Who are Indigenous Peoples?
The diversity between regions and countries, coupled with differences in backgrounds, cultures, historical context, practices, and conditions, has made it challenging to establish a single, authoritative definition at the international level for all Indigenous Peoples.
Despite the lack of a universal definition, self-identification as Indigenous is considered as a fundamental criterion and this is the practice followed in the UN and its specialized agencies. The Article 33 of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) refers to the right of Indigenous Peoples to decide their own identities and procedures of belonging.
In addition, one of the most cited descriptions of the concept of the Indigenous Peoples is one provided by José Martínez Cobo in his “Study of the problem of discrimination against indigenous populations”, which includes the following elements:
- Historical continuity with pre-invasion and/or pre-colonial societies that developed on their territories;
- Distinctiveness;
- Non-dominance; and
- A determination to preserve, develop and transmit to future generations their ancestral territories and identity as peoples in accordance with their own cultural patterns, social institutions and legal system.
It also notes that an Indigenous person is one who belongs to these Indigenous populations through self-identification as Indigenous and is recognized and accepted by these populations as one of its members. This preserves for Indigenous Peoples the right to decide who belongs to them, without external interference.
What is Indigenous Peoples’ conceptualization of health?
Indigenous Peoples' concept of health and well-being is holistic and encompasses spiritual, environmental, cultural and social dimensions in addition to physical and mental health. They view health as both an individual and a collective right, strongly determined by community, land, and the natural environment. Indigenous Peoples approach health as an equilibrium of spirituality, traditional medicine, biodiversity and the interconnectedness of all that exists. This leads to an understanding of humanity in a significantly different manner than the mainstream society.
The Permanent Forum on Indigenous Issues (UNPFII) has noted that the right to health "materializes through the well-being of an individual as well as the social, emotional, spiritual and cultural well-being of the whole community”. These dimensions of the conceptualization of the right to health of Indigenous Peoples, which goes beyond the physical world, are inextricably linked with the realization of other rights, including the rights to free, prior and informed consent; self-determination; development; culture; land, territories, and resources; language, among others.
However, due to colonial legacies, the Indigenous Peoples' concept of health is frequently disregarded within non-Indigenous health systems, creating significant barriers to access. In particular, a lack of an intercultural approach and understanding of the concept of health of Indigenous Peoples can have a detrimental effect on their well-being.
What is the right to health of Indigenous Peoples?
The right to health of every human being is enshrined in multiple international and national instruments and forms as an important component of human rights law. The right to health is interrelated with various other human rights. For Indigenous Peoples, the right to health is interrelated with other rights recognized in the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP).
The UNDRIP embodies the most comprehensive international instrument concerning the rights of Indigenous Peoples. It explicitly recognizes the individual and collective rights of Indigenous Peoples, establishing a universal framework that sets minimum standards for their survival, dignity and well-being worldwide.
Article 24 of the UNDRIP recognizes the right of Indigenous Peoples to their traditional medicines, to maintain their health practices and to access social and health services without discrimination, and it affirms the equal right of Indigenous individuals to the enjoyment of the highest attainable standard of physical and mental health. For Indigenous Peoples to exercise their health rights, the UNDRIP expands upon the dimensions and interconnection with other rights, such as the right to self-determination (Art 3); the right to improve their economic conditions (Art 21.1); the right to development, to be actively involved in developing and determining health (Art 23); and the right to free, prior and informed consent (Arts. 10,11,19,28, 29, and 32).
It is worth noting that Article 24 of the UNDRIP is aligned with the language used in Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which is a legally binding treaty that recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Other health-related provisions contained in other binding international and regional human rights instruments are also applicable to Indigenous Peoples.
What challenges do Indigenous Peoples face in realizing the right to health?
The right to health for Indigenous Peoples includes four essential, interrelated elements: availability, accessibility, acceptability and quality:
Availability: Refers to the need for a sufficient quantity of functioning health facilities, goods and services for all. Indigenous Peoples often live in areas where health facilities lack staff, medicines or other essential suppliers. This challenge is further exacerbated by the lack of data on the health and social conditions of Indigenous Peoples, including information about how their health differs depending on their age, sex, location and socio-economic status, which are essential for understanding and addressing coverage gaps.
Accessibility: Requires that health facilities, goods and services must be accessible to everyone. Accessibility has four dimensions: non-discrimination, physical accessibility, economic accessibility (affordability) and information accessibility. For Indigenous Peoples, these four dimensions often overlap.
