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A human rights-based approach to health workforce education
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2019
- Document code
- A/74/174
Document
Access to medicines in the context of the right-to-health framework
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2013
- Document code
- A/HRC/23/42
Document
Access to medicines in the context of the right-to-health framework 2013, para. 3
- Paragraph text
- Access to medicines is an integral component of the right to health, as enunciated under article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The Committee on Economic, Social and Cultural Rights in its interpretation of the normative content of article 12 issued its general comment No. 14 (2000) on the right to the highest attainable standard of health, which provides that all health services, goods and facilities, including medicines, should be made available, accessible, acceptable and of good quality. While several aspects of the right to health are understood to be progressively realizable, certain core obligations cast immediate obligations on States, including the provision of essential medicines to all persons in a non-discriminatory manner.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 4
- Paragraph text
- The right-to-health framework sets out key elements that should be fulfilled by States to ensure access to medicines. First, medicines should be made available in sufficient quantities within a country to meet the needs of the people. In fulfilling this obligation States should select essential medicines that reflect the priority diseases in the population, procure them in sufficient quantities and ensure their availability in all public health facilities. Second, medicines should be accessible in terms of economic affordability and physical distance from where the population lives on the basis principle of non-discrimination. Third, medicines should be determined to be culturally and ethically acceptable to the population. Finally, States also have the obligation to put in place strong regulatory mechanisms and transparent processes which ensure the quality, safety and efficacy of medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 5
- Paragraph text
- Furthermore, States have the obligation to respect, protect and fulfil the right to health, including access to medicines. The duty to respect extends to the obligation of States to refrain, inter alia, from denying or limiting equal access for all persons, including vulnerable groups, to all health services, including medicines. The duty to protect requires a State to ensure that third parties do not obstruct the enjoyment of the right to health. For example, a State should ensure that privatization of the health sector and the supply of medicines by private companies does not constitute a threat to the availability, accessibility, acceptability of quality medicines. The duty to protect also extends to the regulation of the marketing and sale of safe and good quality medicines by third parties. Finally, the duty to fulfil necessitates that States take positive measures that enable and assist individuals and communities to enjoy the right to health and give sufficient recognition to the right to health in the national political and legal systems, preferably by way of legislative implementation. In this context and as part of States' immediate obligations to take deliberate, concrete and targeted steps towards the full realization of the right to health, States should adopt a national health policy with a detailed national plan of action aimed at ensuring access to medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 6
- Paragraph text
- While States have the primary responsibility for enhancing access to medicines, it is a shared responsibility in which numerous national and international actors have a role to play. In its general comment No. 3 (1990) on the nature of States parties' obligations, the Committee on Economic, Social and Cultural Rights also stressed the obligation of States to take steps, individually and through international assistance and cooperation, especially economic and technical, towards the full realization of the rights recognized in the Covenant, including the right to health. Moreover, in the spirit of Articles 55 and 56 of the Charter of the United Nations, articles 2(1) and 23 of the Covenant, as well as the Alma-Ata Declaration on Primary Health Care, States should recognize the essential role of international cooperation and comply with their commitment to take joint and separate action to achieve the full realization of the right to health. According to the Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines, pharmaceutical companies should integrate human rights, including the right to health, into their strategies, policies, programmes, projects and activities.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 7
- Paragraph text
- Market-oriented approaches to medicines in a highly competitive global marketplace often project issues related to access to medicines as a matter of profit rather than a public health concern. While it is understandable that private pharmaceutical companies should follow such an approach, there is a growing need for States to balance that market-driven perspective by positioning access to medicines in the right-to-health framework. There is thus the need to shift the dominant market-oriented paradigm on access to medicines towards a right-to-health paradigm and reaffirm that access to affordable and quality medicines and medical care in the event of sickness, as well as the prevention, treatment and control of diseases, are central elements of the enjoyment of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 8
- Paragraph text
- Ensuring access to medicines also requires a functioning health system that encapsulates the key elements of the right to health: availability, accessibility, acceptability and quality. As part of the State obligation to fulfil the right to health and with a view to the progressive realization of access to affordable and quality medicines, the Special Rapporteur urges States to adopt a detailed national plan of action on medicines. The plan of action should be backed by a strong political will and commitment that prioritizes access to medicines within the public health budget and allocates resources accordingly. This is particularly pertinent in the context of the current global economic crisis, where some States are increasingly taking retrogressive measures such as reducing spending on health by reducing national health budgets. The Special Rapporteur stresses that States have the burden of proving that deliberately retrogressive measures have been introduced after careful consideration of all alternatives and that they are justified under full use of the State party's maximum available resources.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 9
- Paragraph text
- National plans should also include principles of non-discrimination, transparency and participation. Participation of all stakeholders, including vulnerable groups, in health-related decision-making is the cornerstone of the right-to-health framework. Participation provides individuals with an opportunity whereby they can advance their health rights. It is through participation and empowerment that individuals, patient groups and communities can claim their right to health and achieve improvements in accessing such essential medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 10
- Paragraph text
- Based on the submissions received from various stakeholders and following numerous consultations, the Special Rapporteur considers, henceforth, the main determinants of access to medicines in the context of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 11
- Paragraph text
- An efficient and functional health system is crucial to ensure the availability of medicines, particularly essential medicines, in sufficient quantities, at all times and in all public health facilities. Under the right-to-health framework, States have an immediate obligation to take legal and administrative measures to ensure that access to essential medicines for their populations is secured by all available means. However, a third of the world's population, living mainly in developing countries, still do not have regular access to essential medicines. During the period 2001-2009, the average availability of essential medicines in public health facilities was only 42 per cent and in private sector facilities was 64 per cent. For chronic conditions, most of which require life-long access to medicines, the availability in public and private sectors was even poorer, at 36 per cent and 55 per cent respectively. Despite momentous gains in the past decade, only 8 million out of 14.8 million people living with HIV globally receive necessary treatment.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 12
- Paragraph text
- Inadequate prioritization of health, insufficient resources and poor governance has increased the inability of governments to finance efficient health systems that enhance access to medicines, consequently increasing their dependence on out-of-pocket payments and international donor funding. Even where international donors like the United States President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, Tuberculosis and Malaria have stepped in to fill this gap, they have only managed to reach a portion, though significant, of those who need these medicines due to limited budgets.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 13
- Paragraph text
- There are wide disparities between the global burden of disease and the global consumption of medicines. For example, in 2004, South-East Asia and Africa accounted for 54 per cent of the global burden of disease predominantly caused by communicable diseases. However the geographical breakdown (by main markets) of sales of new medicines launched during the period 2004-2008 indicates that North America, Europe and Japan accounted for 95 per cent of the sales, while Africa and Asia, representing more than two-thirds of the world population, only accounted for 5 per cent of the market. During this period 90 per cent of the global production of medicines was also concentrated in the developed regions of the world.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 14
- Paragraph text
- Manufacturing capacities in developing countries are limited to countries such as China, India, Brazil, South Africa, Thailand, Kenya, the Syrian Arab Republic and Egypt. Even in the developed world, large innovator multinational companies are concentrated in a small number of countries such as Switzerland, the United Kingdom, the United States, Germany, France and Japan. The Special Rapporteur recognizes that while factors such as inefficient procurement and poor distribution practices do determine the availability of medicines in a country, it may still be politically and strategically important for developing countries to ensure the security of access to medicines for their populations through local production.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 15
- Paragraph text
- Investing in local production as a long-term strategy holds the promise of improving medicines security in developing countries. Fulfilling this goal would require, inter alia, a coherent policy framework that explicitly links local production to improved access to medicines and is backed by strong political commitment. The Special Rapporteur notes with satisfaction that in this respect a regional plan of action was drawn up for local production of essential medicines aiming to promote access to medicines in the east African region by the East African Community.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 16
- Paragraph text
- There are, however, several challenges that need to be addressed in order to ensure sustainability of local production of essential medicines. In the short term, the pressures of reaching economies of scale and countering price competition from importers can mean higher prices for locally produced medicines. This results in a greater burden on the public health budgets of developing countries.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 17
- Paragraph text
- Lack of data on the price difference between locally produced and imported medicines is also a drawback in promoting local production. To help determine the affordability of locally produced medicines in the long term, States should also collect disaggregated data on the prices of imported medicines in comparison to locally produced medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 18
- Paragraph text
- In complying with their obligation to ensure availability of medicines, States may consider the following policy options to develop an enabling environment that promotes the growth of local pharmaceutical industry: (i) levying taxes on imports of medicines that can be locally produced, except for active pharmaceutical ingredients which are generally not imported; (ii) providing subsidies; (iii) tax incentives; (iv) guaranteed government procurement to local manufacturers; and (v) a regulatory framework to increase local competitiveness. As highlighted during the Special Rapporteur's consultations, local production of medicines has indirect benefits, such as (i) promoting transfer of technology (ii) providing employment and capacity-building of local people through training programmes for local pharmacists (ii) microbiologists and technicians, and (iii) setting up local institutes of higher education and contributing to capacity-building of the regulatory agencies. Thus, opting for local generic production should be weighed and balanced against a number of benefits, including strategic security in medicines supply, which would be achieved in the long run as opposed to the higher prices in the short run.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 19
- Paragraph text
- States should also take advantage of flexibilities under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement). The 2001 Doha Declaration on TRIPS and Public Health reaffirms these flexibilities in support of World Trade Organization (WTO) members' right to protect public health and to promote access to medicines for all. Furthermore, paragraph 6(i) of the Decision of the General Council of 30 August 2003, under the Doha Declaration on TRIPS and Public Health, specifically allows least-developed countries (LDCs), more than half of whom are party to a regional trade agreement, to produce medicines locally in the public health interest, irrespective of patents on medicines, with the intention of making medicines more affordable by increasing economies of scale through regional sales.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 20
- Paragraph text
- According to the right-to-health framework, medicines should be economically accessible to all sectors of the population. Medicines should therefore be priced in a fair and equitable manner and be affordable so as to not disproportionately burden poorer households. This is an even greater problem in developing countries, where up to two-thirds of expenditure on medicines is individually financed through out-of-pocket payments. Such payments are primarily responsible for catastrophic health expenditures, annually pushing approximately 100 million people, mostly in developing countries, into poverty. Ensuring affordable and equitable pricing of essential medicines is therefore a key determinant of access to medicines in most developing countries.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 21
- Paragraph text
- States have a legal obligation under the right to health to ensure that production of essential medicines by the private sector does not threaten affordability and accessibility of medicines. Market monopoly or market domination combined with insufficiently competitive forces in the market to ensure efficient prices can result in monopolistic pricing leading to high cost of medicines. Hence, price regulation becomes critical. In some countries, however, the term "price control" has acquired a negative connotation, including that it affects revenue-induced innovation for pharmaceutical companies. In developed countries, where a substantial proportion of the population is covered by health insurance schemes, governments frequently apply price control mechanisms as part of the overall strategy to contain costs. The absence of price controls in developing countries causes grave problems if private-sector monopoly over manufacture and distribution of vital medicines remains unregulated. Such unfettered monopoly can lead to profit-maximizing pricing. In developing countries with high income-inequality it would mean that access to medicines is only affordable to the wealthy. States that inadequately use price controls to ensure affordability of medicines would fail in their obligation to use all available resources, including regulatory powers, to promote the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 22
- Paragraph text
- States which responded to the Special Rapporteur's survey reported on the use of price control mechanisms to promote affordability of medicines, particularly essential medicines. Accordingly, external reference pricing (ERP), therapeutic reference pricing (TRP), as well as the regulation of manufacturers' selling price and distributor's mark-ups, have been applied as the most common methods for setting a ceiling price for medicines. States also reported the use of competition law as the preferred indirect price control mechanism. Tax incentives to manufacturers, wholesalers and retailers and government subsidies to manufactures were indicated as other methods of indirect control used by States to control prices of medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 23
- Paragraph text
- According to the respondent States, ERP is the primary method used by regulatory bodies to set a retail price above which medicines cannot be sold to consumers. Under ERP, the price of a specific medicine in one or several countries is used as a benchmark to set or negotiate the price of medicines in a given country. Regrettably, some developing countries select developed countries, with higher medicines prices, as reference countries, resulting in substantially higher medicines prices. For example, in 23 developing countries, public sector prices for generic medicines were 1.9 to 3.7 times higher than even the international reference price (calculated at the median price of multi-sourced medicines offered to developing countries by different suppliers) and for originator brands, 5.3 to 20.5 times the international reference price. To secure the lowest price for medicines and enhance affordable and equitable access to essential medicines, purchasing States should therefore select reference countries whose level of economic development is similar to theirs. If States use high-price countries for referencing, they should adjust the benchmark price to the levels of local income per capita when setting prices.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 24
- Paragraph text
- The Special Rapporteur was informed that pharmaceutical companies adopt various methods to reduce price transparency in order to work around any loss incurred from ERP. They introduce their products in high-price markets first, to be used as reference countries, thus maximizing the price. Additionally, transparency is reduced when companies list high prices in a country while granting discounts and rebates on the condition of confidentiality.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 25
- Paragraph text
- Under the right to health, access to information includes providing consumers with information on the prices of medicines. This has been a good practice adopted in some States, which require by law that the maximum retail price of medicines be printed on medicine packages.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 26
- Paragraph text
- About half of the surveyed States use TRP to set the ceiling price of medicines. TRP is applied generally in developed countries, where the reimbursement price of a medicine is fixed at the average or lowest price of other drugs in its therapeutic class that are available on the internal market. Manufacturers may price their medicines at a higher level and if the patient decides to purchase a medicine which is not covered by the reimbursement limit, they will have to pay the difference. States informed the Special Rapporteur that they offered alternatives to companies to set their prices below that limit, thus avoiding the extra cost to the patient. TRP allows doctors and patients to select the lowest price medicine from a range of alternatives within a therapeutic group, improving consumer awareness about options available and thereby helps increase transparency in the market.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 27
- Paragraph text
- States also exercise other forms of direct regulation through cost-based pricing, which is based on actual costs of production, a profit margin and a percentage, fixed or regressive, towards distributors' mark-ups. Determining actual costs of production, however, requires reliable and documented evidence of actual local costs of production, which is difficult to obtain given the global dimension of pharmaceutical production. Alternative methods to determine costs of production have included proxies, for example tax paid on manufacturing costs through excise returns and customs duties on landed costs of active pharmaceutical ingredients (APIs). Transparency in providing costs of production is important to ensuring fair pricing of medicines, while allowing for a profit margin that sustains the industry. However, accounting manipulations, use of transfer pricing by companies, and corruption in government agencies pose additional challenges to ensuring a transparent system of cost-based pricing.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 28
- Paragraph text
- In contrast to cost-based pricing, market-based pricing fixes the maximum retail price through an "average" formula for all brands in a therapeutic category that have a specific market share. Market-based pricing therefore tends to cap the price of medicines at the middle range between the highest and lowest price, making medicines more expensive in comparison to cost-based pricing.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 29
- Paragraph text
- In some States, the use of health insurance schemes to reimburse patients the cost of essential medicines is common and vital to ensuring access to affordable medicines for people. This is done through the subsidizing of prescription medicines, usually from a preferred list of medicines, with patients making a co-payment for the medicines and the State bearing the remaining cost. The Special Rapporteur notes that the trade policies of some countries are pushing trade partners to establish judicial or administrative forums to determine when a reimbursement price unlawfully restricts the "value" of a patent on a medicine, thereby restraining the listing of such a medicine on the reimbursement schemes. At best, compelling governments to establish such forums is a waste of crucial administrative resources that could be spent delivering health goods and services. The Special Rapporteur therefore advises States to guard against trade interests prevailing over primary and immediate obligations to ensure access to affordable medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 30
- Paragraph text
- Prices of medicines are also affected by high add-on costs. Distribution mark-ups can represent over 40 per cent of the price ultimately paid on medicines by consumers. States tend to regulate mark-ups in the distribution chain through varied incentives or disincentives for wholesalers, retailers, public sector, private sector and suppliers in general to ensure continuity of the supply chain and access for consumers. Most developing countries use fixed percentages to regulate mark-ups throughout the distribution chain. While this method can reduce the price of specific medicines, it may also encourage the sale of higher-priced medicines rather than low-cost generic ones. To address this shortcoming, some developing and many developed countries use regressive mark-ups: the higher the cost of the product, the lower the mark-up it attracts. Some States do not apply mark-ups to medicines on the essential medicines list, or reimbursable lists, or if they do, they apply mark-ups differentially based on whether it is a branded medicine or a generic.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 31
- Paragraph text
- States which responded to the Special Rapporteur's survey also recommended, as a good practice in reducing medicine prices, the regulation of the price at which manufacturers can sell medicines to intermediaries along with the regulation of distribution mark-ups in the supply chain. In this context, the Special Rapporteur urges States to assess the impact of distribution mark-up regulations on medicine prices while maintaining the viability of different actors in the supply chain to ensure security of the medicines supply chain.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 32
- Paragraph text
- Imported medicines usually exact a tariff in the country of import which is normally added onto the cost of a medicine. Half of the surveyed States indicated that a tariff or levy is imposed on imported medicines. Tariffs are indeed applied to finished pharmaceutical products in 38 per cent of countries and to APIs in 41 per cent. The States, however, reported having differential policies with respect to import tariffs levied on such specific medicines as antibiotics, antiretrovirals (ARVs), cancer drugs and vaccines, which is a positive practice and can help reduce the prices of these life-saving medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 33
- Paragraph text
