A/HRC/38/37 ignores or insufficiently addresses one or more rights, including the right to health, of a group of the population; a failure to address human rights as determinants of health; and a tendency towards policy fragmentation across areas that affect health. 25 Applying the principle of the interdependence and indivisibility of all human rights is therefore essential for the full realization of the right to health.26 22. Strong and committed leadership, including at the highest levels, is indispensable if effect is to be given to the changes necessary to integrate human rights into public health on a sustainable basis. Such leadership is crucial for rectifying the “pathologies of power”: the power imbalances that are often at the root of poor health outcomes for persons in disadvantaged and vulnerable situations. 27 These power differentials cut across relations between government and governed, communities and established authorities, health personnel and the persons they serve, and those who determine social, cultural, religious and other norms and practices and those who are, effectively, compelled to abide by them even to their detriment. Without committed leadership and effective participation, negative power dynamics are likely to continue to undermine the enjoyment of the right to health. 28 Dedicated leadership would oversee the implementation of a coordinated approach to health policy in a whole-of-government push to engage other sectors whose policy has an impact on health, examples being the education, trade, water and sanitation, nutrition and transport sectors. 29 This coordinated approach would have, as a key goal, the realization of “the whole nexus of intersecting, interdependent rights”.30 2. Aligning law and policy with human rights 23. A legal and policy framework anchored in human rights norms is crucial to ensuring the effective implementation of the Sustainable Development Goals relating to the full realization of human rights, including the right to health. In the last decade, there have been significant setbacks regarding the realization of the right to health and human rights in general. The Special Rapporteur on health expressed concern that the effects of the tendency to adopt a selective approach to human rights are most detrimental for groups that are already experiencing discrimination and that are often unable to access health services, with the result that poverty, social exclusion, inequalities and discrimination are reinforced and health suffers. 31 Other negative trends impacting the right to health include rising inequalities, which have seen indigenous peoples, minorities, persons with disabilities and other populations and groups in vulnerable situations face barriers to access to essential services. 24. In the area of sexual and reproductive health and rights, restrictive laws and policies in some countries threaten the gains that have been made so far, particularly in preventable maternal and child mortality. The use of penal laws to hinder access to maternal health services, and to criminalize entire population groups, such as lesbian, gay, bisexual, transgender and intersex persons, sex workers and persons who use drugs, contributes to stigma and discrimination. Its correlation with poor health outcomes of those groups is well documented. 25. In tandem with the protection of the right to health in national law and the adoption of a national health policy, the right to health framework requires that States adopt legislative, administrative, budgetary, judicial, promotional and other measures towards the 25 26 27 28 29 30 31 8 Ibid., para. 42. Ibid., para. 43. Paul Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (University of California Press, 2004). Alicia Ely Yamin and Rebecca Cantor, “Between insurrectional discourse and operational guidance: challenges and dilemmas in implementing human rights-based approaches to health”, Journal of Human Rights Practice, vol. 6, No. 3 (November 2014), p. 463. WHO, Leading the realization of human rights to health and through health: Report of the HighLevel Working Group on the Health and Human Rights of Women, Children and Adolescents (2017), p. 35. Ibid., p. 11. See A/HRC/29/33, paras. 42 and 44–45.