HEALTH RIGHTS management of resources … should be given to the most vulnerable or marginalized groups of the population’.18 There is now an increasing number of commitments by wealthy countries to provide aid for development and health-related assistance in the South. The most important of these is probably that stemming from the Millennium Declaration and the Millennium Development Goals (MDGs).19 The Special Rapporteur on the Right to Health has noted that four of the MDGs are directly health-related and two others are closely linked to health.20 He further argues that bringing to bear a human rights’ lens with respect to the MDGs helps to ensure their benefits reach the disadvantaged and vulnerable, such as minorities and indigenous peoples. With respect to international financial institutions (IFIs), the CESCR has stated that they should pay more attention to the protection of the right to health in their policies and programmes. In its General Comment No.2, it stated that in any structural adjustment programme or other loan programme IFIs have an obligation to ensure that: (1) the right to health is protected in policies promoting or enabling the privatization of services (2) the human rights implications (especially for minorities and disadvantaged populations) of such policies have been addressed through a broad process of consultation (3) necessary checks and balances have been put in place to protect the interests of the most vulnerable members of society, including minorities and indigenous peoples. The multiple layers of discrimination and exclusion faced by indigenous peoples and minorities shape many important social determinants of health, and not merely degrading or unacceptable encounters during treatment. These incidents are only surface manifestations of the institutional and structural forms of discrimination and exclusion that permeate popular culture, development policies, educational institutions, and the employment and housing markets, and affect the well-being of minorities and indigenous peoples throughout the course of their lives. Often physical remoteness of services and a lack of culturally appropriate health practices and health information combine with discrimination and other forms of socio-economic marginalization and exploitation to impact on indigenous peoples’ lives. It is not only the availability, accessibility, acceptability and quality of health facilities, goods and services that is affected, but also the environmental health and even the identity of minorities and indigenous peoples. Realizing the right to health – including access to health care and to the basic preconditions of health – is fundamental to permit indigenous peoples and minorities to dignified lives and to participate as full members of their societies. 45