- At the same time, for 92 per cent of all States, tariffs contribute less than 0.1 per cent of their gross domestic product and hence hold little economic value. However to promote local production States may consider the strategic value of tariffs on particular medicines. For instance, tariffs on imported finished products that are already manufactured locally have a stronger economic and social basis in promoting local production. The Special Rapporteur therefore encourages States to revise tariff policies in light of the lack of evidence of their economic value to State revenues, whilst allowing for tariffs that incentivize local production.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 34
- Paragraph text
- Taxes constitute the third largest component in price add-ons for medicines after the manufacturer's price and distribution mark-ups paid by the consumer. At the country level, the tax range for medicines is between 5 and 34 per cent. These can include State tax, stamp duties, community tax, State excise duties and freight tax. Taxes are applied variably depending on whether a medicine is locally produced or imported and sold in the in the public or private sector. Almost half of the States surveyed reported that taxes are not levied on medicines. Of those in which they are, some provide exemptions for medicines listed on the national essential medicines lists, donated medicines, antiretroviral drugs, imported generic medicines, cancer and diabetes medicines. The Special Rapporteur encourages States to refrain from taxing medicines, especially essential medicines, and instead consider other ways to generate revenue for health, such as so-called sin taxes - excise taxes levied on socially harmful goods such as tobacco, alcohol and junk foods.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 35
- Paragraph text
- Pricing policies of pharmaceutical industries greatly impact the affordability of medicines. Under the right to health, pharmaceutical companies have a shared responsibility to ensure that the prices of their medicines do not put them out of the reach of a majority of the population. Earlier tiered pricing of essential medicines was the norm, whereby essential medicines were sold systematically at a lower price in developing countries as compared to developed countries. Later many multinationals however opted for universal tiered prices. Tiered pricing policies have now re-emerged. Some multinational companies now engage in tiered pricing between and within countries, based on income levels (equity based pricing), which can be profitable for companies due to increases in volume and attractive to developing countries due to reductions in prices. In practice, however, tiered pricing has been limited to certain medicines such as ARVs, vaccines and contraceptives. Moreover, given the lack of guarantee of low prices and the diminished role for government decision-making in such pricing policies, alternatives such as promoting robust market competition have been recommended as good practices with a view to lowering the prices of medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Health
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 36
- Paragraph text
- As part of their obligation to ensure affordability of medicines, States employ competition laws to take action against companies that abuse a dominant position in the market. This would include measures against such practices as charging excessive prices, restricting other companies from accessing the market, collusive tender practices, and restrictive agreements. For example, in 2002, one country's competition commission found that charging excessively high prices for ARVs was an illegal abuse of market dominance.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 37
- Paragraph text
- During his consultations, the Special Rapporteur learnt that competition law is one of the most commonly used methods to reign in excessively high prices charged by pharmaceutical companies. States should apply competition law to monitoring mergers between generic and brand name pharmaceutical companies, which could potentially block future market competition. Competition law represents an accountability mechanism for legal redress under the right-to-health framework and provides a powerful tool to check wrongful practices by pharmaceutical companies that engage in anticompetitive practices, which can also negatively affect access to medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 38
- Paragraph text
- Competition laws that are well formulated and enforced could also counter anticompetitive practices at every stage of the pharmaceutical supply chain. For example, such laws can address attempts by originator companies to influence suppliers in order to restrict supply of active pharmaceutical ingredients to potential competitors, or prevent agreements between larger pharmaceutical companies from using distribution strategies that reduce wholesaler competition, which would restrict smaller companies' access to the market, adversely impacting on the price of medicines. States should also consider including representatives of civil society groups on the panels of competition authorities, which has been demonstrated to have positive results in reducing the prices of medicines in some States.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 39
- Paragraph text
- Evidence from developed and developing countries shows that competition, including among generic companies, can reduce the prices of essential medicines. In the context of ARV medicines, from 2000 to 2011, market competition induced by a significant number of generic companies in the market substantially reduced the prices of those medicines. With respect to improving affordability of essential medicines, competitive public procurement and generic substitution has also proved successful. The Special Rapporteur encourages States to enact competition laws and formulate policies for their effective enforcement in order to ensure affordable prices for essential medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 40
- Paragraph text
- In order to ensure availability of essential medicines, States should first identify medicines required to address priority health needs of the population under a national essential medicines list (NEML). This is consistent with States' core obligation to provide essential medicines listed in the WHO Essential Medicines List (EML). These include painkillers, anti-infectives, anti-bacterials, anti-tuberculosis, anti-retrovirals, blood products, cardiovascular medicines, vaccines and vitamins.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 41
- Paragraph text
- The NEMLs are based on the rationale that a limited range of priority medicines contributes to better health care and optimizes the use of financial resources in resource-limited settings. The NEML also serves as a guide for public procurement of medicines and provides guidance for local production of medicines. Notably, in both developed and developing countries NEMLs are used to guide cost-containment measures for pharmaceutical expenditures.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 42
- Paragraph text
- Under the right-to-health framework, the process of selection of essential medicines should be evidence-based, transparent and participatory. It should also be a part of the national plan of action on medicines, aimed at ensuring availability and affordability of medicines. The WHO EML is revised every two years by the Expert Committee on the Selection and Use of Essential Medicines (the Expert Committee). Revisions should be based on documentary evidence and include the participation of various groups, such as pharmaceutical companies and patients' groups, through a transparent application process. In contrast, responses to the questionnaire received from States revealed that civil society and community representatives were often excluded in the process of selecting essential medicines for NEMLs. Participation by civil society and communities can also contribute towards providing some evidence of health issues faced by the population.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 43
- Paragraph text
- Inclusion in the WHO EML implies that States should make medicines affordable for those who need it, including patented medicines. The Special Rapporteur is, however, aware of concerns about selective practices in including patented medicines in the WHO EML. In more recent versions of the WHO EML, some expensive patented ARVs, anti-malarial and anti-tuberculosis medicines have been included, while such key ARVs as Raltegravir, Darunavir and Etravirine have not. It is important therefore to ensure that the revisions to the WHO EML are conducted in an inclusive and transparent manner that addresses concerns of all groups. The Special Rapporteur also notes that in some States, patented medicines are included on the NEMLs to bring them within the purview of cost-control mechanisms that ensure their affordability. It has come to his attention however that some countries exclude patented medicines from the NEML, and thereby from cost-control measures to which they would otherwise be subject, which can detrimentally impact on the affordability to patients. Essential medicines, be they patented or off-patent, should be included in both the WHO EML and NEMLs in a timely manner where indicated by evidence of the burden of disease.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 44
- Paragraph text
- Non-communicable diseases (NCD) also disproportionately impact developing countries, which face 80 per cent of the global NCD burden. However, only 22 per cent of the 359 essential medicines on the 2003 WHO EML relate to NCDs. Several applications for the treatment of mental health, cancers and cardiovascular diseases are pending review by the WHO Expert Committee. Underrepresentation of medicines for NCDs in the WHO EML also limits guidance for States in the development of their NEMLs.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 45
- Paragraph text
- During the consultations, concerns were raised about the lack of uptake by States of certain essential medicines listed on the WHO EML due to political, cultural and legal considerations, especially of medicines for mental health, palliative care, drug dependence and sexual and reproductive health. For example, access to medical abortion pills such as mifepristone with misoprostol, though included on the WHO EDL, are culturally and legally restricted in many States, limiting women's accessibility to sexual and reproductive health. Criminalization of the activities of drug users in many States also restricts the availability of opioid substitutes, buprenorphine and methadone, proven to be effective in treating drug dependence, despite the fact that they are listed on the WHO EML. The Special Rapporteur recalls that access to essential medicines for vulnerable and marginalized groups should not be impeded by political, legal and cultural considerations. States should take steps to ensure that these medicines are included in their NEMLs and are made available and accessible to such groups.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 46
- Paragraph text
- States have devised ingenious ways in resource-limited settings to ensure access to the most essential medicines, as was highlighted during the Special Rapporteur's consultations. For example, in one country essential medicines are classified into different segments as per product: vital medicines (e.g. emergency medicines), essential medicines (e.g. to treat fever, headaches) and necessary medicines (e.g. multivitamins). According to the procurement rules in that country, health facilities should procure the required quantity of vital medicines first, then essential, and finally necessary medicines. This helps minimize stock-outs affecting the most vital health concerns while more sustainable solutions are devised to meet the needs for other medicine. The Special Rapporteur encourages such innovative approaches, which are tailored to local conditions and are consistent with the core right to health obligation of ensuring the availability and accessibility of essential medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 47
- Paragraph text
- Efficient and transparent procurement of medicines is central to ensuring the availability of medicines in sufficient quantities in all public health facilities. Procurement of medicines occurs at the international, national, regional and local levels. Inefficiencies of procurement at each level can cause unreliable medicine supplies and higher costs. An efficient procurement system is one that relies on transparent management, a limited drug selection that is based on a restricted list (for example, NEML), accurate and scientific forecasting of need, competitive tendering, bulk purchasing, pre-qualification of proposed suppliers and close monitoring of selected suppliers, and reliable financing. The Special Rapporteur is pleased to note that most States that responded to his questionnaire have formulated national medicine procurement policies.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 48
- Paragraph text
- With respect to quantification of medicines needs, one developing country experience indicates reliance on historical data gathered from hospitals all over the country and the epidemiological pattern of disease, which are reviewed every six months. A 20 per cent buffer to account for shortages or seasonal increases in disease is then added. Stock shortages are nevertheless commonly reported in this State. Fewer than half of the respondent States had a policy in place to address medicines shortages. States attributed stock shortages to insufficient funding for procurement, inaccurate forecasting of needs, inadequate buffer stock of essential medicines, and inefficient distribution and record-keeping systems. Stock shortages can force patients to resort to more expensive private health centres, inappropriate medicines or even forego treatment altogether. Over-quantification of demand, on the other hand, is equally harmful, as it can lead to the wastage of scarce resources and the expiry of medicines, for which safe disposal systems are lacking in many States. States are therefore encouraged to develop more scientific, reliable and evidence-based methods for forecasting and quantification such as the use of computerized methods for quantification and reliance on data about actual consumption where there are reliable records available. Participation of civil society and the affected communities must be encouraged as it helps create information networks to monitor and inform competent health authorities on medicine stocks.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Humanitarian
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 49
- Paragraph text
- International shortage of medicines, especially cancer medicines, was also raised as an issue by civil society participants to the survey. Such shortages in medicines are attributed to a limited number of manufacturers, shortages of raw materials, production problems and stockpiling. They negatively impact States' ability to procure medicines for public health facilities and seriously affect their availability to patients. States should therefore identify particular medicines markets that face such shortages and promote the development of local production of these medicines to ensure supply sustainability in the long term.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 50
- Paragraph text
- The Special Rapporteur satisfactorily notes that a majority of States surveyed by the Special Rapporteur reported the use of competitive bidding for public procurement of medicines. A transparent competitive bidding process, both at the national and international level, can bring down prices and save substantial medicine-related expenditure by States. The success of competitive bidding largely depends on transparent management, which provides clear and sufficient tender information to all government agencies involved. Efficient and transparent management can also protect against bid-rigging practices in public procurement systems.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 51
- Paragraph text
- In decentralized systems, however, poor financial and procurement capacities combined with weak governance present challenges which has even led to different prices in different regions of the same country. Decentralized systems also pose challenges for bulk procurement, which is routinely used in public procurement systems around the world. While decentralized procurement has the advantage of increasing local level accountability, it is susceptible to fragmentation, which causes duplication of procurement and negatively impacts coordinated negotiations, resulting in less favourable contract terms for governments. To maintain purchase volumes, some States have adopted systems to centrally negotiate prices while requiring lower levels of government to order their requirements through the successful bidder at the price negotiated at the central level. The Special Rapporteur recommends streamlining guidelines at the national level to ensure better coordination and efficient decentralized procurement.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 52
- Paragraph text
- Good procurement practice requires that suppliers be certified for Good Manufacturing Practices (GMP) to ensure quality assurance. A robust, multi-level tender process would exclude suppliers that do not meet GMP standards. Suppliers' licensing agreements must also be strictly monitored throughout the supply chain until the time of delivery. States should publish the names of manufacturers who do not meet GMP standards and disqualify them from future bidding.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 53
- Paragraph text
- Accountability mechanisms are essential for addressing corrupt practices, especially in the selection, procurement and registration of medicines. The States, civil society and pharmaceutical companies that participated in the Special Rapporteur's questionnaire raised concerns about corruption within the public procurement system. To prevent corruption in government procurement, different procurement functions of selection, quantification, pre-selection (eligibility) of suppliers and adjudication of tenders should be independently managed by different offices and trained individuals. Such separation of functions will allow for transparency and avoid potential conflict of interest.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 54
- Paragraph text
- The right to health obliges States to ensure that distribution systems function in a manner that secures physical accessibility to quality essential medicines at all points of distribution. The distribution chain places various responsibilities on different entities, and may include private actors, who also have a responsibility to ensure that their actions do not adversely impact on the right to health. Most States consulted by the Special Rapporteur have national regulations in place for distribution of essential medicines in the public and private sector. These regulations cover storage, transport and handling of medicines and temperature sensitive products.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 55
- Paragraph text
- To control the quality of medicines through the distribution chain, medicines must be maintained at the required temperature and according to labelling requirements, and stored in clean, dry and well-sanitized areas. States reported several challenges in meeting these requirements. Poor warehouses and cold storage facilities were cited as the major obstacles to maintaining the quality of essential medicines in developing countries, especially in rural areas. In some countries temporary storage was resorted to which lacked temperature or quality control standards. Such practices can be detrimental to the quality of medicines and this calls for urgent investment to develop adequate distribution infrastructure for public health facilities. Alternatively, States may consider including in the procurement contract a condition requiring medicines to be delivered directly to district level stores or health facilities.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 56
- Paragraph text
- The involvement of numerous agencies throughout the distribution process would necessitate continuous monitoring of timely distribution and medicine quality. Diversions of donated low-priced medicines from public health facilities into the private sector were observed in some countries. This can be addressed through effective monitoring of the distribution chain. States surveyed by the Special Rapporteur, however, reported weak data collection and monitoring systems, partly due to lack of skilled personnel to manage these systems. There is therefore an urgent need to build government capacity for identification of weaknesses in distribution systems and to devise cost-effective methods to monitor the performance and suitability of distributors. To address this situation, States may consider adopting certification programmes for distributors, a successful practice in some developing countries. Additionally, States could invest in cost-effective Internet- and mobile phone- based technologies linked to centralized computer data systems, relaying real-time data to monitor the movement of medicines from procurement through distribution and transportation and finally to delivery at health centres. Participation of communities and civil society is vital for making such measures effective.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 57
- Paragraph text
- The State obligation of ensuring access to acceptable medicines under the right to health relates to how medicines are prescribed, dispensed, sold and used. Errors in choosing or writing prescriptions, dispensation errors by pharmacists and incorrect consumption of medicines by patients can cause adverse health events and drug reactions. States' obligation to protect health also extends to safeguarding the public against the proliferation of irrational use of medicines, which results in wastage of scarce supplies and widespread health hazards.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 58
- Paragraph text
- Standard Treatment Guidelines (STGs) are invaluable for rational prescription of medicines, as they provide guidance on the most appropriate treatment options with respect to the local burden of disease. Unfamiliarity with STGs has been demonstrated in the instances of inappropriate use of antimicrobials for non-bacterial infections, over-use of injections where oral formulations are indicated and irrational combinations for fixed dose medications. Incorrect choice of medicines by physicians has been linked to higher levels of resistance, increased costs, morbidity and mortality in patients. As a good practice, prescribers and health-care workers should be regularly trained in STGs to promote rational prescribing to patients. Regularly updating, monitoring and evaluating the effectiveness of STGs promote adequate access to appropriate medicines. However, this has not been done in many countries, which is a challenge that States ought to overcome.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 59
- Paragraph text
- In many developing countries, pharmacies are the first point of contact for patients with the health-care system. Despite regulations restricting the sale of prescription medicines over-the-counter (OTC), in many developing countries this practice is rampant. In the case of antibiotics, unrestricted sale combined with irrational prescription have led to the public health threat of increased resistance to antibiotics. Countries with more restrictive antibiotic prescription have recorded relatively lower rates of resistance. Rational use of appropriate medicines requires strong enforcement of regulations by States. It also requires pharmacies and health centres to restrict OTC sale of medicines in accordance with law.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 60
- Paragraph text
- Numerous stakeholders perceive unethical commercial marketing and promotion of medicines by pharmaceutical companies as a serious concern. Billions of dollars are spent by the pharmaceutical industry on marketing through sales representatives, samples and advertising. Doctors are offered gifts under the pretext of continued medical education. Multinational pharmaceutical companies have been fined for promoting unapproved medicines, with little impact on their practices. Unethical promotion negatively affects the prescribing patterns of doctors, who would then tend to prescribe less rationally and to quickly adopt new medicines. Prescribers consequently obtain information on medicines from pharmaceutical companies, rather than consulting STGs. During the consultations, some States pointed to the existence of voluntary national industry codes to address pharmaceutical promotion. However, these have been criticized as ineffective. The Special Rapporteur recommends formulating strong enforceable regulatory systems, with accountability measures, to discourage unethical marketing and promotion of medicines by pharmaceutical companies.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 61
- Paragraph text
- According to the right-to-health framework, States are required to protect the population from unsafe and poor-quality medicines. Quality assurance for medicines includes such aspects as registration and marketing of good quality, safe and efficacious products under ethically and medically validated clinical trials, continuous regulation of the quality of production of medicines and prevention of sub-standard and spurious medicines from being sold on the market after registration.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 62
- Paragraph text
- Poor quality medicines are genuine products that do not meet quality specifications due to poor manufacturing practices. They can cause drug resistance, adverse effects and even death. Contrary to popular belief, recent studies indicate that there may be fewer poor quality medicines on the market than previously estimated. A potential explanation for this could be the tendency to conflate poor-quality with counterfeit medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 63
