dcsimg


Issues in focus

This section contains a non-exhaustive list of issues and references drawn from the work of the mandate in areas considered of special focus, in particular by the current mandate-holder, Dainius Pūras (2014-present). 

Global health in the post-2015 development agenda

Current rates of preventable ill-health and deaths among new-borns, children under 5 and adults remain unacceptably high. Universal health-care coverage is still a dream for many. The realization of the right to health is impeded by many factors, and most of them are related to inequalities, and selective approaches to human rights principles and existing scientific evidence. This can and must be addressed with the strong commitment by States and concerted efforts by all stakeholders.

In the context of the post-2015 agenda, the right to health framework can be a useful and powerful analytical and operational tool for the transition to the Sustainable Development Goals. And the Sustainable Development Goals can be instrumental for the effective and holistic realization of the right to health, if human rights are effectively incorporated in their conceptualization. (A/HRC/29/33, 2015).

See Open letter on the inadequate recognition of sexual and reproductive health and rights in the Post-2015 Development Agenda (November 2014).

See forthcoming report of the Special Rapporteur to the General Assembly in 2016 on “the right to health and Agenda 2030"

The right to health and public policy

Primary care is to be strengthened in the twenty-first century as the crucial cornerstone of modern medicine and public health. Without a well-established infrastructure of primary health care, all achievements of modern science and the practice of medicine might be compromised and could be misused. When health policy chooses to prioritize specialized services, the latter tend to function without the necessary ethical and human rights safeguards, leading to barriers in access to services for people and groups who have more health needs or to the ineffective use of those services, or to both.

Primary care and the modern public health approach often lose the battle for resources to the biomedical model and vertical programmes of treatment of diseases through specialized health care. When resources are allocated to specialized health care this may reinforce power asymmetries and funding imbalances, which often favour powerful groups representing vested interests in the health sector and industry. States, when meeting their obligation to protect, respect and fulfil the enjoyment of the right to health, should be aware of, and be willing and able to address, such power asymmetries. They should also provide mechanisms for independent monitoring; as such mechanisms are essential tools in ensuring accountability.

If that does not happen, power asymmetries and imbalances may lead to scenarios where (a) preference in allocating budgets is given to expensive biomedical technologies which are not necessarily used in an ethical and cost-effective way; (b) there are increased incentives for corruptive practices when expensive specialized health-care interventions in public sector do not serve those in most need; (c) the filters (tiers) in health-care systems do not properly function, and mild cases flow into specialized care, placing the entire health-care system at risk of poor management of the principles of medical ethics and health economics. That has negative impact on the full realization of right to health and generates negative public health outcomes. (A/HRC/29/33, 2015)

Violence as a major obstacle for the realization of the right to health

Protection from all forms of violence is a cross-cutting issue present in all key elements of the realization of the right to health.  Violence needs to be addressed in a comprehensive and proactive way, not only as a cause of serious violations of human rights, but also as a consequence of a lack of political will to effectively invest in human rights, including the right to health.

It was not until the end of the twentieth century that the close link between violence and health began to be sufficiently understood.  Since then, the burden of violence has been documented and the effectiveness of programmes, with particular attention devoted to women and children and community-based initiatives, has been assessed.

All forms of violence are harmful and detrimental to the health and development of human beings, starting from the youngest children.  Any form of violence, including collective violence, does not originate in a vacuum. Violence has roots in unhealthy relationships amongst individuals, and is reinforced by the failure to promote and protect good-quality human relations, starting with relationships between an infant and the primary caregiver. (A/HRC/29/33, 2015)

See also forthcoming report of the Special Rapporteur to the General Assembly in 2016 which will focus on “The right to health and the post-2015 Development Agenda”.

Mental health

The historical divide, both in policies and practices, between mental and physical health has unfortunately resulted in political, professional and geographical isolation, marginalization and stigmatization of mental health care.  The modern public mental health approach, which emerged in the global scene in the end of twentieth century with a critical mass of new evidence on the importance of mental health and the effectiveness of integrated approaches, still faces enormous challenges.

