In addition, the role of the health sector and that of other sectors in improving the health of individuals and populations must also be balanced. A modern understanding of the effective realization of right to health requires a "health in all policies" approach. To fully achieve goals, such as to reduce infant or under-5 mortality, improve mental health, reduce the burden of non-communicable diseases or promote the health of older persons, all sectors and all branches responsible for public policies need to be involved.

The cooperation between sectors can also be beneficial to facilitate access to preschool education, especially for children of families at risk, and enable community readiness to accept and integrate children and adults with disabilities into all of the everyday life of the community. This approach can also offer opportunities for adolescents and youth at risk to find alternatives to youth violence by engaging them in community programmes that support recreation centres for older persons, thus contributing to the reinforcement of intergenerational links and improving the quality of human relationships in general.

Other thematic reports have explored the enjoyment of the right to health and the underlying determinants, including water and sanitation, occupational health, the right to health in conflict, unhealthy foods, and the right to health of migrants, older persons and persons with psychosocial disabilities (including the key issue of informed consent).

A first requirement is breaking the cycle of discrimination against women. This does not mean simply removing discriminatory provisions in the law, particularly as regards access to land or other productive resources, but it also requires that the structural causes of de facto discrimination be addressed. In particular, measures should be taken to relieve women of the burden imposed on them by the duties they assume in the "care" economy, and to improve their economic opportunities by better access to education and employment. Older women are particularly at risk of food insecurity as the cumulative effect of discrimination in accessing employment tends to leave older women with disproportionately lower (or no) incomes and pensions in later life; yet older women are expected to take care of other, more dependent members of the household.

The right to social security, as guaranteed under the International Covenant on Economic, Social and Cultural Rights, includes access to health care; benefits and services to persons without work-related income due to sickness, disability, maternity, employment injury, unemployment, old age or death of a family member, including contributory or non-contributory pensions for all older persons; family and child support sufficient to cover food, clothing, housing, water and sanitation; survivor and orphan benefits. The Special Rapporteur observes that, in many cases, the specific situation of women is not considered in the design and implementation of programmes. Three examples may serve to illustrate this.

Optimize fiscal expenditures for gender-responsive social protection and care infrastructure, such as equitable, quality, accessible and affordable early childhood education, childcare, elder care, health-care, and care and social services for persons with disabilities and persons living with HIV and AIDS, which meet the needs of both caregivers and those in need of care, bearing in mind that social protection policies also play a critical role in reducing poverty and inequality and supporting inclusive growth and gender equality;

[The Commission [...] urges Governments, at all levels [...] to take the following actions:] [Strengthening normative, legal and policy frameworks]: Undertake all appropriate measures to recognize, reduce and redistribute unpaid care work by prioritizing social protection policies, including accessible and affordable quality social services, and care services for children, persons with disabilities, older persons, persons living with HIV and AIDS and all others in need of care, and promote the equal sharing of responsibilities between women and men;

Urges governments and stakeholders to address the increased vulnerability to HIV faced by older women and women and girls with disabilities, ensuring their equal access to prevention, treatment, care and support, as an integral part of their HIV and AIDS response;

Urges Governments and other relevant stakeholders to address the challenges faced by older women in accessing HIV prevention, treatment, care and support, as well as in caring for people living with or affected by HIV and AIDS, including orphaned children in vulnerable situations;

Encourages Governments to increase the provision of resources and facilities to women who find themselves having to provide care and/or economic support for those infected with HIV or affected by the pandemic and to address the challenges faced by the survivors and caregivers, in particular children and older persons, as well as to ensure the balanced sharing of the provision of care by both men and women;

Urges Governments and other relevant stakeholders to address the challenges faced by older women in accessing HIV prevention, treatment, care and support, as well as in caring for people living with or affected by HIV and AIDS, including orphaned children in vulnerable situations;

Encourages Governments to increase the provision of resources and facilities to women who find themselves having to provide care and/or economic support for those infected with HIV or affected by the pandemic and to address the challenges faced by the survivors and caregivers, in particular children and older persons, as well as to provide the balanced sharing of the provision of care by both men and women;

Urges Governments and other relevant stakeholders to address the challenges faced by older women in accessing HIV prevention, treatment, care and support as well as in caring for people living with or affected by HIV and AIDS, including orphaned children in vulnerable situations;

Urges Governments and other relevant stakeholders to address the challenges faced by older women in accessing HIV prevention, treatment, care and support as well as in caring for people living with or affected by HIV and AIDS, including orphaned grandchildren;

Urges Governments and other relevant stakeholders to address the challenges faced by older women in accessing HIV prevention, treatment, care and support as well as in caring for people living with or affected by HIV/AIDS, including orphaned grandchildren;

Urges Governments and other relevant stakeholders to address the challenges faced by older women caring for people living with or affected by HIV/AIDS, including orphaned grandchildren;

Urges Governments and other relevant stakeholders to address the challenges faced by older women caring for people living with or affected by HIV/AIDS, including orphaned grandchildren;

Encourages Governments to recognize the challenges facing girls and women, particularly older women, who are primary caregivers for people living with HIV/AIDS, and to provide them with the necessary economic and psychosocial support;

Women in rural areas are often disproportionately affected by the lack of adequate health and social services and inequitable access to land and natural resources. Similarly, their situation in conflict settings presents particular challenges with regard to their employment and reintegration, given that it is often exacerbated by the breakdown of services, resulting in food insecurity, inadequate shelter, deprivation of property and lack of access to water. Widows, women with disabilities, older women, single women without family support and female-headed households are especially vulnerable to increased economic hardship owing to their disadvantaged situation, and often lack employment and means and opportunities for economic survival.

