A/HRC/33/57 72. There has also been an enormous rise in the incidence of non-communicable diseases among indigenous peoples, who experience disproportionately high rates of cardiovascular illness and diabetes. Such high rates are linked to the migration of indigenous peoples from rural to urban areas, whose lifestyles rapidly change to incorporate modern diets high in calories, fat and salt.48 For example, in the Philippines, development and changes in agricultural practices and dietary preferences have contributed to soaring rates of diabetes, renal disease, cardiovascular disease, hypertension and cancer. 49 Moreover, global data reveal high rates of alcohol and tobacco use among indigenous peoples, in particular men. 73. States should take specific steps to combat the extraordinary burden of these illnesses among indigenous peoples. Affordable access to key medications, such as insulin and anti-hypertensives, should be ensured, as their high out-of-pocket costs can lead to a rapid, yet preventable, deterioration in health. Telemedicine or mobile health initiatives to monitor indigenous peoples with chronic illness living in remote areas should also be considered. The value of exercise and sport should not be underestimated, both in terms of non-communicable disease prevention and indirect health benefits, such as increased social inclusion and self-esteem. Among indigenous Australian youth there is a positive relationship between self-reported participation in sport and health outcomes, including mental health; involvement in sport has even been shown to deter juvenile delinquency.50 It is very encouraging that traditional games and sports events such as the World Indigenous Games held in 2015 are being supported and promoted by States, given their role in prevention of illness and wellness promotion. 74. Good occupational health for indigenous persons is also crucial. For example, some indigenous peoples suffer from silicosis as a consequence of poor occupational hygiene in stone processing factories, a traditional livelihood in some indigenous territories of the Russian Federation. States should protect the health of indigenous peoples working in both traditional and mainstream industries.51 B. Environmental health, climate change and displacement 75. Poor environmental health has long been a concern of indigenous peoples. The Committee on the Rights of the Child has highlighted the importance of environmental health to children and recognized climate change as a particularly urgent threat to indigenous children’s health and lifestyles, noting that States should put children’s health concerns at the centre of their climate change adaptation and mitigation strategies (general comment No. 15). Those who are already vulnerable, including indigenous peoples, experience the worst effects of climate change (A/HRC/31/52). For example, climate change is contributing significantly to food insecurity among the Inuit peoples of the Canadian Arctic, whose hunting and fishing practices have been threatened by significant reductions in their icy hunting grounds.52 Replacement of traditional food sources with mainstream dietary elements is costly in such locations, and carries its own health risks. 48 49 50 51 52 Michael Gracey and Malcolm King (see footnote 39). Penelope Domogo, presentation to the Expert Seminar on Indigenous Peoples and the Right to Health. Submission by Cultural Survival. Outcome document of the expert seminar entitled “Finno-Ugric peoples and sustainable development: health of indigenous peoples”, held in Petrozavodsk, Russian Federation, on 25 and 26 May 2016. Sheila Watt-Cloutier, presentation to the Expert Seminar on Indigenous Peoples and the Right to Health. 19