44 HEALTH RIGHTS First, the underlying determinants of health (safe, potable drinking water; adequate sanitation facilities; hospitals, clinics, etc.; trained medical and professional personnel) have to be available in sufficient quantity within the state party. Second, health facilities, goods and services have to be accessible to everyone. The CESCR clarifies that accessibility has four overlapping dimensions, which are particularly important for minorities and indigenous peoples: (a) health facilities, goods and services must be accessible to all in law and in fact (b) health facilities, goods and services must be within safe physical reach for all sections of the population and medical services and underlying determinants of health, such as water and sanitation, must be within safe physical reach, including in rural areas (c) economic accessibility requires that health facilities, goods and services must be affordable for all – poorer households should not be disproportionately burdened with health expenses as compared to richer households (d) accessibility includes the right to seek, receive and impart information and ideas concerning health issues – often indigenous peoples and minorities do not have access to health information in their own languages. Third, the CESCR states that all health facilities, goods and services must be respectful of medical ethics and culturally appropriate. Cultural acceptability requires respect for traditional medicines and practices, which have not been shown to be harmful to human health.17 Fourth, health facilities, goods and services must be scientifically and medically appropriate and of good quality. Activists should bear in mind that the realization (or lack thereof ) of the right to health for minorities and indigenous peoples is particularly dependent on the actions and decisions of other actors beyond the state: (1) third-party states, which provide bilateral aid, hold sovereign debt, exercise influence over corporations and wield power over international institutions; (2) international institutions (the World Bank, IMF and WTO), which set the terms of loans and press for reforms to comply with trade and intellectual property agreements or policies regarding privatization of services; (3) transnational corporations (TNCs), which often have assets and budgets that dwarf those of the countries they are investing in, and which call for reforms of tax, labour and environmental laws that affect health in order to enhance their profitability. The CESCR explicitly states in General Comment No.14 that state parties and other actors should provide assistance and cooperation to enable developing countries to fulfil their core and other obligations. The CESCR also specifically states that: ‘priority in the provision of international medical aid, distribution and