A/HRC/33/57 Provide 40. Although certain indigenous peoples have stated that communities should take ownership over responses to emerging crises and rely less on external support, 22 this does not absolve States of their obligations to provide financial and other support. States incur a special obligation to provide (for those who do not have means) the necessary health insurance and health-care facilities, a specific right under the International Covenant on Economic, Social and Cultural Rights.23 Even in times of severe resource constraints, individuals and groups in situations of vulnerability should be protected by the adoption of relatively low-cost, targeted programmes (E/1991/23-E/C.12/1990/8). States can adopt measures, temporarily or permanently, to remedy structural discrimination: these can include programmes or the provision of funding or other resources to achieve the highest attainable standard of health. 41. States should also provide certain resources while indigenous peoples establish their own services and workforce cadre. For example, in the absence of sufficient medical professionals able to speak indigenous languages, States should provide interpretation services facilitating effective communication in health-care settings, as is done in Norway, where a 24-hour-a-day Sami interpretation service has been established in collaboration with indigenous peoples.24 Affordable versions of such programmes could be implemented by other States, given the rapidly increasing prevalence of mobile telephone coverage worldwide. Training and incorporating traditional indigenous practitioners into health-care systems could also address immediate shortages of medical staff in remote indigenous territories. Promote 42. States should ensure that health-care research agendas sufficiently recognize and involve indigenous peoples. Failure to collect health data disaggregated by ethnicity, selfidentified indigenous status or cultural identity can conceal deep inequities. Disaggregated data should be collected, in a consensual manner, to identify barriers to the enjoyment of the right to health and for inclusive policymaking. Such data should address issues such as gender, socioeconomic status and disability, as data focused purely on indigenous status does not fully capture the composite rights of indigenous peoples who are marginalized owing to other aspects of their identity. 25 43. For health-care facilities, goods and services to be acceptable to indigenous peoples, they must be culturally appropriate. This requires communicating in a respectful and inclusive way, empowering patients in decision-making and building relationships so that patients and providers work together to ensure maximum effectiveness of care. 26 To achieve this, three steps are necessary: changes should be made to mainstream health-care facilities, goods and services; more indigenous individuals should be trained as health-care providers; and indigenous-specific services should be created. 44. To improve mainstream services, States should ensure that curricula of medical and health-care training programmes render graduating professionals culturally competent. Programmes should include education on colonial history and its legacies (where relevant), indigenous culture (including traditional approaches to medicine), stereotyping and racism, 22 23 24 25 26 12 Submission by the Inuit Circumpolar Council. Committee on Economic, Social and Cultural Rights, general comment No. 14. Submission by Norway. Doreen Demas, presentation to the Expert Seminar on Indigenous Peoples and the Right to Health. National Aboriginal Health Organization, Cultural Competency and Safety: A Guide for Health Care Administrators, Providers and Educators (Ottawa, 2008).