Article XII. Health and well-being

1. Indigenous peoples have the right to legal recognition and practice of their traditional medicine, treatment, pharmacology, health practices and promotion, including preventive and rehabilitative practices.

2. Indigenous peoples have the right to the protection of vital medicinal plants, animal and mineral in their traditional territories.

3. Indigenous peoples shall be entitled to use, maintain, develop and manage their own health services, and they shall also have access, on an equal basis, to all health institutions and services and medical care accessible to the general population.

4. The states shall provide the necessary means to enable the indigenous peoples to eliminate such health conditions in their communities which fall below international accepted standards for the general population.

I. INTERNATIONAL AUTHORITIES AND PRECEDENTS

1. Draft United Nations Declaration on the Rights of Indigenous Peoples (UN 1994)

Article 24: "Indigenous peoples have the right to their traditional medicines and health practices, including the right to the protection of vital medicinal plants, animals and minerals.

They also have the right to access, without any discrimination, to all medical institutions, health services and medical care."

2. C 169, Convention on Indigenous and Tribal People (ILO Convention 1989)

Article 24: "Social security schemes shall be extended progressively to cover the peoples concerned, and applied without discrimination against them."

Article 25:

1. Governments shall ensure that adequate health services are made available to the peoples concerned, or shall provide them with resources to allow them to design and deliver such services under their own responsibility and control, so that they may enjoy the highest attainable standard of physical and mental health.

2. Health services shall, to the extent possible, be community-based. These services shall be planned and administered in co-operation with the peoples concerned and take into account their economic, geographic, social and cultural conditions as well as their traditional preventive care, healing practices and medicines.

3. The health care system shall give preference to the training and employment of local community health workers, and focus on primary health care while maintaining strong links with other levels of health care services.

4. The provision of such health services shall be co-ordinated with other social, economic and cultural measures in the country.

3. Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights (OAS 1988)

Article 10: "Right to Health

1. Everyone shall have the right to health, understood to mean the enjoyment of the highest level of physical, mental and social well-being.

2. In order to ensure the exercise of the right to health, the States Parties agree to recognize health as a public good and, particularly, to adopt the following measures to ensure that right:

f. Satisfaction of the health needs of the highest risk groups and of those whose poverty makes them the most vulnerable."

4. American Declaration on the Rights and Duties of Man (UN 1948)

Article XI: “Every person has the right to the preservation of his health through sanitary and social measures related to food, clothing, housing and medical care, to the extent permitted by public and community resources.�

5. International Covenant on Economic, Social and Cultural Rights (UN 1966)

Article 11(1): “The State Parties to the present Covenant recognize the right of everyone to an adequate standard of living for himself and his family, including food, clothing, housing and to the continuous improvement of living conditions...�

Article 12(1): “The State Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard for physical and mental health. (2). The Steps to be taken by the State Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

(a) the provision for the reduction of the still birth-rate and of infant mortality and for the healthy development of the child;

(b) the improvement of all aspects of environmental and industrial hygiene;

(c) the prevention, treatment and control of epidemic, endemic, occupation and other disease;

(d) the creation of conditions which would assure to all medical service and medical attention in the event of sickness.�

6. International Convention on the Elimination of all Forms of Racial Discrimination (UN 1965)

Article 5(e)(iv): “...States Parties undertake to prohibit and to eliminate racial discrimination in all its forms and to guarantee the right of everyone to public health, medical care, social security and social services."

7. Universal Declaration of Human Rights (UN 1948)

Article 25(1): “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.�

8. African Charter on Human and Peoples’ Rights (Banjul Charter 1981)

Article 16: “(1) Every individual shall have the right to enjoy the best attainable state of physical and mental health. (2) States parties to the present Charter shall take necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick.�

9. Copenhagen Declaration on Social Development and Programme of Action of the World Summit for Social Development (Copenhagen, Denmark, March 6-12, 1995)

C. Commitments.

Commitment 6. "We commit ourselves to promoting and attaining the goals of universal and equitable access to quality education, the highest attainable standard of physical and mental health, and the access of all to primary health care. The purpose of these activities is to eradicate poverty, promote full and productive employment and foster social integration. To this end, at the national level, we will: (g) Recognize and support the right of indigenous people to education in a manner that is responsive to their specific needs, aspirations and cultures, and ensure their full access to health care"

