A/HRC/33/57 Education 55. Education is a key underlying determinant of health for indigenous peoples. Illiteracy rates are frequently high (CERD/C/EDU/CO/20-22) and indigenous children are significantly less likely than non-indigenous children to attend school, which undermines health through decreased health literacy and loss of the numerous, indirect benefits of higher educational attainment. Lower educational attainment is “inextricably tied” to homelessness and the overrepresentation of indigenous peoples in the prison system.32 Decreased participation in formal education is frequently the result of a combination of a lack of availability, accessibility, acceptability and quality. Even where services are accessed, boys and girls record different completion rates: for instance, 89 per cent of indigenous girls in Peru aged 12-16 drop out of school (see A/HRC/29/40/Add.2, para. 68). 56. States should do more to provide redress for these health rights violations. Investing in indigenous children’s early development through education and providing support to families (e.g. around parenting) are highly effective means of reducing health inequalities. States should cooperate to ensure the adoption of effective interventions: for instance, nurse-family partnerships have been adapted for use in indigenous communities following evidence of effectiveness in the United States of America.33 At the primary and secondary levels, educational facilities should be made available and accessible by States, including through radio broadcasts and long-distance education programmes or through the establishment of mobile schools for nomadic indigenous peoples (general comment No. 11). Family and community integrity 57. The importance of healthy communities and families to indigenous children cannot be underestimated. Such support networks provide physical, mental and social health benefits, help to break entrenched cycles of intergenerational disadvantage and build resilience and capability. The Committee on the Rights of the Child has noted, in its general comment No. 11, that maintaining the best interests of the child and the integrity of indigenous families should be primary considerations in the development of health and other programmes. Unfortunately, indigenous children are still removed from their homes at a significantly higher rate than their non-indigenous counterparts, which can cause significant childhood trauma. Moreover, indigenous children are vulnerable to abuse while in the care of the State. States should prevent and provide redress for any action that deprives indigenous peoples, including children, of their ethnic identities, such as placement of indigenous children in alternative care. Mental health 58. The high prevalence of mental illness and suicide among indigenous peoples is alarming, particularly among indigenous youth. There are various protective factors and preventive strategies for suicide, including strong cultural affiliations (A/HRC/21/53). One systematic review found that school-based suicide prevention strategies reduced depression and feelings of hopelessness and that “gatekeeper” training (teaching specific community groups how to identify and support individuals at high risk of suicide) increased the 32 33 Submission by Brenda Gunn, University of Manitoba, Canada. Submission by Australia. 15