women in indigenous communities is inextricably linked
to social norms and attitudes regarding sexual protection and family planning. Thus, precautions
against sexually transmitted infections and HIV/AIDS are often forgone, resulting in high rates of
sexually transmitted infections amongst indigenous youth. In Latin America, rates of HIV
infection among women have risen from 4 percent in 1990 to 30 percent in 2007; in countries
like Haiti, Guyana, and Dominican Republic, the rate of infection among adolescent women is
estimated to be at 50 percent.xi
1.2 Infant and Child Mortality among Indigenous Peoples
Despite the significant decline in infant mortality rates in many regions, studies show systematic
heightened mortality for indigenous children in comparison to the rest of the population. For
example, in Latin America, infant mortality among indigenous children is 60 percent greater than
for non-indigenous children (48 per one thousand births compared to 30 per one thousand,
respectively), ranging from 1.11 times higher in Chile to 3.09 times higher than the general
population in Panama.xii Specific studies have documented that children from the Campa
Ashaninka and Machiguenda in Peru, the Wayu of Venezuela, the Tzotzil of Mexico, and the
Xavante in Brazil have a higher risk of death before reaching one year of age than nonindigenous children.xiii xiv
The probability of death of indigenous children varies according to where they reside, often even
according to their village. Generally, the lowest risk is among children who live in cities.
Nevertheless, in certain countries the gap between indigenous and non-indigenous is most
noticeable in urban areas.xv In PAHO/WHO’s 2007 Health in the Americas report, it was stated
that in Bolivia, Ecuador, Guatemala, Mexico and Panama, which have collected information on
ethnic group and mother’s area of residence infant mortality rates are consistently higher among
rural indigenous populations than among their non-indigenous rural peers as well as among
urban indigenous populations.xvi
1.3 Mental health
In many countries in the world, indigenous youth and adolescents have poorer mental health
outcomes, and higher rates of disability due to injuries and accidents than their non-indigenous
counterparts. These inequalities and social disparities are interrelated and have negative
implications with regard to the enjoyment of the right to health (access to health services, goods
and facilities, including traditional medicine, clean water, sanitation, and sufficient number of
trained health workers in indigenous communities), and other related human rights such as the
right to physical and mental integrity, to security of person, to education in their own language,
and to benefit from scientific progress on equal basis regarding other populations, among
With regard to depression amongst indigenous young people, the information is insufficient and
more research is necessary; however the data that is available in the region of the Americas
shows that the prevalence of depression is higher amongst indigenous communities than nonindigenous communities. Experiences of colonization, racism, cultural and ethnic
marginalization, tension between traditional and western values, and limited access to
resources and information put indigenous young people at a greater risk of depression and in
some cases suicide.
PAHO/WHO created an Adolescent and Youth Regional Strategy and Plan of Action to enhance
the health and well-being of adolescents, which, in turn, “strengthens national capacity to build
social capital and secure healthy populations during their most economically productive years
and later on in life.”xvii The Plan of Action calls for inter-agency data sharing regarding
indigenous youth and adolescents, gathering information on indigenous adolescents by
developing quality surveys, and creating or enhancing leadership programs, especially among
indigenous youth.xviii
The complex health situation of indigenous peoples in Latin America and the Caribbean is
largely a product of social exclusion, discrimination, poverty, and poor access to health services.
These factors lead to high psychosocial vulnerability, and limited access to mental health
services, especially in rural areas.
Although there is limited epidemiological data regarding the mental health of these populations,
several countries and aboriginal groups are concerned about the lack of answer to their needs,
reflected in terms of high rates of alcohol consumption and high rates of suicide, among other
key problems.
The PAHO/WHO Regional Strategy and Plan of Action on Mental Health (2009) expresses the
need to support countries, and vulnerable and special-needs groups, with special mention to
indigenous populations. In recent years, two projects were implemented by PAHO/WHO
involving indigenous communities in selected countries of Latin America and Canada. The aim
of those projects has been to promote the exchange among representatives of these
communities, in order to identify common areas of interest; to learn how mental health problems
are identified in the socio-cultural context of those groups; and to identify best practices that
take into account respective socio-cultural considerations that may render a western mental
health perspective less effective. The involved communities have shown interest in the
continuation of the projects.
1.4 Communicable Diseases: Tuberculosis and Malaria
In 2011, there were 8.7 million reported cases of tuberculosis worldwide; that same year, 1.1
million deaths occurred as a result of the disease.xix Due to poverty and associated issues,
tuberculosis continues to disproportionately affect indigenous peoples around the globe. For
instance, the Guaraní, Bolivia’s third-largest indigenous group, “contract tuberculosis at a rate
that is five to eight times the national average;”xx the Aboriginal population in Canada is about
4.3% of the total Canadian population, but accounts for about 19% of estimated TB disease
burden; xxi and the Kalaallit Nunaat in Greenland are 45 times more likely to get active TB than
the Danish population.xxiiWhilst programs have been designed to combat tuberculosis, it often
does not reach indigenous peoples because of issues related to poverty, poor housing, lack of
access to medical care and drugs, cultural barriers, language differences, and geographic
The WHO Governing Bodies are currently considering a new global strategy and targets for
tuberculosis prevention care and control after 2015. A key pillar of the draft strategy is the
strengthening and expansion of the core functions of TB programs, with a particular emphasis
on outreach services to underserved and vulnerable populations in consultation with
communities and civil society.xxiii
Like many other communicable diseases, malaria affects indigenous peoples disproportionately,
but the degree of concentration is more extreme than for any other health problems in
Southeast Asia, the eastern part of the Indian subcontinent, and the Amazon Region of South
America. This is because malaria vectors there are closely associated with forests, and the
majority of indigenous peoples in those regions inhabit forested areas; traditionally living from
swidden agriculture requiring frequent movement from place to place and use of makeshift
shelters, which further increases exposure. Conditions are getting worse because of increasing
population density and encroachment on traditional lands by non-indigenous peoples, and
corporate economic activities.
Over the last 20 years, the malaria situation among indigenous peoples has improved in most of
these areas for a number of reasons. Deforestation, while having many negative effects, is
associated with less exposure to malaria, although this is seen more in tropical Asia than in
South America.xxiv Insecticide-treated bed nets have been introduced on a large scale and have
been well accepted and shown to reduce risk.xxv Village volunteers have been trained and
equipped with rapid tests for malaria and effective antimalarial medicines.xxvi However, these
advances are partial, and are fragile, because they depend on international financing;
furthermore, emerging artemisinin resistance compromises current antimalarial treatments in
Southeast Asia.xxvii
1.5 Nutrition
Poor nutrition is one of the health issues that most affects indigenous peoples around the world.
The rates of malnutrition for indigenous children in Latin America are double that of the general
population of the region.xxviii In addition to circumstances of extreme poverty, indigenous peoples
suffer from malnutrition because of environmental degradation and contamination of the
ecosystems in which indigenous communities have traditionally lived, loss of land and territory,
and a decline in abundance or accessibility of traditional food sources. These changes in
traditional diet, combined with other changes in lifestyle, have resulted in widespread
malnutrition among indigenous …
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