10. World Bank Operational Directive 4.20 (OD 4.20) (September 1991)

Para. 15(e): “Plans that draw upon indigenous knowledge are often more successful than those introducing entirely new principles and institutions. For example, the potential contribution of traditional health providers should be considered in planning delivery systems for health care.�

11. World Bank Operational Manual, "Description and Sample Outline of an Environmental Action Plan, Operational Directive 4.02 , (July 1992)

Para. 4: "A Comprehensive EAP [Environmental Assessment Plan] normally covers a broad range of topics similar to those listed below. The weight accorded to each item covered depends on local circumstances.

(b) An analysis of major cross-sectoral issues (e.g., demography, public health and safety, cultural and natural heritage) and socioeconomic factors important to the environment and resource use. Basic information required for the cross sectoral analysis includes the following:

(iii) Cultural and natural heritage: Data on environmental or human induced risk to the preservation of specific major sites, structures, and remains of archeological, historical, cultural, religious, or aesthetic value; identification of natural resources of particular biological, ecological, medical, or touristic value."

12. Alliance for Sustainable Development documents signed by signed the Presidents of Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama and a Representative of the Prime Minister of Belize, at the Central American Ecological Summit for Sustainable Development in Managua, Nicaragua (October 12, 1994)

Annex II: Commitments of the Alliance:

"Social Commitments:

Education and Health. We pledge to place priority on providing education and health for the people of Central America, as prerequisites for sustainable development in the region.

Food and Nutritional Security. We aim to guarantee and effective food and nutritional security system for the peoples of Central America, in accordance with the characteristics and customs of each country..."

13. Program of Immediate Actions Derived from the Declaration of San Salvador II for the Investment in Human Capital signed by the Presidents of Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama and the Prime Minister of Belize, and El Costa Verde, in the Republic of El Salvador (March 30, 1995)

"To develop a Promotion and Education Program for Health that stimulates integral health, strengthens healthy life styles, and develops responsibility for individual and collective health, while encouraging community participation and horizontal cooperation."

14. Summit of the Americas Plan of Action, signed by 34 heads of state participating in the Summit of the Americas (Miami, Florida 1994)

III. "Eradicating Poverty and Discrimination in Our Hemisphere.

17. Equitable Access to Basic Health Services. Despite impressive gains in the Hemisphere, limitations on health services access and quality have resulted in persistently high child and maternal mortality, particularly among the rural poor and indigenous groups. ...Develop or update country action plans or programs for reforms to achieve child, maternal and reproductive health goals and ensure universal, non-discriminatory access to basic services, including health education and preventive health care programs.

The plans and programs will be developed according to a mechanism to be decided upon by each country. Reforms would encompass essential community-based services for the poor, the disabled, and indigenous groups; stronger public health infrastructure; alternative means of financing, managing and providing services; quality assurance; and greater use of non-governmental actors and organizations."

II. DOMESTIC AUTHORITIES AND PRECEDENTS

15. Argentina

Ley 23.302 de 1985

Article 18: �La autoridad de salud coordinará con los gobiernos de provincia las realizaciones de planes intensivos de salud para las comunidades indígenas, para la prevención y la recuperación de la salud física y psíquica de sus miembros, creando unidades sanitarias móviles para la atención de las comunidades dispersas. Se promoverá la formación del personal especializado para el cumplimiento de la acción sanitaria en las zonas de radicación de las comunidades�.

Artículo 19: �Se declara prioritario el diagnóstico y tratamiento mediante control periódico, de las enfermedades contagiosas, endémicas y pandémicas en toda el área de asentamiento de las comunidades indígenas. Dentro del plazo de sesenta días de promulgada la presente ley deberá realizarse un catastro sanitario de las diversas comunidades indígenas, arbitrándose los medios para la profilaxis de las enfermedades y la distribución en forma gratuita bajo control médico de los medicamentos necesarios�.

