A/HRC/27/66 have a treaty right to health, often violated, that must be considered in any planning for disaster risk reduction. 42. If the health rights of indigenous peoples are at risk in “normal” times, their vulnerability will be exacerbated in disaster situations where underlying disaster risks have not been addressed. Access to health services, which for many indigenous communities is already challenging, can become even more difficult following a disaster, when increased demand, and often preventable damage to transport infrastructure and health facilities, can compound the challenges. Other disaster-related health risks that may disproportionately affect indigenous peoples include outbreaks of infectious diseases, increases in vectorborne disease, and a lack of safe drinking water and of access to adequate sanitation. It is also worth pointing out that the health security systems of indigenous communities are linked to the health of their forest and ecosystem. The declining population of medicinal herbs and the destruction of their habitats constitute another source of increasing vulnerabilities and health risk. 6. Migration 43. Throughout the world, humans are migrating to urban areas at an unprecedented rate. It is estimated that by 2030, six out of every ten people will live in a city, and that by 2050, this proportion will increase to seven out of ten.26 This includes indigenous peoples throughout the world. In the United States, for example, nearly 67 per cent of those selfidentifying as American Indian or Alaska Native, either alone or in combination with another race, were living in cities in the year 2000.27 This trend toward urbanization was first recognized among this population in 1970 and the percentage of Native Americans living in cities has grown steadily ever since. 44. The root causes of migration to urban settings are closely linked to human rights violations, which compel indigenous peoples to migrate from their lands and territories. These include dispossession of lands and territories, environmental considerations, and insecurity due to conflict.28 Indigenous peoples living in urban areas face particular challenges to the fulfilment of their rights, including their access to housing, safe water and sanitation. Once in urban areas, indigenous peoples are likely to establish themselves in informal settlements, which are at increased risk from extreme weather events (E/C.19/2013/14). The serious disconnection from their lands, territories and resources also has a disastrous impact on the spirituality of indigenous peoples and their spiritual relationship with the land. B. Lack of participation of indigenous peoples in decision-making and lack of recognition of community-driven initiatives 45. As discussed earlier, indigenous peoples have the right to participate in decisionmaking in matters that affect them. They should therefore be actively engaged in disaster risk reduction, prevention and preparedness initiatives, particularly if these measures are likely to take place on, or somehow affect, their lands, territories and resources. Indigenous peoples also have a great deal to contribute to disaster risk reduction, preparedness and 26 27 28 12 World Health Organization, Urban population growth. Available from www.who.int/gho/ urban_health/situation_trends/urban_population_growth_text/en/ (accessed 4 August 2014). United States Census Bureau, The American Indian and Alaska Native Population: 2010. Available from www.census.gov/prod/cen2010/briefs/c2010br-10.pdf (accessed 4 August 2014). UN-Habitat, Securing Land Rights for Indigenous Peoples in Cities: Policy Guide to Secure Land Rights for Indigenous Peoples in Cities (Nairobi, 2009), p. 14.