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Statement by Mr Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health at the 29th session of the Human Rights Council

17 June 2015

Mr President, Excellencies,
Distinguished Delegates,
Ladies and Gentlemen,

It is my pleasure to be here with you today. As I took office in August 2014, this is the first time I am addressing the Council in the capacity of the Special Rapporteur on the right to the enjoyment of the highest attainable standard of physical and mental health (right to health).

I am here today to present my first thematic report (A/HRC/29/33), which considers the work of the mandate through its first 12 years and the establishment of the right to health framework, including challenges and opportunities, and outlines how I see the way forward. I also present a report on my country visit to Malaysia, which took place in November last year.

Ladies and Gentlemen,

The analytical framework developed by my predecessors, Paul Hunt and Anand Grover, consists of several key elements and has a general and inclusive application to all aspects of the right to health, including the underlying and social determinants of health, and timely and appropriate medical care.  The framework is intended to address the crucial question of what do human rights in general, and what does the right to health in particular, bring to policy-making process? Despite progress made, the question itself and its practical implications remain valid today, and will continue guiding my work.

My predecessors have elaborated on the challenges and opportunities related to progressive realization of the right to health, and the obligations of immediate effect. They stressed that the perception of the progressive realization of the right to health is often misunderstood in the law, or used as a pretext not to apply the law.  Although the full realization of the right to health is subject to progressive realization, I will continue to underline that our right to enjoy this right takes effect immediately, and it is linked to the planned and budgeted efforts by Governments to ensure the step-by-step complete realization of the right to health for everyone, everywhere.

One of most important obligations of immediate effect related to right to health is the duty to avoid discrimination. I will continue to underline, as done by my predecessors, the need to respect, protect and fulfil the enjoyment of right to health and other related rights of those groups who appear in vulnerable situations and face discrimination in general, including in the exercising the right to health.

The Ebola crisis has starkly reminded us that we should not only react effectively to provide urgent international assistance and contain epidemic outbreaks, we need also to seriously analyze and address the root causes of outbreaks like this.  And one the root causes is generally a lack of capacity or will to implement rights based approach to health policies.  Moreover, there is insufficient attention by global institutions to diseases of poverty and neglected diseases, and huge inequalities within and between States and regions are exacerbated by failing healthcare systems in some countries.

Mr President,

In my report, I present my views on the challenges and opportunities for the full realisation of the right to health that I hope to summarise in this intervention. 

I consider the departure from universal human right principles and standards, as enshrined in Universal Declaration, and from evidence provided by the modern public health approach, as a major obstacle for effective realization of the right to health.

History and evidence show that selective approaches to human rights only reinforce the cycle of poverty, inequalities, social exclusion, discrimination and violence, and are detrimental to the full enjoyment of the right to health. Moreover, inequalities and discrimination remain a crucial factor that hampers the full realization of the right to health as well as the healthy development of individuals and societies.

Unequivocal political will to apply human rights principles and standards to national normative frameworks and public policies is essential in addressing existing imbalances and power asymmetries in the formulation and implementation of health related public policies.
In connection to this, the meaningful participation and empowerment of all stakeholders should be promoted.  I consider trustful partnerships between policy makers in the health sector, and civil society actors, including NGOs, academia and professional associations as one of the cornerstones of effective health systems.  It also acts as a guarantee for the full realization of the right to health and related rights. Moreover, effective monitoring and accountability mechanisms should be in place to ensure the full realisation of the right to health for all.

The role of health sector is becoming increasingly important for the promotion and protection of human rights, in particular of marginalized and disadvantaged groups. In my view, the health sector should take the leadership in the promotion of “health in all policies” approach. 

For the health sector to be able to play this role, healthcare systems need to be operational and well financed, and healthcare services should be available, accessible, acceptable and of good quality. Primary care needs to be strengthened as a crucial foundation of health system, enabling the effective use and enjoyment of modern medicine and public health.