- Paragraph text
- Accessibility of information with respect to the quality, safety and efficacy of medicines is necessary for the enjoyment of the right to health. Before acquiring marketing approval, pharmaceutical companies are legally required in most countries to provide data demonstrating the safety, quality and efficacy of new medicines, generated from medically and ethically valid clinical trials. However, during the Special Rapporteur's consultations, diverse stakeholders noted non-transparency of clinical trial data as a concern. Trial data is not made public by pharmaceutical companies and regulators on the ground of protecting commercial information. Moreover, data relied upon for registration of medicines is often subject to publication bias (only positive results are published or are overrated), which is misleading and potentially harmful for patients. The Special Rapporteur notes with satisfaction that national and regional regulatory bodies are taking steps to make this data available through clinical trial registries. However, critics still point to content and functionality shortcomings in these registries. The Special Rapporteur encourages States to take regulatory measures to ensure that information on the safety, quality and efficacy of medicines, even if negative, is made publicly available in functional trial registries.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 64
- Paragraph text
- Poor-quality medicines are not related solely to imported medicines, as it is popularly perceived. Therefore quality inspections cannot be limited to border controls and inspections. It is important to have standard regulatory requirements for both domestically produced and imported medicines, along with regular inspections of production facilities and distribution chains for which persistent shortages have been reported.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 65
- Paragraph text
- Regulators in some of the developing countries surveyed by the Special Rapporteur reported the use of outdated methods and processes for enforcement, largely due to the lack of technical capacity, financial and human resources. For example, one such State regretted having sufficient inspectors to guard only 3 out of 41 ports of entry. Inspection of foreign production sites is an even greater challenge for resource-constrained importing countries. Regulatory bodies in many countries are generally funded by user fees, collected through licensing fees and inspection activities. However, these funds are insufficient to sustain effective regulation, given the scale and volume of production and import in most countries. States should therefore substantially increase budgetary support for their regulatory authorities to sustain the quality control activities and increase recruitment and training of staff. Regulatory bodies of importing developing countries could cooperate with their counterparts in the exporting countries to build regulatory capacities, share local inspection information of companies under their jurisdiction, and conduct joint inspections through cost-effective use of resources.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Humanitarian
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 66
- Paragraph text
- The Special Rapporteur also notes the ongoing global debate to deal with the growing challenge of counterfeit medicines. He points out that since the term "spurious/sub-standard/falsely-labelled/falsified and counterfeit" (SSFFC) medicines was coined, it has regrettably been used as a catch-all phrase to represent anything from poor-quality to "counterfeit" medicines, which is specific to the domain of trademark violations. Such a linkage is counterproductive to access to medicines. This type of conflation was demonstrated by incidents in which unilateral action was taken by some countries against legitimate generic medicines as being counterfeit and even under the national laws in some countries which included generic medicines under the definition of counterfeit medicines, thereby threatening their import into that country. The Special Rapporteur expresses concern that an international legal remedy focusing on enforcement of trademark rights to counter the problem of counterfeit medicines takes away from the public health focus of strengthening of regulatory capacities in developing countries to deal with poor quality medicines and instead diverts limited State policing machinery to enforce private rights.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 67
- Paragraph text
- The Special Rapporteur calls upon the States to shift from the dominant market-oriented perspectives on access to medicines towards a right-to-health paradigm in promoting access to medicines. He emphasizes that access to affordable and quality medicines and medical care in the event of sickness, as well as the prevention, treatment and control of diseases, are central elements for the enjoyment of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 68
- Paragraph text
- The Special Rapporteur urges States to adopt and implement a national plan of action on medicines and ensure that the right-to-health framework for access to medicines is fully integrated in the plan of action.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 69
- Paragraph text
- The Special Rapporteur encourages States to ensure that central principles of non-discrimination, transparency, accountability, and multi-stakeholder participation, particularly of affected communities and vulnerable groups, are adequately reflected in the policies and activities under the national plan of action on medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 70a
- Paragraph text
- [With regard to long-term security and affordability of medicines, the Special Rapporteur recommends that States:] Develop a policy framework on local production of medicines to ensure long-term accessibility and affordability of medicines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 70b
- Paragraph text
- [With regard to long-term security and affordability of medicines, the Special Rapporteur recommends that States:] Strengthen the regulatory framework to increase the competitiveness of the local industry and provide administrative and financial support, subsidies and guaranteed purchases;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 70c
- Paragraph text
- [With regard to long-term security and affordability of medicines, the Special Rapporteur recommends that States:] Use flexibilities under the TRIPS Agreement to promote regional collaboration to pool resources and facilitate competitiveness of local production.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71a
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Adopt price control measures in pricing and reimbursement policies with a view to ensuring access of the population, and vulnerable groups particularly, to affordable medicines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71b
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Select countries with a similar level of economic development to that of the State concerned as reference countries in order to secure the lowest price medicines through external reference pricing;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71c
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Monitor and regulate, if necessary, manufacturers' selling prices as well as distribution mark-ups in the supply chain, while ensuring incentives for wholesalers and retailers for sustainable distribution;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71d
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Resist trade policies that undermine the ability of States to reimburse the price of essential medicines to local pharmaceutical companies;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71e
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Eliminate import tariffs on medicines, except when considered to be strategic to the promotion of local production of essential medicines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71f
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Remove taxes on all medicines, especially essential medicines, and consider other revenue options for health, such as excise taxes on socially harmful goods such as tobacco, alcohol and junk foods;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 71g
- Paragraph text
- [With regard to ensuring affordability of medicines, the Special Rapporteur recommends that States:] Adopt competition laws and policies to prevent pharmaceutical companies from indulging in anti-competitive practices and promote competitive pricing of medicines together with strong enforcement.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 72
- Paragraph text
- Promote competitive policies across therapeutic markets to secure reductions in prices of medicines over tiered pricing to secure a greater government role in decision-making related to prices of medicines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 73
- Paragraph text
- [With regard to ensuring availability of essential medicines, the Special Rapporteur recommends that States:] Adopt a national essential medicines list and regularly update it by selecting essential medicines that are evidence-based and adequately reflect the national burden of disease, irrespective of cost or patent status, including through a transparent and participatory determination process;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 73b
- Paragraph text
- [With regard to ensuring availability of essential medicines, the Special Rapporteur recommends that States:] Ensure that access to essential medicines for treating mental health, drug dependence, sexual and reproductive health and palliative care is based purely on health needs and evidence and not restricted on account of extraneous non-health considerations;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 73c
- Paragraph text
- [With regard to ensuring availability of essential medicines, the Special Rapporteur recommends that States:] Ensure that the list of National Essential Medicine is arrived at with participation of all stakeholders, including the affected communities, particularly the vulnerable groups.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 74a
- Paragraph text
- [With respect to efficient and transparent procurement and distribution systems, the Special Rapporteur recommends that States:] Adopt scientific and evidence-based quantification of essential medicines, ensure competitive bidding, require stringent prequalification for suppliers, monitor delivery of medicines and formulate effective policies to address stock-outs;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 74b
- Paragraph text
- [With respect to efficient and transparent procurement and distribution systems, the Special Rapporteur recommends that States:] Increase financial, technical and logistical support to strengthen distribution networks, maintain the quality of medicines in transport and storage and adopt distributor certification programmes.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75a
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Develop and regularly update Standard Treatment Guidelines and ensure adequate training of prescribers as a part of continuing medical education policies;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75b
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Regulate pharmacies, including online pharmacies, and retailers to ensure appropriate dispensation of medicines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75c
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Prohibit unethical commercial marketing and promotion of medicines by pharmaceutical companies through legal accountability measures based on strict penalties and cancellation of manufacturing licences;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75d
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Ensure transparency of data related to quality, safety and efficacy of medicines, including the mandatory publication of adverse data;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75e
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Increase budgetary support for national regulators and increase recruitment of inspectors at competitive salaries;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75f
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Improve South-South cooperation to conduct joint inspections of manufacturing facilities and share information and good practices;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2013
Paragraph
Access to medicines in the context of the right-to-health framework 2013, para. 75g
- Paragraph text
- [With regard to rational and appropriate use of medicines and their quality, safety and efficacy, the Special Rapporteur recommends that States:] Avoid conflation of poor-quality medicines, a quality control issue, with counterfeit medicines, a trade issue.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2013
Paragraph
Commentary on the COVID-19 Pandemic
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2020
- Document code
- A/75/163
Document
Corruption and the right to health
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2017
- Document code
- A/72/137
Document
Corruption and the right to health 2017, para. 1
- Paragraph text
- Corruption can have a devastating effect on good governance, the rule of law, development and the equitable enjoyment of all human rights, including the right to health. Corruption has been the subject of international legal commitments as well as recent political commitments. The 2030 Agenda for Sustainable Development and the Sustainable Development Goals (targets 16.5 and 16.6) stipulate that corruption and bribery, in all their forms, should be substantially reduced by 2030 and that effective, accountable and transparent institutions should be developed at all levels.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 2
- Paragraph text
- While corruption manifests at many levels within societies and States, the present report focuses on the links between corruption and the enjoyment of the right to the highest attainable standard of health. Corruption in government, institutions and society at large is a significant obstacle to the enjoyment of the right to health of individuals and groups. In countries with a higher level of perceived national corruption, there is a much higher prevalence of poor health. Corruption in Government and society can reduce the ability of the government to raise resources for health and other social sectors through putting off investors or donors or as a result of tax evasion.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 3
- Paragraph text
- In many countries health is among the most corrupt sectors. Health sector corruption, including for example the bribing of health officials and unofficial payments to health-care providers, obstructs the ability of States to fulfil their right to health obligation and to guarantee available, accessible, acceptable and good quality health services, goods and facilities. Yet corruption affecting health also occurs in other sectors and industries, for example, the water sector, and the food and beverages, tobacco and other industries. Moreover, corruption has significant implications for equality and non-discrimination since it has a particularly marked impact on the health of populations in situations of vulnerability and social exclusion, in particular those living in poverty and children.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Poverty
- Person(s) affected
- All
- Children
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 4
- Paragraph text
- The right to health provides a valuable normative framework and constitutes a legally binding imperative to analyse and address corruption affecting health and occurring in and beyond the health sector. The framework reflects notions of good governance, transparency, accountability and participation, which are key when it comes to combating corruption. It places legal obligations on States to guarantee access to health-related goods and services for all, including individuals and groups in situations of vulnerability, and this requires them to take actions to curb corruption where it occurs.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 5
- Paragraph text
- The present report is the result of extensive consultations among a wide range of stakeholders, including representatives of relevant United Nations agencies, civil society and academic experts. In May 2017, the Special Rapporteur convened an expert consultation in Bangkok and is very grateful to those who participated and provided valuable inputs for the present report.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 6
- Paragraph text
- Corruption is generally defined as “the misuse of public or entrusted power for private gain”. In relation to health, in many countries varying degrees of responsibility for public roles is entrusted to private actors, including private health professionals, pharmaceutical companies and health insurance companies. Corruption occurs in both the public and private sectors.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 7
- Paragraph text
- A distinction is frequently made between “grand” and “petty” corruption. Grand or “high-level” corruption refers to acts committed at a high level of government that distort policies of the central government, for example a health minister “skimming” money off a loan from a foreign country. Petty or “administrative” corruption is smaller-scale everyday corruption by low- and mid-level public officials in their interaction with citizens, for example an informal payment from patient to doctor.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 8
- Paragraph text
- Other definitions distinguish between types of corruption, which among other forms include political and institutional corruption. “Political corruption” means manipulation by political decision makers of, for example, policies and rules of procedure in the allocation of resources, such as a government accepting a bribe in exchange for the construction of a large private hospital in the capital. “Institutional corruption” results from the normalization of behaviours that compromise truth-seeking and lead to the formation of perverse incentive structures, and thus addresses the behaviour of actors who exploit their institutional positions to influence institutional processes and actions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 9a
- Paragraph text
- [All in all, corruption is a multidisciplinary phenomenon demanding a response from many fields of study. From a legal perspective, the United Nations Convention against Corruption (General Assembly resolution 58/4, annex) lists five acts of corruption, which can be translated as follows to the health context:] The bribery of national and foreign public officials in exchange for an undue advantage;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 9b
- Paragraph text
- [All in all, corruption is a multidisciplinary phenomenon demanding a response from many fields of study. From a legal perspective, the United Nations Convention against Corruption (General Assembly resolution 58/4, annex) lists five acts of corruption, which can be translated as follows to the health context:] Embezzlement, misappropriation or other diversion of funds from the health budget by a public official;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 9c
- Paragraph text
- [All in all, corruption is a multidisciplinary phenomenon demanding a response from many fields of study. From a legal perspective, the United Nations Convention against Corruption (General Assembly resolution 58/4, annex) lists five acts of corruption, which can be translated as follows to the health context:] Trading in influence;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 9d
- Paragraph text
- [All in all, corruption is a multidisciplinary phenomenon demanding a response from many fields of study. From a legal perspective, the United Nations Convention against Corruption (General Assembly resolution 58/4, annex) lists five acts of corruption, which can be translated as follows to the health context:] Abuse of functions;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 9e
- Paragraph text
- [All in all, corruption is a multidisciplinary phenomenon demanding a response from many fields of study. From a legal perspective, the United Nations Convention against Corruption (General Assembly resolution 58/4, annex) lists five acts of corruption, which can be translated as follows to the health context:] Illicit enrichment.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 10
- Paragraph text
- There are many other manifestations of corruption in the health sector and beyond. The present report focuses on several non-exhaustive, illustrative examples.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 11
- Paragraph text
- Both corruption occurring in society at large (general corruption), as well as corruption specifically occurring in the health or other health-related sectors, have a negative impact on the enjoyment of the right to health. These forms are intertwined. Corruption in society at large may affect the regulatory environment and the efficiency of State institutions. It hinders economic growth and sustainable development as well as equitable distribution of resources. It undermines public confidence in the State and may obstruct attainment of the commitments made through Sustainable Development Goal 16 to create effective and accountable institutions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 12
- Paragraph text
- Corruption is particularly detrimental in that it increases mistrust on the part of all stakeholders, especially users of services, not only in the health-care system but also in the abilities and performance of local and national authorities in general. While little research has been done on the impact of corruption on health outcomes, it is suggested, for example, that countries with higher levels of corruption have higher levels of child mortality.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Children
- Year
- 2017
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Corruption and the right to health 2017, para. 13
- Paragraph text
- Alongside general corruption, health sector corruption is widespread and has serious consequences for the enjoyment of the right to health on the basis of equality and non-discrimination. The most common forms of corruption in the health sector are selling government posts, absenteeism, bribes, procurement corruption, theft or misuse of property, fraud, and embezzlement of user fee revenue, as well as informal payments to health-care providers. A range of stakeholders may be implicated in these and other corrupt practices in the health sector affecting the enjoyment of the right to health. These include but are not limited to health ministers, parliaments, accrediting and licensing bodies, public and private insurers, hospitals, health professionals and health professional associations, community health workers, pharmacists, pharmaceutical companies and biotechnology companies, medical researchers and medical research groups and patients and patient support groups. As will be argued below, they all bear responsibilities with regard to the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
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Corruption and the right to health 2017, para. 14
- Paragraph text
- Corruption is a significant challenge to the delivery of quality health care, which is central both to the right to health and to the commitment under Sustainable Development Goal 3 to universal health coverage. The health sector is extremely vulnerable to corruption at all levels — grand and petty, political and institutional — and occurring in both the public and private sectors. It is estimated that every year 180 billion euros are lost to fraud and corruption in health care globally. Health sector corruption negatively affects the (financial) resources available for health care; resources that are drained through embezzlement and procurement fraud are no longer available for paying salaries, funding health-care delivery or maintenance. For example, there is evidence suggesting that health sector corruption has a negative effect on cancer care and care for HIV/AIDS. While these trends are visible in countries at all levels of development, it is evident that lower-income countries are more deeply affected by health sector corruption and a lack of transparency. In some countries, the health sector is considered to be the most corrupt sector of all.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 15
- Paragraph text
- The lesser form of corruption, namely, petty corruption, is quite common in the health sector and includes informal payments from patient to health-care provider, absenteeism of health personnel and preferential treatment. These forms of corruption are also sometimes called “survival corruption”, as they are exacerbated by a lack of resources in health-care settings, poor working conditions, low pay, and hierarchical structures, which drive people to engage in such acts. There is evidence that this “microform” of corruption has a particularly negative effect on the poor in society, as they are often unable to pay the bribes necessary for a certain service.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 16
- Paragraph text