There are two key messages of the modern public mental-health approach that should be highlighted. Firstly, there is no health without mental health. Secondly, good mental health means much more than absence of a mental impairment.

The modern understanding of mental health includes good emotional and social well-being, healthy non-violent relations between individuals and groups, with mutual trust of, tolerance of and respect for the dignity of every person. In that regard, promoting good mental health should be a cross-cutting priority relevant to the sustainable development agenda, as it is of concern to many of its elements, including the protection of dignity and people in order to ensure healthy lives and strong inclusive economies; promote safe and peaceful societies and strong institutions; and catalyse global solidarity for sustainable development (A/HRC/29/33 and E/CN.4/2005/51).

See also A/HRC/32/32 on mental health in adolescence.

The life-cycle approach to the right to health

The Special Rapporteur believes that the life-cycle approach can be used as one method to identify the critical elements of the challenges and opportunities for the reduction of preventable deaths and the improvement of health indicators, well-being and quality of life.

Such an approach helps identify critical elements of challenges and opportunities for full realization of the right to health. It is during some important stages of the life course that the right to health needs to be particularly protected, since during those stages there is a greater risk of violations of human rights, including the right to health. On the other hand, interventions during those critical stages of life open up new opportunities and offer new health protective factors. The life-cycle approach can help in the prevention of chronic diseases in adult life through the effective protection of children from early childhood adversities. (A/HRC/29/33, 2015)

The role of stakeholders: participation and empowerment

The active and informed participation of all stakeholders is one of the key elements of the analytical framework of the right to health. There is growing understanding and evidence that top-down relations between governments and local authorities and populations, including civil society, and paternalistic relations between health personnel and users of health-care services do not effectively contribute to the realization of the right to health.

The meaningful involvement of all actors, in particular civil society, and the empowerment of those who use health-related services, especially the poor and other groups in vulnerable situations, is a crucial precondition for the full realization of the enjoyment by everyone of the right to health and other rights.

Civil society plays a key role as agent of change, advocates good practices, provides independent monitoring and, in many instances, provides necessary services. Trustful partnerships between government agencies, State-run health-care services and the non-profit sector, including civil society, constitute one of the cornerstones of effective health systems and act as a guarantee for the effective realization of health-related human rights.

The role of medical doctors and other health-care professionals is also crucial. With the ongoing change of paradigm, from paternalistic top-down medicine to partnership between health-care providers and users, the medical profession should reconsider some of its traditional views. Education in the health-care sector is one important element in that regard. Modern medical doctors need to be not only good clinicians but also effective community leaders, communicators, decision makers and managers. (A/HRC/29/33, 2015).

Health systems and health financing

At the heart of the right to the highest attainable standard of health lies an effective and integrated health system, encompassing health care and the underlying determinants of health, responsive to national and local priorities, and accessible to all. Strong health system is an essential element of a healthy and equitable society. The right-to-health approach to strengthening health systems helps establish a health system in the same way as the right to a fair trial helps to establish a court system.  (A/HRC/7/11, 2008 and E/CN.4/2006/48, 2006).

The principles embodied in the Alma-Ata Declaration on Primary Health Care (1978) and the Ottawa Charter for Health Promotion (1986) remain relevant today.

Full realization of the right to health is contingent upon the availability of adequate, equitable and sustainable financing for health, at the domestic and international levels. States have the obligation to ensure adequate, equitable and sustainable domestic funding for health, in particular, to ensure that adequate funds are available for health and to prioritize funding for health in national budgets; ensure equitable allocation of health funds and resources; and cooperate internationally to ensure the availability of sustainable international funding for health. 

There are a number of substantive issues in regarding health financing, including taxation and international funding for health; pooling mechanisms, including social health insurance; and allocative concerns, such as allocation of health funds and resources among primary, secondary, and tertiary health care and the resource divide between rural, remote and urban areas.  The contemporary landscape of health financing is characterized by persistent deficits and recurring challenges in financing health systems throughout the world. (A/67/302, 2012).