Artículo 20: �La autoridad de aplicación llevará a cabo planes de saneamiento ambiental, en especial para la provisión de agua potable, eliminación de instalaciones inadecuadas, fumigación y desinfección, campañas de eliminación de roedores e insectos y lo demás que sea necesario para asegurar condiciones higiénicas en los lugares de emplazamiento de las comunidades indígenas promoviéndose, a ese efecto, la educación sanitaria de sus integrantes y el acceso a una vivienda digna�.

Artículo 21: � En los planes de salud para las comunidades indígenas deberá tenerse especialmente en cuenta:

a) La atención bucodental;

b) La realización de examenes de laboratorio que complementen los examenes clínicos;

c) La realización de examenes cardiovasculares, a fin de prevenir la mortalidad prematura;

d) El cuidado especial del embarazo y parto y la atención de la madre y el niño

e) La creación de centros de educación alimentaria y demás medidas necesarias para asegurar a los indígenas una nutrición equilibrada y suficiente;

f) El respeto por las pautas ofrecidas en la Directiva de la Organización Mundial de la Salud, respecto de la medicina tradicional indígena integrando a los programas nacionales de salud a las personas que a nivel empírico realizan acciones de salud en áreas indígenas;

g) La formación de promotores sanitarios aborígenes especializados en higiene preventiva y primeros auxilios.

Las medidas indicadas en este capítulo lo serán sin perjuicio de la aplicación de los planes sanitarios dictados por las autoridades nacionales, provinciales y municipales, con carácter general para todos los habitantes del país.�

16. Bolivia

Ley 1.493 de 1993

Artículo 19: �Compete al Ministro de Desarrollo Humano actuar en todo lo inherente al desarrollo, la formación, el bienestar y calidad de vida de la persona, asegurando la compatibilidad de sus actos con las estrategias probadas por el Presidente de la República, y en particular: ... (f) Formular, instrumentar y fiscalizar políticas y programas en salud incluyendo la prevención, protección y recuperación de la salud, así como nutrición, saneamiento e higiene; en el desarrollo rural y social de las comunidades y pueblos originarios, preservando su identidad y organización; en el desarrollo urbano con el estímulo de la construcción de la vivienda social, y atender los problemas de la marginalidad urbana y rural�.

17. Brazil

- Decreto 1.141 de 1994

Art. 11: �As açoes de saúde para as comunidades indígenas destinam-se ao alcance do equilíbrio bio-psico-social e dar-se-ão para valorizar e complementar as prácticas da medicina indígena, tendo como finalidades:

I. Reduçao da mortalidade geral, em especial a materno-infantil;

II. Interrupçao do ciclo de doenças transmissíves;

III. Comabate à desnutriçao.�

Art. 12: �Será garantido aos índios e às comunidades indígenas a acesso às açoes de nível primário, secundário e terciário do Sistema Ünico de Saúde.�

Art. 13: �São assegurados os serviços de atençao primária à saúde no interior de terras indígenas.�

Art. 14: �O órgãno federal de assistência ao índio integrará o Sistema Único de Saúde-SUS, a partir da utilização da rede pública e conveniada, bem como dos seus mecanismos de financiamiento, para asegurar meios outros que viabilizem assitência integral e diferenciada, consideradas as especificidades das comunidades indígenas.�

- Estatuto das sociedades indigenas (Proyecto de ley)

Art. 117: “É assegurado aos índios e as comunidades indígenas a assisténcia especial nas ações de saúde, eduçapo, e de apoio as atividades produtivas, em observáncia ao reconhecimento das comunidades indígenas como grupos etnicamente diferenciados.

Parágrafo único. A assisténcia especial de que trata o caput deste artigo npo exclui o acesso dos fndios e das comunidades indígenas aos meios de assisténcia assegurados aos demais brasileiros.�

Art. 121: “O sistema de prevenção e assistência a saúde para as comunidades indígenas destina-se a complementar as práticas de medicina indígena, visando a redução do risco de doenças e outros agravos e o estabelecimento de condições que assegurem aos índios e as comunidades indígenas o acesso universal e igualitário as atividades e aos serviços de saúde.�

Art. 122: “As ações de saúde voltadas para os índios e suas comunidades terão como príncipio:

I. o respeito e a valorização das diferentes práticas da medicína indígena:

II. o perfil epidemológico, a situação sanitária, as condições de bem-estar físico, mental e social e as formas de interação dessas comunidades com a sociedades envolvente.