- Three main characteristics make the health sector particularly vulnerable to corruption: (a) power asymmetries or an imbalance of information, inter alia, between health-care provider and patient and between government, the private sector and rights holders; (b) uncertainty inherent in selecting, monitoring, measuring and delivering health-care services; and (c) the complexity of health systems: the large number of parties involved makes it more difficult to generate and analyse information in a transparent manner. A fourth problem, sometimes termed “provider moral hazard”, is that health professionals, public officials or private actors may choose to act in their own interests rather than in the interests of the rights holders towards whom they bear duties. Moreover, where health systems lack transparency, participation and accountability, a fertile breeding ground is created for corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
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Corruption and the right to health 2017, para. 17
- Paragraph text
- Health reforms introduce organizational changes that can mitigate corruption but may also open new channels for abuse. As discussed during the expert consultation held in Bangkok, transferring responsibility for public health facilities from national to local governments may make them more accountable and less corrupt, but it can also create opportunities for local officials to divert resources for personal gain. Deregulation can eliminate requirements that are exploited by public officials to charge bribes, but it can also eliminate rules and oversight that are necessary to protect the public against unscrupulous actors. Permitting doctors to combine public and private practices is often justified as assuring staffing of public facilities, but may create situations where patients cannot obtain treatment to which they are entitled in public facilities, either because doctors are unavailable or because they encourage patients to see them privately.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 18
- Paragraph text
- The Special Rapporteur is concerned that there is a “normalization of corruption” in health care; corruption can be so pervasive that it becomes accepted as “normal”. Yet these practices lead to groups and individuals being disadvantaged and to the infringement of human rights, such as access to health care on the basis of equality and non-discrimination. Changing views and perceptions in institutions and society of corruption as normal, unavoidable and justified is an important element in addressing the problem of corruption. Informal payments can be reduced by engaging with the public in a debate about the adverse consequences of corruption, with a view to changing cultural values in relation to corruption. Codes of conduct and ethics, training and education can also be used to support responsible conduct among professionals, including avoiding corrupt behaviour, although they may not be sufficient alone for behaviour change where it is most needed. States should also take action to address other trigger factors such as low or unpaid salaries, cumbersome administrative procedures and excessive red tape, as well as enhancing transparency, participation and accountability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 19
- Paragraph text
- Beyond the health sector, corrupt practices that have a direct impact on the right to health have occurred in other private sector companies, including private water companies, tobacco manufacturers, food and beverage manufacturers, car manufacturers and the natural resources extraction industry. Such practices include, for example, bribery of public officials and the manipulation of scientific research practices. In his previous reports, the Special Rapporteur has highlighted how power asymmetries have given rise to the widespread prioritizing of specialized medicine over primary care and public health interventions, including poverty reduction, labour conditions and early childhood services (see A/HRC/35/21, paras. 21-26). Such asymmetries generate preferences for physical health care over mental health care; biomedical interventions over non-biomedical interventions; the prioritization of certain disciplines that promote expensive biomedical technologies over social sciences in public health research agendas; and limited space for civil society participation in health policymaking.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 20
- Paragraph text
- Although many everyday practices in health-related services may not be considered as corruption, legally speaking, their accumulation and their acceptance by various stakeholders have a detrimental cumulative effect on the performance of health-care systems and, indirectly, on individual and societal health. It is for that reason that the present report is focused not only on those forms of corruption that are legally defined as breaking the law and should be brought to justice, but also on those practices which undermine principles of medical ethics, social justice, as well as effective and transparent health-care provision. When such practices are not properly addressed, they pave the way to non-transparent decisions at all levels of policymaking, policy implementation and services provision and thus lead to corrupt environments and foster institutional corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 21
- Paragraph text
- Mindful that the nature of corruption means that it is often difficult to distinguish intentional malfeasance from inefficiencies, errors, and differences in judgments and in priorities, the Special Rapporteur underlines that enhancing transparency is particularly important not only to address clearly corrupt practices but also to address these harmful phenomena, which obstruct the enjoyment of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 22
- Paragraph text
- In the context of universal health coverage, as one of the important global commitments under the 2030 Agenda, it is critical to strengthen health-care systems so that all segments of population trust primary care and primarily use this level of services for most health conditions. This would be an effective anti-corruption measure to help decrease the prevailing tendency whereby users of health services prefer to bypass primary care and use specialized health-care services. The Special Rapporteur welcomes recent initiatives developed and replicated in some countries through which medical doctors educate the general population against wasteful or unnecessary use of medical tests, treatments and procedures in health care. Such initiatives, inter alia, “choosing wisely”, “realistic medicines” or “preventing over-diagnosis”, should be supported by States as effective measures to develop rational health-care services and thus prevent unnecessary and costly use of specialized interventions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 23
- Paragraph text
- The right to health is recognized in the Constitution of the World Health Organization (WHO) and protected by the Universal Declaration of Human Rights and international human rights treaties which are binding on States parties, including the International Covenant on Economic, Social and Cultural Rights, the International Convention on the Elimination of All Forms of Racial Discrimination, the Convention on the Elimination of All Forms of Discrimination against Women, the Convention on the Rights of the Child, the Convention on the Rights of Persons with Disabilities and the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families. Additionally, regional human rights treaties and many domestic constitutions protect the right to health. These international treaties and domestic laws obligate States to take action to respect, protect and fulfil the right to health and to address corruption where it interferes with their right-to-health obligations. They should inform responses to corruption alongside other legal instruments, such as the United Nations Convention against Corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Families
- Persons on the move
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 24
- Paragraph text
- The right to health gives rise to obligations that provide a framework for action for duty bearers, as well as a framework of reference for monitoring and accountability. The right to health is subject to progressive realization. This means that many aspects of the right to health do not have to be realized immediately; rather, States must take effective and targeted measures towards the progressive realization of the right to health. However, States also have some immediate obligations, including core obligations such as the equitable distribution of health facilities, goods and services; the provision of essential medicines; access to minimum essential food, basic shelter, safe and potable water and sanitation; and the adoption of a national health strategy and plan of action on the basis of epidemiological information. The Committee on the Rights of the Child has also highlighted that universal health coverage is a core obligation (see the Committee’s general comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health, para. 72). States must adopt and enforce legislative, regulatory and policy measures to ensure that corruption does not impede the fulfilment of their progressive and core obligations.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Children
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 25
- Paragraph text
- Corruption undermines the State’s obligation to realize the right to health “to the maximum of its available resources”. Notably, embezzlement diverts financial resources from their intended purpose. Corruption also reduces the ability of governments to generate maximum resources, including through international cooperation, in the first place by making countries less attractive to donors and investment, and may support tax evasion. Measures to prevent and protect against corruption offences are therefore an essential component of this obligation.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 26
- Paragraph text
- Moreover, since the right to health includes not only a right to health care but also to the determinants of health, it offers a road map and tools for addressing corrupt action in the health sector as well as corruption affecting the social, environmental and other determinants of health. Measures to address the right to health should be holistic and integrated, go beyond the provision of health services and be underpinned by cross-departmental commitment (see A/HRC/32/32, para. 37). It requires the improvement not only of outcomes but also of processes, for example with governance and health systems required to operate on the basis of principles including transparency, participation, accountability and non-discrimination, all of which have a particular importance for addressing corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 27
- Paragraph text
- In recent years, a number of United Nations human rights bodies have acknowledged the negative impacts of corruption on the enjoyment of human rights. By its decision 2002/106, the Sub-Commission on the Promotion and Protection of Human Rights appointed a Special Rapporteur on the impact of corruption on human rights, in particular economic, social and cultural rights. In her reports, the Special Rapporteur established that the enjoyment of both civil and political and economic, social and cultural rights are seriously undermined by corruption. In a report published in 2015, the Advisory Committee to the Human Rights Council explained that a human rights perspective on the impact of corruption can move the victims to the centre of the fight against corruption by highlighting the negative impacts of corruption on the individuals and groups concerned. The human rights perspective also reveals that the State bears the ultimate responsibility for such acts. Establishing the links between corruption and human rights can promote access to human rights mechanisms to combat corruption, thus creating new opportunities for monitoring and litigation (see A/HRC/28/73, paras. 27-28 and 32).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 28
- Paragraph text
- When it comes to addressing corruption and a lack of transparency, the right to health is closely related to and dependent upon other human rights and fundamental freedoms that are critical to the fight against corruption, including the right to life; freedom of expression including the right to seek, receive and impart information; freedom of association; and the right to a fair trial. For example, freedom of expression offers a basis for protecting whistle-blowers, which is of key importance in combating corruption, while the right to information is vital to access information including on financial transactions and decision-making processes that may reveal corruption. The promotion and protection of these rights will also therefore be vital tools to address corruption affecting health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 29
- Paragraph text
- The right to health requires that health-care goods, services and facilities be available in adequate numbers; financially and geographically accessible, as well as accessible on the basis of non-discrimination; acceptable, that is, respectful of the culture of individuals, minorities, peoples and communities and sensitive to gender and life-cycle requirements and of good quality, thus meeting all the criteria of availability, accessibility, acceptability and quality (AAAQ).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Ethnic minorities
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 30
- Paragraph text
- Petty and grand corruption and institutional and political corruption can have a negative impact on the availability, accessibility, acceptability and quality of health care. When money that has been allocated to the health sector is embezzled, the availability of health services and goods is affected.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 31
- Paragraph text
- Corruption can also arise when States fail in their obligation to ensure that there is an adequate number of health professionals receiving domestically competitive salaries as petty corruption is often used by health professionals or other local officials to make up for inadequate, or unpaid salaries, although it should also be noted that bribes and illicit charges also occur where health professionals earn adequate salaries. As well as competitive salaries, reward for correct performance can also help to tackle corruption. Absenteeism of health service staff also negatively affects availability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 32
- Paragraph text
- As to physical accessibility, health sector corruption can lead to choices that are less favourable to the community, for instance as a result of bribes, health-care facilities may be built in urban or wealthy areas rather than in locations accessible to poor or rural populations.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 33
- Paragraph text
- In terms of affordability, health-care providers can make health-care services more expensive by demanding payments (informal or under-the-table payments), which can put treatment out of reach and be a matter of life or death, contribute to morbidity or impoverish patients and their families. The payment of bribes by patients for privileged care is common in many countries and results in discriminatory access to care, with wealthier patients likely to access care more easily than those that are too poor to pay bribes. As a result of bribery in procurement processes, medicines may be more expensive.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Equality & Inclusion
- Health
- Person(s) affected
- Families
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 34
- Paragraph text
- In terms of information accessibility, a lack of information about rights in the health system can provide a smokescreen for corruption. Moreover, patients are vulnerable due to the so-called “information imbalance” in the health sector, with doctors being more knowledgeable about the health-care services that they provide than the receivers.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 35
- Paragraph text
- Corruption also infringes medical ethics, which are an essential component of acceptable health care. Lastly, in terms of quality, corruption can affect the quality of medicines, for example, when regulators are bribed to carry out less rigorous checks, or when hospital administrators purchase medicines of unknown quality. Quality can also be compromised where bribes are extorted or accepted in decisions on hiring staff, or accrediting, licensing or certifying facilities, in deciding which medicines to include on essential medicines lists, or to market unregulated medicines, which can increase mortality and morbidity among those affected, as well as hampering disease control efforts. Nepotism, cronyism and other forms of favouritism can also compromise the quality of health and health-related services.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 36
- Paragraph text
- The right to health requires that States take action, including policy, legislative and budgetary action, to prevent corruption from impeding the available, accessible, acceptable and good-quality health care.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 37
- Paragraph text
- Corruption compromises the ability of the State to guarantee the underlying and social determinants of health including safe drinking water, safe and nutritious food and a healthy environment, and exacerbates the discrimination and inequalities that prevail in societies throughout the world.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 38
- Paragraph text
- To take the example of water, around 10 per cent of water sector investment is lost to corruption. Corruption can make water inaccessible and unaffordable and affect the quality of water. In some low-income countries, corruption can add an estimated 30-45 per cent to the price of connection to a water network. The increasing role played by private sector actors in water services requires the State to adopt an appropriate regulatory framework.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Water & Sanitation
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 39
- Paragraph text
- The harmful effects of the tobacco industry and unhealthy foods industry has been covered up by manufacturers and industry lobbyists, including through sponsoring research to downplay links to health problems. Misinformation, pressure and bribery from private sector actors, including the food and beverage and breast-milk substitute industries and the tobacco and the polluting industries, can interfere with the obligation of governments to adopt an appropriate legislative, regulatory and policy framework to promote and protect public health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 40
- Paragraph text
- Discrimination encompasses any distinction, exclusion or restriction that has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise by all persons, on an equal footing, of all rights and freedoms. Non-discrimination and equality are human rights obligations which are fundamental to realizing the right to health. Not only must health and other goods and services be available to all on the basis of non-discrimination, but broader promotion and protection of equality and non-discrimination are vital in guaranteeing the equitable enjoyment of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 41
- Paragraph text
- There is ample research indicating that corruption and a lack of transparency exacerbate socioeconomic deprivation. Lower social groups carry a heavier burden in a society rife with corrupt elements. In turn, the equal enjoyment of the right to health is deeply affected by poverty and income inequality.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Poverty
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 42
- Paragraph text
- In the health sector, low-income and other groups in vulnerable situations are affected the most by corruption and a lack of transparency. Lower-income groups have the most difficulty affording the informal payments that are often required to receive the medical treatment they need. In health-care settings that face a high level of corruption, the poorer sections of the population and those who live in rural areas may suffer longer waiting periods at public health clinics and are also more frequently denied vaccines than rich and urban sections of the population. Health sector corruption can also lead to discrimination more directly when health-care providers and professionals treat patients differently according to their income and their contact with the medical profession.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 43
- Paragraph text
- There are several intersecting groups in society that suffer from corruption on other grounds. There is, for example, evidence that corruption does not affect rural areas in the same way as it affects urban areas. Women can often be particularly affected by health sector corruption. In many countries, they are more likely to use health care than men, a pattern partly explained by their increased use of services during their reproductive years. They may thus be disproportionately affected by the effects of health sector corruption, for example when they lack the money to afford informal payments necessary for assistance around childbirth. Women may also be more vulnerable to informal payments where they lack economic means, for example where they do not participate equally in the paid labour force or do not have equal access to or control of financial resources within the household. Furthermore, women constitute a large proportion of health-care personnel, and can thus be disproportionately affected when health sector corruption negatively affects the timely payment of proper wages.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Economic Rights
- Health
- Person(s) affected
- Men
- Women
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 44
- Paragraph text
- Meaningful participation of people in decisions that affect their health and socioeconomic well-being is a key component of the right to health and crucial when it comes to combating corruption in health care and in society at large. States’ obligations under article 12 of the International Covenant on Economic, Social and Cultural Rights require that the right to participate in decision-making processes affecting their health and development must be an integral component of any relevant policy, programme or strategy. Sustainable Development Goal target 16.7 stipulates the duty to ensure responsive, inclusive, participatory and representative decision-making at all levels.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 45
- Paragraph text
- Participation in health decision-making leads to improved health outcomes and is essential for ensuring the distribution of policies and programmes to broader segments of the population, thus making governance more accountable. Participation goes beyond merely being educated, informed or consulted. It implies a human right to actively engage individuals and groups in the development, implementation and review of policies, standards, indicators, benchmarks or legislation, particularly aimed at including the voices and needs of more vulnerable or otherwise underrepresented and especially affected populations.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 46
- Paragraph text
- Key elements of meaningful participation with the aim of preventing and controlling corruption are the active disclosure of important health-related information and the participation of relevant stakeholders in health decision-making, including in health sector plans, in the annual budget process and in review processes for health laws, policies and programmes. In the context of budgets, participation involves the engagement of a variety of stakeholders in determining the allocation of funding, as well as monitoring expenditure. Methods for realizing participation include forums and conferences, local health committees and teams, citizens’ juries, public meetings, but also institutional participation, for example in hospital boards. Key stakeholders include, but are not limited to, national health assemblies, community-based and grass-roots organizations, professional associations and other non-governmental bodies and civil society organizations.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 47
- Paragraph text
- Patients’ organizations and other more empowered interest groups may exert influence on health decision-making by lobbying in favour of the prescription and reimbursement of expensive drugs or particular programmes or treatments in a health service at the expense of other treatments or programmes. Paradoxically, these activities can reinforce imbalances and power asymmetries, as they too often result in undue pressure on policymakers to invest in specialized care and vertical programmes of treatment for certain diseases at the expense of primary care and holistic medicine. Thus participation has to be carefully planned, balanced and accompanied by open and transparent planning mechanisms to ensure representation of a broad range of civil society and other key stakeholders.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 48
- Paragraph text
- Where there is opacity surrounding decisions at the political, macro or micro levels, corruption can flourish, go undetected and occur with impunity. Transparency unveils corruption and is inextricably linked to the right to access information, participation and accountability. Access to information and transparency laws provide a framework for addressing corrupt practices, while the regulations and monitoring arrangements are also vital. Transparency can often be enhanced by the participation of rights holders and civil society organizations in decision-making processes that may be prone to corrupt practices.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Civil & Political Rights
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 49
- Paragraph text