All key elements of health-care systems must be balanced. That includes the relationships between the curative and preventive aspects of health care, so that power asymmetries do not weaken primary care and preventive medicine. The modern public-health approach should be strengthened and a right balance between all elements of the health-care system should be ensured so that the implementation of health policies is not dominated by vertical “disease-based” programmes and specialized health-care services. (A/HRC/29/33, 2015).

See also report A/HRC/4/28 (2007) on health and the human rights movement, and the role of healthcare workers; and report A/HRC/29/33 on the role of stakeholders.

Access to medicines

The issue of access to medicines is an essential part of the work of the mandate. Medical care in the event of sickness and the prevention, treatment and control of diseases depend to a great extent on timely access to quality medicines. There remains an intrinsic link between poverty and the realization of the right to health, where developing nations have the greatest need and the least access to medicines.

Despite progress made, an estimated 2 billion people still lack access to essential medicines. For these people the full enjoyment of the right to health remains an elusive goal, including due to the obstacles to access to medicines of good quality, affordable and in a timely fashion, mostly in developing countries. This constitutes a challenge to human dignity, the basis of all human rights, including the rights to life, health and development of all persons. From a human rights perspective, access to medicines is intrinsically linked with the principles of equality and non-discrimination, transparency, participation, and accountability. States are obliged to develop national health legislation and policies and to strengthen their national health systems.

Key issues related to access to medicines must be taken into account such as: sustainable financing, availability and affordability of essential medicines; price and quality control; dosage and efficacy of medicines; procurement practices and procedures, supply chains, etc. There are the different dimensions of the issue, such as, the role and responsibilities of pharmaceutical companies; the impact of intellectual property laws and free-trade agreements; and the implications and elements of a right-to-health approach to access to medicines (see A/63/263, A/HRC/17/43 and A/HRC/23/42).

See also:

HIV/AIDS and the right to health

Driven by the urgency of the right to life and powered by the Millennium Development Goal to halt and begin to reverse the AIDS epidemic, the global response to HIV succeeded in reducing the number of new HIV infections by 35% since 2000. 

The effective realisation of the right to health in the global AIDS response means not only securing access to health care but equally addressing the underlying determinants of health, in particular discrimination and stigma. Social inequalities and exclusion shape health outcomes and contribute to the increasing disease burden borne by marginalized groups. In addition, a health condition such as HIV/AIDS may involve exposure to compounded forms of discrimination that reinforce existing inequalities.

The HIV epidemic continues to be a metaphor for great inequalities within and between countries. Specific populations and communities – often the most fragile and marginalized – continue to be left out and bear the brunt of the epidemic. The human rights principles of non-discrimination, equality, participation, access to justice and accountability, have been crucial in making the AIDS response effective.

The epidemic continues to be attended by human rights violations fuelled by discrimination, violence, punitive laws, policies and practices. HIV-related discrimination is often deeply interwoven with other forms of discrimination based on gender, race, disability, drug use, sexual orientation and gender identity, immigration status, being a sex worker, prisoner or former prisoner.

The enjoyment of the highest attainable standard of health is a fundamental human right that includes non-discriminatory, affordable and acceptable access to quality health care services, goods and facilities. Yet, around the world, even where healthcare services are in place, people face various forms of discrimination and violence in relation to health care.

Punitive laws, policies, and practices impede, and sometimes altogether bar, the disadvantaged and marginalized from accessing information, as well as health goods and services that are critical to the prevention, treatment, and care of HIV. There is a large body of evidence which clearly demonstrates that punitive frameworks drive people away from health services, particularly those who are most in need.

The full realization of human rights in the response to HIV/AIDS is therefore crucial to ending the epidemic by 2030 as committed in the 2030 Agenda for Sustainable Development. Ending AIDS is not just critical to realizing health for all.  It will also advance and depend on progress in many of the Sustainable Development Goals such as gender equality, peace, justice and inclusive institutions and partnerships for the goals.

See media statement on “AIDS epidemic still being driven by human rights violations”, at http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=20055&LangID=E

See report on right to health and criminalization of same-sex conduct and sexual orientation, sex-work and HIV transmission (A/HRC/14/20).