Moreover, achieving universal health coverage is one of the main goals and processes for the post-2015 agenda, and in this connection commitments made in the Alma-Ata Declaration and Ottawa Charter should be re-affirmed and re-vitalized by all stakeholders.

In my report, I stress that there is no health without mental health. Good mental health means much more than the absence of mental impairment. Modern understanding of mental health includes good emotional and social well-being, and healthy non-violent relations between individuals and groups with mutual trust, tolerance and respect to the dignity of every person.  Mental health is relevant to many key elements of the post-2015 agenda and the formulation of the Sustainable Development Goals, and it should be a priority in public policies in parity with physical health. 

I also underline that violence, which is a public health problem, should be considered as a serious human rights challenge with a detrimental impact on the health of individuals and societies. There should be no excuse or justification for any form of violence, and it should be addressed through concerted efforts by all actors.  I hope to contribute to this with the work of the mandate. 

I will use the life-cycle approach to address some of the issues of concern to the mandate.  In future thematic reports and country visits, I plan to show that the effective promotion and protection of the rights of children and adolescents, especially by investing in early childhood, offers huge potential for the full realization of the right to health in our societies.  Synergies between the right to survival and right to holistic development should drive inter-sectorial policies and accountability mechanisms, and I will be elaborating on this in my report to the General Assembly this year.

Ladies and Gentlemen,

During my time in office, I have conducted a country visit to Malaysia, which took place from 19 November to 2 December 2014.  I would like to extend my sincere appreciation to the Government of Malaysia for extending an invitation and for their excellent cooperation before, during and after the visit. 

I commend Malaysia for its commitment to realizing the right to health, in particular for advances made in reducing poverty, increasing spending on health, and improving basic health-related indicators. Maternal and infant mortality rates have plummeted in the last few decades, and the country has effectively controlled the outbreaks of recent epidemics.  The population of Malaysia has enjoyed relatively high standards of healthcare in the past few decades at affordable levels. 

However, in order to fully realize the right to health, I encourage the Government to address a number of serious challenges.  These challenges are connected to what I see as a selective approach to human rights and the discrimination against groups in vulnerable situations mostly based on certain restrictive interpretations of culture or religion that curtail the rights of these groups, including the right to health. These arguments go against international human rights obligations, principles and standards, and when initiated, supported or tolerated by public authorities, they threaten the development of a healthy and inclusive society.

In my report, I make recommendations to the authorities related to the need to ratify ALL human rights treaties and optional protocols, to remove all reservations and ensure timely reporting to monitoring bodies in order to ensure effective accountability for its human rights obligations and its full compliance with established human rights principles and standards. 

During my visit, I assessed issues related to the health-care system and financing, and the barriers to exercise the right to health faced by particular groups such as women and girls; indigenous communities; migrants, refugees and asylum seekers; lesbian, gay, bisexual and transgender (LGBT) persons; persons living with HIV/AIDS; children; and persons with psychosocial and developmental disabilities. I make specific recommendations to address the situation of each group both at the normative and policy levels but also al the health-system level. 

The rights of all people living in Malaysia need to be protected, including the right to health, and more efforts are needed to combat the discrimination of the more disadvantaged groups, and to achieve their full inclusion and participation in society.

Mr President,

Over the past few decades, measurable improvements have been made in health indicators and the realization of the right to health worldwide. This has enabled important progress in development goals, and the introduction in many countries of health related public policies with a human rights and a modern public health approach.

Moreover, the last twelve years have implied the consolidation of the right to health framework based on the key role of human rights in policy making. I hope to continue contributing to the full realisation of the right to health and related rights by providing guidance on how to address current challenges, and how to exploit existing opportunities.  

Ladies and Gentlemen,

I feel honoured and privileged to have been given the opportunity to monitor, examine and promote the realization of the right to health worldwide, and I intend to do so with the support and collaboration of all Member States, national human rights institutions, and civil society organisations.

In the discharge of my functions, while I will be advised by many, I will endeavour to strictly preserve my independence and impartiality.

Thank you for your attention and support.