minority-health

How is minority health a human rights issue?

What do we mean by marginalized minority populations?

In this chapter, minority is used as an umbrella term to refer to marginalized ethnic, racial, cultural, and linguistic minorities as well as indigenous people. There is no internationally agreed-upon definition as to which groups constitute minorities or indigenous populations. This chapter will use these terms broadly, focusing on the marginalization of minorities and the effect of marginalization upon their health and human rights.

In 1979, the former Special Rapporteur of the Sub-Commission on Prevention of Discrimination and Protection of Minorities, Francesco Capotorti, provided one of the most widely accepted definitions of minorities:

A group numerically inferior to the rest of the population of a state, in a non-dominant position, where members—being national of the state—possess ethnic, religious, linguistic characteristics differing from those of the rest of the population and show, if only implicitly, a sense of solidarity, directed towards preserving their culture, tradition, religion or language.1

The UN Minorities Declaration, adopted by the General Assembly in 1992, contains a more general definition of minorities, stating that minorities are persons belonging to national or ethnic, cultural, religious, and linguistic minorities.2 The Office of the High Commissioner of Human Rights (OHCHR) stated that “[t]he difficulty in arriving at an acceptable definition lies in the variety of situations in which minorities exist.”3 The OHCHR further states:

It is often stressed that the existence of a minority is a question of fact and that any definition must include both objective factors (such as the existence of a shared ethnicity, language or religion) and subjective factors (including that individuals must identify themselves as members of a minority).4

There has also been extensive discussion relating to indigenous peoples, but the United Nations has yet to adopt any definition.

What are the issues and how are they human rights issues?

Minorities are among the most marginalized groups in society and experience higher rates of mortality, limited access to health services, and poorer health outcomes. Marginalization, social exclusion, and stigma, as well as other social and economic determinants like unemployment and poor material circumstances, affect access to health services and health status. A human rights-based approach that addresses social and economic determinants of health, including discrimination, is required to address the persistent inequalities of minority populations in health status and access to health.

Minority populations are also more vulnerable to pandemic diseases such as HIV/AIDS and tuberculosis.5 For more information on HIV/AIDS and minorities please see Chapter 2 on HIV, AIDS, and human rights. For more information on tuberculosis and minorities, please see Chapter 3 on Tuberculosis and human rights.

Right to non-discrimination and equality before the law

Discrimination against minority populations remains a central problem and affects the enjoyment of all rights, including health. International human rights law prohibits discrimination on the basis of race, color, language, national or social origin, or other status. The International Convention on the Elimination of all forms of Racial Discrimination (ICERD) defines racial discrimination as “any distinction, exclusion, restriction or preference based on race, colour, descent, or national or ethnic origin” that impairs the enjoyment of human rights and fundamental freedoms. Likewise, prohibition against discrimination on the basis of race, color, language, national or social origin, or other status is listed in the International Covenant on Economic, Social and Cultural Rights (ICESCR), the International Covenant on Civil and Political Rights (ICCPR) and the Convention on the Rights of the Child (CRC). These human rights instruments require state parties to take all appropriate means to eliminate discrimination and to ensure that all public authorities and institutions conform with this obligation.

Right to health

The right to health is expressly recognized in Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), which notes “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”6 Article 5 of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) also states:

States Parties undertake to prohibit and to eliminate racial discrimination in all its forms and to guarantee the right of everyone, without distinction as to race, colour, or national or ethnic origin, to equality before the law, notably in the enjoyment of…. [inter alia, t]he right to public health, medical care, social security and social services.7

However, minority and indigenous populations face disproportionate barriers to realizing the right to health. They often face limited access to health services and experience increased illness and greater mortality relative to majority populations in the same region and socioeconomic class. Likewise, indigenous peoples are often marginalized and “are poorer, less educated, die at a younger age, are much more likely to commit suicide, and are generally in worse health than the rest of the population.”8 For example, according to the World Health Organization (WHO):

