Gro Brundtland

International Consultation on the Health of Indigenous Peoples - Nov. 23, 1999

Gro Brundtland
November 23, 1999— Geneva, Switzerland
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Ladies and Gentlemen:

It is a great privilege and pleasure for me to be here today to welcome you to this International Consultation on the Health of Indigenous Peoples. WHO is firmly committed to the rights and the aspirations of indigenous peoples for long and healthy lives. So we take pride in hosting this consultation to move the agenda forward.

Three years ago, when the United Nations Conference on Human Settlements observed the International Decade of the World's Indigenous Peoples, world leaders decried the damage to the environment and land of indigenous peoples. Wally N'Dow, Secretary-General of that conference, reminded us that the harm is not only to the peoples who have for centuries and millenniums lived on those lands. The rest of the world suffers as well. When we marginalize indigenous peoples, we cut off a vast body of knowledge that is of great value to humanity. That is clear to those of us in the health field, who depend on the wisdom passed down through the generations, of plants and herbs and flowers that have the power to heal.

But our debt to indigenous peoples is more than the knowledge they have endowed. As Mr N'Dow said, "They teach us how to live more correctly." Indigenous peoples teach us about the values that have permitted humankind to live on this planet for many thousands of years without desecrating it. They teach us about holistic approaches to health that seek to strengthen the social networks of individuals and communities, while connecting them to the environment in which they live. And they teach us about the importance of a spiritual dimension to the healing process.

We come together today to confront some daunting challenges to these values. Despite the adoption of the Universal Declaration of Human Rights 50 years ago, indigenous peoples continue to be subject to systematic denial of their fundamental human rights to cultural identity, to land, to liberty, to health, and to life itself.

Life expectancy at birth is 10 to 20 years less for indigenous peoples than for the rest of the population. Infant mortality is 1.5 to 3 times greater than the national average. Malnutrition and communicable diseases, such as malaria, yellow fever, dengue, cholera and tuberculosis, continue to affect a large proportion of indigenous peoples around the world.

The health of indigenous peoples in many regions is also threatened by damage to their habitat and resource base. Environmental assessments show that certain Arctic populations are among the most exposed in the world to environmental contaminants. Some of these contaminants are carried to the Arctic and accumulate in animals used as traditional foods. Radioactive contamination has made the inhabitants of the Bikini Islands dependent on food aid because the locally grown food is too radioactive to eat.

Development is taking its toll in lives as well. Large scale tourism disrupts local social, cultural and political structures. Logging, mining and the building of dams and agri-business displace thousands of people from their land, removing them from their basic food sources, their way of life, and their very livelihoods. The arrival of development ventures in Kalimantan since 1970 has resulted in the degradation of the world's oldest rainforest and the disruption of lives of three million Dayak people.

Most troublesome, indigenous peoples are over-represented among the world's poor. This does not mean only that they have low incomes. Poverty is multi-dimensional and like others in poverty, indigenous peoples are less likely to live in safe or adequate housing, more likely to be denied access to safe water and sanitation, more likely to be malnourished, and more likely to lack access to appropriate, affordable, and culturally-sensitive health services.

A commitment to preserving the dignity of human beings, and to assuring human rights tell us that we must do everything possible to maintain the culture and livelihoods of indigenous peoples. Adding more weight to this are studies which show that when this is done, the health status of indigenous peoples is higher. Maintenance of traditional lifestyles and culture has been associated with decreased rates of infant mortality, low birth weight, cancer, high blood pressure, and diabetes.

Traditional culture also confers important benefits in promoting healthy personal behaviours such as physical activity, and lower levels of cigarette smoking and drug use. Tradition and cultural grounding provide health-promoting resources on which people can draw strength. These resources are not limited to health services; they include social support networks, promotion of self-sufficiency, and access to food and other material networks.

On the other hand, preserving traditional culture can easily lead to attempts at isolating indigenous people and building "museum cultures" that are separated from the modern society that surrounds them. We must be careful not to build walls between traditional culture and modern society so that we exclude indigenous people from participation in the country's political, economic and cultural affairs. This balance between the right to participation and the right to remain different is a delicate one, but one thing is clear: no-one except the indigenous peoples themselves can determine how this balance is struck.

Clearly, indigenous peoples have the knowledge and cultural base on which to build healthier societies. But they cannot do so alone. Governments have a responsibility and an obligation to do their part as well. Many governments have not only shied away from this responsibility, but they deny formal recognition of indigenous peoples entirely. Some national governments have taken steps in the right direction, by developing comprehensive policies and strategies to address the health problems of indigenous peoples. Nonetheless, there are few examples where their actions have reduced the disparities between indigenous peoples' health and that of other people within national boundaries.

