PRACTICAL APPLICATION: HEALTH AND SOCIAL SECURITy

1 4 9 x I . H E A LT H A N D S O C I A L S E C U R I T y Danida: Tool Kit: Best Practices for Including Indigenous Peoples in Sector Programme Support, 2004. Nepal: Creation of social security and afirmative action programmes There is broad political agreement that the existing inequality between indigenous peoples and dominant communities in Nepal needs to be addressed. Indigenous peoples in Nepal in general have lower wealth, educational achievement, health and political inluence than the national average. However, there is also signiicant diversity among the indigenous groups in Nepal. Some groups, such as the Thakali and the Newar, are actually above the national average in most statistics, while others, such as the Chepang or the Raute are severely marginalized. To deal with the large diversity and target support to those groups that need it most, the indigenous peoples’ umbrella organization, Nepal Federation of Indigenous Nationalities NEFFIN, independently started dividing indigenous peoples into ive categories, ranging from advantaged to endangered. Government and donors have since adopted this categorization also. The Ministry of Local Development, for example, started providing cash transfers to individuals from the highly marginalized and endangered indigenous groups in 2008. Some indigenous organizations are calling for generalized ethnic-based afirmative action to beneit all indigenous people. This is complicated somewhat by the very substantial socio-economic differences among the groups. While the ive categories are useful in differentiating the indigenous peoples, the system is based on neither objective criteria nor recurrent data collection. Therefore, some voices are now calling for a more dynamic system, in which afirmative action would be based on a regularly reviewed set of socio-economic criteria. Thus, disadvantaged indigenous groups would qualify based on their level of disadvantage, rather than on the basis of their status as indigenous people. However, these discussions are ongoing in the constitution-making process, and no comprehensive policy has yet been devised. Programme to Promote ILO Convention No. 169, project reports Nepal, 2008-9; Bennett, Lynn and Parajuli, Dilip 2007. Nepal Inclusion Index: Methodology, First Round Findings and Implications for Action. Draft paper. United States: Suicide prevention programs Suicide accounts for nearly one in ive deaths among Native American and Alaskan Native youths 15- 19 year olds; a considerably higher proportion of deaths than for any other ethnic groups within the United States. In fact, differences in suicide rates between Native American and Alaskan Native youths and other ethnic youths have been noted for over three decades. Suicide prevention programmes that are culturally appropriate and incorporate culturally speciic knowledge and traditions have been shown to be the most successful and well received by Native American and Alaskan Native indigenous communities. Such prevention programmes are largely successful because they incorporate positive messages regarding cultural heritage that increase the self-esteem and sense of mastery among Native American and Alaskan Native youths, and focus on protective factors in a culturally appropriate context. They also teach culturally relevant coping methods such as traditional ways of seeking social support. http:indigenousissuestoday.blogspot. com200802suicide-native-american-and-alaskan. html. Brazil: Enawene Nawe The Enawene Nawe are a small Amazonian indigenous people who live in the forests of Mato Grosso, Brazil. They were irst contacted in 1974, when they numbered only 97 individuals. Today their population is around 500. The Enawene Nawe have refused to get closer to the towns and hospitals because of the health problems and suffering they have experienced when they came in contact with the outsiders. They are also aware that they should not rely on outsiders for healthcare. Therefore, in addition to their herbalists, shamans and mastersingers, community members are receiving training in Western healthcare and medicines. The new specialists are called “Baraitalixi” or “little herbalists”. The training is conducted in the longhouses in their language and in the presence of everyone. The Baraitalixi, 1 5 0 I N D I G E N O U S T R I B A L P E O P L E S ’ R I G H T S I N P R A C T I C E – A G U I D E T O I L O C O N V E N T I O N N O . 1 6 9 supported by professional health staff via radio contact, are advising and treating up to 80 cases a month. A special ward has also been set up for the indigenous people at the local hospital with hooks for the hammocks of the Enawene Nawe, and space is provided for relatives to stay. The hospital staff is also given basic training about the Enawene Nawe to ease contact. Case prepared by Choncuirinmayo Luithui. ‘Healthcare and the Enawene Nawe’ in: How Imposed Development Destroy the Health of Tribal peoples; Survival International Publication, 2007. Australia There are signiicant disparities in health status between Aboriginal and Torres Strait Islander peoples and other Australians, encompassing their whole life cycles. There is a 17-year gap in life expectancy between the indigenous peoples and other Australians, higher mortality rates, earlier onset of diseases and more incidences of stress-related problems affecting social and mental wellbeing. In July 2003, the Australian Health Ministers agreed to establish a National Strategic Framework for Aboriginal and Torres Strait Islander Health NSFATSIH whose key goal is: “To ensure that Aboriginal and Torres Strait Islander peoples enjoy a healthy life equal to that of the general population that is enriched by a strong living culture, dignity and justice.” Building on this endorsement, in December 2007, the Council of Australian Governments COAG committed to work with indigenous communities to close the gap on indigenous disadvantage, recognizing that special measures are needed to improve indigenous peoples’ access to health services and that the active involvement of these peoples is crucial in the design, delivery, and control of these services. COAG declared its commitment to: close the life expectancy gap within a • generation by 2030 halve the gap in mortality rates for indigenous • children under ive by 2018 halve the gap in literacy and numeracy • outcomes by 2018 In addition COAG has also agreed to: provide access to early childhood education • for all four-year-olds living in remote