In some regions of Australia, the Aboriginal and Torres Strait Islanders have a diabetes prevalence rate as high as 26%, which is six-times higher than in the general population. Among Inuit youth in Canada, suicide rates are among the highest in the world, at eleven-times the national average. For ethnic minorities in Viet Nam, more than 60% of childbirths take place without prenatal care compared to 30% for the Kinh population, Viet Nam’s ethnic majority.9

Studies have shown that minority and indigenous populations have lower access to health services, health information, and adequate housing and safe drinking water than the general population. Children, in particular, have a higher mortality rate and are more likely to suffer from severe malnutrition.10

Health care facilities, goods, and services
The Committee on Economic, Social and Cultural Rights (CESCR) has expressly addressed minority populations in General Comment 14 on the right to health:

States are under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, including . . . minorities . . . to preventive, curative and palliative health services; [and] abstaining from enforcing discriminatory practices as a State policy.11

The CESCR states that governments have a legal obligation to eliminate and abstain from all discriminatory practices in health care delivery to minorities. Similarly, the UN Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable standard of physical and mental health (Special Rapporteur on the right to health) also writes that states have a legal obligation “to ensure that a health system is accessible to all without discrimination, including … minorities [and] indigenous peoples.”12 The human rights principles of discrimination and equality require that states take affirmative action, for example through outreach programs, to ensure that minorities have the same access to health care in practice as others.13

CESCR General Comment 14 explains that the right to health requires States to ensure that minorities have physical accessibility to health facilities:

[H]ealth facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as ethnic minorities and indigenous populations . . .14

This is particularly relevant for minority populations that are geographically isolated or are predominantly living in rural locations. Under this obligation, States are obligated to ensure that health facilities are provided in “safe physical reach.”

Under the right to health, facilities must be provided in a medically ethical and culturally appropriate manner. General Comment 14 explains that “culturally appropriate” includes “respectful of the culture of individuals, minorities, peoples and communities . . . as well as being designed to respect confidentiality and improve the health status of those concerned.”15

Social and economic determinants of health
In General Comment 14, CESCR explains that the right to health is “an inclusive right extending not only to timely and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health.”16 Moreover, the determinants of health must also be physically accessible, economically affordable, and available in sufficient quantity and provided in a non-discriminatory manner.17

The determinants of health, as described above, “are in turn shaped by a wider set of forces: economics, social policies, and politics.”18 Michael Marmot explains that “material deprivation is not simply a technical matter of providing clean water or better medical care. Who gets these resources is socially determined.”19 Minorities, as a marginalized population, are more vulnerable to the social and economic determinants of health and consequently experience poorer health outcomes. As Richard Wilkinson and Michael Marmot explain, “It’s not simply that poor material circumstances are harmful to health; the social meaning of being poor, unemployed, socially excluded, or otherwise stigmatized also matters.”20

Rights of women

Minority women are particularly vulnerable to multiple forms of discrimination because they bear the double burden of both gender and minority stigma. CERD explains:

Racial discrimination does not always affect women and men equally or in the same way. There are circumstances in which racial discrimination only or primarily affects women, or affects women in a different way, or to a different degree than men. Such racial discrimination will often escape detection if there is no explicit recognition or acknowledgement of the different life experiences of women and men, in areas of both public and private life.21

Minority women especially face barriers to education and full participation in the economic, cultural, political, and social life of their communities and in society.22 In many places, minority women receive fewer health and reproductive health services, less information and are more vulnerable to physical and sexual violence.23

Reproductive and sexual health
Minority women face sexual and reproductive health rights violations from within their own communities, such as pressure to abstain from using contraception or to marry early, as well as from discriminatory policies aimed at women from particular minority groups, such as forced sterilization. For example, a study conducted by the Center for Reproductive Rights found that Romani women face widespread human rights violations, specifically reproductive rights violations. Violations include coerced or forced sterilization, misinformation in reproductive health matters, physical and verbal abuse by medical providers, racially discriminatory access to health care resources and treatment, and denial of access to medical records.24

