The Human Development Index rate in many countries is low and it is argued that minorities are more likely to experience lower life expectancy due to unequal access to health care and a higher incidence of some diseases than majority groups. These disparities are related to several causes. Health and sanitation conditions are often worse in regions where minorities live. Existing infrastructure for medical services might be more limited in remote or impoverished areas where minorities are based. In hospitals, lack of medical professionals able to communicate in their languages. The cultural practices of minorities may be unfamiliar to mainstream medical personnel, which may inhibit the effective prescription of pre- and post-natal care. All of these factors combine to reduce minorities' access to good health care, impacting negatively on their infant and maternal mortality rates and causing minorities in many countries to suffer disproportionately from malnutrition, HIV/AIDS or other diseases (on HIV/AIDS see also section 4.6 of this Guide).

Strategies to achieve the health-related MDGs will need to take account of these circumstances in order to be successful. According to the UN Committee on Economic, Social and Cultural Rights (CESCR), this means ensuring that health facilities, goods and services are within safe physical reach for all sections of the population; that medical services and underlying determinants of health, such as water and sanitation, are within safe physical reach, including in rural areas; that health facilities, goods and services are affordable for all; and that the right to seek, receive and impart information and ideas concerning health issues is assured.²²

Reaching areas were some minorities live may require special effort, as will the provision of primary health care services that are adapted to minority cultures, environments and traditional medical practices. In Thailand, the MDG Report acknowledged that regions with a high proportion of minorities had less health care: "There are difficulties accessing primary health care in the North due to the mountainous terrain. In the southernmost provinces, complexities based on gender, culture, religion and language can make access to or use of primary health care difficult".²³ In response, the Government of Thailand elaborated additional targets under MDGs 4 and 5, namely, to reduce by half, between 2005 and 2015, the under 5 mortality rate and the maternal mortality rate "in highland areas, selected northern provinces and three southernmost provinces".

Minorities could be trained as health care providers as a measure to improve community health care programmes. Minority health workers can ensure that health information is made available in minority languages and is culturally appropriate, while simultaneously addressing some of the discrimination issues that minorities can face from health workers. In Romania, one measure adopted to help reduce ethnic disparities in health was the creation of the office of Roma Community Health Mediator (Government of Romania 2003, p. 12 and 22). One of the strategies in Bolivia to reach the health MDGs is the use of the Intercultural Health Approach through the development of the health with identity programme. Through a process of training health personnel in relation to the importance of promoting respect for the practices and traditions of indigenous peoples, the approach acknowledges the need to overcome cultural barriers in the offering of health services (UNDP Bolivia 2001, p. 13). In the United States, the Red Cross has created a targeted HIV/AIDS awareness programme for Hispanic communities: the programme was created based on languages, customs, family relationships, spirituality, sexuality and health beliefs of Hispanic and Latino communities.²⁴

Ensuring the right to participation of minorities – particularly minority women – in health programme design is an important means of devising strategies for the MDGs that will work. This will help to ensure that health programmes are attuned to the priority health concerns of minority communities as well as to the cultures, lifestyles and traditional medical practices of these groups. This standard is already reflected in ILO Convention 169 Concerning Indigenous and Tribal Peoples: article 25 stresses that health services should be community-based, and planned and administered in cooperation with the peoples concerned, taking into account their traditional preventive care, healing practices and medicines.

It is particularly important to respect the link between land rights and health. Where minority communities have been displaced from their land or housing - sometimes in the name of improving their access to health and other public services - the effects have often been devastating on the human development of community members. Achieving the health MDGs for these communities may therefore need to take into consideration unresolved land rights issues.

Discrimination in the provision of health care decreases the chances of reaching the health MDGs Culture impacts significantly on health and appropriate healthcare

	There are many benefits to creating specially targeted health programmes for minorities. A community radio health programme in Peru has created the space to exercise the right to express oneself in one's native language. Before Bienvenida Salud! (Welcome Health!), certain indigenous languages, such as Urarina, had never been heard on the radio in Loreto, Peru. The radio programme reads letters of complaints about rights' violations by the State, including lack of health posts or health personnel. When these situations are exposed and denounced over the radio, people across these small and dispersed communities recognize they face similar problems and can join together to act. Letters also recount success stories (e.g. bridges that were repaired, health posts that were built, initiatives for reforestation and community control of natural resources), which promote a sense of effective agency and understandings of their health rights. By bringing rights into health MDGs' strategies, minority groups can be empowered for wider improvements in their capacity to change their situation. Source: A.E. Yamin, "Health rights", in M. Salomon, (ed.). Economic, Social and Cultural Rights: A Guide for Minorities and Indigenous Peoples, London: MRG, 2005 (p. 41-54).