A/76/202 example, “culturally appropriate educational programmes are needed to encourage indigenous youth to pursue higher education and become leaders able to represent their own communities and defend the rights of their peoples”. 54 4. Health 37. Worldwide, indigenous peoples experience disproportionately poor health outcomes, 55 reduced life expectancy 56 and higher levels of diabetes, tuberculosis 57 and suicide, 58 which tend to worsen in urban contexts. Poverty, margi nalization and lack of access to affordable nutritional foods can lead to alarming levels of obesity and diabetes. 38. The inability to grow traditional foods and associated changes in diet and the loss of traditional medicines have had a negative impact on the health of indigenous peoples. Indigenous women are often the holders of unique indigenous knowledge about food production and medicine, which tends to be devalued in the urban context, including owing to discrimination based on gender and ethnicity. 59 39. In Australia and Canada, there are fears around seeking health care, notably among indigenous women living in urban areas, because of racial discrimination in the health-care system and the lack of indigenous health-care professionals. 60 In the Congo, “the low turnout of indigenous women at the hospital could be explained by the fear they may have of being ill-received by medical staff”. 61 40. Indigenous peoples living in urban areas often experience barriers to receiving adequate health care, including mental health services, to address the effects of intergenerational and current trauma. The health care provided is frequently insufficient, not culturally appropriate and does not meet quality standards. 62 The lack of cohesion and indigenous representation to engage in advocacy for their rights in urban policy decisions further affects health services and indicators. 63 5. Culture and identity 41. The impact of historical and current colonization and associated intergenerational trauma presents a unique set of challenges to indigenous peoples’ sense of identity and maintenance of their cultural and spiritual relationship with land and resources. In many instances, indigenous peoples nevertheless preserve their collective life, customs and traditions in cities and develop new forms of cultural expression. In other terms, they retain individual and collective rights in the process of urbanization. 42. Common misconceptions exist about indigenous peoples living in urban areas being less “authentic” or not “genuinely indigenous”. 64 In contrast, indigenous __________________ 54 55 56 57 58 59 60 61 62 63 64 12/20 A/HRC/45/34/Add.1, para. 50. A/HRC/24/41/Add.1. The gap in life expectancy between indigenous and non -indigenous people in years is 13 in Guatemala, 10 in Panama, 6 in Mexico, 20 in Nepal, 20 in Australia, 17 in Canada and 11 in New Zealand. State of the World’s Indigenous Peoples: Indigenous Peoples’ Access to Health Services (United Nations publication, 2016). See www.un.org/development/desa/indigenouspeoples/mandated -areas1/health.html. See www.who.int/news-room/fact-sheets/detail/suicide. E/C.19/2021/6, para. 21. Submission by the National Association of Friendship Centres. A/HRC/45/34/Add.1, para. 41. Submission by the UNICEF Latin America and Caribbean Regional Office, UNICEF country offices in Bolivia (Plurinational State of), Brazil and Guyana and UNI CEF New Zealand. National Council of Urban Indian Health (virtual consultation). UN-Habitat, Urban Indigenous Peoples and Migration, p. 10. 21-10081