The Committee is concerned about the conditions of health-care services for older women, not only because women often live longer than men and are more likely than men to suffer from disabling and degenerative chronic diseases, such as osteoporosis and dementia, but because they often have the responsibility for their ageing spouses. Therefore, States parties should take appropriate measures to ensure the access of older women to health services that address the handicaps and disabilities associated with ageing.

[Actions to be taken by Governments, the United Nations system and civil society, as appropriate:] (h) Adopt preventive and promotional health policies at an early stage where possible in order to prevent health problems and dependence of older women and enable them to lead independent and healthy lives;

Women represent a disproportionate percentage of the world's poor as a consequence of discrimination, leading to a lack of choice and opportunities, especially formal employment income. Poverty is both a compounding factor and the result of multiple discrimination. Older women with disabilities, especially, face many difficulties in accessing adequate housing, they are more likely to be institutionalized and do not have equal access to social protection and poverty reduction programs .

The right of women with disabilities to choose their place of residence may be adversely affected by cultural norms and patriarchal family values that limit autonomy and oblige them to live in a particular living arrangement. Thus, multiple discrimination can prevent the full and equal enjoyment of the right to live independently in the community. In the case of older persons with disabilities, age and impairment, separately or jointly, can increase their risk of institutionalization . In addition, it has been widely documented that institutionalization may expose persons with disabilities to violence and abuse, with women with disabilities particularly exposed .

In its general comment No. 12 (1999) on the right to adequate food, the Committee on Economic, Social and Cultural Rights defined the necessary elements required for the right to food (i.e., the possibility either to feed oneself directly from productive land or other natural resources, or to purchase food) as follows: (a) availability; (b) accessibility; and (c) adequacy. Availability relates to the presence of sufficient food on the market to meet population needs. Accessibility refers to both physical and economic access: physical accessibility means that food should be accessible to all persons, including the physically vulnerable, such as children, older persons and persons with a disability; economic accessibility means that food should be affordable without compromising other basic needs, such as education, health care or housing. Adequacy requires that food satisfy dietary needs (factoring in a person's age, living conditions, health, occupation, sex and so on), be safe for human consumption, free of adverse substances, culturally acceptable and nutritious.

The 1948 American Declaration of the Rights and Duties of Man and the 1969 American Convention on Human Rights are the relevant instruments for the Americas. The Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights of 1988 focuses on the obligation of States to promote social, economic, and cultural human rights. It includes the right to social security, as a protection from the consequences of old age and of disability, which prevents a person from securing the means for a dignified and decent existence.

In general recommendation No. 24, the Committee on the Elimination of Discrimination against Women also discusses issues of concern to women with disabilities. The Committee recognizes that societal factors may be determinative of health status and that special attention should be given to the health needs and rights of women with disabilities, among other vulnerable groups. General recommendation No. 27 pertains to the protection of the human rights of older women and addresses women with disabilities by discussing the double discrimination and gender stereotyping older women with disabilities face, especially in regard to their access to education, health-care services, legal services and their increased susceptibility to violence. General recommendation No. 28 focuses on the core obligations of States parties under article 2 and discusses the enhanced vulnerability for discrimination that women with disabilities face in civil and penal laws, regulations and customary laws and practice. The Declaration on the Elimination of Violence against Women 1993 (see General Assembly resolution 48/104) also makes reference to violence and women with disabilities.

Older women experience disability more frequently as they age, and older women with disabilities are at particularly high risk of violence. Older women face multiple forms of discrimination, with gender, disability and age compounded by other forms of discrimination. General recommendation No. 27 of the Committee on the Elimination of Discrimination against Women, on older women and protection of their human rights, recognizes that, inter alia, gender stereotyping and traditional and customary practices can have harmful impacts on all areas of the lives of older women, in particular those with disabilities, and can result in physical violence as well as psychological, verbal and financial abuse.

Violence against women is too often discussed in a theoretical vacuum that focuses only on interpersonal and structural inequalities between men and women, thereby excluding analysis on intra-gender inequalities. It is important to recognize the obstacles faced by women who experience multiple and intersecting forms of discrimination, for example women with disabilities, women who belong to ethnic or cultural minorities, women who live in poverty, women who live in rural areas, women who lack citizenship status and older women, among others. This increases the risk that some women will experience targeted, compounded or structural discrimination, in addition to gender-based violence (A/HRC/17/26, para. 17).

28. Exhorte les gouvernements à octroyer une aide accrue au titre de l’accueil et de la réintégration de ceux qui sont de retour dans leur pays, en accordant une attention particulière aux besoins des victimes de la traite et des migrants en situation de vulnérabilité, notamment les enfants, les femmes âgées et les femmes handicapées ;

25. Exhorte les gouvernements à octroyer une aide accrue au titre de l’accueil et de la réintégration de ceux qui sont de retour dans leur pays, en accordant une attention particulière aux besoins des victimes de la traite et des migrants en situation de vulnérabilité, notamment les enfants, les femmes âgées et les femmes handicapées ;