Non-discrimination: Indigenous Peoples often face discriminatory practices and differential treatment when accessing healthcare facilities, fueling mistrust and discouraging the use of services1. Racism may even contribute to misdiagnosis and mistreatment for serious illnesses. The revitalization of Indigenous Peoples' cultural identity is essential for addressing discrimination and promoting their health and well-being.
Physical accessibility. Indigenous Peoples often experience challenges related to the physical accessibility of health services, particularly as many reside in geographically isolated areas, hindering timely and appropriate care. Indigenous persons with disabilities living in remote areas face additional hardships, often being required to periodically reconfirm their disability through central medical organizations to remain eligible for disability pensions.
Economic accessibility (affordability). Indigenous Peoples are often among the most socioeconomically marginalized groups. Many engage in the informal economy, which tends to lack coverage under social security schemes. This is further compounded within health systems, where access to health is contingent on insurance or earnings, rather than being based on universal health coverage for all.
Information accessibility. Challenges to access information may occur due to diverse factors, including lack of culturally appropriate health information available in Indigenous languages, limited educational opportunities leading to higher illiteracy rates and the presence of paternalistic and discriminatory attitudes within the healthcare system.
Acceptability: Relates to respect for medical ethics, culturally appropriate and sensitivity to gender. Indigenous Peoples’ concept of health is frequently disregarded within nonindigenous health systems, creating significant barriers to access. In particular, the lack of understanding of social and cultural factors deriving from the health-related knowledge, attitudes and practices of Indigenous Peoples can have deleterious effects on their well-being. The lack of an intercultural approach to healthcare can impact health-seeking behaviours, utilization of services, interactions with healthcare professionals and adherence to treatment. Culture, as well as land and language, hold healing potential for Indigenous Peoples, and relying on conventional approaches alone often proves ineffective and, in some cases, even detrimental to the healing process for Indigenous Peoples. Culturally appropriate health for Indigenous Peoples entails recognizing and valuing their diversity, encompassing their cultures, languages, beliefs, values, and appreciation of this diversity.
Quality: Extends to the underlying determinants of health, for example safe and potable water and sanitation as well as requiring that health facilities, goods, and services are scientifically and medically approved. The traditional health practices of Indigenous Peoples are often disregarded compared to mainstream evidence-based healthcare services, perceived to be of higher quality. As a result, traditional medicine and practices are frequently overlooked and under-resourced in healthcare research. This element encompasses the Indigenous Peoples’ underlying determinants of health, such as access their lands, territories and resources; the manifestation, practice, development and teaching of their spiritual and religious traditions; active involvement in developing and determining health programmes affecting them; and the preservation of their traditional medicines and to maintain health practices. These factors and conditions show that the right to health of Indigenous Peoples is dependent on and contribute to the realization of other individual and collective rights.
Why should Indigenous Peoples be distinguished from “local communities”?
Indigenous Peoples hold a distinct constituency as rights holders under international human rights law, as provided by international instruments, including the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). This distinctive status entitles them to collective rights that are indispensable for their existence, well-being and integral development as peoples.
The three United Nations Indigenous-specific mandates, namely the United Nations Permanent Forum on Indigenous Issues, Special Rapporteur on the Rights of Indigenous Peoples, and the United Nations Expert Mechanism on the Rights of Indigenous Peoples (EMRIP) have advised against conflating or equating Indigenous Peoples with non-Indigenous peoples or entities, including minorities, vulnerable groups or “local communities.”
What is WHO doing to advance the right to health of Indigenous Peoples?
WHO is committed to working together with countries and the United Nations system towards a more equitable and healthier world where the health-related rights of each and every person are fully realized.
WHO’s work on the health of Indigenous Peoples covers leadership, awareness raising and partnerships; normative activities; capacity building; and technical support to countries. It includes supporting countries to integrate Indigenous Peoples’ perspectives into health policies and programmes, and analysis of the barriers Indigenous Peoples face in the availability, accessibility, acceptability and quality of physical and mental health services.
WHO is committed to scale up efforts for the advancement of Indigenous Peoples' health globally, supporting collective initiatives promoting Indigenous Peoples’ rights, and the implementation of the UN System-Wide Action Plan on the Rights of Indigenous Peoples. WHO contributes to inter-agency efforts through the Inter-Agency Support Group on Indigenous Peoples Issues and serves as the Group’s co-chair, together with United Nations Department of Economic and Social Affairs, in 2024.