The European Court of Human Rights has heard cases on Roma women being sterilized without their full and informed consent. Usually, these procedures are conducted while the patient is in the hospital and undergoing another procedure. Below is an excerpt from a blog, explaining the process of surgical sterilization on Roma women:

Between 1971 and 1991 in Czechoslovakia, now Czech Republic and Slovakia, the “reduction of the Roma population” through surgical sterilization, performed without the knowledge of the women themselves, was a widespread governmental practice. The sterilization would be performed on Romani women without their knowledge during Caesarean sections or abortions. Some of the victims claim that they were made to sign documents without understanding their content. By signing these documents, they involuntarily authorized the hospital to sterilize them. In exchange, they sometimes were offered financial compensation or material benefits like furniture from Social Services – though it was not explicitly stated what this compensation was for. The justification for sterilization practices according to the stakeholders was “high, unhealthy” reproduction.25

In two recent cases, the European Court of Human Rights held that the sterilization of Roma women without their full and informed consent violated the women’s right to privacy.26

Minority women are especially vulnerable to systematic sexual violence, such as targeted rape. During armed conflicts, minority women can suffer from systematic sexual and other violence because of their ethnic, religious, tribal, or indigenous identity. Systematic violence against minority women during conflict was reported in conflicts, including Iraq, Afghanistan, Somalia, Sudan, Democratic Republic of Congo, Sri Lanka, Colombia, Guatemala, Kyrgyzstan, and Burma. Unfortunately, minority women often have limited or no access to justice and face discrimination from the police force and judicial system,27 and are therefore unable to seek redress for these gross human rights violations.

Access to health care
Poverty, remote geographic location, language barriers, and inaccessibility of health care prevent minority women from accessing and using health and reproductive health services. In some cases, minority women may be refused health services, receive inferior care, or be abused by health workers due to discrimination against minorities.28 As a result, minority women are vulnerable to health and reproductive issues. For example, the Karen ethnic minority group in Thailand has one of the highest maternal mortality rates in the country. The Special Rapporteur on the right to health writes that the “burden of maternal mortality falls disproportionately on women in developing countries [and that] in both developing and developed countries, the burden of maternal mortality falls disproportionately on ethnic minority women, indigenous women and women living in poverty.”29

Minority women are more likely to be living in poverty and are therefore less likely to have access to care, less likely to have routine care, and more likely to delay care. Poverty can also exacerbate reproductive health problems and can lead to poor nutrition and stress. “Poverty remains one of the most significant barriers to the full actualization of reproductive health, and the link between health, income and minority status is well established.”30

Freedom from harmful cultural practices

Tension exists between rights of minorities and indigenous peoples to maintain their cultural identity and practice their culture, and the rights of women to be free from harmful cultural practices, such as female genital mutilation (FGM). Harmful practices such as FGM may be presented as integral cultural practices, but they may not be supported by everyone. Especially in patriarchal societies, it is highly unlikely women will challenge accepted cultural practices.31

Right to education

Education is one of the social determinants of health and lack of education can limit the enjoyment of the right to health and other economic and social rights. Generally, lower levels of education are associated with poorer health outcomes, including illness, malnutrition, and higher rates of infant mortality. Therefore, it is important to consider access to education and quality education as part of the broader picture of health.

Non-discrimination and equal access
Minority populations experience unequal or restricted access to education as well as inappropriate education strategies.32 Under international human rights law, governments have the obligation to ensure that “persons belonging to minorities have equal access to quality education leading to equal educational outcomes.”33 To ensure equal access, governments should address all forms of discrimination against minorities. This includes, as CESCR explains, indirect discrimination which are laws or policies that may not be discriminatory at face value but have a disparate impact upon minorities.34 For example, “requiring a birth registration certificate for school enrolment may discriminate against ethnic minorities or non-nationals who do not possess, or have been denied, such certificates.”35

