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United Nations |
A/HRC/29/33 |
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General Assembly |
Distr.:
General 2 April
2015 Original:
English |
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Human Rights Council
Twenty-ninth session
Promotion and protection of all human rights, civil,
political, economic, social and cultural rights,
including the right to development
Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of
the Highest Attainable Standard of Physical and Mental Health, Dainius Pϋras
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Summary |
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In the present
report, submitted pursuant to Council resolution 24/6, the Special Rapporteur
provides a brief account of his activities since he took office in August
2014. |
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The main focus of
the report is on the work of the mandate of the Special Rapporteur on the
right to health, focusing on the right to health framework, and
the development of the contours and content of the right to health. He then
reflects on how he sees the way forward, based on the current context,
challenges and opportunities for the full realisation of the right to health.
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The Special
Rapporteur provides his conclusions and observations. |
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Contents
Paragraphs Page
I. Introduction.........................................................................................................
13
3
II. Activities during the reporting
period..................................................................
412
3
A. Communications transmitted to States.............................................................. 4 3
B. Country visits................................................................................................ 56 3
C. Cooperation with the United Nations system and
intergovernmental
organizations...............................................................................................
711
3
D. Cooperation with non-governmental organizations.......................................... 12 4
III. Overview of the work of the mandate (20032014)........................................... 1331 4
IV. The way forward: context, challenges and opportunities................................... 3263 7
A. The policy approach to the right to health................................................... 3748 8
B. Right to health policies: power asymmetries,
unbalanced approaches and other challenges............................................
4963
9
V. Themes as priorities........................................................................................ 64118 11
A. Global health in the post-2015 agenda........................................................ 6467 11
B. The right to health and public policy........................................................... 6873 12
C. Mental health and emotional well-being.................................................... 7485 13
D. The life-cycle approach to the right to health.............................................. 8692 15
E. The right to health of persons with disabilities.......................................... 93100 16
F. Violence as a major obstacle for the realization of the right to health 101109 17
G. The role of stakeholders......................................................................... 110118 18
VI. Conclusions and observations........................................................................ 119122 20
A. Conclusions............................................................................................ 119121 20
B. Observations................................................................................................. 122 20
Mental health and
emotional well-being
1. The historical divide, both in
policies and practices, between mental and physical health has unfortunately resulted in political,
professional and geographical isolation, marginalization and stigmatization of
mental health care.
2. The
modern public mental health
approach, which emerged in the global scene in the end of twentieth century with a critical mass of new evidence on
the importance of mental health and the effectiveness of integrated approaches,
still faces enormous challenges. It is regrettable that, in many countries and regions of the world, modern mental health care is still not available. Moreover,
in countries which can afford to give resources to
mental-health
services, those
resources are often used to support segregated psychiatric institutions where
stigmatizing and human
rights-unfriendly services are provided.
3. The Special Rapporteur would like
to highlight two key messages of the modern public mental-health approach. Firstly, there is
no health without mental health. Secondly, good mental
health means much more than absence of a mental impairment.
4. The
modern understanding of
mental health includes good emotional and social well-being, healthy
non-violent relations between individuals and groups, with mutual trust
of, tolerance of and respect for the dignity of every person. In that regard, promoting good mental health should be a cross-cutting priority relevant to the
sustainable development agenda, as it is of concern to many of its elements, including the
protection of dignity and
people in order to ensure healthy lives
and strong inclusive
economies; promote
safe and peaceful societies and strong institutions; and catalyse global
solidarity for sustainable development (see A/69/700).
5. By investing in the good mental health of children and
youth, a substantial contribution is made not only to the sustainable development of our economies, for which good emotional and cognitive abilities are needed, but also the root causes of intolerance and social exclusion
are addressed and healthy and cohesive societies promoted.
6. It is estimated that the burden of
mental-health
problems and mental disabilities constitutes 14 per cent of general burden of disease.[1]
However, compared with physical health, mental health is given inadequately low priority and
insufficient human and financial resources.
7. The end of twentieth century brought two main messages to the international community. The first message was about the centrality of mental health in the modern
health policies, based
on the high burden of
mental-health
problems and mental disorders. The second message was that, contrary to the
previous understanding,
effective measures are possible if outdated traditions are abandoned and
the modern public health
approach is applied. In the twenty-first century there is no place for psychiatric
institutions based on stigma and segregation, and there is a need, in
words of G.H. Brundtland to
ensure that ours will be the last generation that allows shame and stigma to
rule over science and reason.[2]
8. However, after more than a decade
since the publication of the landmark World Health Report 2001, mental health remains hostage to outdated attitudes and inadequate
services. Studies show that, in many instances, there is either no access to mental health services at all, or those services are stigmatizing and
violate human rights.[3]
9. One of the significant obstacles to the implementation of modern
public mental-health
principles is a lack of political will, including on global health agenda, to
recognize the centrality
of mental health in the
full realization of the right to health and to implement the principle of parity between physical and mental health. The
Special Rapporteur is concerned that, despite clear
evidence of the increasingly heavy burden of
mental ill-health, many important stakeholders continue to marginalize this field of health.