Drug policy and drug use

Human rights is central to international drug control and States remain legally bound by their obligations to respect, protect, and fulfil human rights including while developing and implementing their responses to drugs.  The Special Rapporteur on the right to health has examined the human rights impact of international drug control and remains deeply concerned that existing policy approaches contribute to an environment of increased human rights risk, and in many cases, can fuel widespread and systemic abuses.

The death penalty for drug offences does not meet the threshold of ‘most serious crimes’ for the purposes of the International Covenant on Civil and Political Rights. The arbitrary deprivation of life is not limited to judicial executions and extends to summary executions by military and police, and the unnecessary use of lethal force in the context of drug enforcement.  Drug enforcement policies can contribute to and worsen violent criminal drug markets within which homicides increase significantly, therefore, States must ensure full adherence to international human rights law and existing standards with regard to the use of force in all anti-drug operations.

The criminalisation of drug consumption and possession for personal use has contributed to a range of negative consequences for the health, security, and human rights of individuals and communities across the globe. There is clear evidence that criminalisation drives those most in need away from vital health interventions or places them in prison with significant implications for public health. Worldwide, criminalisation has fuelled incarceration rates, contributing to overcrowded prisons and overtaxed criminal justice systems, placing individuals at increased risk of arbitrary detention and inhuman or degrading treatment while incarcerated. Treating low level drug possession for personal use as a criminal act intensifies discrimination by placing individuals in increased conflict with the law, which negatively affects their chances for employment, education and other opportunities for social inclusion.

In recent years, States have explored decriminalisation regimes as a means to improve the safety and well-being of their communities, with documented, positive outcomes for health and public safety.  To adequately address the drug problem, States must protect, respect, and fulfil the right to health of the population by committing maximum available resources to ensure access to affordable and quality health services.  This includes access to essential medicines, palliative care, comprehensive drug prevention and education, drug treatment, and harm reduction. 

See press release, “Tackling the world drug problem: UN experts urge States to adopt human rights approach”, at http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=19833&LangID=E

See report of the Special Rapporteur on the right to health and international drug control, compulsory treatment for drug dependence and access to controlled medicines (A/65/255), and Submission on drug policy laws from the Special Rapporteur on the right to health, for the consideration of the Committee against Torture, November 2012

Sexual and reproductive health rights

Sexual and reproductive health are integral elements of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.  Many of the numerous obstacles to sexual and reproductive health rights are interrelated and entrenched and operate at different levels: clinical care, the level of health systems, and the underlying determinants of health. In addition to biological factors, social and economic conditions play a significant role in determining women’s sexual and reproductive health. Applying human rights to these questions can deepen analysis and help to identify effective, equitable and evidence-based policies to address these complex problems. (E/CN.4/2004/49, 2004).

Many causes of maternal mortality are closely related to a failure to realize the right to the highest attainable standard of health.   Properly integrated, the right to health can help ensure that the relevant policies to address maternal mortality are more equitable, sustainable and robust.  The right to health also provides a powerful campaigning tool in the struggle for a reduction in maternal mortality.  The burden of maternal mortality is borne disproportionately by developing countries. In many countries, marginalized women, such as women living in poverty and ethnic minority or indigenous women are more vulnerable to maternal mortality. Maternal mortality and morbidity rates reveal sharp discrepancies between men and women in their enjoyment of sexual and reproductive health rights. (A/61/338, 2006).

The Special Rapporteur has considered the impact of criminal and other legal restrictions on abortion; conduct during pregnancy; contraception and family planning; and the provision of sexual and reproductive education and information. Some criminal and other legal restrictions in each of those areas, which are often discriminatory in nature, violate the right to health by restricting access to quality goods, services and information. They infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity. Moreover, the application of such laws as a means to achieving certain public health outcomes is often ineffective and disproportionate. (A/66/254, 2011)

The nature of and challenges associated with sexual and reproductive health rights in adolescence have also been examined by the mandate. Healthy sexual development requires not only physical maturation, but an understanding of healthy sexual behaviours and a positive sense of sexual well-being.  Sexual initiation can be a natural and healthy aspect of adolescence, and adolescents have the right to be provided with the tools and information to navigate sex safely. Sexual activity among adolescents is widespread, although rates vary significantly. Yet, adolescents around the world face significant discrimination and barriers in accessing the information, services and goods needed to protect their sexual and reproductive health, resulting in violations of their right to health.  States should adopt a comprehensive gender-sensitive and non-discriminatory sexual and reproductive health policy for all adolescents and to integrate it into national strategies and programmes.  These policies must be consistent with the human rights standards and recognize that unequal access by adolescents constitutes discrimination.  (A/HRC/32/32, 2016).