Many children from minority populations face discrimination both institutionally, such as being placed in a poorer quality school, or by teachers and students, such as by bullying. For example, the discriminatory education system in the Czech Republic barred Roma children from accessing quality education that would prepare them to be productive members of society. In the Czech Republic, Roma children were disproportionally placed in “practical” schools that provided sub-standard education rather than “standard” schools. In 2000, 19 Roma Czech nationals filed a case with the European Court for Human Rights claiming they were discriminated against on the basis of their race/ethnic origin in accessing education, and the Court found educational segregation discriminatory.36 However, according to a February 2012 report from the Open Society Foundations, an estimated 20% of Roma children in the Czech Republic are still placed in “school designed for pupils with mild mental disabilities, compared to two percent of their non-Roma counterparts.”37

Exclusion and inequality in education are especially felt by minority and indigenous girls. A 2011 UNICEF report concludes that “Attendance and completion of secondary school is still largely beyond the reach of the poorest and most marginalized groups and communities in many countries. Girls, adolescents with disabilities and those from minority groups are especially disadvantaged.”38

For example, the MDG Report from Laos indicates that “compared with boys, girls from the Sino-Tibetan group [of minorities] are much less likely to be in school than those from the Lao-Tai group.” In China, girls from minority groups have experienced much lower rates of secondary school enrolment than Han girls, according to a 2010 article published by the World Bank.39 Countries should pay special attention to the multiple forms of discrimination facing young minority girls.

Content and delivery of curriculum
International human rights law demands that education for minorities, including curriculum and teaching methods, should be provided in a culturally appropriate manner and of good quality equal to national standards.40 “Culturally appropriate” refers to restrictions or limitations that would limit a minority’s access to education. For example, the Committee on the Rights of the Child (CRC Committee) explains, “Discriminatory practices, such as restrictions on the use of cultural and traditional dress, should be avoided in the school setting.”41 Likewise, The Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities (Declaration on Minorities), passed by the United Nations General Assembly, provides that “States shall take measures to create favourable conditions to enable persons belonging to minorities to express their characteristics and to develop their culture, language, religion, traditions and customs, except where specific practices are in violation of national law and contrary to international standards.”42

Educational instruction should be provided in minority languages whenever possible. The Declaration on Minorities explains that “States should take appropriate measures so that, wherever possible, persons belonging to minorities may have adequate opportunities to learn their mother tongue or to have instruction in their mother tongue.”43 Many minorities speak two or more languages, which is important for their full participation in society. However, bilingualism can create difficulties and disadvantages in education—for example, if they are required to study in a language that is not their mother tongue.44 The CESCR explains, “Discrimination on the basis of language or regional accent is often closely linked to unequal treatment on the basis of national or ethnic origin” and that it can hinder the enjoyment of many rights.45 It also explains that “States parties should ensure that any language requirements relating to employment and education are based on reasonable and objective criteria.”46

Curricula that reflect minority cultures and history should also be provided.47 The Declaration on Minorities explains that “States should, where appropriate, take measures in the field of education, in order to encourage knowledge of the history, traditions, language and culture of the minorities existing within their territory. Persons belonging to minorities should have adequate opportunities to gain knowledge of the society as a whole.”48 The CRC elaborates on this obligation for indigenous peoples: “In order to effectively implement this obligation, States parties should ensure that the curricula, educational materials and history textbooks provide a fair, accurate and informative portrayal of the societies and cultures of indigenous peoples.”49

Right to political participation

The CESCR identified political participation as an important aspect of the right to health in General Comment 14. CESCR writes that an “important aspect is the participation of the population in all health-related decision-making at the community, national and international levels.”50 CESCR further explains:

The formulation and implementation of national health strategies and plans of action should respect, inter alia, the principles of non-discrimination and people’s participation. In particular, the right of individuals and groups to participate in decision-making processes, which may affect their development, must be an integral component of any policy, programme or strategy developed to discharge governmental obligations under article 12. Promoting health must involve effective community action in setting priorities, making decisions, planning, implementing and evaluating strategies to achieve better health. Effective provision of health services can only be assured if people’s participation is secured by States.51

International human rights law considers political and community participation as an important element of the right to health. Alicia Yamin writes that: “Realization of the right to health further implies providing individuals and communities with an authentic voice in decisions defining, determining, and affecting their well-being.”52 Therefore, minority under-representation in public decision-making is an important element in understanding the structural determinants of minority health.

