Statement by Dainius Puras Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of phsyical and mental health at the 71st session of the General Assembly

New York, 25 October 2016

Mr. Chairperson,
Distinguished Delegates,
Ladies and Gentlemen, 

It is a pleasure to be here with you today to discuss my report on the right to health in the context of the 2030 Agenda for Sustainable Development and the Sustainable Development Goals, known as “SDGs”.

The 2030 Agenda is one of the most important and ambitious strategies to emerge from the United Nations. We have learnt from experience that inequities, inequality and discrimination are major threats and obstacles to global development, peace, and the enjoyment of human rights.

At an instrumental level, the SDGs and international human rights law have much to offer each other. The 2030 Agenda includes a commitment to be “implemented in a manner that is consistent with the rights and obligations of States under international law”.  Careful attention to human rights obligations and duties can help galvanize global and national efforts towards implementing the Goals.

The focus of the report that I bring to you today is precisely the contribution that the right to health can make towards the effective implementation of Agenda 2030 and the SDGs.  While in my report I raise many challenges and opportunities, in this statement I would like to highlight a few key issues.

Mr. Chairperson,

The Millennium Declaration and the Millennium Development Goals focused on improved human development outcomes in health, education, poverty and gender equality in low-income countries.  That agenda received unprecedented attention, financial support, and political commitment from the international community throughout its 15 years.

The 2030 Agenda inherits that strategic space and can be a powerful policy tool to influence international and domestic development agendas through the second and third decades of the millennium.  The SDGs are broad, universal, and designed to be integrated, interlinked and crosscutting. Importantly, the 2030 Agenda makes a broad commitment to “[ensuring] that no one is left behind”. 

In my report, I underline that health is central to the SDGs as it is both an outcome of and a path to achieving poverty reduction and sustainable development. Progress in health is both dependent on and a consequence of progress towards Goal 3, but also towards other Goals.

While there are many synergies between the SDGs and the right to health, there are also a number of challenges that I highlight in my report. Many of the health-related targets are reductive in their approach and do not reflect critical right-to health elements, including strong commitment to equality, participation, and accountability.

Many of the Goals’ health-related targets and indicators focus narrowly on biomedical aspects, despite the requirement to ensure that health promotion and primary care are grounded in human rights and modern public health principles. In my view, a superficial interpretation of the health indicators threatens to undermine the fulfilment of right-to-health obligations, in particular of core obligations of immediate effect which include non-discriminatory access to health goods, services, and facilities; access to food, housing and sanitation, safe and potable water, and essential medicines; universal health coverage; and conducive national legal and policy environments. 

In addition, Agenda 2030 suffers from weak accountability requirements, unclear guidance on how to implement the SDGs at the national level and a failure to make commitments or offer guidance on how to transform the global financial system to support such a broad and ambitious global strategy. The role of the private sector also poses various human rights challenges.

Distinguished Delegates,

In my report, I elaborate on a few issues which I consider to be crucial from to ensure a successful implementation of Agenda 2030 and the full realisation of the right to health.  These issues are: inequity and equality; accountability; universal health coverage; and violence.

The commitments to leaving no one behind and ensuring accountability are fundamental principles of human rights. Universal health coverage is crucial to ensuring equity in implementing the right to health, while violence is a vital and under attended underlying determinant of health and a systemic barrier to gaining access to health care, improving well-being and meeting the SDGs.  

I also underline the importance of addressing the grossly unmet need for rights-based mental health services through the 2030 Agenda and the commitment to promote universal health coverage and quality health care.  Mental health care has traditionally been addressed as the management of medical condition with psychotropic medications and institutionalization without the person’s consent.  We should move away from this and invest in community-based social medicine and social psychiatry with a modern public health approach grounded in human rights.

Each of the aforementioned issues represents a new focus compared with the millennium agenda and requires full commitment and operational engagement in both rich and poor countries. The 2030 Agenda targets and indicators do not adequately address those issues, creating uncertainties about how States are to carry out their implementation. In my view, human rights and the right to health can offer a legally grounded and instructive framework to address these gaps. 