See also:

Environment and climate change

With the Paris Agreement, adopted on 12 December 2015, the Parties to the UN Framework Convention on Climate Change responded to the calls of many to have a robust reference to human rights in the agreement. Even if the language included in the final text was not what many of us had hoped for, this makes it the first multilateral environmental agreement to explicitly recognize the importance of human rights.

The right to health is an inclusive right, extending not only to timely and appropriate health care, but also to the underlying determinants of health, such as access to quality food, to safe and potable water and adequate sanitation, healthy occupational and environmental conditions, and access to health-related education and information. The effects of climate change on the full enjoyment of the right to health already are alarming. They are threatening human health and well-being by increasing causes of morbidity and mortality. Climate-related changes such as heat, drought, flood, hurricanes, are associated with increased rates of cardiovascular disorders, respiratory, gastrointestinal, and renal problems. Environment determinants such as pollen, smoke, dust, stagnant water can lead to chronic ailments.

Climate change also has a negative impact on human dignity and security. Its human and environmental impacts include loss of land and housing, diminished quantity and quality of food production, food insecurity and malnutrition, and forced displacement.

As climate change is intrinsically discriminatory, it perpetuates existing inequalities. Those most affected are the ones in vulnerable situations, the poor and marginalized. They are most affected not only by associated conflict, ill-health and disease but also by fragile and inadequate public health and health care systems, which are unable to cope with the threat-multiplying effects of climate change.

Climate change is not only affecting human physical health, it is also impacting on the mental health and well-being of individuals and communities affected. Poor physical health and ailments are associated with poor quality of life and psychological distress.  (See statement by the Special Rapporteur for a Panel Discussion on the Impacts of Climate Change on the Right to Health in the context of the Analytical Study on the Impacts of Climate Change on the Right to Health, 2016)

See also:

Non-discrimination: groups in vulnerable situations

The Special Rapporteur has been mandated to pay attention to the situation of “vulnerable and marginalized groups”, and has been further asked to apply a gender perspective and to pay special attention to the needs of children in the realization of the right to health.  Certain groups and sectors of the populations receive the attention of the mandate given the heightened risks and challenges they face in realising their right to health.

Children and adolescents

The prevention of child mortality should remain a global priority. But beyond sheer survival, children have a right to thrive, develop in a holistic way to their full potential, and enjoy good physical and mental health in a sustainable world. Early childhood is a crucial time for effective investments in individual and societal health and it must receive significantly more attention, and a more adequate response from all relevant actors, including in the post-2015 agenda.

The right of young children to healthy development is key to promote and protect the right to health throughout life as well as to foster sustainable human development; however it has yet to receive adequate attention.  Development in childhood consists of interconnected domains: physical, cognitive-linguistic and social-emotional. The three critical elements of healthy child development are stable, responsive and nurturing caregiving; safe, supportive environments; and appropriate nutrition. These elements can be safeguarded through good practices such as planned, safe pregnancy and childbirth; exclusive breastfeeding in the first six months followed by appropriate complementary feeding and responsive parenting; preventive interventions such as vaccines for the treatment of diseases; protection of children from all forms of violence, neglect and abuse; and the reduction of environmental risks.
 
These elements can be safeguarded through good practices such as planned, safe pregnancy and childbirth; exclusive breastfeeding in the first six months followed by appropriate complementary feeding and responsive parenting; preventive interventions such as vaccines for the treatment of diseases; protection of children from all forms of violence, neglect and abuse; and the reduction of environmental risks. (A/70/231, 2015)

Adolescence is a life stage when inequities become more sharply differentiated in terms of access to services, life decisions and future trajectories. Foundations laid down during adolescence, in terms of emotional security, health, education, skills, resilience and the understanding of rights will have profound implications for the social, economic and political development of adolescents. The costs of failing adolescents are high, which is why a powerful case exists for paying greater attention to the right of adolescents to the highest attainable standard of health and development.

