Minority groups suffer worse health outcomes than the rest of the population, according to a new report published by Minority Rights Group International (MRG). State of the World’s Minorities and Indigenous Peoples 2013, released to coincide with the UN General Assembly meeting on the post-Millennium Development Goals (MDGs) agenda, calls for - among other things - greater measures to combat disparities in global health outcomes between minority groups and majority communities.
“The MDGs have resulted in much that is good. But one of the fundamental flaws with them has been the lack of a right or equity perspective,” said Carl Soderbergh, MRG's policy and communications director. “Minority and indigenous communities often are marginalized from all aspects of life in their countries.”
For example, infant mortality among indigenous groups in China’s Yunnan Province was 7.8 percent, compared to 5.4 percent for non-indigenous groups in Yunnan and a national average of 2.6 percent, the report shows.
In Papua, Indonesia, HIV infection rates among minority groups are 15 times the national average. The government does not break down the data by ethnicity, but in 2008 UNAIDS estimated that the HIV rate was 2.4 percent among the general population, while in the indigenous Papuan-populated highlands, the rate went up to 3.4 percent.
“Minorities and indigenous peoples around the world suffer far worse health outcomes than majorities,” said Soderbergh. “So, for example, in Guatemala, indigenous children suffer approximately 20 percent higher malnutrition than majority communities. In Europe, Roma communities… disproportionately have less access to vaccines than majorities.”
Soderbergh says that the fields of maternal care, child health and mental health are particularly vulnerable to disparities.
Discrimination and lack of access
According to the report, lack of access to healthcare and systemic patterns of discrimination are major causal factors behind these figures.
“Partly because minority and indigenous communities don’t necessarily live in the towns and the cities, and they live in remote areas, they have less access to health,” said Farah Mihlar, co-author of the South Asia section of the report.
In Ethiopia, where the MDG for child mortality has largely been met, rates of under-five mortality in the Gambela region, inhabited mostly by minorities, remain stubbornly high: 15.7 percent, more than double the rate in the capital Addis Ababa, the report shows.
In some regions in countries like India, certain minority groups have absolutely no healthcare access. “In India, for example, you find in some cases clear discrimination. In a study that was done, they found that [in] 21 percent of villages, there was no access for low-caste people,” said Mihlar. “So we’re not talking about less access, we’re saying that they just had no access at all to health services.”
Link between land and health
For minority indigenous groups, the fight for ownership and access to traditional lands and the right to health are deeply intertwined.
“The fabric of traditional societies was shredded by colonization,” wrote Michael Gracey and Malcolm King in a prominent 2009 research paper. “Many indigenous groups have to live on unproductive land or in towns, cities and their fringes, slums or squatter camps that are environmentally degraded health hazards, contaminated by heavy metals and industrial waste.”
“It can be argued that, in securing recognition of their rights to their traditional lands, they are also securing recognition of the principal underlying determinants included in their right to health,” wrote Carla Clarke in the MRG report. “This is because, as they gain recognition that the land belongs to them, they can then fight for the need for healthcare services in these areas.”
A number of lawsuits have been brought by indigenous peoples concerning health, but most of these are related to adverse effect on their health as a result of the use of traditional lands. In Nigeria, for instance, the Ogoni argued that oil exploration within Ogoniland had led to significant negative environmental and health consequences.
MRG’s Clarke said: “Litigation may not be a complete panacea but, on current trends, without judicial intervention it is difficult to see substantial progress being made in realizing the right to health for indigenous communities.”
The UN acknowledged the need for a more inclusive approach to the post-MDG agenda. In the outcome paper to the General Assembly special event on the MDGs released two days ago, member states said that they would “emphasize inclusivity and accessibility for all, and will place a particular focus on those who are most vulnerable and disadvantaged”.
Soderbergh believes that there are simple solutions that can improve the healthcare services of minority groups. “What governments need to do is ensure that user fees are kept at a minimum, if [charged] at all, in order to make sure that healthcare is accessible to all.”
Mihlar also argues that getting timely data that is disaggregated by ethnicity is vital. “One of the major difficulties we had in writing this report and doing this research was the lack of data on this subject,” she said. “As a result of this, it’s difficult to draw a clear picture and to be able to address policies and practices in a targeted manner that can improve the situation for minorities.”
The report also points to the need to invest in infrastructure to ensure that even those living in remote areas have access to care. Although this is considered to be costly, the UN High Level Panel of Eminent Persons, in their report on the post-2015 agenda released in May, calculated that doing so would raise expenditures by “only 15 to 20 percent”.
Using simple innovations, such as mobile health clinics, can help states such as those in South Asia, which lack the capacity to reach the most remote areas, where many members of minority and marginalized communities live.
Finally, ensuring access to healthcare information can also aid disadvantaged groups. In Tanzania, where HIV prevention campaigns are all conducted in Swahili, pastoral communities are unable to understand the messages, according to the report. “Public healthcare information has to be disseminated in languages and in ways that are relevant to minority and indigenous communities,” said Soderbergh.