International human rights law explains that everyone has political rights, including the right to take part in government. The International Convention on the Elimination of Racial Discrimination (ICERD) explains that everyone, without distinction as to race, color, or national or ethnic origin, has political rights, including the right to vote in elections and to stand or elections, to take part in government, and to have equal access to public service.53 However, minority populations are “almost always under-represented in national parliaments, in local governments, and in other areas of public life.”54 Minorities face discrimination from effective [political] participation, which manifests itself in a range of ways including dissemination of information, civic advocacy and activism, and direct involvement in electoral politics.55

For example, in some countries, minorities are prevented from exercising their right to participate fully and effectively in public life in through electoral provisions. In Bosnia and Herzegovina, the country’s electoral provisions infringed upon the rights of minorities by preventing them from being candidates for the presidency and the House of the People solely on the ground of their race/ethnicity or religion. Two members of minorities, one Roma and one Jewish, against whom these provisions discriminated, brought the case to the European Court of Human Rights, which found that certain provisions of the Bosnian Constitution and election laws discriminated against minorities.56

The right to effective participation can be ensured through different means beyond equality in the electoral process, including “consultative mechanisms to special parliamentary arrangements and, where appropriate, may even include forms of territorial or personal autonomy.”57 Alicia Yamin writes about the link between health and the construction of a functional democracy: “health-related resource distribution, evidence of discrimination and disparities, and the like are analyzed not just in terms of their impact on health status but also their relation to laws, policies, and practices that limit popular participation in decision-making and, in turn, the establishment of a genuinely democratic society.”58

Rights of stateless and mobile populations

Lack of birth registration and identity documents presents a serious barrier for many minorities in accessing public services, including health care. For children born into minority or indigenous families living in remote areas, the risk of not being registered is even higher.59 There are an estimated 15 million stateless persons in the world, and most belong to ethnic, religious, or linguistic minorities.60 For example, in late 2001, more than half of all Roma in Serbia did not have a birth certificate or any document proving their citizenship. Almost one-third did not possess a health card.61 The denial of birth registration or identity cards to minority groups is discriminatory and is contrary to international law.62 While access to health care is only one factor shaping overall health, it is also critical to increasing social inclusion of minorities and ensuring equal opportunities for all.

Rights of indigenous populations

Indigenous populations are unique with respect to their history, culture, ecology, geography, and politics. “As such, Indigenous Peoples have distinct status and specific needs relative to others. Indigenous Peoples’ unique status must therefore be considered separately from generalized or more universal social exclusion discussions.”63 This resource does not adequately address the unique concerns of indigenous peoples, but rather introduces human rights concepts used in the area of indigenous peoples and health. It is recommended that the reader take note of this and pursue additional resources on indigenous rights. Resources are provided in Section 7 near the end of this chapter.

Indigenous people are often discriminated against or experience disparities in accessing health services and health outcomes. They are more likely to “suffer from poorer health, are more likely to experience disability and reduced quality of life and ultimately die younger than their non-indigenous counterparts.”64 This inequality in health status of indigenous peoples “goes to the heart of the relationship between health and power, social participation, and empowerment.”65

In General Comment 14 on the right to health, CESCR dedicates a section to “identify elements that would help to define indigenous peoples’ right to health in order better to enable States with indigenous peoples to implement the provisions contained in Article 12 of the Covenant.”66 CESCR explains that:

  • Indigenous peoples have the right to specific measures to improve their access to health services and care.
  • Health services should be culturally appropriate, taking into account traditional preventive care, healing practices and medicines.
  • States should provide resources for indigenous peoples to design, deliver and control [health] services so that they may enjoy the highest attainable standard of physical and mental health.
  • The vital medicinal plants, animals and minerals necessary to the full enjoyment of health of indigenous peoples should also be protected.

