of minorities had less health care: “There are difficulties accessing primary health care in the North due to the mountainous terrain. In the southernmost provinces, complexities based on gender, culture, religion and language can make access to or use of primary health care difficult”.23 In response, the Government of Thailand elaborated additional targets under MDGs 4 and 5, namely, to reduce by half, between 2005 and 2015, the under 5 mortality rate and the maternal mortality rate “in highland areas, selected northern provinces and three southernmost provinces”. Minorities could be trained as health care providers as a measure to improve community health care programmes. Minority health workers can ensure that health information is made available in minority languages and is culturally appropriate, while simultaneously addressing some of the discrimination issues that minorities can face from health workers. In Romania, one measure adopted to help reduce ethnic disparities in health was the creation of the office of Roma Community Health Mediator (Government of Romania 2003, p. 12 and 22). One of the strategies in Bolivia to reach the health MDGs is the use of the Intercultural Health Approach through the development of the health with identity programme. Through a process of training health personnel in relation to the importance of promoting respect for the practices and traditions of indigenous peoples, the approach acknowledges the need to overcome cultural barriers in the offering of health services (UNDP Bolivia 2001, p. 13). In the United States, the Red Cross has created a targeted HIV/AIDS awareness programme for Hispanic communities: the programme was created based on languages, customs, family relationships, spirituality, sexuality and health beliefs of Hispanic and Latino communities.24 Ensuring the right to participation of minorities – particularly minority women – in health programme design is an important means of devising strategies for the MDGs that will work. This will help to ensure that health programmes are attuned to the priority health concerns of minority communities as well as to the cultures, lifestyles and traditional medical practices of these groups. This standard is already reflected in ILO Convention 169 Concerning Indigenous and Tribal Peoples: article 25 stresses that health services should be community-based, and planned and administered in cooperation with the peoples concerned, taking into account their traditional preventive care, healing practices and medicines. It is particularly important to respect the link between land rights and health. Where minority communities have been displaced from their land or housing - sometimes in the name of improving their access to health and other public services - the effects have often been devastating on the human development of community members. Achieving the health MDGs for these communities may therefore need to take into consideration unresolved land rights issues. Key Messages  Discrimination in the provision of health care decreases the chances of reaching the health MDGs  Culture impacts significantly on health and appropriate healthcare Office of the National Economic and Social Development Board, Thailand Millennium Development Goals Report 2004, Bangkok, 2004, p. 29. 23 For more information see http://www2.redcross.org/services/hss/hivaids/hispanic.html (accessed 9 August 2009). 24 Chapter 4: Minorities in Development 43