- There are particular challenges to transparency in the health sector. Asymmetric information between providers, payers and users leads to provider or user moral hazard. Information is divided between a multitude of different actors, including regulators, payers, providers, users and suppliers, which reduces transparency. There are many varying ways to improve transparency depending on the context. For example, transparency in procurement is enhanced through public access to procurement bidding results, monitoring of the prices paid and analysis of bids. Transparency in recruitment can be supported through the publication of criteria. Transparency through the promotion of information that sets out the services and treatments to which individuals are entitled and how these services are reimbursed can help minimize inequalities in access to care through corrupt practices. The publication of transparent waiting lists can negate the practice of bribery to access more rapid treatment.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 50
- Paragraph text
- There is a significant demand from civil society for accountability of Governments and other institutions. Sustainable Development Goal 16 includes a commitment to create effective, transparent and accountable institutions at all levels. Accountability is at the heart of human rights and central to the fight against corruption. Human rights-based accountability for corruption helps reveal where corruption has taken place and resulted in human rights abuses. Effective accountability processes are also important for the reason that they can have a deterrent effect in relation to corruption. It is therefore troubling that research suggests that accountability for corruption is rare, indicating a need for governments to take concerted steps to strengthen accountability mechanisms and processes.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 51
- Paragraph text
- Accountability comprises three elements: monitoring (“what is happening, where and to whom (results) and how much is spent, where, on what and whom (resources)”), review (“analysing whether pledges, promises and commitments have been kept by countries, donors and non-state actors”) and remedies and action. The rule of law, transparency and access to information, including on decision-making processes, budgets and financial transfers in both the public and private sectors, provide vital conditions which help to strengthen accountability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 52
- Paragraph text
- Health systems are complex and a wide range of monitoring and review processes have a role to play in enhancing accountability for the right to health in the context of corruption. In terms of monitoring, budget monitoring, effective and accurate accounting, audits and public expenditure tracking surveys are ways of monitoring how funds have been allocated and whether they have been distributed as intended, or whether corruption may have occurred. Yet in many low-income countries, Governments lack financial and technical capacity to operate such systems in an effective way. As well as monitoring of funds, monitoring of health professionals’ practice and supplies is also important. The establishment of well-resourced and independent anti-corruption and fraud agencies to prevent and detect corruption, including in the health sector, can also support the monitoring dimension of accountability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 53
- Paragraph text
- Judicial, quasi-judicial, political and administrative mechanisms at the local, national and international levels can all play an important review function. It is essential that rights holders are aware of their entitlements and that complaints procedures are simple and accessible. Independent complaints procedures are often valuable. Rights holders must be able to participate in review procedures carried out by quasi-judicial, political or administrative bodies. Moreover, whistle-blower protection in the public and private sectors for individuals in procurement bodies, health authorities, health service providers and suppliers of medicine and equipment supports review through encouraging the reporting of corruption. Domestic human rights bodies, such as national human rights institutions, as well as international mechanisms such as the United Nations treaty bodies and the universal periodic review, can provide an important contribution to enhancing accountability for the right to health, including in the context of corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
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Corruption and the right to health 2017, para. 54
- Paragraph text
- Governments must take action where monitoring and review have revealed corrupt practices. Not only should sanctions be applied, but remedies must also be awarded and implemented. Accountability should not be exclusively equated with a blame and punishment model that puts front-line workers in the firing line. Rather it is better understood as reinforcing the rule of law, including the promotion and protection of the right to health in the health system. Court judgments, as well as recommendations from other review bodies, can lead to actions by governments and other duty bearers producing transformative changes in the health sector.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 55
- Paragraph text
- Under the Universal Declaration of Human Rights, all organs of society have human rights responsibilities. It is now widely acknowledged that, while States parties are ultimately accountable for the right to health, all members of society, including health professionals and the private business sector have responsibilities regarding the realization of the right to health. As indicated in the Guiding Principles on Business and Human Rights: Implementing the United Nations “Protect, Respect and Remedy” Framework, private actors have the responsibility to “respect” human rights.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 56
- Paragraph text
- Private hospital and insurance boards and other institutions responsible for the financing and provision of health care or underlying determinants have an important role to play in combating corruption and lack of transparency within their organizations. They must ensure that they comply with national laws and regulations regarding corruption and human rights. They may adopt an anti-corruption strategy, including internal regulations aimed at prohibiting and preventing the diversion of budgets, medicines or medical supplies for personal advantage; the acceptance of informal payments by their health personnel; preferential treatment for well-connected individuals; the use of hospital equipment for private business; the improper referral of public hospital patients to private practices; and illegitimate absenteeism of medical personnel while being paid. When it comes to preventing informal payments, the creation of individual contracts with personnel and increased pay scales while sanctioning poor performance are recommended. In the case of whistle-blowers, hospital boards and other actors should refrain from punitive actions and provide adequate protection and guarantees to safeguard their personnel and services.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 57
- Paragraph text
- Organizations administering health insurance schemes and insurance regulators have a responsibility to prevent embezzlement, theft and illicit enrichment from the health insurance budget and bias in favour of certain procedures, medical professionals or products due to conflicts of interests. They should avoid adverse selection practices leading to patients being refused on the basis of their health status, age, financial capacity or other factors.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
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Corruption and the right to health 2017, para. 58
- Paragraph text
- The medical profession has a responsibility to abstain from unethical and unprofessional behaviour under its professional codes, which often emphasize a commitment to integrity and non-corrupt behaviour. Among other acts, the medical profession is to refrain from favouritism and other forms of preferential treatment for well-connected individuals; accepting bribes; using hospital equipment for private business; and referring public hospital patients to their private practices. They should remain independent from outside organizations that have vested interests in their clinical activities. They should avoid conflicts of interest that compromise their decisions regarding the care of patients.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 59
- Paragraph text
- Education in the health-care sector is one important element in that regard. The doctrine of the “five-star doctor” needs to be reaffirmed to translate modern values and scientific evidence into everyday medical practice. Modern medical doctors need to be not only good clinicians but also effective community leaders, communicators, decision makers and managers. That philosophy should be complemented by a strong human rights-based approach and evidence gained from the modern public health approach.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 60
- Paragraph text
- While medical doctors and other health-care workers are accountable and responsible for ethical conduct and non-corrupt behaviour, it is crucial that corrupt practices and institutional corruption do not affect decisions made at the level of academic medicine. Medical schools that train future medical doctors and carry out medical research and university hospitals that provide a tertiary level of health-care services and use expensive biomedical technologies have a key role in preventing corruption in the rest of the health-care system. It is very important to use the principle of academic autonomy in a responsible way. The academic medical elite has enormous power over decision-making and when they advise policymakers on how to invest resources proper accountability mechanisms need to be in place.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 61
- Paragraph text
- Within the health sector, the pharmaceutical industry stands out as being particularly prone to corruption. Corrupt practices take place at all stages of the pharmaceutical value chain, including during research and development, manufacturing, registration, distribution, procurement and marketing. The key problems are a lack of objective data and understanding of corruption in the pharmaceutical sector, a weak legislative and regulatory framework, potential undue influence from companies and a lack of leadership committed to anti-corruption efforts.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 62
- Paragraph text
- While governments have the primary duty to regulate and oversee the pharmaceutical sector, the pharmaceutical industry has a responsibility to engage with governments on the issue of corruption. It has an independent responsibility to prevent corruption throughout its value chain, inter alia, through institutional checks and balances, protection and security of medicines and the adoption of monitoring and accountability procedures such as audits and whistle-blowing mechanisms for all staff in the company.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 63
- Paragraph text
- The Special Rapporteur has raised the issue of the global burden of obstacles (see A/HRC/35/21) that persists in mental health-care systems globally and how this hinders the realization of the right to health. Obstacles include the overuse of biomedical model and biomedical interventions, in particular psychotropic medications; power asymmetries; and the use of biased evidence. The Special Rapporteur advocated for a shift in mental health policies and services.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 64
- Paragraph text
- Existing evidence shows that mental health policies and services are especially prone to ineffective and corrupt practices, as well as the use of biased evidence. These obstacles, if not properly addressed, divert mental health policies and services from the effective realization of the right to health and hinder implementation of Sustainable Development Goals, including Goal 3 and a very important target: to promote mental health and well-being.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 65
- Paragraph text
- Mental health policies and services illustrate how lack of transparency and accountability in the relationships between the pharmaceutical industry and academic medicine can lead to institutional corruption and have a detrimental effect on mental health policies and services, not only on a national or regional scale but also at the global level.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 66
- Paragraph text
- As mentioned above, institutional corruption occurs when an organization or institution is no longer sufficiently independent to pursue its stated goals or mission effectively. It occurs when systematic practices develop within an institution that are legal, accepted and normative, but nonetheless undermine its integrity. Thus, institutional corruption results from the normalization of behaviours that compromise truth seeking and from perverse incentive structures (e.g., promotions; peer-reviewed publications) that reward problematic behaviour. It is a solution-, not blame-, oriented framework — a “bad barrel” rather than a “bad apple” problem.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 67
- Paragraph text
- Representatives of academic psychiatry and other mental health researchers can have significant and long-lasting ties to drug manufacturers yet believe that they are immune to explicit or implicit bias, provided that they disclose these ties. Similarly, journal editors can have financial ties to the same drug companies and publish these studies, also believing that their judgment is not compromised. However, there are decades of research demonstrating that scientists are not immune to guild interests and implicit bias and that transparency or disclosure of financial conflicts of interest is an insufficient solution.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 68
- Paragraph text
- Thus, the framework of institutional corruption highlights both the harm done and what is lost, namely, harm to patients; loss of public trust and confidence in the integrity of academic medicine; and distortion of the scientific evidence base. It exposes the economies of influence that contribute to those harms and losses and it is a call for action to neutralize those influences. Below, the Special Rapporteur reviews three main areas in the mental health field using this framework, namely, the process of development and promotion of diagnostic categories for mental health conditions, psychotropic drug research and clinical practice guidelines.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 69
- Paragraph text
- Because of its global reach, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been referred to as the “bible” of psychiatric diagnosis and is used worldwide in psychiatric research. However, over the last decade there have been increasing concerns that the interconnected needs of the pharmaceutical industry and the psychiatric community may have played a role in the development or expansion of questionable diagnostic categories.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 70
- Paragraph text
- A 2006 study found that the majority of DSM-IV (fourth edition of the Manual) panel members had financial ties to drug companies and that 100 per cent of the Mood Disorders work group and the Schizophrenia and Psychotic Disorders work group had commercial ties to the companies that manufacture antidepressants and antipsychotics. Despite a disclosure policy implemented by the American Psychiatric Association one year later, the majority of individuals serving on the DSM-5 (fifth edition of the Manual) still had such ties and, as with the DSM-IV, the most conflicted panels were those for which pharmacological treatment was the first-line intervention.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 71
- Paragraph text
- The widening of disease boundaries has medicalized normal human experience (e.g., “social anxiety disorder”), resulting in expanded markets for treatment and diverting attention away from the cultural, socioeconomic and political context of emotional distress.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 72
- Paragraph text
- Studies have revealed that commercially funded trials are up to four times more likely to report industry-friendly results than trials without such financial conflicts of interest. In addition, there is clear evidence of publication bias in psychotropic drug trials; research demonstrating the ineffectiveness of a drug can be suppressed or written in a way that conveys a positive result. Such publication biases result in an inflated perception of efficacy and an underestimation of the harms of psychotropic medications.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 73
- Paragraph text
- The Special Rapporteur observes that pharmaceutical companies have a vested interest in finding a new indication (namely, a new disorder) for their drugs when a patent expires since this allows the drug manufacturer to obtain an additional three years of exclusivity for the drug in question. Pharmaceutical companies have used “exclusivity” as an informal mechanism to effectively extend patent protection for that time period.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 74
- Paragraph text
- The inclusion of new disorders in DSM-5 referred to above have led some to question whether the updated edition inadvertently functioned as a vehicle for high-profit patent extensions. It was found that in the majority of clinical trials testing drugs for new DSM disorders (e.g., “Binge-eating disorder”), there were commercial ties between DSM-5 panel members and the pharmaceutical companies that manufactured the drugs that were being tested for these new disorders. This is not to suggest any wrongdoing on the part of DSM panel members, but rather to emphasize the economies of influence at play and that transparency alone is an insufficient measure for systemic problems.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 75
- Paragraph text
- The Special Rapporteur is seriously concerned that treatment guidelines for mental health conditions are particularly vulnerable to industry capture because the absence of biological markers for mental health conditions increases clinical uncertainty and subjective judgments. Bias in such guidelines creates the potential to expose patients to harm from unnecessary treatment or from treatment that is not evidence-based and leads to a drain on resources.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 76
- Paragraph text
- When guidelines are produced by medical specialty groups, especially those with strong and pervasive industry ties, these groups tend to recommend market-driven treatment options (e.g. pharmacotherapy) when less expensive and safer (e.g., lifestyle change or psychosocial support) approaches are available. For example, meta-analyses,, re-analyses of antidepressant clinical trial data, and narrative reviews have explicitly concluded that because of the risk benefit profile, antidepressants should not be used as a first-line intervention for mild depression, as this may result in overtreatment. Nonetheless, some guidelines produced by industry-funded psychiatry specialty organizations continue to use a predominately biological framework and recommend antidepressant medication as a first-line intervention for even mild depression.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 77
- Paragraph text
- Institutional corruption in the mental health system has several consequences. One of them is the medicalization of human diversity and misery, which expands the number of patients labelled with mental illness. According to WHO, more than 300 million people of all ages globally suffer from depression, and depression is the leading cause of disability worldwide. However, some researchers have raised serious questions about the reliability of these disease burden estimates. One study concluded that poor-quality data limit the interpretation and validity of global burden of depression estimates. They warn that uncritical application of these estimates to international health-care policymaking could divert scarce resources from other public health-care priorities. While industry certainly profits from a biological approach that emphasizes these disease burden estimates, the attainment of the right to health globally becomes ever more elusive.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
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Corruption and the right to health 2017, para. 78
- Paragraph text
- It is the global burden of such obstacles, rather than the global burden of mental disorders, that should be addressed as a priority in mental health policies and services. In that connection, corruption in mental health research, education and services should be addressed as one of the most important concerns or obstacles.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 79
- Paragraph text
- Indeed, institutional corruption in mental health has reinforced the medicalization of emotional distress and has thereby undermined the ability of decision makers to focus on the underlying and social determinants of health and address the way in which the health of socially disadvantaged groups is determined by exposures to societal and environmental risks and resources.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 80
- Paragraph text
- Certainly, many people are in need of mental health services and often they do not have access to them. However, all stakeholders, especially policymakers and the leadership of the psychiatric profession, must address the fact that overdiagnosis and overtreatment of milder forms of anxiety, depression, inattention, age-related cognitive decline and the like unnecessarily creates pathological identities in people and exposes individuals to the iatrogenic effects of labelling and the side effects of treatments without offering them benefit to offset the harm. Individualizing, decontextualizing and medicalizing emotional distress reinforces health disparities by reducing the capacity of health systems to serve those with more severe mental health problems — the ones, often from disadvantaged groups, who need the care the most.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 81
- Paragraph text
- The medicalization of the public mental health field is driven by a lack of transparency and accountability in medical education and research and leads to biased evidence being translated into practice worldwide. This is an unacceptable tendency and must be addressed by States and international organizations, with a view to ensuring that mental health policies nationally and globally are driven by non-biased evidence and a human rights-based approach. The obvious crisis in academic psychiatry, influenced by a doubtful relationship with the pharmaceutical industry, has contributed to what could be called the “corruption of knowledge” in mental health and represents a warning signal not only to mental health-care practice and research but to the health sector as a whole.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 82
- Paragraph text
- Corruption has a devastating effect on good governance, the rule of law and equitable access to public goods and services. Corruption is a human rights concern and it has a particularly damaging effect on the enjoyment of the right to health. The health sector is especially prone to corruption, which threatens the sustainability of health-care systems worldwide.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 83
- Paragraph text
- The right to health offers a valuable normative framework and a legally binding imperative to address corruption in and beyond the health sector. The framework embraces the principles of good governance, transparency, accountability and participation. The right to health is closely related and dependent on other human rights, which are also important for combating corruption, including freedom of expression, which gives guarantees to whistle-blowers.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 84
- Paragraph text
- All forms of corruption at all levels have a negative impact on realization of the right to health. Many of these forms originate from power imbalances and asymmetries, which are widely prevalent in the health sector. Such asymmetries are perpetuated by non-transparent decision-making and reinforce ineffective and harmful policymaking and health services provision.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 85
- Paragraph text
- In accordance with their legal obligations under international human rights law, as well as high-level political commitments made in the Sustainable Development Goals to address corruption and develop effective, accountable and transparent institutions by 2030, States should provide leadership to confront the domestic and global causes of corruption and its impact on the right to health through legal, policy and programming measures in the health and related sectors.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 86
- Paragraph text
- Applying a human rights-based approach to health and related policies and avoiding selective approaches to human rights and the production and use of evidence in the realization of the right to health are the most effective measures for combating corruption.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87a
- Paragraph text
- [The Special Rapporteur urges States to:] Implement the United Nations Convention against Corruption and to explicitly criminalize the corrupt acts identified in that treaty and which are also prevalent in the health sector;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87b
- Paragraph text