Notes

1 Capotorti F, Study on the Rights of Persons Belonging to Ethnic, Religious and Linguistic Minorities, U.N. Doc E/CN.4/Sub.2/384/Rev.1, U.N. Sales No. E.78.XIV.1 (1979): 96.

2 UN General Assembly, Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities, U.N. Doc. A/RES/47/135 (Dec 18, 1992). www.un.org/documents/ga/res/47/a47r135.htm.

3 UN Office of the High Commissioner for Human Rights (OHCHR), Minority Rights, Fact Sheet No.18 (Rev.1), www.ohchr.org/Documents/Publications/FactSheet18rev.1en.pdf.

4 OHCHR, Minority Rights: International Standards and Guidance for Implementation (2010). www.ohchr.org/Documents/Publications/MinorityRights_en.pdf.

5 UN Office of the High Commissioner for Human Rights, Towards Developing Country Engagement Strategies on Minorities: An Information Note for OHCHR Staff and Other Practitioners. www.ohchr.org/Documents/Publications/Strategies_on_minoritiesEN.pdf.

6 International Covenant on Economic, Social and Cultural Rights (ICESCR). http://www2.ohchr.org/english/law/cescr.htm.

7 International Convention on the Elimination of all forms of Racial Discrimination (ICERD).http://www2.ohchr.org/english/law/cerd.htm.

8 World Health Organization (WHO), Health of indigenous peoples (Oct. 2007). www.who.int/mediacentre/factsheets/fs326/en/index.html.

9 Ibid.

10 United Nations Office of the High Commissioner for Human Rights and the World Health Organization, The Right to Health, Fact Sheet No.31. www.ohchr.org/Documents/Publications/Factsheet31.pdf.

11 UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 14, E/C.12/2000/4 (Aug. 11, 2000).

12 UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/7/11 (Jan. 31, 2008).

13 UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (Paul Hunt), A/HRC/7/11 (Jan. 31, 2008).

14 UN Committee on Economic, Social and Cultural Rights, General Comment No. 14, E/C.12/2000/4, para. 12(b)(ii) (Aug. 11, 2000).

15 UN Committee on Economic, Social and Cultural Rights, General Comment No. 14, E/C.12/2000/4 (Aug. 11, 2000), para. 12(b)(ii).

16 Ibid.

17 Ibid.

18 World Health Organization, Social determinants of health: Key concepts. www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/index.html.

19 Marmot M, “Social determinants of health inequities,” Lancet 365 (2005) 1099–1104. www.who.int/social_determinants/strategy/Marmot-Social%20determinants%20of%20health%20inqualities.pdf.

20 Wilkinson R and Marmot M, “Social determinants of health: the solid facts” (2003). www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf.

21 UN Committee on the Elimination of Racial Discrimination (CERD), General Recommendation No. 25: Gender related dimensions of racial discrimination (Mar. 20, 2000).

22 UN Office of the High Commissioner for Human Rights, United Nations Forum on Minority Issues: Compilation of Recommendations of the First Four Sessions 2008-2011. http://www2.ohchr.org/english/bodies/hrcouncil/minority/docs/Forum_On_Minority_Pub_en_low.pdf.

23 United Nations Office of the High Commissioner for Human Rights and the World Health Organization, The Right to Health, Fact Sheet No.31. www.ohchr.org/Documents/Publications/Factsheet31.pdf.

24 Center for Reproductive Rights, Body and Soul: Forced Sterilization and other Assaults on Roma Reproductive Freedom in Slovakia (2003). http://reproductiverights.org/sites/default/files/documents/bo_slov_part1.pdf.

25 Stoyanova G, Forced sterilization of Romani women – a persisting human rights violation, (Romedia Foundation, February 7, 2013). http://romediafoundation.wordpress.com/2013/02/07/forced-sterilization-of-romani-women-a-persisting-human-rights-violation/.