In my report, I emphasize that as a key precondition for the full realization of all human rights, including the right to health, civil society actors working on health-related issues should be able to do their work in a safe and enabling environment, which includes the full exercise of public freedoms.

I am particularly concerned about the limited space for civil society and human rights defenders working on health-related rights in many countries. This is particularly the case for those defenders working on women’s rights; on sexual and reproductive health rights, or defending the right to be free from discrimination and violence based on sexual orientation and gender identity. Those who claim land and health-related rights against the powerful interests of private sector actors, such as local and indigenous communities, also face serious risks in many parts of the world.

The 2030 Agenda for Sustainable Development and the SDGs reflect an unprecedented political commitment that offers opportunities for the realization of the right to health and other human rights.
However, to turn this political commitment into reality, pledges must be firmly grounded in international human rights law and the legally binding obligations to promote and protect human rights, including the right to health.

Mr. Chairperson,
Distinguished Delegates,

Amongst other recommendations in my report, I urge States to ensure full compliance with universal human rights law and principles and refrain from selective approaches to the right to health and related human rights when developing strategies towards the implementation of the SDGs. 

National and local legal and policy frameworks should be compatible with the right to health and that national laws, policies and programmes should include targeted actions to support enabling legal and policy environments, with attention to the rule of law, health governance, law enforcement and access to justice.

States should identify disparities and prioritize the most vulnerable through collection and disaggregation of health-related data, using both qualitative and quantitative methods, to monitor progress and support review and accountability in the implementation of the SDGs. 

I want to emphasize that making visible the reality and needs of marginalized populations is crucial to be able to address their situations effectively. For this, States should make sure that the collection of high-quality and timely data for the SDGs are disaggregated in line with the “stratifiers” identified in the 2030 Agenda, and on further grounds as appropriate in the health context of different countries.

I strongly believe that rights holders, in particular those in the most vulnerable situations, should be empowered to participate in the design, implementation and monitoring of laws, policies and practices relevant to implementing the SDGs and realizing the right to health.  For this, all measures that restrict the space for civil society, in particular human rights defenders, to operate should be removed to ensure safe and enabling environments for them to operate.

Health-care systems should be effective, transparent and accountable, with a focus on primary health care and health promotion, and should be ready to address imbalances and power asymmetries within and beyond health-care systems in all decisions aimed at reaching universal health coverage. 

The focus on addressing financial exclusion should not neglect the equally important issue of discrimination on other grounds, such as race, colour, sex, religion, property, birth, physical or mental disability, health status (including HIV/AIDS), sexual orientation and gender identity, age and civil, political, social or other status.

I advocate for States to ensure that the focus on access to essential medicines and other life-saving interventions does not neglect equally important non-biomedical interventions, including psychosocial interventions, that promote mental and physical health and well-being, reduce violence and contribute to the realization of the right to health and the SDGs.

It is in the interest of States to guarantee substantial investments in healthy human relationships, emotional and social well-being and social capital, starting from interventions that address infant-parent interactions in early childhood and moving through the entire life cycle.

I also recommend that the High-level Political Forum on sustainable development meet as often as needed, be well resourced financially and with relevant expertise, and that States report on a regular basis after conducting monitoring and participatory reviews at the national level.  The political forum should consider standards established and reviews undertaken by international human rights mechanisms, such as the universal periodic review, treaty bodies and special procedures of the Human Rights Council.  

Mr. Chairperson,

The 2030 Agenda provides momentum to pave the way, both in developing and developed countries, for sustainable investments in modern public health policies and break the vicious cycle of poverty, inequities, social exclusion, discrimination and violence.

States and other actors implementing the Sustainable Development Goals must not be tempted to target the “low-hanging fruit” at the expense of the most marginalized and vulnerable.  The next two decades are crucial to boost our efforts to transform the world into a more peaceful, just and inclusive global community with particular attention to those in most need. 

Thank you.