Adolescent health is the result of interactions between early childhood development and the specific biological and social role changes that accompany puberty, shaped by social determinants and by risk and protective factors that affect the uptake of health-related behaviours. While adolescents themselves have the capacity to contribute to their own health and well-being, they can only achieve this goal if States respect and protect their rights and provide them with access to the necessary conditions, services and information. (A/HRC/32/32, 2016)

See also press releases on

Women and girls

Women and girls face significant barriers to the full enjoyment of their right to health, in particular when it comes to sexual and reproductive health rights. Due to certain restrictive interpretations of religious and cultural values and beliefs, which dominate the political discourse and praxis in certain countries, women and girls do not always have adequate access to comprehensive sexual and reproductive health services or comprehensive sexuality education.

The mandate has paid attention to the interaction between criminal laws and other legal restrictions relating to sexual and reproductive health and the right to health. Realization of the right to health requires the removal of barriers that interfere with individual decision-making on health-related issues and with access to health services, education and information, in particular on health conditions that only affect women and girls. In cases where a barrier is created by a criminal law or other legal restriction, it is the obligation of the State to remove it.

The removal of such laws and legal restrictions is not subject to resource constraints and can thus not be seen as requiring only progressive realization. Barriers arising from criminal laws and other laws and policies affecting sexual and reproductive health must therefore be immediately removed in order to ensure full enjoyment of the right to health (A/66/254, 2011).

Gender-based violence is also an issue of concern for public health and is associated with adverse consequences on the physical and mental health of women affected. Women and girls also face compounded forms of discrimination owing to their social, cultural and religious backgrounds. This includes the prevalence of child marriage, and the practice of female genital mutilation.  Early marriage is often associated with early and frequent pregnancies which result in higher infant and maternal mortality and morbidity rates. In addition, child marriage causes girls to drop out of school and increases the risk of domestic violence, given the subsequent impact on girls’ personal and economic autonomy.

The removal, partially or wholly, of the external female genitalia, or otherwise the injury of female genital organs, for non-medical or non-health reasons, can lead to multiple immediate and long-term health consequences. The Special Rapporteur has underlined that this is a form of violence against women and girls, even if not intended as an act of violence, and a violation against their basic human rights and fundamental freedoms, including their right to health.
Addressing harmful traditional practices is part of the core obligations of States parties to the Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of the Child. These practices constitute a denial of the dignity and integrity of those affected; are based on unacceptable discrimination and violence on the basis of sex, gender, age and other grounds; and often cause severe physical and/ or psychological harm or suffering (A/HRC/29/33/Add.1, 2015).

See also reports on visits to Malaysia (A/HRC/29/33/Add.1, 2015) and Paraguay (A/HRC/32/32/Add.1, 2016).

Persons with disabilities

All too often children and adults with different forms of disabilities are deprived of the full realization to the right to health.  The human rights standards set forth by the Convention on the Rights of Persons with Disabilities (CRPD) present a good opportunity to rethink the historical legacy of previous models and to move away from those health-care practices which are against human rights and the modern public health approach.

There is a unique and historic opportunity to end the legacy of the overuse and misuse of the biomedical model. All persons with disabilities have a right to health, including to quality health-care services. Persons with disabilities should not be discriminated against and should enjoy the right to health in their communities as persons without disabilities do.

The CRPD Convention is challenging traditional practices of psychiatry, both at the scientific and clinical-practice levels. In that regard, there is a serious need to discuss issues related to human rights in psychiatry and to develop mechanisms for the effective protection of the rights of persons with mental disabilities.  The traditional arguments that restrict the human rights of persons diagnosed with psychosocial and intellectual disabilities, which are based on the medical necessity to provide those persons with necessary treatment and/or to protect his/her or public safety, are seriously being questioned as they are not in conformity with the Convention.  (See A/HRC/29/33)

See also:

Migrants, refugees, and asylum-seekers

The right to health of migrant workers, including low-skilled migrant workers, as well as irregular migrants, refuges and asylum seekers, outlines the responsibility of States as well as of non-State actors to respect, protect and fulfil their right to health.  

