STATE OF THE WORLD's INDIGENOUs PEOpLEs - CINU

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EMBARGOED UNTIL 14 January 2010STATE OF THE WORLD’S INDIGENOUS PEOPLESNot for distributionWHO has begun to debate this definition and to consider the possibility ofincorporating a cultural aspect into its concept of health. 6 Many organizationsthat promote health are thus beginning to recognize that the conventionaldefinition is insufficient to capture the full meaning of health in societies that arediverse in their cultures, religions and forms of social organization.For indigenous peoples, health is equivalent to the “harmonious coexistence ofhuman beings with nature, with themselves, and with others, aimed at integralwell-being, in spiritual, individual, and social wholeness and tranquillity”. 7The indigenous concept of health articulates physical, mental, spiritual andemotional elements, from both individual and communal points of view, andinvolves political, economic, social and cultural aspects. It is shaped byindigenous peoples’ historical experiences and worldviews, and is expressedin the rules and norms that are applied in the community and practised by itsmembers. To promote health and prevent illness, an indigenous communityseeks to recuperate and maintain its interior and exterior equilibrium,including the harmony between community members who are sick and theworld around them.the indigenous conceptof health articulatesphysical, mental,spiritual and emotionalelements, from bothindividual and communalpoints of viewTraditional health systems in indigenous communities are complex andquite structured in their content and internal logic. They are characterizedby a combination of practices and knowledge about the human body, andcoexistence with other human beings, with nature and with spiritual beings.They involve all aspects of health promotion, prevention of illness and treatmentand rehabilitation, but differ from most Western health systems in that theytake an integral or holistic approach. 8 Many indigenous families address illnesswith a variety of approaches and practices, using either traditional or Westernmedicine, or a combination of the two. If treatment administered in the homeproves insufficient, the choice is made—often by a woman, who is the primarydecision-maker in this arena—as to whether to send the sick person to apractitioner of traditional or of Western medicine. In the absence of state healthsystems that incorporate the philosophies and practices of both traditional andWestern medicine, the choice becomes polarized between the two systems,often to the detriment of the sick person.6 In its Session 101 in January 1998, the WHO Executive Board was requested to amend theWHO definition of health to include the concept of spirituality. WHO considers spirituality,religiousness and personal beliefs as three of the areas by which to analyze the quality oflife of an individual. See WHO (1998).7Health Workshop, Guaranda, Bolívar, Ecuador, 1995.8 It is important to present working definitions of the terms “Western” and “traditional”medicine. Western medicine, also called Occidental medicine, biomedicine, conventional,allopathic, or orthodox medicine, is a system of medical practices that use an approachof treating illness through remedies that produce effects that oppose the symptoms of theillness. The Pan-American Health Organization (PAHO) has defined traditional medicine andindigenous health systems to “include the entire body of ideas, concepts, beliefs, myths,procedures and rituals (whether explainable or not) connected with the maintenance ofhealth or health restoration through the treatment of physical and mental illness or socialimbalances in a particular individual, community, or people. This body of knowledge,grounded in the people’s cosmic visions, explains the etiology, nosology and procedures forthe diagnosis, prognosis, cure, disease prevention, and health promotion”. See PAHO (1997).HEALTH | 157
EMBARGOED UNTIL 14 January 2010STATE OF THE WORLD’S INDIGENOUS PEOPLESNot for distributionTuberculosis in indigenous and non-indigenous populationsTuberculosis, a disease that primarily affects people living in poverty, affects at least 2 billion people in theworld, according to 2008 statistics. As a result of poverty and associated issues, tuberculosis continuesto disproportionately affect indigenous peoples around the globe. Indigenous peoples are at an increasedrisk of suffering from tuberculosis. Whilst programmes have been designed to combat tuberculosis, theyoften do not reach indigenous peoples because of issues related to poverty, poor housing, a lack of accessto medical care and drugs, cultural barriers, language differences and geographic remoteness.The statistics surrounding indigenous people in the context of tuberculosis indicate that in Canada, in 2006, the First Nations tuberculosis rate was 27.4 per 100,000, or 35 times higherthan among the non-aboriginal population born in Canada. Tuberculosis is a particular threat tothe Inuit in Canada, where the rates are 121 per 100,000, or just over 150 times higher than thenon-aboriginal population; 9in New Zealand, the ratio is 21.1 among Pacific Islanders and Maoris, making them at least 10times more likely to contract tuberculosis than other people living in New Zealand; 10in Kalaallit Nunaat (Greenland) the tuberculosis rate was 157 per 100,000, making them 45 timesmore likely to get active tuberculosis than the Danish population. 11Health and the collective rights of indigenous peoplesInternational human rights instruments such as the Universal Declaration of Human Rights, the InternationalCovenant on Economic, Social and Cultural Rights, the Convention on the Elimination of All Forms of Discriminationagainst Women and the Convention on the Rights of the Child have traditionally provided the legal framework forthe foundation of international human rights, including the right to health. These instruments include provisionsfor the right to life and for the “right of everyone to enjoy the highest attainable standard of physical and mentalhealth”, 12 with some specifically recognising the rights of individuals from marginalized populations, includingindigenous peoples and ethnic minorities.In the case of indigenous peoples, the right to health should not be conferred only on individuals, but should alsobe applied at the collective level. Until recently, however, few legal instruments had incorporated the conceptof collective rights. In the same way that the establishment of individual rights has advanced over time, a setof collective rights is never beginning to be articulated at the international level, such as the approval of theDeclaration on the Rights of Indigenous Peoples by the United Nations General Assembly. 13 This is perceived byindigenous peoples as a human rights instrument which, in time, will increase the political will of states to buildnew relationships with indigenous peoples, and to confront the exclusion to which they have been subjected.9Public Health Agency of Canada (2006) and Statistics Canada (2006).10Das, Baker & Calder (2006).11Skifte (2004).12International Covenant on Economic, Social, and Cultural Rights, Article 12.1.13The Declaration was adopted by the newly established Human Rights Council in June 2006 and, on 13 September 2007, by theUnited Nations General Assembly.158 | CHAPTER V
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