indigenous communities by 2013 halve the gap in Year 12 or equivalent • attainment rates by 2020 halve the gap in employment outcomes by • 2018 Further, the Australian Government established the National Indigenous Health Equality Council in July 2008 to advise on the development and monitoring of health-related goals and targets. In New South Wales, a special policy has been developed to address the high level of need related to mental health and wellbeing in Aboriginal communities and the relatively low levels of utilisation of specialist mental health services. The Aboriginal Mental Health and Well Being Policy 2006-2010 sets out strategies and actions to: Enhance key working partnerships such • as those between the Area mental health services and Aboriginal Community Controlled Health Services ACCHSs; Improve mental health leadership to • ensure appropriate service responsiveness for Aboriginal people, their families and carers across emergency and acute, early intervention and prevention, and rehabilitation and recovery services; Develop speciic mental health programs for • Aboriginal people of all ages who have or are at risk of mental illness.; Increase expertise and knowledge through a • range of data and evaluation activities; Strengthen the Aboriginal mental health • workforce, both in increased positions in Area Health Services and ACCHSs and in training and skill development. Council of Australian Governments’ Meeting, Melbourne 20 December, 2007: http:www.coag. gov.aucoag_meeting_outcomes2007-12-20; Aboriginal and Torres Strait Islander Health Performance Framework, 2008 Report; http:www. health.gov.au; http:www.health.gov.auinternetministers publishing.nsfContentmr-yr08-nr-nr104.htm; New South Wale Aboriginal Mental Health and Well Being Policy 2006-2010: http:www.health.nsw.gov. 1 5 1 x I . H E A LT H A N D S O C I A L S E C U R I T y aupoliciespd2007pdfPD2007_059.pdf. Case prepared by: Chonchuirinmayo Luithui India Indigenous peoples in India known as Scheduled Tribes fall way behind the rest of the national population in terms of key health indicators see table in section 11.1. For example, the rate of child mortality among Scheduled Tribes is 58 higher than for the rest of the Indian population. Health care is a major problem in the remote and isolated areas where the majority of indigenous peoples live, and lack of food security, sanitation and safe drinking water, poor nutrition and high poverty levels aggravate the situation. Most indigenous communities in India continue to be dependent on forest and natural resources for their livelihood and subsistence. However, through processes of modernization and development and the accompanying destruction of indigenous habitats, indigenous systems of medicine, skills and natural resources used in traditional remedies are fast disappearing. There are no speciic policies to target health care of indigenous peoples in India yet, but the health situation of Scheduled Tribes has found mention in the 11 th Five Year Plan 2007 -2012 and a comprehensive strategy has been laid out in the Draft National Tribal Policy, 2006. The approach of the 11 th Five Year Plan is to “attempt a paradigm shift with respect to the overall empowerment of the tribal people”. The Plan provides for increased efforts to make available affordable and accountable primary health care facilities to Scheduled Tribes and to bridge the yawning gap in rural healthcare services. Periodic reviews are to be conducted on the delivery system and function of the health care institutions under three broad headings to optimise service in the tribal areas: i health infrastructure; ii manpower; and iii facilities, like medicine and equipment. The Draft National Tribal Policy 2006 proposes a detailed, targeted strategy, which aims to address the speciic problems faced by indigenous peoples in relation to health and medical care. This includes enhancing access to modern healthcare by developing new systems and institutions; a synthesis of Indian systems of medicine like Ayurveda and Siddha with tribal systems and modern medicine; decentralizing control of medical staff to village and district level; area-speciic methods for provision of clean drinking water, which take into account the different kinds of terrain in tribal areas. The Policy is still a draft but an encouraging feature also relected in the Eleventh Plan is the recognition of the need for strategies, which combine indigenous medicine with mainstream allopathic systems. 8 Moving away from a purely service-delivery approach has the potential to make healthcare in interior tribal areas much more accessible, while also providing scope for indigenous peoples to contribute their extensive traditional knowledge. Social Justice, Eleventh Five Year Plan 2007-2012, Planning Commission, Government of India; http: tribal.nic.ininalContent.pdf. 8 It is also signiicant to note that the National Health Policy, 2002 recognises the need for special measures and separate schemes, tailor- made to the health needs of scheduled tribes, among other vulnerable groups, and emphasises the need to strengthen alternative systems of medicine xII. TRADITIONAL OCCUPATIONS, LABOUR RIGHTS AND vOCATIONAL TRAINING 1 5 3 x I I . T R A D I T I O N A L O C C U PAT I O N S , L A B O U R R I G H T S A N D V O C AT I O N A L T R A I N I N G The ILO’s concern for indigenous peoples started as early as 1920, primarily as a concern for their conditions as exploited workers see section 14.1. This concern led, among other things, to the adoption of the ILO’s Forced Labour Convention No. 29 in 1930. Continued research during the 1950s showed that indigenous peoples had a need for special protection in the many cases where they were victims of severe labour exploitation, including discrimination, and forced and child labour. In recognition of the need to address the situation of indigenous peoples in a holistic and comprehensive way, ILO Convention No. 107 was adopted in 1957. The Convention has a special section on conditions of employment and was adopted with a view to “improve the living and working conditions of these populations by simultaneous action in respect of all the factors which have hitherto prevented them from sharing fully in the progress of the national community” preamble, ILO Convention No. 107. Due to the continued and crucial relevance of labour rights for indigenous peoples, Convention No. 169 and the UN Declaration on the Rights of Indigenous Peoples also include special provisions on employment and labour rights.