10. Mental health deserves much more
attention and must be effectively
mainstreamed within
the Sustainable Development Goals through the goals and benchmarks related to health and sustainable development. The high number of suicides and suicide attempts are an indicator that the
mental health of individuals and population needs to be addressed very
seriously.[4] Concerted and effective measures need to be applied to substantively address this challenge and reduce the numbers
of suicides, which have in many countries reached epidemic rates. The Special
Rapporteur will further analyse the relevance of human rights in addressing suicide and other mental
health issues as a public health challenge.
11. In some regions, resources
allocated to mental health care are used ineffectively and predominantly for maintaining large segregated psychiatric
long-term care institutions and separate psychiatric hospitals. In such
institutions, psychotropic medications are too often overprescribed, including
as a measure of chemical restraint or even as a punishment. That is an example of an imbalance: when resources are
used for biomedical
interventions and institutionalization and not for the development of
psychosocial interventions through community-based services meeting more
closely the individual needs of people. Such imbalances feed ineffective
systems, reinforce stigma and social exclusion and lead to systemic violations
of human rights, sometimes amounting to torture or ill-treatment.
12. This, once again, reflects power asymmetries between interest groups
behind different forms
of services and interventions,
and a lack of transparency, monitoring and accountability in mental health-care systems. WHO recommendations are very clear
about the five obligatory components of community-based care for persons with severe
psychosocial disabilities,
which comprise access to psychotropic medications, psychotherapy,
psychosocial rehabilitation, vocational rehabilitation and employment and
supported housing. However,
in many countries, a
number of those components are not being
implemented.[5]
D. The life-cycle approach to the right to health
13. There is overwhelming evidence that many children die too young from preventable causes and/or
suffer high levels of violence and insecurity. Consequently, the health status, quality of life and
well-being of many individuals, groups and entire societies worldwide remain unacceptably low. The Special
Rapporteur believes that the life-cycle approach can
be used as one method
to identify the critical elements of the challenges and opportunities for the
reduction of preventable deaths and the improvement of health indicators,
well-being and quality of life.
14. The Special Rapporteur is planning
to address right-to-health challenges using, among other methods, a life-cycle
approach. Such an approach helps identify critical elements of challenges and
opportunities for full realization of the right to health. It is during some
important stages of the life course that the right to health needs to be
particularly protected, since during those stages there is a greater risk of
violations of human rights, including the right to health. On the other hand,
interventions during those critical stages of life open up new opportunities
and offer new health protective factors. The life-cycle approach can help in
the prevention of chronic diseases in adult life through the effective
protection of children from early childhood adversities.
15. In line with the life-cycle approach, the Special Rapporteur will
dedicate his next thematic report to the challenges to, opportunities for and best practices in promoting the right to health in early childhood. He will
analyse two interdependent and indivisible rights directly related to the right to health: the right to survival and the right to
development during first five years of life.
16. The right to survival relates to the prevention of
infant and under-5
mortality. Despite many achievements in the field of medicine, 6 million children under 5 die every year in the world. Those children do not die of unknown
or incurable diseases or illnesses; they die because of the conditions in which
they and their parents live and poor
governance and accountability.
17. The launch of the technical guidance on the
application of a human rights-based approach to the implementation of policies
and programmes to reduce and eliminate preventable mortality and morbidity of
children under 5 years of age (A/HRC/27/31) in 2014 is a serious attempt to put an end to
the unacceptable epidemics of preventable deaths of infants. The human rights-based approach is critically important in that regard since child mortality is
intimately linked with human rights of women and the widespread discrimination
against vulnerable groups of population.
18. The
right to holistic development
is another equally important element of the right to health of children.
Children need to be protected through the promotion
and protection of their economic, social and cultural rights. Furthermore, from the moment of birth, children
should also be considered as citizens entitled
to all rights, including civil rights and freedoms. Their right to health
should be promoted not only through the prevention of child mortality and
morbidity but also through the protection of childrens right to holistic development.
19. The life-cycle approach will be also be used in addressing the right of adolescents and youth to health; the role of family and parenting; mental-health issues and ways to prevent violence as a public health problem; and important issues around healthy ageing .