- [The Special Rapporteur urges States to:] Ensure the integration of the right to health as a standard in anti-corruption laws and policies aimed at regulating the health sector;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87c
- Paragraph text
- [The Special Rapporteur urges States to:] Provide for comprehensive whistle-blower protection for those reporting corruption offences in the health sector and beyond, which includes guaranteeing the anonymity and protection of whistle-blowers;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87d
- Paragraph text
- [The Special Rapporteur urges States to:] Progressively build resilient health systems, with a special focus on health promotion and primary care, so as to root out the problem of systemic incentives for corruption in health sector;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87e
- Paragraph text
- [The Special Rapporteur urges States to:] When elements of a health sector are decentralized or handed over to the private sector, to ensure that there are sufficient checks and balances to ensure that this transition addresses corruption and, at the least, does not lead to more corruption. There must be adequate oversight, transparency and monitoring of private sector and decentralized provision;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87f
- Paragraph text
- [The Special Rapporteur urges States to:] Raise awareness among the actors in the health sector, including health-care providers, insurers and the providers of medicines and medical equipment about the harmful effects of corruption on the right to health and insist on their responsibilities under the right to health;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87g
- Paragraph text
- [The Special Rapporteur urges States to:] Raise awareness among the general population about the negative impact of all forms of corruption in the health sector on individual and societal health and well-being. National human rights institutions can play a role in such awareness-raising and this may include the establishment of corruption-reporting hotlines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87h
- Paragraph text
- [The Special Rapporteur urges States to:] Guarantee the right to participation of the population in all actions aimed at combating corruption in health, such as through the disclosure of important health-related information, as well as in the design and delivery of health programmes;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87i
- Paragraph text
- [The Special Rapporteur urges States to:] Engage a variety of stakeholders, such as community organizations, professional organizations and civil society organizations, including those representing groups in vulnerable situations, in determining the allocation of funding, as well as in monitoring budget expenditure at the national, local and institutional levels;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Humanitarian
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87j
- Paragraph text
- [The Special Rapporteur urges States to:] Ensure monitoring and accountability in the health sector and related sectors through the establishment of well-resourced and independent anti-corruption and fraud agencies, as well as accessible and effective accountability procedures for health system users who encounter corrupt practices;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87k
- Paragraph text
- [The Special Rapporteur urges States to:] Ensure judicial and other forms of review of violations of anti-corruption legislation; and effective remedies where corruption leads to a violation of the right to health;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87l
- Paragraph text
- [The Special Rapporteur urges States to:] Address petty corruption by health professionals by guaranteeing decent living wages and working conditions, job security and reward for good performance and conduct;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87m
- Paragraph text
- [The Special Rapporteur urges States to:] Prevent misuse of dual practices whereby health-care providers inappropriately refer patients to their own private practices; and take measures to reduce theft and improper billing in hospitals;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87n
- Paragraph text
- [The Special Rapporteur urges States to:] Create awareness among health-care providers that preferential treatment of well-connected individuals is unethical and at odds with the main principles for realization of the right to health;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87o
- Paragraph text
- [The Special Rapporteur urges States to:] Develop non-biased and evidence-based treatment guidelines to reduce opportunities for corruption;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87p
- Paragraph text
- [The Special Rapporteur urges States to:] Create awareness, for example through the development of ethical guidelines, among health-care providers that they should remain independent from outside organizations and avoid conflicts of interest with the best interests of their patients;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87q
- Paragraph text
- [The Special Rapporteur urges States to:] Create awareness among health system users of their rights as well as identifying and reporting corrupt acts;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 87r
- Paragraph text
- [The Special Rapporteur urges States to:] Support initiatives that prevent excessive and unnecessary use of diagnostic and treatment interventions and involve users of services in shared decision-making with medical doctors.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88a
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Take into account the Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines (A/63/263, annex);
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88b
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Address, through legal, policy and other measures, corrupt practices taking place in all stages of the pharmaceutical value chain, including during research and development, manufacturing, registration, distribution, procurement and marketing of medicines;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88c
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Strengthen measures to address corruption and unethical practices in the process of generation of knowledge through research, dissemination of such knowledge through medical education and the development of guidelines for diagnostics and treatment of health conditions;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88d
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Strengthen those elements in the medical education curriculum of future medical doctors that strengthen their knowledge and skills in order to prevent them from becoming involved in corrupt acts, unethical behaviour, reliance on excessive and unnecessary medical interventions, disease mongering, favouritism, informal payments and other practices that are either corrupt or increase the risk of corruption;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88e
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Address the production and dissemination of biased outcomes of research in psychiatry and prevent, through transparent changes in medical education, research and practice, institutional corruption in psychiatry and mental health care;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2017
Paragraph
Corruption and the right to health 2017, para. 88f
- Paragraph text
- [The Special Rapporteur also urges other relevant stakeholders to:] Enhance transparency and avoid misusing the principle of academic autonomy when investments in health and health care are addressed, so that the integrity of academic medicine and its commitment to the realization of the right to health is not undermined.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2017
Paragraph
Criminalisation of sexual and reproductive health
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2011
- Document code
- A/66/254
Document
Criminalisation of sexual and reproductive health 2011, para. 6
- Paragraph text
- The right to sexual and reproductive health is an integral component of the right to health. The International Covenant on Economic, Social and Cultural Rights emphasizes aspects of the right to sexual and reproductive health in article 12.2 (a). General Comment No. 14 of the Committee on Economic, Social and Cultural Rights states that the right to health includes measures to improve child and maternal health, sexual and reproductive health services, including access to family planning, prenatal and post-natal care, emergency obstetric services and access to information, as well as to resources necessary to act on that information (E/C.2/2000/4, para. 14). Moreover, it notes that women's right to health requires the removal of all barriers interfering with access to health services, education and information, including in the area of sexual and reproductive health (ibid., para. 21). The recommendations of the Committee have consistently supported that approach.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Children
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 7
- Paragraph text
- The Convention on the Elimination of All Forms of Discrimination against Women requires States to take action to ensure that women are afforded broad equality in, inter alia, education, employment and access to health care. The Convention specifically provides for a proper understanding of maternity as a social function, access to family planning information, and the elimination of discrimination against women in marriage and family relations. Furthermore, article 16.1 (e) mandates that women be provided the same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise those rights.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Children
- Families
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 8
- Paragraph text
- The Convention on the Rights of the Child provides for the protection of the right to health of young persons under the age of 18. Article 24 of the Convention affirms the right to health as established in the International Covenant on Economic, Social and Cultural Rights, which is especially relevant given the importance of sexual and reproductive health to the lives of young women and men. The Convention urges States to ensure prenatal and post-natal care for mothers, develop family planning education and services and ensure the elimination of traditional practices that are "prejudicial to the health of children".
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Children
- Men
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 9
- Paragraph text
- Reproductive health rights also feature prominently in the Programme of Action of the 1994 International Conference on Population and Development, the 1995 Beijing Platform for Action and the Millennium Development Goals, which affirm the rights of women to control all aspects of their health, to respect bodily autonomy and integrity and to decide freely in matters relating to their sexuality and reproduction, free of discrimination, coercion and violence. The Beijing Platform for Action states that States should consider removing punitive measures related to sexual and reproductive health. The relationship between improved sexual and reproductive health for women and poverty reduction is particularly emphasized. Unfortunately, the Millennium Development Goals Report 2010 declared that progress in parts of the world in some indicative areas, such as adolescent pregnancy and contraceptive use, had slowed and that aid for family planning as a proportion of total aid to health had declined sharply between 2000 and 2008.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Adolescents
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 10
- Paragraph text
- General Comment No. 14 of the Committee on Economic, Social and Cultural Rights elaborates the concept of reproductive health, stating that women and men have the freedom to decide if and when to reproduce and the right to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice and appropriate health-care services that will, for example, enable women to go safely through pregnancy and childbirth (E/C.12/2000/4, footnote 12). Sexual health is a "state of physical, emotional, mental and social well-being related to sexuality, not merely the absence of disease, dysfunction or infirmity". The Programme of Action of the International Conference on Population and Development states that sexual health includes the right to a satisfying and safe sex life as well as the freedom to decide when and how often to reproduce (A/CONF.171/13, para. 7.2). It also states that sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Men
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 11
- Paragraph text
- Criminal laws are enacted by the State to regulate conduct perceived as threatening, dangerous, or harmful to an individual, to other individuals or society. Such laws represent the strongest expression of the State's power to punish and are among its most intentional acts. Criminal laws punish those who engage in prohibited conduct; they are also intended to deter others from similar conduct, incapacitate and rehabilitate offenders, and provide restitution for victims.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 12
- Paragraph text
- The use of overt physical coercion by the State or non-State actors, such as in cases of forced sterilization, forced abortion, forced contraception and forced pregnancy has long been recognized as an unjustifiable form of State-sanctioned coercion and a violation of the right to health. Similarly, where the criminal law is used as a tool by the State to regulate the conduct and decision-making of individuals in the context of the right to sexual and reproductive health the State coercively substitutes its will for that of the individual.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 13
- Paragraph text
- States also use other legal restrictions, including provisions in civil and administrative laws to restrict or prohibit access and/or availability of sexual and reproductive health services, goods and information.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 14
- Paragraph text
- In their application, criminal laws and other legal restrictions may prevent access to certain sexual and reproductive health-care goods, such as contraceptive methods, directly outlaw a particular service, such as abortion, or ban the provision of sexual and reproductive information through school-based education programmes or otherwise. In practice, these laws affect a wide range of individuals, including women who attempt to undergo abortions or seek contraception; friends or family members who assist women to access abortions; practitioners providing abortions; teachers providing sexual education; pharmacists supplying contraceptives; employees of institutions that are established to provide family planning services; human rights defenders advocating for sexual and reproductive health rights; and adolescents seeking access to contraception for consensual sexual activity.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Adolescents
- Families
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 15
- Paragraph text
- Criminal laws and other legal restrictions on sexual and reproductive health may have a negative impact on the right to health in many ways, including by interfering with human dignity. Respect for dignity is fundamental to the realization of all human rights. Dignity requires that individuals are free to make personal decisions without interference from the State, especially in an area as important and intimate as sexual and reproductive health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 16
- Paragraph text
- Criminal laws and other legal restrictions affecting sexual and reproductive health may amount to violations of the right to health. Although the present report deals predominantly with the impact of these laws and legal restrictions on women and girls, it by no means discounts similar problems faced by men and boys. Women, however, are generally more likely to experience infringements of their right to sexual and reproductive health given the physiology of human reproduction and the gendered social, legal and economic context in which sexuality, fertility, pregnancy and parenthood occur. Persistent stereotyping of women's roles within society and the family establish and fuel societal norms. Many of those norms are based on the belief that the freedom of a woman, especially with regard to her sexual identity, should be curtailed and regulated (see E/CN.4/2002/83, para. 99). Where women transgress these stereotype-driven norms in the pursuit of sexual and reproductive freedom, they are often punished severely, with resultant adverse effects on their health outcomes and violations of their right to health. The criminal laws and other legal restrictions examined in the present report facilitate and justify State control over women's life, such as forcing women to continue unwanted or unplanned pregnancies.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 17
- Paragraph text
- The causal relationship between the gender stereotyping, discrimination and marginalization of women and girls and their enjoyment of their right to sexual and reproductive health is well documented (see E/CN.4/2002/83 and E/CN.4/2004/49). Criminalization generates and perpetuates stigma; restricts their ability to make full use of available sexual and reproductive health-care goods, services and information; denies their full participation in society; and distorts perceptions among health-care professionals which, as a consequence, can hinder their access to health-care services. Criminal laws and other legal restrictions disempower women, who may be deterred from taking steps to protect their health, in order to avoid liability and out of fear of stigmatization. By restricting access to sexual and reproductive health-care goods, services and information these laws can also have a discriminatory effect, in that they disproportionately affect those in need of such resources, namely women. As a result, women and girls are punished both when they abide by these laws, and are thus subjected to poor physical and mental health outcomes, and when they do not, and thus face incarceration.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 18
- Paragraph text
- States most frequently cite two grounds for implementing criminal or other restrictive laws in relation to the right to sexual and reproductive health: public health and public morality. Public morality cannot serve as a justification for enactment or enforcement of laws that may result in human rights violations, including those intended to regulate sexual and reproductive conduct and decision-making. Although securing particular public health outcomes is a legitimate State aim, measures taken to achieve this must be both evidence-based and proportionate to ensure respect of human rights. When criminal laws and legal restrictions used to regulate public health are neither evidence-based nor proportionate, States should refrain from using them to regulate sexual and reproductive health, as they not only violate the right to health of affected individuals, but also contradict their own public health justification.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 19
- Paragraph text
- Securing the rights of women is crucial to improving health outcomes for both sexes. However, substantial underreporting of reproductive and sexual health problems is a serious challenge and probably arises for a variety of political, social, and cultural reasons. By generating a chilling effect on the open exchange of information and data collection, criminalization further exacerbates the underreporting of important health indicators. As a result, effectively addressing poor health outcomes is rendered impossible, and difficulties faced by the international community in meeting core development goals are compounded. Moreover, development indicators do not capture the full impact of criminalization because they only address specific quantifiable public health data and exclude deprivations of dignity and autonomy.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 20
- Paragraph text
- The use by States of criminal and other legal restrictions to regulate sexual and reproductive health may represent serious violations of the right to health of affected persons and are ineffective as public health interventions. These laws must be immediately reconsidered. Their elimination is not subject to progressive realization since no corresponding resource burden, or a de minimis one, is associated with their elimination.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 21
- Paragraph text
- Criminal laws penalizing and restricting induced abortion are the paradigmatic examples of impermissible barriers to the realization of women's right to health and must be eliminated. These laws infringe women's dignity and autonomy by severely restricting decision-making by women in respect of their sexual and reproductive health. Moreover, such laws consistently generate poor physical health outcomes, resulting in deaths that could have been prevented, morbidity and ill-health, as well as negative mental health outcomes, not least because affected women risk being thrust into the criminal justice system. Creation or maintenance of criminal laws with respect to abortion may amount to violations of the obligations of States to respect, protect and fulfil the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 22
- Paragraph text
- The Committee on the Elimination of Discrimination against Women has strongly disapproved of restrictive abortion laws, especially those that prohibit and criminalize abortion in all circumstances (see CEDAW/C/CH/CO/4, para. 19). It has also confirmed that such legislation does not prevent women from procuring unsafe illegal abortions and has framed restrictive abortion laws as a violation of the rights to life, health and information. The Committee on the Rights of the Child is also concerned about the impact of highly restrictive abortion laws on the right to health of adolescent girls. The Committee against Torture has further stated that punitive abortion laws should be reassessed since they lead to violations of a woman's right to be free from inhuman and cruel treatment. The Human Rights Committee concluded that equality between men and women required equal treatment in the area of health and the elimination of discrimination in the provision of goods and services and addressed the need to review abortion laws to prevent rights violations (see CCPR/C/21/Rev.1/Add.10, paras. 20, 28 and 31). The former Special Rapporteur on the right to health called for removal of punitive measures against women who seek abortions (see E/CN.4/2004/49, para. 30).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- Adolescents
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 23
- Paragraph text
- In States where abortion is criminalized, particular grounds for seeking an abortion may be exempt from criminalization. In the most severe cases, however, abortion is completely criminalized without exception - a situation that exists in only a handful of States - or allowed only to save the life of the woman. Approximately 25 per cent of the world's population lives under legal regimes that prohibit all abortions except for those following rape or incest, as well as those necessary to save a woman's life. Slightly less restrictive legal regimes permit abortion on a number of physical health, mental health and socio-economic grounds, such as poverty and number of children. Finally, abortion is unrestricted on any grounds in 56 States, though limits still exist with respect to how late in pregnancy an abortion will be permitted.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 24
- Paragraph text
- Other legal restrictions also contribute to making legal abortions inaccessible. Conscientious objection laws create barriers to access by permitting health-care providers and ancillary personnel, such as receptionists and pharmacists, to refuse to provide abortion services, information about procedures and referrals to alternative facilities and providers. Examples of other restrictions include: laws prohibiting public funding of abortion care; requirements of counselling and mandatory waiting periods for women seeking to terminate a pregnancy; requirements that abortions be approved by more than one health-care provider; parental and spousal consent requirements; and laws that require health-care providers to report "suspected" cases of illegal abortion when women present for post-abortion care, including miscarriages. These laws make safe abortions and post-abortion care unavailable, especially to poor, displaced and young women. Such restrictive regimes, which are not replicated in other areas of sexual and reproductive health care, serve to reinforce the stigma that abortion is an objectionable practice.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 25
- Paragraph text
- The World Health Organization (WHO) has confirmed that legal grounds largely shape the course for women with an unplanned pregnancy towards a safe or an unsafe abortion. As legal restrictions primarily influence whether abortion is safe or not, more unsafe abortions are likely to occur in legal regimes that are more restrictive of abortion. The rate of unsafe abortions and the ratio of unsafe to safe abortions both directly correlate to the degree to which abortion laws are restrictive and/or punitive. Unsafe abortions are estimated to account for nearly 13 per cent of all maternal deaths globally. A further 5 million women and girls suffer short- and long-term injuries due to unsafe abortions, including haemorrhage; sepsis; trauma to the vagina, uterus and abdominal organs; cervical tearing; peritonitis; reproductive tract infections; pelvic inflammatory disease and chronic pelvic pain; shock and infertility.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 26
