A/HRC/33/57 owing to a lack of research. That should not be viewed exclusively as a source of tension between indigenous peoples and mainstream health-care providers. Indigenous communities themselves often face challenges internally in seeking to balance traditional and modern approaches to health and in addressing other social issues.10 B. Respect, protect and fulfil framework Respect 28. Articles 2 (2) and 3 of the International Covenant on Economic, Social and Cultural Rights and article 24 of the United Nations Declaration on the Rights of Indigenous Peoples prohibit discrimination in access to health care and the underlying determinants of health. States must refrain from denying or limiting indigenous peoples’ access to public healthcare facilities, goods and services. That immediate obligation is not subject to the principle of progressive realization. States should also refrain from prohibiting or impeding indigenous peoples’ use of traditional preventive care, healing practices and medicines. 29. Laws, policies and programmes concerning health should be reviewed (together with indigenous peoples) and discriminatory elements removed or replaced. That obligation extends to laws that are not de jure discriminatory but that have a disproportionate impact on indigenous peoples. The obligation to respect extends to abstaining from enforcing broader discriminatory laws or practices that can have detrimental health effects. For example, laws and policies sanctioning practices such as the forced sterilization of indigenous women and female genital mutilation should be removed. 30. The obligation to respect extends to the underlying determinants of health. States should refrain from unlawfully polluting the air, the water and the soil, for example through industrial waste from State-owned facilities or extractive industries. Such activities are too frequently carried out on land inhabited by indigenous peoples and, along with the agricultural use of pesticides, can represent a violation of indigenous peoples’ healthrelated rights.11 31. Indigenous peoples must also be permitted to self-identify within States, which would facilitate the collection of data disaggregated by health and other criteria, for the provision of funding and assistance in realizing health-related rights. While certain jurisdictions have banned the collection of data disaggregated by ethnicity for compelling reasons, such laws should not be applied to prevent indigenous peoples from improving their well-being.12 Protect 32. States often turn a blind eye to racism in health-care settings, even in the presence of pervasive, persistent evidence that indigenous peoples are treated discriminatorily. States should take measures to ensure equal access to treatment and health-care facilities within their jurisdiction, as well as to protect indigenous peoples from discrimination perpetrated by third-party health-care providers. States should consider implementing workforce awareness-raising activities and campaigns challenging racist behaviour and stereotyping and promoting more culturally sensitive approaches. 10 11 12 Submission by the Inuit Circumpolar Council. See, e.g., Social and Economic Rights Action Centre and Center for Economic and Social Rights v. Nigeria (2001). Ian Anderson and others, “Indigenous and tribal peoples’ health (The Lancet–Lowitja Institute Global Collaboration): a population study”, The Lancet, vol. 388, No. 10040 (20 April 2016). 9