Non-discrimination: groups in vulnerable situations

The Special Rapporteur has been mandated to pay attention to the situation of groups in vulnerable and marginalized situations, as well as to apply a gender perspective, and to pay special attention to the needs of children in the realization of the right to health. Below find an overview and highlights of specific work done by the mandate on the right to health as it relates to each of the groups, as well as relevant statements and press releases.

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.  Early childhood must receive significantly more attention and a more adequate response from all relevant actors.

The right of young children to healthy development is key to promoting and protecting the right to health throughout life, and to foster sustainable human development. 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 like planned, safe pregnancy and childbirth; vaccines for the prevention of diseases; and protecting  children from all forms of violence, neglect and abuse, among others (A/70/213, 2015).

In adolescence, inequities become more sharply differentiated in terms of access to services, life decisions and future trajectories. Foundations laid during adolescence for emotional security, health, education, skills, resilience and the understanding of rights have profound implications for the social, economic and political development of adolescents. The costs of failing adolescents are high. This is why greater attention must be paid to the right of adolescents to the highest attainable standard of health and development.

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. States need to provide them with access to the necessary conditions, services and information (A/HRC/32/32, 2016).

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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. 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 education.

The mandate has looked at 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. It requires access to health services, education and information, in particular on health conditions that only affect women and girls. In cases where legal barriers are created, it is the obligation of the State to immediately remove them 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. It is associated with adverse consequences on the physical and mental health of women affected. Examples of harmful practices against women and girls include child marriage and female genital mutilation.

Early marriage is often associated with early and frequent pregnancies, which result in higher infant and maternal mortality and morbidity rates. Child marriage also causes girls to drop out of school and increases their risk of domestic violence.

The removal of external female genitalia 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 one—and a violation against their basic human rights and fundamental freedoms, including their right to health.

Addressing harmful traditional practices is one 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).

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Persons with disabilities

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.

All too often children and adults with different forms of disabilities are deprived of the full realization of the right to health. 

The human rights standards set forth by the Convention on the Rights of Persons with Disabilities (CRPD) present a good occasion to rethink the historical legacy of previous models, and to move away from 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.

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 (A/HRC/29/33).

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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.  

There are a number of relevant issues regarding migrant workers, 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;
  • the mental health of migrant workers; and
  • the issue of women migrant workers and their right to sexual and reproductive health.

Migrant workers often start the migration process as relatively healthy individuals. However, the complexity and diversity of circumstances throughout 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 informs 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 way, 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 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).

For more on this issue, see the report on occupational health (A/HRC/20/15, 2012).

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Lesbian, gay, bisexual, transgender and intersex persons

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).

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Older persons

Noting the significant pace of the world's ageing, there is a need of a paradigm shift. Society should move beyond a simple search for healthy ageing 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).

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