The UN International Decade for the World's Indigenous Peoples, and the Draft Declaration on the Rights of Indigenous Populations, sound the call to governments across the world that indigenous peoples have rights to survival, dignity and well-being that must be respected and promoted. Article 22 of the draft declaration make it clear that indigenous populations have the right to special measures for the immediate improvement of social conditions, including their health. Just as important are Articles 23 and 24, which emphasize the rights of indigenous peoples to determine their own priorities for health programmes and to use traditional medicines and health practices.

Partnerships between governments and the indigenous peoples movement are therefore important; indeed they are essential. Only through partnership can societal systems mutually reinforce each other. This is why the groundswell of the indigenous movement in recent years is so important. It sends a signal that collaboration must be based on the perceptions and expressed needs of indigenous peoples, rather than on assessments of those far removed from their reality.

WHO will play a role to ensure that the billion and a half people who have been excluded from economic development and the health "revolution" of the 20th century are lifted from poverty and ensured healthy lives in the 21st. Redressing the plight of indigenous peoples is an integral part of this agenda.

It has long been recognized that poverty is a major risk factor for death, disease and disability. Illness and disabilities among the poor lead to a vicious circle of marginalization, to falling into or remaining in poverty, and then to added morbidity. But the other side of that coin that improved health status can prevent poverty and offer a route out of poverty has been given much less attention. The evidence shows that better health translates into greater, and more equitably distributed, wealth by building physical and social capital and increasing productivity.

The significance of these findings is clear: to turn the vicious circle into a virtuous one, WHO must focus its resources more directly and effectively towards poverty reduction by improving and protecting the health of the poor, and advocating the fact that health is key to economic and human development.

How will we do it? By developing and promoting the most effective health strategies that contribute to reduction of poverty. We know that many health interventions do not adequately reach or serve the poor. We also know that universal access to health services is a necessary condition for eliminating the "health divide". But even this is not sufficient. As indigenous peoples know well, the cultural barriers to health care are often as significant as financial barriers.

Many of the determinants of health among the poor like those of indigenous peoples - lie outside the health sector. Thus, achieving better health among the poor requires a broad approach in which WHO and Member States engage with others responsible for economic and social development to ensure that all national policies, including those of the health sector, improve and protect the health of the poor. This means, for example, striving to make globalization more inclusive and to distribute its benefits more equitably.

This consultation will be an important boost to efforts to develop a global plan of action for improving the health of indigenous peoples. WHO wants to be a strong partner in this endeavour, while recognizing that the leadership must come from indigenous peoples themselves. What can WHO do?

WHO can build knowledge about the mechanisms by which protection of traditional lifestyles and cultural practices lead to better health among indigenous peoples. WHO can also develop better measures to monitor health inequalities between indigenous peoples and others within national boundaries, by helping national governments collect and analyze health statistics that take into account ethnic differences. WHO also can advance and widely disseminate knowledge about how policies and practices in economic development or in specific sectors affect the health of indigenous peoples.

At the international level, WHO can advocate for the plan of action developed from this meeting and others with international and regional development agencies. WHO can also urge development leaders to recognize and support the efforts of indigenous peoples to promote their own healthy development policies. And at the national level, WHO can support national governments in making the health of indigenous peoples a higher priority, identifying effective health strategies, and promoting learning across countries about the most effective policies that improve the health of indigenous peoples.

Our success - WHO's and yours - will depend on shaping public opinion and stimulating public action through elected representatives and civil society - at local, national, regional and global levels. The fundamental message we send is that health is a fundamental human right, enshrined in the Universal Declaration of Human Rights. This means more than universal access to adequate health care. It depends on the assurance of many other rights in the Declaration: access to education and information, the right to food in sufficient quantity and of good quality, the right to decent housing, and the right to live and work in an environment where known health risks are controlled.

I believe this message is reaching and being understood by those in the development community and, to an increasing degree, by political leaders around the world. Broad political commitment can be forged to take seriously the vision of sustainable human development. But it depends on generating wider appreciation of the crucial role played by health in development, connecting health to the broader process of societal change, and gaining adherence to the principles of equity and human rights.

In 1855, Chief Seattle said "The earth does not belong to mankind; mankind belongs to the earth. Man did not weave the web of life; he is but one strand. Whatever he does to the web, he will be doing to himself. All that happens to the earth will happen to the children of the earth."

He was right. We cannot separate the people from their environment. Investing wisely in health means caring for our natural environment and ensuring that we endow future generations with that precious resource. If we manage, hundreds of millions of people now and in the future - will be better able to fulfil their potential, enjoy their legitimate human rights and be driving forces in development. People would benefit. The economy would benefit. The environment would benefit.

We have a long way to go to reach this goal. Be assured that WHO stands with you in the struggle.

Thank you.

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