26 Case of V.C. v. Slovakia, 18968/07 (Nov. 8, 2011) and Case of N.B. v. Slovakia, 29518/10 (June 12, 2012).

27 Minority Rights Group International, Minority women deliberately targeted for rape and other violence – new global report (July 6, 2011). www.minorityrights.org/10851/press-releases/minority-women-deliberately-targeted-for-rape-and-other-violence-new-global-report.html.

28 Minority Rights Group International, State of the World’s Minorities and Indigenous Peoples 2011 (2011). www.minorityrights.org/10848/state-of-the-worlds-minorities/state-of-the-worlds-minorities-and-indigenous-peoples-2011.html.

29 UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/HRC/4/28 (Human Rights Council, Jan 17., 2007).

30 Bakhru TS, Reproductive rights: a long way to go (2011) from Minority Rights Group International, State of the World’s Minorities and Indigenous Peoples 2011 (2011). www.minorityrights.org/10848/state-of-the-worlds-minorities/state-of-the-worlds-minorities-and-indigenous-peoples-2011.html.

31 Minority Rights Group International, State of the World’s Minorities and Indigenous Peoples 2011 (2011). www.minorityrights.org/10848/state-of-the-worlds-minorities/state-of-the-worlds-minorities-and-indigenous-peoples-2011.html.

32 UN Office of the High Commissioner for Human Rights, United Nations Forum on Minority Issues: Compilation of Recommendations of the First Four Sessions 2008-2011. http://www2.ohchr.org/english/bodies/hrcouncil/minority/docs/Forum_On_Minority_Pub_en_low.pdf.

33 UN Human Rights Council, Recommendations of the Forum on Minority Issues at its third session, on minorities and effective participation in economic life (14 and 15 December 2010), U.N. Doc. A/HRC/16/46 (Jan 31, 2011). http://www2.ohchr.org/english/bodies/hrcouncil/docs/16session/A-HRC-16-46.pdf.

34 UN Committee on Economic, Social and Cultural Rights, General Comment No. 20, E/C.12/GC/20 (July 2, 2009).

35 Ibid. at para. 10 (b).

36 D.H. and Others v. The Czech Republic, 57325/00 (Nov. 13, 2007). See also, Orsus and Others v. Croatia, 15766/03 (Mar. 16, 2010)(15 Roma children living in Orehovica, Podturen and Trnovec and born between 1988 and 1994, were required to attend segregated classes with only Roma pupils. The Court found that “the placement of the applicants in Roma-only classes at times during their primary education had no objective and reasonable justification” and therefore there was a violation article 14 prohibiting discrimination.).

37 Open Society Foundations, Failing Another Generation: The Travesty of Roma Education in Czech Republic (2012). www.opensocietyfoundations.org/sites/default/files/failing-another-generation-20120601_0.pdf. See also, Thomasen K, A Hard Look at Discrimination in Education in Germany, (Open Society Foundations, Oct. 17, 2012). www.opensocietyfoundations.org/voices/hard-look-discrimination-education-germany.

38 UNICEF, State of the World’s Children 2011: Adolescence: An Age of Opportunity (2011). www.unicef.org/publications/files/SOWC_2011_Main_Report_EN_02242011.pdf, pg. 67.

39 Minority Rights Group International, State of the World’s Minorities and Indigenous Peoples 2011 (2011). www.minorityrights.org/10848/state-of-the-worlds-minorities/state-of-the-worlds-minorities-and-indigenous-peoples-2011.html.

40 UN Committee on Economic Social and Cultural Rights, General Comment No. 13, E/C.12/1999/10 (Dec. 8, 1999).

41 Committee on the Rights of the Child (CRC), General Comment No. 11, U.N. Doc. CRC/C/GC/11 (Feb. 12, 2009).

42 UN General Assembly, Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities, U.N. Doc. A/RES/47/135 art. 4(2) (Dec 18, 1992). www.un.org/documents/ga/res/47/a47r135.htm.

43 Ibid.

44 Izsák R, Report of the independent expert on minority issues U.N. Doc. A/HRC/19/56, (United Nations Human Rights Council, Jan. 3, 2012).

