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How is minority health a human rights issue?

What are minority health rights?

It is widely recognized that ethnic, racial, or indigenous minorities often suffer increased illness and greater mortality in comparison to the majority ethnic population in the same region and socio-economic class. This disparity signals a health inequity, defined by the European Office of the World Health Organization as “differences in health which are not only unnecessary and avoidable but, in addition, are . . . unfair and unjust.”1 In other words, even if all individually determined risk factors for poor health were equal, minorities would still suffer from poorer health status.

Major factors contributing to the poorer health of minorities are discrimination, social exclusion, and an overrepresentation of minorities in the ranks of the poor. The right to the highest attainable standard of health recognizes the importance of broader social determinants of health, such as a respect for human rights.2  Thus, public health and human rights approaches are inseparable in addressing the disparate health situation of minorities.

The human rights of minorities impacting the protection and promotion of health include:

• Freedom from discrimination in all areas including health, education, employment, housing, and social services
• Equal access to health care and social services
• Freedom from any distinction, exclusion, restriction, or preference based on race, color, national or ethnic origin, language, religion, birth, or any other status, which has the purpose or effect of impairing the enjoyment of human rights and fundamental freedoms
• Equal recognition as a person before the law, equality before the courts, and equal protection of the law
• Equal participation in shaping decisions and policies concerning their group and community at local, national, and international levels
• The right to maintain and enjoy their culture, religion, and language
• The requirement not only to respect and protect fundamental rights, but also to fulfill them, for all persons.

Who are the Roma?

Roma are a diverse people originally of Indian origin who make up the largest ethnic minority in Europe, estimated at up to 9 million people. 3   Approximately 70% of Roma live in Central, Eastern, and South-East Europe and constitute between 6-11% of the populations of Bulgaria, Former Yugoslav Republic, Macedonia, Romania, and the Slovak Republic.4  The term Roma refers to persons describing themselves as Romas, Gypsies, Travellers, Manouches, and Sinti. The Roma language, Romanis, is an Indic language closely related to Hindi. Many dialects exist, but there is broad recognition of the unity of Romanis.

The history of the Roma in Eastern and Central Europe is marked by racism and human rights abuses. State policies towards the Roma have vacillated between intense assimilation efforts (forced sterilization, removal of children to state institutions) and social exclusion. Massive social and economic transitions in the region since 1989 have brought about a resurgence of anti-Roma sentiment and a worsening of their social and economic standing. Western Europe has also seen a rise in anti-Roma violence as a reaction to real and perceived increased migration. Despite centuries of discrimination and attempts at forced assimilation, many Roma communities have maintained a distinct identity characterized by strong extended-familial bonds and an adherence to traditional cultural practices. The discrimination and abuses against Roma continue to be one of the gravest human rights dilemmas facing Europe.5

Who are the San?

The San are the oldest inhabitants of Southern Africa, where they resided in the Kalahari Desert—now divided between Angola, Botswana, Namibia, and South Africa. They lived there for at least 20,000 years, and sources trace San communities to as early as 8000 BC. Bantu-speaking peoples from East and Central Africa arrived in San territory around the 15th century to be followed by European colonists in the 17th to 19th centuries. San today number close to 100,000, and around 80% live in Botswana and Namibia. The San are also known, somewhat derogatively, as Basarwa,6 Khwe, and Bushmen. Despite their popular image as leather-clad hunters and gatherers, hardly any San today subsist entirely through these traditional means.

Marginalized and displaced from their land, the San suffer from a host of social problems. Access to resources is low, as is the availability of social and medical services. Education facilities are poor, and illiteracy rates are high. Many have been relocated from their land through a mixture of force and bribery.7  Perceived as childlike, the San have little say in policy decisions. As a result, the San are plagued by high unemployment, poverty, alcohol abuse, and drug dependency—bringing with them domestic violence and petty crime.8

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Did you know?

About Roma health

• A representative survey in Hungary found that 25% of Roma interviewed reported having faced discriminatory treatment in hospitals and other health care institutions, and 44.5% reported discriminatory treatment by general practitioners.9
• Until 1990, the Czechoslovak government sterilized Roma women programmatically as part of policies aimed at reducing the “high, unhealthy” birth rate of Roma women. This practice has been documented in the Czech Republic and Slovakia as late as 2004.10
• In late 2001, more than half of all Roma in Serbia did not have a birth certificate or any document proving their citizenship. Almost one-third did not possess a health card.11
• In Bulgaria, the World Bank estimates that though Roma account for only 8.8% of the population, they make up almost half (46%) of the country’s poor.12
• Poverty among the Roma in Serbia is between 4 and 5 times higher than among the general population.13
• The majority of Roma in South East Europe (53%) reported going hungry in the previous month, compared with only 9% in average population. Almost twice as many of the Roma children have low weight at birth compared with the national average population.14
• Data from the Czech Republic indicated that 64% of Roma children in primary schools are in special schools, in comparison with 4% for the total population. In Hungary, Roma make up approximately half the number of students enrolled in special schools.15

About San health

• The San are the only ethnic group in Namibia whose health and economic status have declined since independence. San life expectancy is 22% below the national average.16
• Maternal and infant mortality is extremely high. About 40% of all deaths of women of childbearing age are related to sexual and reproductive rights.17
• Namibia has highest tuberculosis rate in the world. In parts of Tsumkwe where the San reside, rates of more than 1,500 TB cases per 100,000 people were recorded in 2004.18
• Access to health information and services is very low in San communities. Three quarters of respondents in Tsumkwe indicated that there is “little that a person can do to prevent getting malaria” and that “health workers cannot do a lot for malaria.”19
• Namibia has an HIV prevalence rate of 21.3%. 80% of females in Tsumkwe did not know if HIV/AIDS was a problem in their community, 85% responded “do not know” when asked about their risk of infection, while 26% had their first sexual contact under age 15.20
• Alcohol-related violence in San communities is responsible for a substantial number of injuries to women, children, and men. The San also suffer from a high prevalence of folate, thiamin, and iron deficiency, likely linked to alcohol consumption.21

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