Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
47th session of the Human Rights Council
Agenda Item 3: Strategic Priorities of Work
It is a great honour to make my first presentation to the Human Rights Council as Special Rapporteur. I have taken up functions amidst the COVID-19 pandemic which has seen unprecedented demands on resilience of every nation across the world. I would like to pass my sincere condolences to the families of those who died and extend deep gratitude for those who every day are on the frontlines of this pandemic.
Today I bring to your attention two issues. A report on the right to health in Fiji, following a country visit by my predecessor Dainius Pūras, in late 2019, and my first report to the Human Rights Council presenting my strategic priorities and my vision.
The country visit report identified that Fiji had a strong political will to realize the right to health, has modernized outpatient and hospital care, invested in infrastructure and increased doctors’ salaries and initiated public-private partnerships in the health sector.
Mental health care should comply with the requirements of the Convention on the Rights of Persons with Disabilities and ensure investment in community-based rehabilitation, care and support needs. Fiji is also undertaking efforts to increase capacity for maternal health. Unsafe abortion is a leading cause of maternal mortality and morbidity, as well as breast and cervical cancer and violence against women, girls and LGBTIQ persons is high. Calls to repeal laws criminalizing sex workers have not been successful. More efforts will also be needed to address health care for diabetes (one in three people in Fiji has diabetes) and to improve health-care facilities.
In the report on my strategic priorities, I elaborate on my vision for the mandate. I plan to ensure continuity and build on the work undertaken by my predecessors Paul Hunt, Anand Grover and Dainius Pūras.
Through the lens of intersectionality I will address how multiple oppressions and discrimination intersect and the impact this has on the enjoyment of the right to health. People are not intrinsically vulnerable. Vulnerabilities are rather brought by the obstacles people face in the social, economic and political contexts they live. Historic and ongoing discrimination experienced by people on multiple grounds, as well as unsatisfactory economic and social rights, lead to violations and abuses of the enjoyment of the of the highest attainable standard of physical and mental health.
I will examine how racism and coloniality continue to impact the enjoyment of the right to health. Coloniality is to be understood as the living legacies of colonialism in social orders and knowledge systems that created racial hierarchies, enabling a social discrimination that has outlived formal colonialism.
As a Black woman who grew up in the Apartheid era in South Africa and now a medical doctor by profession, I will strive to fulfil my mandate applying anti-coloniality, anti-racism and non-discrimination principles in my approach to the right to health.
To remedy global persistent inequality and ensure accountability, I will adopt a “substantive equality approach” through intersectional frameworks in the realization of the right to health.
During my tenure I will focus, closely monitor and publicly report the following priority themes:
Global health in the area of the COVID-19 Pandemic
There is no doubt that COVID-19 is having a disproportionate impact on Black people, indigenous peoples and other ethnically, religiously and racially persecuted groups, such as the Rohingya and Roma, specifically those located in the global South. The pandemic is also exposing existing structural faultiness of health systems and global inequalities. Countries with less developed health–care services and social determinants of health (such a access to water and food) have experienced a greater burden of COVID-19 victims, both fatalities and persons with long-term consequences. Countries with more financial means have gained preferential access to COVID-19 vaccines, while people in the so-called Global South are being left behind. I support the call for vaccine equity and call upon all players in global health to support temporary waivers of intellectual property to enable low- and middle-income countries to access scientific knowledge and further call on solidarity to support local research, development, manufacturing, distribution and access to COVID-19 vaccine.
Sexuality, gender based-violence and femicide
I agree with my predecesors when they said that violence needs to be addressed in a comprehensive and proactive way, not only as a cause of serious violations of human rights, but also as a consequence of a lack of political will to effectively invest in human rights, including the right to health.
As a first-responder over the years, on matters of sexuality, gender-based violence, femicide and violations against persons on the basis of their real or imputed sexual orientation or gender identity I will ensure a focus on these topics during my tenure.
Sexual and reproductive health rights
Building on the policy approach of my predecessors in this area, as well as WHO working definition on sexual health, I will devote particular attention to the right to sexual and reproductive health with a focus on non-discrimination and with the understanding that sexual health is fundamental to the overall health and wellbeing of individuals, couples and families; that it requires a positive and respectful approach to sexuality and sexual relationships and the possibility of having pleasurable and safe sexual experience, free of coercion, discrimination and violence.
My next report to the General Assembly will be devoted to this topic, and I will then continue to further examine issues related to the impact of COVID-19 on sexual and reproductive health rights, criminalization and other legal restrictions on abortion and conduct during pregnancy, contraception, and the provision of comprehensive sexual and reproductive education and information. I will also work towards ending criminalization of consensual sex between adolescents of similar ages and decriminalisation of sex work.
Innovation and digital technology: sexual and reproductive health rights, digital interventions and tele-health.
Innovation and digital technology are going to keep transforming health care provision more than any other force. National legal frameworks, policy and professional governing body regulations must not impede access to tele-health. COVID-19 catalysed innovation in various regions of the world and I will attempt to champion ongoing equitable digital health-care solutions, in particular regarding sexual and reproductive health rights. We must ensure that the digital divide does not leave others behind and that innovation and digital technology in health do not perpetuate racism, sexism, ableism or discrimination based on gender identity or sexual orientation.
Racism and the right to health
Racism and the connected enjoyment of the right to health will be an important area of my work in the years to come.
In terms of the right to health, systemic racism reinforces other systems of oppression and manifests in differential access to both health care and the underlying determinants of health. People of African descent and indigenous communities experience multiple forms of systemic oppression, land dispossession, that translates in a distribution of resources, power and opportunities along racial lines, to their detriment. Racism leads to increased rates of mortality and morbidity.
Health equity, another priority under my tenure, will only be achieved if structural and systemic barriers to accessing health-care services, goods and facilities are eliminated, and the underlying and social factors of the right to health are met, including food, housing, education, healthy natural and workplace environments. Entitlements such as informed consent, bodily integrity and freedom from torture, ill-treatment and harmful practices, must be achieved in order to promote physical and mental health.
The current COVID-19 vaccine equity crisis, where billions of people in the Global South are being left behind, illustrates the importance of health equity for the realization of the right to health in the midst of an on-going pandemic . It is through the employing the principles of medical ethics and human rights safeguards the world over, that there can be resilient and efficient primary health care infrastructure that serves all people. States, when meeting their obligation to protect, respect and fulfil the enjoyment of the right to health, must end corruption and poor management of resources in the health sector.
Non-communicable diseases: reproductive cancers
During my tenure, I will aim to support ongoing efforts to eliminate cervical cancer. Similarly to the current situation with COVID-19, the current availability of vaccines for the human papillomavirus – the cause of cervical cancer are skewed towards wealthier countries.
I will also look at the right to health progress and challenges to achieve the SDGs and the impact of social determinants of health , as well as at privatization, public-private partnerships and health aid and funding in the health sector.
I am looking forward to the opportunity to cooperate with you on these important issues in order to ensure that billions of people throughout the world realize the full enjoyment of the right to the highest attainable standard of physical and mental health.