45 UN Committee on Economic Social and Cultural Rights, General Comment No. 20, U.N. Doc. E/C.12/GC/20 (July 2, 2009).

46 Ibid.

47 UN Office of the High Commissioner for Human Rights, United Nations Forum on Minority Issues: Compilation of Recommendations of the First Four Sessions 2008-2011. http://www2.ohchr.org/english/bodies/hrcouncil/minority/docs/Forum_On_Minority_Pub_en_low.pdf.

48 UN General Assembly, Declaration on the Rights of Persons Belonging to National or Ethnic, Religious and Linguistic Minorities, U.N. Doc. A/RES/47/135 (Dec 18, 1992). www.un.org/documents/ga/res/47/a47r135.htm, art. 4(4).

49 UN Committee on the Rights of the Child, General Comment No. 11, U.N. Doc. CRC/C/GC/11 (Feb. 12, 2009).

50 UN Committee on Economic, Social and Cultural Rights, General Comment No. 14, U.N. Doc. E/C.12/2000/4 (Aug. 11, 2000), para. 11. See also para. 17: “A further important aspect is the improvement and furtherance of participation of the population in the provision of preventive and curative health services, such as the organization of the health sector, the insurance system and, in particular, participation in political decisions relating to the right to health taken at both the community and national levels”; and para. 34 “States should refrain from … preventing people’s participation in health-related matters.”

51 Ibid. at para. 54.

52 Yamin AE, “The right to Health Under International Law and Its Relevance to the United States” . American Journal of Public Health 95 (July 2005): 7.

53 International Covenant on Economic, Social and Cultural Rights, art. 5(c). http://www2.ohchr.org/english/law/cescr.htm.

54 UN Office of the High Commissioner for Human Rights, United Nations Forum on Minority Issues: Compilation of Recommendations of the First Four Sessions 2008-2011. http://www2.ohchr.org/english/bodies/hrcouncil/minority/docs/Forum_On_Minority_Pub_en_low.pdf.

55 Ibid.

56 Claridge L, Discrimination and Political Participation in Bosnia and Herzegovina: Sejdic and Finci V. Bosnia and Herzegovina(Minority Rights Group International, Mar. 12, 2010). www.minorityrights.org/9773/briefing-papers/discrimination-and-political-participation-in-bosnia-and-herzegovina.html.

57 UN Office for the High Commissioner for Human Rights, United Nations Forum on Minority Issues: Compilation of Recommendations of the First Four Sessions 2008-2011. http://www2.ohchr.org/english/bodies/hrcouncil/minority/docs/Forum_On_Minority_Pub_en_low.pdf.

58 Yamin AE, “The right to Health Under International Law and Its Relevance to the United States” American Journal of Public Health 95 (July 2005): 7.

59 World Health Organization, Health of indigenous peoples (Oct. 2007). www.who.int/mediacentre/factsheets/fs326/en/index.html.

60 UN Office of the High Commissioner for Human Rights, Minority Rights: International Standards and Guidance for Implementation (2010). www.ohchr.org/Documents/Publications/MinorityRights_en.pdf.

61 Cameron L, ‘The Right to an Identity’. Roma Rights Quarterly. (European Roma Rights Centre, 2007). www.errc.org/cikk.php?cikk=1066.

62 UN Office of the High Commissioner for Human Rights, Minority Rights: International Standards and Guidance for Implementation (2010). www.ohchr.org/Documents/Publications/MinorityRights_en.pdf.

63 World Health Organization: Commission on the Social Determinants of Health, Closing the gap in a generation: Health equity through action on the social determinants of health (2008): 36. http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf.

64 U.N. Department of Economic and Social Affairs, State of the World’s Indigenous Peoples (2009). www.un.org/esa/socdev/unpfii/documents/SOWIP_web.pdf.

65 World Health Organization: Commission on the Social Determinants of Health, Closing the gap in a generation: Health equity through action on the social determinants of health (2008): 157.http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf.

66 UN Committee on Economic, Social and Cultural Rights, General Comment No. 14, E/C.12/2000/4, para. 27 (Aug. 11, 2000),