III. a participação da comunidade indígena, através de seus representantes, na formulação da política de saúde, e em todas as fases das ações de saúde.�

Art. 123: “-É reconhecido e garantido o sistema tradicional de saúde de cada comunidade indígena, componente de sua organização social, costumes, crenções e tradiçcões.�

18. Canada

- Royal Commission on Aboriginal Peoples, Vol 3 Recommendations, 3.2.1

“The government of Canada acknowledge a fiduciary responsibility to support Aboriginal nations and their communities in restoring Aboriginal families to a state of health and wholeness.�

3.3.2

“Governments recognize that the health of a people is a matter of vital concern to its life, welfare, identity and culture and is therefore a core area for the exercise of self-government by Aboriginal nations.�

- Nisga’a Agreement

“Nisga'a Lisims Government may make laws in respect of the authorization or licensing of individuals who practice as aboriginal healers on Nisga'a Lands, but, this authority to make laws does not include the authority to regulate products or substances that are regulated under federal or provincial laws of general application.�

19. Ecuador

Constitución Política del Estado Ecuatoriano

Artículo 44: El Estado formulará la política nacional de salud y vigilará su aplicación; controlará el funcionamiento de las entidades del sector; reconocerá, respetará y promoverá el desarrollo de las medicinas tradicional y alternativa, cuyo ejercicio será regulado por la ley, e impulsará el avance científico-tecnológico en el área de la salud, con sujeción a principios bioéticos.

Artículo 84: El Estado reconocerá y garantizará a los pueblos indígenas, de conformidad con esta Constitución y la ley, el respeto al orden público y a los derechos humanos, los siguientes derechos colectivos a los pueblos indígenas: (12) A sus sistemas, conocimientos y prácticas de medicina tradicional, incluido el derecho a la protección de los lugares rituales y sagrados, plantas, animales, minerales y ecosistemas de interés vital desde el punto de vista de aquella.

20. Colombia

Resolución No. 10.013 de 1981

"Considerando ...[q]ue la población indígena amerita un tratamiento preferencial por sus condiciones socio-culturales especiales�.

Artículo 2: "Los programas de prestación de servicios de salud de atención primaria que se desarrollan en comunidades indígenas deberán adaptarse a la estructura organizacional, política, administrativa y socio-económica, en forma tal que se respeten sus valores, tradiciones, creencias, actitudes y acervo cultural.

Artículo 3: Antes de iniciar cualquier programa de atención primaria con participación de comunidades indígenas, deberá realizarse en cada una de éstas un estudio previo que permita conocer la cultural, soci-económica y sanitaria y su concepción mítica de la salud y la enfermedad.

Artículo 4: Con base en el estudio a que se alude en el artículo segundo, se elaborarán modelos conducentes a prestar servicios eficaces de atención primaria de salud ya proponer la forma de integrar la medicina tradicional autóctona con la medicina institucionalizada.

Artículo 12: Para [efectos] de la organización y participación de la comunidad, se tendrán en cuenta ante todo los diferentes tipos de organización existentes en las comunidades indígenas.

21. Panama

-Régimen Especial de la Comarca Kuna Yala

Artículo 20: "Son atribuciones del Congreso General Kuna;...18) Velar y tomar medidas conducentes a la salud de la población, solicitando a las Autoridades Nacionales competentes para la instalación y equipamento del Centro de Salud y el Hospital en la Comarca�.

Artículo 62: "El Estado, a través del Ministerio de Salud garantizará a la Comarca el adecuado y efectivo equipo y recursos humanos idóneos a los Centros de Salud y Hospitales. Igualmente el abastecimiento de los medicamentos�.

Artículo 63: "Los médicos, las enfermeras, las auxiliares y otros funcionarios que laboren en dichos establecimientos de salud, procuran observar las normas consuetudinarias vigentes, tratando lo posible la compatibilización con las prácticas de etnomedicina, que sirven como medio para reabilitar la salud e la población�.

Artículo 64: "En las comunidades de la Comarca se crearán Comité de Salud, sujeto a las autoridades establecidas en la presente Ley y el mismo procurará promover, proteger, recuperar, participar en la planificación y la ejecución de los Programas del Ministerio de Salud en las Comunidades�.