Regarding migrant workers, there are a number of relevant issues in this regard, including the sending State’s responsibility to provide access to information and to regulate recruitment agencies; right to health concerns regarding immigration policies, such as compulsory medical testing, detention and deportation of irregular migrant workers or migrant workers with specific health status; access to health facilities, goods and services, especially by irregular migrant workers; specific industries comprising jobs usually shunned by the local population and considered degrading; mental health of migrant workers; as well as the issue of women migrant workers and their right to sexual and reproductive health. Migrant workers often commence the migration process as relatively healthy individuals. However, the complexity and diversity of circumstances throughout the various dimensions of the migration cycle may render them highly vulnerable to poor physical and mental health outcomes, compromising the enjoyment of other rights.

By mandating that non-discrimination inform all aspects of State policy, the right to health framework does not allow for any distinction between regular and irregular migrant workers on the one hand, and nationals of States, on the other. In this aspect it differs from the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families which allows irregular migrant workers access to health facilities, goods and services only when urgently needed.  Non-discrimination requires that socio-economic rights, such as access to health facilities, goods and services, be equally available to nationals and non-nationals, including irregular migrant workers.

Existing migration policies around the world have led to high numbers of migrants, refugees and asylum seekers in detention. One of the main concerns relating to migrant workers, refugees, and asylum seekers in detention is their mental and physical health needs. Long periods of detention and poor living conditions facilitate the transmission of communicable diseases and can have devastating effects on the mental health of migrants. This is exacerbated in the case of asylum seekers and refugees, who often suffer from previous trauma from violence, persecution and displacement (A/HRC/23/41, 2013).

See reports on occupational health (A/HRC/20/15, 2012) and visit to Malaysia (A/HRC/29/33/Add.1, 2015)

Lesbian, gay, bisexual, transgender and intersex people

Criminal laws concerning consensual same-sex conduct, sexual orientation and gender identity often infringe on various human rights, including the right to health. These laws are generally inherently discriminatory and, as such, breach the requirements of a right-to-health approach, which requires equality in access for all people. The health related impact of discrimination based on sexual conduct and orientation is far-reaching, and prevents affected individuals from gaining access to other economic, social and cultural rights. In turn, the infringement of other human rights impacts on the realization of the right to health, such as by impeding access to employment or housing.

These infringements ultimately undermine the inherent dignity of persons upon which the international human rights framework is based. Denying the dignity of individuals through the criminalization of certain conducts substantially diminishes their self-worth and, in doing so, prevents the realization of the right to health. The decriminalization of such conduct is necessary to address the disempowerment that affected individuals and communities face, and to enable full realization of the right to health (A/HRC/14/20, 2010).

See press releases:

Older persons

Noting the significant pace of the world’s ageing, there is a need of a paradigm shift according to which society should move beyond a simple search for healthy ageing by its citizens and begin working towards active and dignified ageing, which is planned and supported just like any other stage of the individual’s life course. Active and dignified ageing for older persons requires reframing society’s concept of ageing to put more focus on the continued participation of older persons in social, economic, cultural and civic life, as well as their continuous contributions to society.

The right-to-health approach is indispensable for the design, implementation, monitoring and evaluation of health-related policies and programmes to mitigate consequences of an ageing society and ensure the enjoyment of this human right by older persons. Accordingly, health facilities, goods and services should be made available, accessible, affordable, acceptable and be of good quality for older persons.  Encouraging older persons to remain physically, politically, socially and economically active for as long as possible will benefit not only the individual, but also the society as a whole. The promotion and protection of human rights of older persons should be of concern to everyone because ageing is a process that will apply to all (A/HRC/18/37, 2011).

See also press release on “Who cares about the suffering of older persons at the end of their lives? We do”, October 2014, http://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=15152&LangID=E.