- Paragraph text
- The conditions under which unsafe abortions occur include: limited access to information, particularly concerning when and how legal abortions may be obtained; abortion induced by an unskilled provider in unhygienic conditions or by a health-care worker outside of appropriate facilities; abortion induced by the woman herself or a traditional medical practitioner through insertion of an object into the uterus, drinking of a hazardous substance or violent massage; and incorrectly prescribed medicine with no follow-up or further information provided. Criminalization of abortion creates and perpetuates these unsafe conditions. In more liberal regimes, women are able to legally seek service and treatment through professional health-care providers under safe and medically appropriate circumstances, including the use of medical abortion pills, which allow for safe, self-induced early abortions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 27
- Paragraph text
- Criminal prohibition of abortion is a very clear expression of State interference with a woman's sexual and reproductive health because it restricts a woman's control over her body, possibly subjecting her to unnecessary health risks. Criminal prohibition also requires women to continue unplanned pregnancies and give birth when it is not their choice to do so. States are obliged to ensure that women are not denied access to necessary post-abortion medical services, irrespective of the legality of the abortion undertaken.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 28
- Paragraph text
- States are also obliged to protect against infringement of the right to health by third parties. In States where abortion is prohibited, public health and safety regulations regarding abortion, such as provisions for the training and licensing of health-care workers, cannot exist, thus increasing the potential for unsafe abortion practices. Decriminalization, coupled with appropriate regulation and the provision of accessible, safe abortion services, is the most expeditious method of fully protecting the right to health against third-party violations. Additionally, States should take measures to protect those who provide abortions and related services from harassment, violence, kidnappings and murder perpetrated by non-State actors (religiously motivated or otherwise).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 29
- Paragraph text
- States must take measures to ensure that legal and safe abortion services are available, accessible, and of good quality. Safe abortions, however, will not immediately be available upon decriminalization unless States create conditions under which they may be provided. These conditions include establishing available and accessible clinics; the provision of additional training for physicians and health-care workers; enacting licensing requirements; and ensuring the availability of the latest and safest medicines and equipment.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 30
- Paragraph text
- Women are entitled to equal health protection afforded by the State as part of the right to health. Regardless of the legal status of abortion, women are entitled to receive access to goods, services and information related to sexual and reproductive health. In particular, they are entitled to have access to quality health services for the management of complications, including those arising from unsafe abortions and miscarriages. Such care must be unconditional even where the threat of criminal punishment is present, and it should not be contingent on a woman's cooperation in any subsequent criminal prosecution, or used as evidence in any proceeding against her or the abortion providers. Laws must not require health-care personnel to report women for abortion-related care to law enforcement or judicial authorities.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 31
- Paragraph text
- Absolute prohibition under criminal law deprives women of access to what, in some cases, is a life-saving procedure. Even where a clandestine abortion can be performed in a relatively safe, hygienic setting, it may be financially inaccessible for the most vulnerable women. Poor and marginalized women may instead turn to unsafe, self-induced abortions. Where narrow exceptions to the criminalization of abortion exist, such as to save the life of a woman, criminalization may effectively block access to information about legal abortion services. Women often remain unaware of these exceptions because the stigma surrounding the issue of abortion prevents dissemination and discussion of such necessary information. Legal restrictions on the availability of information relating to abortions also exist because criminal laws often include explicit provisions prohibiting the production and distribution of the information.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 32
- Paragraph text
- The provision of health-care goods and services that are of poor quality is a major problem arising from legal regimes criminalizing abortion. In these circumstances, the lack of State and professional regulation of medical practices means that abortions are performed by unskilled practitioners, in unhygienic conditions, in order to evade law enforcement. On the contrary, when performed by trained health-care providers under appropriate conditions, abortion is one of the safest medical procedures available. Criminalization further prevents practitioners from accessing accurate health information and, where exceptions to criminalization exist, the chilling effect created by its associated stigma may prevent health-care workers from seeking training and information on abortion. Health-care workers who choose to perform abortions under these circumstances may accordingly be uninformed and untrained on appropriate abortion procedure and post-abortion care, reducing the quality and availability of legal abortions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 33
- Paragraph text
- Health-care workers have, on occasion, denied women access to legally available sexual and reproductive health services or simply refused to treat women suffering from complications resulting from a clandestine abortion performed elsewhere. Owing to the stigma surrounding abortion, health-care workers have also provided erroneous information to women, such as stating that a woman may have only one legal abortion.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 34
- Paragraph text
- The marginalization and vulnerability of women as a result of abortion-related stigma and discrimination perpetuate and intensify violations of the right to health. Abortion-related stigma prevents women from seeking abortions and prevents those who undergo abortions from requesting treatment for resulting medical complications. The gross underreporting of abortion - only 35 to 60 per cent are reported - is one indicator of the magnitude of the stigma attached to abortion. Although many social and cultural factors generate and exacerbate the stigma attached to abortion, criminalization of abortion perpetuates discrimination and generates new forms of stigmatization. For example, a woman's infertility may be misunderstood to be the result of a previous abortion, placing "culpability" on the woman as a result of the stigma associated with abortion rather than acknowledging that her infertility may be due to various unrelated health conditions.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 35
- Paragraph text
- The stigma resulting from criminalization creates a vicious cycle. Criminalization of abortion results in women seeking clandestine, and likely unsafe, abortions. The stigma resulting from procuring an illegal abortion and thereby breaking the law perpetuates the notion that abortion is an immoral practice and that the procedure is inherently unsafe, which then reinforces continuing criminalization of the practice.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Harmful Practices
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 36
- Paragraph text
- The criminalization of abortion also has a severe impact on mental health. The need to seek illegal health services and the intense stigmatization of both the abortion procedure and women who seek such procedures can have deleterious effects on women's mental health. In some cases, women have committed suicide because of accumulated pressures and stigma related to abortion. In jurisdictions where rape is not a ground for termination of pregnancy, women and girls who are pregnant as a result of rape but who do not wish to continue their pregnancy are either forced to carry the pregnancy to term or seek an illegal abortion. Both options can cause enormous anguish. In electing to pursue either option, the overarching threat of being investigated, prosecuted and punished within the criminal justice system has significant negative impacts on the emotional health and well-being of both those who seek abortions and those who do not. Moreover, while the psychological impact of seeking an illegal abortion or carrying an unwanted pregnancy to term is well documented, no corresponding evidence supports the existence of long-term mental health sequelae resulting from elective abortion.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 37
- Paragraph text
- Maternal health, prenatal and post-natal care, and access to information, are all elements of the right to health elaborated under General Comment No. 14. Additionally, article 10.2 of the International Covenant on Economic, Social and Cultural Rights provides that special protection should be accorded to mothers. The Convention on the Elimination of All Forms of Discrimination against Women also recognizes that women should be provided with appropriate services in connection with pregnancy. In chapter VII.A., the Programme of Action of the International Conference on Population and Development observes that reproductive health includes access to services that enable women to go through pregnancy and childbirth safely. Despite these positive obligations to support women during pregnancy and post-birth, certain States have proposed or enacted criminal laws or other legal restrictions prohibiting certain forms of conduct, which infringe the right to health of affected women.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Infants
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 38
- Paragraph text
- In certain jurisdictions, pregnant women have been prosecuted for various types of conduct during pregnancy. A number of prosecutions have occurred in relation to the use of illicit drugs by pregnant woman, including under pre-existing laws relating to child abuse, attempted murder, manslaughter and criminally negligent homicide. Criminal laws have also been used to prosecute women for other conduct, including alcohol use during pregnancy, the birth of stillborn babies or the miscarriage of a foetus (see A/HRC/17/26/Add.2, para. 68), failing to follow a doctor's orders, failing to refrain from sexual intercourse, and concealment of the birth.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Violence
- Person(s) affected
- Children
- Infants
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 39
- Paragraph text
- In some instances, civil legislation related to child welfare has been expanded to include punitive sanctions for prenatal drug exposure, where such exposure may provide a ground for the termination of parental rights and the removal of the child upon birth. A pregnant woman's positive toxicology report or clinical signs of drug exposure in newborns, may be regarded as proof of child abuse or neglect under these legislative schemes. In some jurisdictions, health professionals are required to test pregnant women or newborns for drug exposure or may do so provided the woman is given notice. Others have enacted legislation authorizing the institutionalization of women who have used drugs during pregnancy. Health professionals may also be obliged to report positive drug-screening results to the Government.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Children
- Infants
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 40
- Paragraph text
- Some States have also criminalized perinatal HIV transmission. For example, in one jurisdiction, a person infected with HIV (and aware of the fact) must "'take all reasonable measures and precautions to prevent the transmission of HIV to others and in the case of pregnant women, the foetus', with criminal sanctions imposed for failure to do so" (see A/HRC/14/20, para. 67). In this case, no exception or defence is allowed in relation to unavailability or lack of access to preventive health-care goods, services and information. Statutes from other jurisdictions, which criminalize HIV transmission generally, may also be applied to perinatal transmission.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 41
- Paragraph text
- Criminalization of conduct during pregnancy impedes access to health-care goods and services, infringing the right to health of pregnant women. Where women fear criminal prosecution, they may be deterred from accessing health services and care, as well as pregnancy-related information. For example, women may not seek antenatal services if they are faced with the risk of prosecution from transmitting HIV, which poses a risk to their health and the health of the foetus. This undermines public health objectives related to HIV, because women may refuse testing entirely if they face criminal penalties for transmission.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 42
- Paragraph text
- While public health goals can justify some degree of interference with personal freedoms, it has been well documented that the public health goals are not realized through criminalization; rather, they are often undermined by it (see A/HRC/14/20, para. 51). The application of criminal law to regulate conduct such as alcohol consumption during pregnancy is a disproportionate response and an ineffective deterrent. A number of professional medical associations oppose use of the criminal law as a means to address substance abuse by pregnant women, on the grounds of ineffectiveness and disproportionality. In order to realize public health outcomes effectively and simultaneously promote the right to health of women, States should not criminalize such conducts during pregnancy, but rather ensure the provision of health-care goods, services and information that promote health throughout pregnancy and childbirth.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 43
- Paragraph text
- Certain criminal laws effectively shift the burden of realizing the right to health away from States onto pregnant women, punishing women for the lack of effective provision of health-care goods, services and education by the Government. For instance, where a woman living with HIV must take all reasonable measures and precautions to prevent the transmission of HIV to the foetus but there is limited or no access to health-care services and antiretroviral treatment, the State fails to provide what is needed for a woman to avoid criminal prosecution. The Special Rapporteur has observed that "where the right to access to appropriate health services … is not ensured, women are simply unable to take necessary precautions to prevent transmission, which could place them at risk of criminal liability" (see A/HRC/14/20, para. 66). As availability of, and access to, health-care goods and services is the responsibility of States, it is particularly perverse that the criminal law has the potential to punish women for the inadequacy of the Government in this respect.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 44
- Paragraph text
- WHO defines family planning as a process that allows people to attain their desired number of children and determine the spacing of pregnancies which is achieved through use of contraceptive methods and the treatment of infertility. Use of family planning methods is an integral component of the right to health. Contraception is a method of fertility control by which family planning is affected. Some forms can also be used for the prevention of sexually transmitted infections, primarily through physical barrier methods of contraception such as condoms. Various other forms of contraception exist, ranging from surgical sterilization to pharmaceutical methods, such as the oral contraceptive pill, which do not protect against sexually transmitted infections.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Children
- Families
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 45
- Paragraph text
- Family planning empowers women to make autonomous and informed choices about their sexual and reproductive health. It reduces maternal mortality by delaying pregnancies in young women who would otherwise face an increased risk of health problems and death from early childbearing. Evidence shows that access to voluntary family planning can reduce maternal deaths by between 25 and 40 per cent. Family planning also reduces the number of unsafe abortions and the perinatal transmission of HIV. Condom use not only results in lower incidences of sexually transmitted infections but, when used correctly and consistently, male condoms are 98 per cent effective toward preventing pregnancy.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Children
- Families
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 46
- Paragraph text
- The global unmet need for family planning remains a significant barrier to achieving rights-related and development goals. WHO estimates that 200 million couples in developing countries would like to delay or stop childbearing but are not using any method of contraception. In 2009, 24 per cent of women of reproductive age in the least developed countries, who were married or in a union, reported not wanting any more children or wanting to delay the birth of their next child. Reasons for the global unmet need included limited access to contraception; limited choice of contraceptive methods; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; and gender-based barriers.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Gender
- Health
- Person(s) affected
- Children
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 47
- Paragraph text
- Family planning allows women to choose whether and when to reproduce and is thus integral to development and the full participation of women in society. In parts of sub-Saharan Africa, contraceptive use is four times higher among women with a secondary education than among those with no education, and is almost four times higher among women in the richest households than those in the poorest households. One cross-national survey suggests that the percentage of women in the labour force is directly related to national birth rates. Strong links have also been observed between contraception use by women and opportunities to work outside of the home; in one country, the average income growth for women with one to three pregnancies was twice that of women who had been pregnant more than seven times.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Gender
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 48
- Paragraph text
- Criminal laws and other legal restrictions that reduce or deny access to family planning goods and services, or certain modern contraceptive methods, such as emergency contraception, constitute a violation of the right to health. The Convention on the Elimination of All Forms of Discrimination against Women calls upon States to ensure access to specific educational information to help to ensure the health and well-being of families, including information and advice on family planning, as well as access to adequate health-care facilities, including information, counselling and services in family planning. In General Comment No. 14, the Committee on Economic, Social and Cultural Rights calls upon States to take measures to "improve child and maternal health, sexual and reproductive health services, including access to family planning … and access to information, as well as to resources necessary to act on that information" (see E/C.12/2000/4, para. 14).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Children
- Families
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 49
- Paragraph text
- In chapter II, principle 8, of the Programme of Action of the International Conference on Population and Development confirms that States should take all appropriate measures to ensure, on a basis of equality of men and women, universal access to health-care services, including those related to reproductive health care, which includes family planning and sexual health. It also stresses the need for participation and notes that family planning programmes are most successful when women are fully involved in the design, provision, management and evaluation of services. It further adds that Governments should remove all unnecessary legal, medical, clinical and regulatory barriers to information and to access to family-planning services and methods. In paragraph 96, the Beijing Platform for Action declares that the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Families
- Men
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 50
- Paragraph text
- However, in many States access to family planning goods and services is severely curtailed by criminal laws and other legal restrictions. In these jurisdictions, women and men (especially the poor) lack access to safe and effective contraception and are denied the freedom to decide whether or not to reproduce.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Men
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 51
- Paragraph text
- For example, some States have criminalized the distribution and use of emergency contraception, justifying such laws with claims that emergency contraception is abortifacient. WHO, however, confirms that emergency contraception is a valid form of contraception. Women who carry an unplanned pregnancy to term as a result of such laws also might face adverse physical and mental health outcomes. At the same time, women who lack access to emergency contraception as a result of criminal prohibitions may ultimately be forced to seek clandestine abortions, thus exposing themselves to the associated health risks.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 52
- Paragraph text
- Restricting access to surgical methods of contraception also contravenes the obligations of States to ensure that quality services are available and accessible. For instance, tubal ligation, a safe and effective sterilization procedure for women, is prohibited by law in some countries except under narrow circumstances where the procedure is therapeutically necessary. Read in conjunction with laws criminalizing violence causing permanent damage to a limb, this law exposes health professionals who perform the procedure to criminal liability, thus restricting women's access to this method of contraception. Women may instead seek tubal ligation procedures in unlicenced health facilities, potentially placing them at the risk of experiencing health complications and effectively denying access to poor women who cannot afford such procedures.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 53
- Paragraph text
- Other laws restricting access to family planning and contraception include a city-wide de facto ban on so-called "artificial" contraception in one jurisdiction, which created significant difficulty for women in accessing reliable forms of birth control (see A/HRC/14/20/Add.1). A total of 70 per cent of the affected population, a majority of whom were poor and marginalized, depended on Government providers for services including female sterilization, oral pills, intrauterine devices and injectables (ibid.). The ban resulted in the absolute deprivation of access to family planning services and contraception for many women and men. In other instances, States require women to obtain their husband's consent and adolescents to obtain parental consent before acquiring various forms of contraception. Other jurisdictions allow pharmacists, and in some cases pharmacies, to refuse to dispense emergency contraception, which is otherwise legally available. These laws directly infringe upon the right of women and girls to make free and informed choices about their sexual and reproductive health and reflect discriminatory notions of women's roles in the family and society.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Adolescents
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 54
- Paragraph text
- Women are also entitled to participate in all decisions affecting their sexual and reproductive health at all levels of decision-making. Community-level participation concerning use of contraception has been shown to increase a woman's autonomy and capacity to freely choose to use condoms, not only providing her with a means of controlling fertility but also protecting her own health in preventing sexually transmitted infections.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 55
- Paragraph text
- The obligation to respect the right to health requires that States abstain from limiting access to contraceptives and other means of maintaining sexual and reproductive health. States should therefore remove criminal laws and other legal restrictions, including parental consent laws and other third party authorizations, to ensure access to family planning and contraceptive goods, services and information. The obligation to protect requires States ensure that neither third parties nor harmful social or traditional practices interfere with access to prenatal and post-natal care and family-planning (see E/C.12/2000/4, para. 35), or curtail access to some or all contraceptive methods. Finally, the obligation to fulfil includes adopting and implementing a national public health strategy, which includes the provision of "a wide range of sexual and reproductive health services, including access to family planning (...) and access to information (see E/CN.4/2004/49, para. 29)".
