A/HRC/33/57 determination and cultural possessions (tangible and intangible), shared decision-making and equal participation in society without discrimination. 20. The Special Rapporteur on the right to health has stated that the right to health raises important issues of law, such as treaty rights to health. 6 Article 37 of the United Nations Declaration on the Rights of Indigenous Peoples confirms that indigenous peoples have the right to the recognition, observance and enforcement of treaties. In line with article 43, the survival, dignity and well-being of indigenous peoples are dependent on the rights recognized in the Declaration, including the right to health, the right to self-determination and treaty rights. Although the rights to self-determination and health are not contingent upon the recognition of treaties, their formal inclusion in treaties provides a mechanism for safeguarding those rights and strengthens the commitment of States to working with indigenous peoples as equal partners in improving their living conditions. Accordingly, States that have not yet adhered to such treaties should consider formally acknowledging those rights in agreements with indigenous peoples. 21. The principle of free, prior and informed consent is another integral element of the right to self-determination. It entitles indigenous peoples to effectively determine the outcome of decision-making affecting them. It is both a process and a substantive mechanism to ensure respect of indigenous peoples’ rights. Free, prior and informed consent should be respected in decisions regarding health legislation, policy and programmes affecting indigenous peoples, which are frequently taken without any meaningful consultation. Health-care policymaking should adhere to both article 12 of the International Covenant on Economic, Social and Cultural Rights (on the right to participate in decision-making) and the United Nations Declaration on the Rights of Indigenous Peoples, and reflect the principles outlined by the Expert Mechanism in its study on the right to participate in decision-making (A/HRC/18/42). IV. Indigenous peoples’ right to health: State obligations 22. Indigenous peoples worldwide share many challenges in realizing the highest attainable standard of health. The challenges are examined in the present report using the availability, accessibility, acceptability and quality framework, with State obligations outlined using the respect, protect and fulfil framework. The availability, accessibility, acceptability and quality framework extends beyond the infrastructure for delivering health care to encompass the facilities, goods and services comprising the underlying determinants of health care, such as safe drinking water and adequate food and sanitation.7 A. Availability, accessibility, acceptability and quality framework Availability 23. Public health and health-care facilities, goods and services should be available in sufficient quantity within a State, depending on its level of development. However, availability is often constrained for indigenous peoples and communities. For example, in certain areas in Africa where indigenous nomadic pastoralists and communities are located, health infrastructure is non-existent.8 For facilities, goods and services to be available, they 6 7 8 Statement to the Third Committee of the General Assembly, 29 October 2004. Committee on Economic, Social and Cultural Rights, general comment No. 14. United Nations, Department of Economic and Social Affairs, State of the World’s Indigenous Peoples: Indigenous Peoples’ Access to Health Services, second volume (New York, 2015). 7