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Life expectancy up to 20 years lower. Indigenous peoples suffer from poorer health, are more likely to experience disability and reduced quality of life and ultimately die younger than their non-indigenous counterparts. The gap in life expectancy between indigenous and non-indigenous people in years is: Guatemala 13; Panama 10; Mexico 6; Nepal 20; Australia 20; Canada 17; New Zealand 11.

Poverty, tuberculosis and lack of treatment. Tuberculosis, a disease that primarily affects people living in poverty, affects at least 2 billion people in the world. As a result of poverty, tuberculosis continues to disproportionately affect indigenous peoples around the globe. While programmes have been designed to combat tuberculosis, they often do not reach indigenous peoples because of issues related to poverty, poor housing, a lack of access to medical care and drugs, cultural barriers, language differences and geographic remoteness.

Poor levels of health, acutely felt by indigenous women. Indigenous peoples experience disproportionately high levels of maternal and infant mortality, malnutrition, cardiovascular illnesses, HIV/AIDS and other infectious diseases such as malaria and tuberculosis. Indigenous women experience these 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. And yet they play a primary role in overseeing the health and well-being of their families and communities. In addition, as the incidence of other public health issues such as drug abuse, alcoholism, depression and suicide increases, urgent and concerted efforts are needed to improve the health situation of indigenous peoples.

Poverty and malnutrition. Poor nutrition is one of the health issues that most affects indigenous peoples around the world. 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.

Self-determination, collective rights, crucial to indigenous health. To address the root causes of indigenous peoples鈥� health problems, there must be full recognition and exercise of indigenous peoples鈥� collective rights to communal assets and self-determination. Many mental health issues such as depression, substance abuse and suicide have been identified as connected to the historical colonization and dispossession of indigenous peoples, which has resulted in the fragmentation of indigenous social, cultural, economic and political institutions.

Health systems appropriate for the indigenous context. Models of health care must take into account the indigenous concept of health and preserve and strengthen indigenous health systems as a strategy to increase access and coverage of health care. This will demand the establishment of clear mechanisms of cooperation among relevant health care personnel, communities, traditional healers, policy makers and government officials.

Emerging Issues

Toxic chemicals and wastes

Existing conventions governing the use and disposal of toxic chemicals and wastes do not adequately protect the rights of the world鈥檚 most vulnerable, including indigenous peoples, who disproportionately suffer from their indiscriminate and irresponsible use. As such, there is an urgent need to create a global, legally binding regime for toxic industrial chemicals and hazardous pesticides to protect the rights of everyone, including indigenous peoples. Such a regime should have strong accountability and compliance mechanisms and be in conformity with international human rights standards, including the United Nations Declaration on the Rights of Indigenous Peoples, the Convention on the Rights of Persons with Disabilities and the Convention on the Rights of the Child.

Indigenous midwives

Traditional indigenous midwives鈥� cultural and clinical knowledge and their contributions to the well-being and positive health of indigenous peoples are largely unacknowledged and sometimes undermined by national health systems. Therefore, indigenous midwifery must be supported by state health policy and integration.

Maternal health and mortality

Across the globe, indigenous women and adolescents face persistent inequalities and stigma, especially in relation to maternal health and maternal mortality, yet the lack of data in this area renders them invisible and presents a major barrier to efforts to address the issue.

Cultural perspective

Indigenous peoples have consistently urged the UN System, regional health organizations and Governments, to fully incorporate a cultural perspective into health policies and programmes and reproductive health services aimed at indigenous women. Furthermore, the roles of traditional midwives should be re-evaluated and expanded to assist indigenous women during their reproductive health processes and act as cultural brokers between health systems and the indigenous communities鈥� values and world views.