12.1. RESPECT fOR INDIGENOUS PEOPLES’ TRADITIONAL OCCUPATIONS

Most indigenous peoples have developed highly specialized livelihood strategies and occupations, which are adapted to the conditions of their traditional territories and are thus highly dependent on access to lands, territories and resources. Such traditional occupations include handicrafts, rural and community-based industries and activities such as hunting, ishing, trapping, shifting cultivation or gathering. In some cases, indigenous peoples are simply identiied by their traditional occupations, as, for example, pastoralists, shifting cultivators and hunter-gatherers. In many cases, lack of respect for indigenous peoples’ rights and cultures lead to discrimination against their traditional livelihoods. This is for example the case in parts of South-East Asia, where practices of rotating agriculture are forbidden by law and in parts of Africa, where pastoralists’ rights to land and grazing are not recognized. 1 Convention No. 169 stipulates that such traditional occupations should be recognised and strengthened: ILO Convention No. 169 Article 23 1. Handicrafts, rural and community-based industries, and subsistence economy and traditional activities of the peoples concerned, such as hunting, ishing, trapping and gathering, shall be recognised as important factors in the maintenance of their cultures and in their economic self-reliance and development. Governments shall, with the participation of these people and whenever appropriate, ensure that these activities are strengthened and promoted. 2. Upon the request of the peoples concerned, appropriate technical and inancial assistance shall be provided wherever possible, taking into account the traditional technologies and cultural characteristics of these peoples, as well as the importance of sustainable and equitable development.

12.2. RESPECTING LABOUR RIGHTS

In many cases, increased pressure on indigenous peoples’ lands and resources implies that traditional livelihood strategies are no longer viable and investments and job opportunities within indigenous territories are often few. Many indigenous workers have to seek alternative incomes and the overwhelming majority of communities have some or even most of their members living outside their traditional territories, where they have to compete for jobs and economic opportunities. 1 For further information on traditional occupations of indigenous and tribal peoples and the many dificulties and challenges faced by them, see Traditional Occupations of Indigenous and Tribal Peoples, ILO, Geneva, 2000. 1 5 4 I N D I G E N O U S T R I B A L P E O P L E S ’ R I G H T S I N P R A C T I C E – A G U I D E T O I L O C O N V E N T I O N N O . 1 6 9 Even where they continue to live in their traditional territories, indigenous people may be taking up new economic activities as primary, secondary or tertiary occupations. For example, a shifting cultivator may take up ishing or wage labour during the dry season after his swidden crop has been harvested and before the next cropping cycle starts. 2 There is a general lack of reliable data and statistics about indigenous peoples’ particular situation with respect to employment. However, where evidence is available, it indicates that indigenous peoples are being discriminated against and are disproportionately represented among the victims of forced labour and child labour. Some of the barriers and disadvantages they face in the national and international labour markets are: Many indigenous workers are not able • to compete on an equal footing, as their knowledge and skills are not appropriately valued, and they have limited access to formal education and vocational training. Indigenous workers are often included in the • labour market in a precarious way that denies their fundamental labour rights. Indigenous workers generally earn less • than other workers and the income they receive compared to the years of schooling completed is less than their non-indigenous peers. This gap increases with higher levels of education. 2 Raja Devasish Roy, “Occupations and Economy in Transition: A Case Study of the Chittagong Hill Tracts”, in Traditional Occupations of Indigenous and Tribal Peoples, ILO, Geneva, 2000, pp. 73-122. Labour exploitation and discrimination affect indigenous men and women differently, and gender is often an additional cause of discrimination against indigenous women. Many indigenous women: Have less access to education and training • at all levels; Are more affected by unemployment and • under-employment; Are more often involved in non- • remunerated work; Receive less pay for equal work; • Have less access to material goods and • formal recognition needed to develop their occupation or to obtain access to employment; Have less access to administrative and • leadership positions; Experience worse conditions of work, for • example related to working hours and occupational safety and health; Are particularly vulnerable to sexual abuse • and harassment and traficking, as they often have to seek employment far away from their communities; Are limited by discriminatory cultural • practices, which, for example inhibit the education of the girl-child or prevent women from inheriting land or participating in decision-making processes. 3 3 Eliminating Discrimination against Indigenous and Tribal Peoples in Employment and Occupation – a Guide to ILO Convention No. 111, ILO 2007.