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Families
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 56
- Paragraph text
- The provision of comprehensive education and information on sexual and reproductive health is an essential component of the right to health and to the realization of other rights, such as the right to education and access to information. Criminal and other laws restricting access to comprehensive education and information on sexual and reproductive health are thus incompatible with the full realization of the right to health and should be removed by States (see E/C.12/2000/4, para. 11). Both women and men are adversely affected by these barriers. Women, however, are disproportionately impacted.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- Men
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 57
- Paragraph text
- General Comment No. 14 places emphasis on access to information because it is a critical component of the right to health (ibid; footnote 8), and particularly guarantees access to sexual and reproductive health information. States are additionally required to provide adequate resources and refrain "from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information (see E/C.12/2000/14, para. 14)". The Committee on the Elimination of Discrimination against Women has recommended that a comprehensive understanding of the content of sexual and reproductive education encompass the topics of reproductive rights, responsible sexual behaviour, sexual and reproductive health, prevention of sexually transmitted infections including HIV/AIDS, prevention of teenage pregnancies, and family planning, and stressed that education campaigns are urgently needed to combat harmful practices such as female genital mutilation. Comprehensive education and information on sexual and reproductive health is also useful in reducing knowledge gaps between men and women on these issues.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- Adolescents
- Men
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 58
- Paragraph text
- The International Guidelines on Sexuality Education of the United Nations Educational, Scientific and Cultural Organization (UNESCO) describe optimal sexual education as "an age-appropriate, culturally sensitive and comprehensive approach … that include programmes providing scientifically accurate, realistic, non-judgmental information". Moreover, comprehensive sexual and reproductive health education and information should provide "opportunities to explore one's own values and attitudes and to build decision-making, communication, and risk reduction skills about all aspects of sexuality". The Special Rapporteur on the right to education has further emphasized that a comprehensive curriculum requires sensitivity to sexual diversity and a gendered perspective (see A/65/162, para. 23).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Gender
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 59
- Paragraph text
- Laws restricting information about sexual and reproductive health and which censor discussions of homosexuality in the classroom fuel stigma and discrimination of vulnerable minorities. For example, laws and policies that promote abstinence-only education reduce sexual education to images and stereotypes of heteronormativity, given their focus on procreation; some of these programmes even contain explicitly discriminatory content on gender and sexual orientation. In certain instances, teachers have been suspended or threatened with lawsuits for engaging in discussions on "inappropriate" sexual matters with their students when discussing sexual and reproductive health issues in the classroom. In other cases, pursuant to abstinence-only and anti-obscenity policies, school districts, courts and legislators have prohibited civil society organizations from meeting in public schools. Such laws and policies perpetuate false and negative stereotypes concerning sexuality, alienate students of different sexual orientations and prevent students from making fully informed decisions regarding their sexual and reproductive health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Equality & Inclusion
- Health
- Person(s) affected
- Ethnic minorities
- LGBTQI+
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 60
- Paragraph text
- Even in jurisdictions where sexual and reproductive health education is permitted in some form, its quality and effectiveness can be severely diminished by policy prescriptions. States have assisted in the dissemination of misinformation on condom use either by distributing materials that contain inaccurate information or by remaining silent on the topic, which allows for the proliferation of contradictory and inaccurate information. Similarly, abstinence-only campaigns that focus only on abstaining from sexual intercourse as a means to avoid sexually transmitted infections and unintended pregnancies provide a narrow and incomplete rather than a comprehensive perspective. Such programmes, which often lack accurate and evidence-based information, have been shown to have a minimal or no effect on reducing the transmission of sexually transmitted infections.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- All
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 61
- Paragraph text
- Studies have shown that while few young people have accurate knowledge about HIV/AIDS, women are generally even less well informed than men. In a UNAIDS study of 147 countries, whereas more than 70 per cent of young men were found to recognize that condoms can protect against HIV, only 55 per cent of young women identified condoms as an effective strategy for HIV prevention. Women and girls are disproportionally impacted by legal restrictions to comprehensive sexual and reproductive health education and information, which both reinforces and exacerbates the gender inequalities that the figures demonstrate. The existence of legal restrictions on access to sexual and reproductive health information and education lead to the provision of inaccurate information through informal sources that are often inaccurate and may reinforce negative gender stereotypes. As a result, young women are less prepared for their sexual and reproductive lives, leaving them vulnerable to coercion, abuse and exploitation, as well as to an increased risk of unintended pregnancy, unsafe abortion, maternal mortality, HIV/AIDS and other sexually transmitted infections.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 62
- Paragraph text
- In jurisdictions where aspects of sexual and reproductive health are criminalized, the availability and accessibility of related information is greatly restricted. For example, penal codes may contain specific provisions that prohibit dispensing information on the prevention or interruption of pregnancies, or materials that supposedly conflict with notions of morality or decency. Punishments can range from fines to imprisonment. Moreover, the restriction of information relating to health can be an unintended result of laws relating to other information, such as pornography laws, which can also extend to criminalize sexual and reproductive health materials. Thus, public health and empowerment programmes and activities that rely on such information - educational campaigns on HIV/AIDS and sexually transmitted infection prevention, family planning, domestic violence, gender discrimination, female genital mutilation, sexual diversity, overall sexual and reproductive health - are effectively prohibited. Women and girls are most likely to be affected by this gap in available services and programming because they are exposed to a higher risk of HIV/AIDS and sexually transmitted infections, maternal mortality, unsafe abortion and unwanted or unplanned pregnancies.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 63
- Paragraph text
- Adequate knowledge about sexual and reproductive health has repeatedly proved to be effecting in lowering rates of maternal mortality; preventing unintended pregnancies, unsafe abortion, HIV/AIDS and other sexually transmitted infections; delaying the onset of sexual intercourse; increasing knowledge about family planning options; and protecting against gender-based violence (see E/C.12/2000/4, para. 21). Empowering women through comprehensive education and information on sexual and reproductive health is also imperative since young women often have less power or control in their relationships, which make them disproportionately vulnerable to coercion, abuse and exploitation. As a tool for empowerment and means to critically examine gender inequalities and stereotypes, comprehensive education and information also becomes a way of eroding deeply entrenched systems of patriarchy; such systems perpetuate violations of women's rights, including their right to health (see A/65/162, paras. 7-9). Providing women with knowledge and skills relating to their sexual and reproductive health, related education and information enhances their freedom in making informed health-related decisions, and promotes their equal participation in society.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Education
- Gender
- Health
- Person(s) affected
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 64
- Paragraph text
- States that implement and enforce criminal or other laws to restrict access to sexual and reproductive health information actively reduce access to information and therefore do not meet their obligation to respect the right to health. As a consequence of such laws and the stigma they generate, third parties, such as teachers, publishers, or booksellers may also deny women and girls access to necessary sexual and reproductive health materials. The obligation of States to fulfil the right to health requires that they develop strategies to ensure that comprehensive sexual and reproductive health education and information is provided to everyone, especially women and young girls.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- Girls
- Women
- Youth
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65a
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Formulate public health policies and programmes that disseminate evidence-based information regarding sexual and reproductive health, as well as the prevention of perinatal HIV transmission;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65b
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Develop comprehensive family planning policies and programmes, which provide a wide range of goods, services and information relating to contraception and are available, accessible and of good quality;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65c
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Decriminalize the supply and use of all forms of contraception and voluntary sterilization for fertility control and remove requirements for spousal and/or parental consent;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65d
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Take steps to ensure the availability, accessibility and quality of a full range of contraceptive methods, including both pharmaceutical and surgical contraceptive methods;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65e
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Decriminalize the provision of information relating to sexual and reproductive health, including evidence-based sexual and reproductive health education;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65f
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Formulate policies to ensure that existing criminal laws, such as those concerning pornography, are not applied to restrict access to, or punish those who provide, evidence-based sexual and reproductive health information and education;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65g
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Take steps to standardize national curricula to ensure that sexual and reproductive education is comprehensive, evidence-based, and includes information regarding human rights, gender and sexuality;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65h
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Decriminalize abortion, including related laws, such as those concerning abetment of abortion;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65i
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Consider, as an interim measure, the formulation of policies and protocols by responsible authorities imposing a moratorium on the application of criminal laws concerning abortion, including legal duties on medical professionals to report women to law enforcement authorities;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65j
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Ensure safe, good quality health services, including abortion, using services, in line with WHO protocols;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65k
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Establish policies and programmes to ensure the accessibility and availability of safe, reliable and good quality services for abortion-related complications and post-abortion care, in line with WHO protocols, particularly in jurisdictions where abortion is criminalized;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65l
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Ensure that accurate, evidence-based information concerning abortion and its legal availability is publicly available and that health-care providers are fully aware of the law related to abortion and its exceptions;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65m
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Ensure that conscientious objection exemptions are well-defined in scope and well-regulated in use and that referrals and alternative services are available in cases where the objection is raised by a service provider;
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2011
Paragraph
Criminalisation of sexual and reproductive health 2011, para. 65n
- Paragraph text
- [In applying a right-to-health approach, States should undertake reforms toward the development and implementation of policies and programmes relating to sexual and reproductive health as required by international human rights law. In that context, the Special Rapporteur calls upon States to:] Suspend/abolish the application of existing criminal laws to various forms of conduct during pregnancy, such as conduct related to treatment of the foetus, most notably miscarriage, alcohol and drug consumption and HIV transmission.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- Women
- Year
- 2011
Paragraph
Deprivation of liberty and the right to health1
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2018
- Document code
- A/HRC/38/36
Document
Digital innovation, technologies and the right to health
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2023
- Document code
- A/HRC/53/65
Document
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ...
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Legal status
- Non-negotiated soft law
- Document type
- Special Procedures' report
- Year
- 2014
- Document code
- A/69/299
Document
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 5
- Paragraph text
- While the enforcement of the right to health has made great strides since the development of the right to health framework, justiciability of the right remains contested. The Committee on Economic, Social and Cultural Rights confirms the justiciability of economic, social and cultural rights generally, but does not elaborate on their justiciable components. All the components of the right to health are justiciable and courts have adjudicated on and enforced the specific obligations of the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 6
- Paragraph text
- Economic, social and cultural rights have historically been accorded less attention than civil and political rights, given that they have erroneously been seen as non-justiciable because of alleged inherent differences between the two sets of rights. Initially, only one international human rights covenant, containing both civil and political rights and economic, social and cultural rights, was envisaged. When it came to drafting that unified instrument, however, the Commission on Human Rights believed that the nature of the rights were different and convinced the General Assembly of the necessity of two separate covenants (A/2929, chap. II, para. 9). The rationale was that "[civil and political rights] were rights of the individual 'against' the State, i.e., against unlawful and unjust action of the State", while economic, social and cultural rights required States to take positive action (ibid., para. 10).
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Social & Cultural Rights
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 7
- Paragraph text
- The division between both sets of rights is artificial, given that there is no intrinsic difference between them. Both may require positive actions, are resource dependent and are justiciable. The requirement to take "necessary steps" in the International Covenant on Civil and Political Rights (art. 2 (2)) is a positive obligation that requires time and resources (A/56/55, paras. 21-23). For example, the right to a fair trial requires States to provide courtrooms, trained professionals and other resources that require time, money and expertise to develop. The Human Rights Committee states that the International Covenant on Civil and Political Rights imposes both negative and positive obligations on States. Civil and political rights were assumed to be justiciable and immediately enforceable because the necessary infrastructure and the means of enforcement already existed when the covenants were drafted.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 8
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- The Vienna Declaration and Programme of Action stresses the indivisible, interdependent and interrelated nature of the two sets of rights. This is reinforced by the necessity of the realization of one to fulfil the other. For example, ensuring equal treatment of men and women in all spheres of their lives, such as the right to found a family, contained in article 23 (2) of the International Covenant on Civil and Political Rights, cannot be achieved unless the right to sexual and reproductive health of women is realized by ensuring their right to access health facilities, goods and services.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- Families
- Men
- Women
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 9
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- Dignity underlies all human rights and was included in the Universal Declaration of Human Rights and both covenants. In its resolution 421 (V) E, the General Assembly recognized that dignity requires full enjoyment of both civil and political rights and economic, social and cultural rights. Some domestic and regional courts have torn asunder the artificial division between the two sets of rights by developing a justiciable right to health through the recognition of dignity. For example, the Supreme Court of India found that to "enhance the dignity of the individual" the right to life should include the right to the basic necessities of life. That right has itself become a stand-alone aspect of the right to health. The Inter American Court of Human Rights views the right to life as containing a positive obligation to "generat[e] minimum living conditions that are compatible with the dignity of the human person", which includes providing the underlying determinants of health for vulnerable groups.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 10
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- The right to health imposes overlapping obligations of immediate effect on States. They include the immediate obligations of non-discrimination and to take steps towards the progressive realization of rights, the core obligation to ensure the minimum essential levels of the right and the obligations to respect and protect. Immediate obligations are outside the ambit of article 2 (1) of the International Covenant on Economic, Social and Cultural Rights. Core obligations are the minimum essential level of a right and are not progressively realized. Duties to respect and protect are akin to obligations under the International Covenant on Civil and Political Rights to respect and ensure - because the duty to ensure includes the duty to protect - which indisputably are justiciable.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 11
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- These obligations of immediate effect may in fact be dependent on resources for their implementation. For example, States may not want to provide expensive medicine, but in cases of essential medicines, they are required to fulfil this obligation. Even if an obligation of immediate effect depends on resources, a State may not rely on the lack of resources as a defence or excuse for not fulfilling the obligation.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Health
- Person(s) affected
- N.A.
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 12
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- The inherent justiciability of these components of the right to health has been demonstrated by the decisions of regional and domestic courts.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- N.A.
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 13
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- Courts are experienced in adjudicating the immediate obligation of non discrimination with regard to health. For example, in Eldrige v. British Columbia (Attorney General), the Supreme Court of Canada found that the Medical and Health Care Services Act discriminated against deaf and hard of hearing people because its lack of provision for sign language interpreters denied them equal benefits under the law.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 14
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- As the United Nations High Commissioner for Human Rights noted in a report to the Economic and Social Council, retrogressive measures are presumptively a violation of the obligation to take steps towards the progressive realization of economic, social and cultural rights (E/2007/82, para. 19). States have the burden to demonstrate that retrogression is not a violation, making the adjudication necessary to determine whether a violation in fact occurred. Retrogression was assessed in decision No. 39/84 of 1984 of the Constitutional Court of Portugal in a case where the Government had attempted to repeal the law that established the National Health Service. The Court found that, once a State fulfils a constitutional obligation, the Constitution protects against abolishment, turning the obligation from a purely positive one to both a positive and a negative obligation.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 15
- Paragraph text
- Core obligations have been adjudicated under the right to life, which obliges the State to ensure the necessities for life. For example, the Supreme Court of Argentina, in Reynoso (2012), found that the State had an obligation to guarantee people access to basic goods and services necessary for their health and life.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 16
- Paragraph text
- Courts have enforced obligations to respect and protect with regard to the right to health. The African Commission on Human and Peoples' Rights elaborated, in Social and Economic Rights Action Center and Center for Economic and Social Rights v. Nigeria, that the obligation to respect within the right to health requires a State "to respect the free use of resources" of an individual or group "for the purpose of rights-related needs". In Marangopoulos Foundation for Human Rights v. Greece, the European Committee of Social Rights held that the State must engage in stronger regulatory practices to protect air quality, including the regulation of private actors, to protect its obligation under the right to health.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 17
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- Only judicial or quasi-judicial bodies and not purely administrative mechanisms can provide access to effective remedies as required by the right to health framework. Effective remedies require an adjudicator to provide appropriate reparation. Only an adjudicator can assess whether the right to health has been violated and provide reparation that includes restitution and guarantees of non-repetition. Restitution often requires imposing an obligation on a third party, such as requiring a hospital to provide essential medicines, and guarantees of non-repetition can be obtained only through structural policy changes that involve other government agencies. Administrative remedies are limited to violations of the relevant statute, and the scope of the statute does not allow the imposition of obligations on other agents and thus cannot provide effective remedies.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Person(s) affected
- All
- N.A.
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 18
- Paragraph text
- Any debate about the general justiciability of the right to health ended with the entry into force of the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights on 5 May 2013 and the Optional Protocol to the Convention on the Rights of the Child on a communications procedure on 14 April 2014. It is recommended that States ensure that the right to health is justiciable in their domestic jurisdictions. Most individual obligations of the right to health are clearly justiciable, and only obligations to fulfil that are progressively realizable require further analysis to confirm their justiciability.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Governance & Rule of Law
- Health
- Year
- 2014
Paragraph
Effective and full implementation of the right to health framework, including justiciability of ESCR and the right to health; the progressive realisation of the right to health; the accountability deficit of transnational corporations; and the current ... 2014, para. 19
- Paragraph text
- Similar to other economic, social and cultural rights, and in keeping with article 2 (1) of the Covenant, the right to health allows States to realize some rights progressively. The progressive realization of the right to health obligations is premised on the understanding that States with limited resources may have the capacity to implement health programmes only in a phased manner.
- Body
- Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
- Document type
- Special Procedures' report
- Topic(s)
- Equality & Inclusion
- Health
- Person(s) affected
- N.A.
- Year
- 2014
Paragraph