A/HRC/41/34 I. Introduction 1. The promotion and protection of the right to mental health and well-being is a priority area for the Special Rapporteur (see A/HRC/29/33). In previous reports and other activities, the mandate holder has brought mental health into focus as a human rights and development priority. In the present report, the Special Rapporteur highlights the importance of the social and underlying determinants of health in advancing the realization of the right to mental health. He uses a mental health promotion framework that emphasizes the importance of improving well-being for everyone including, but not limited to, persons with intellectual, cognitive, psychosocial or other disabilities. A rights-based approach to the promotion of mental health offers an alternative to the biomedical, disease-oriented model that adopts a narrow, individual focus on the prevention of mental health conditions. He highlights the need for and States’ obligations to create and sustain specific conditions that promote a life of dignity and well-being for all. 2. International political processes and commissions have galvanized action on health promotion, commencing with the Ottawa Charter for Health Promotion, adopted in 1986 at the First International Conference on Health Promotion, which established a radical plan for public health action. In 2008, the World Health Organization (WHO) Commission on Social Determinants of Health published its findings on the determinants of health and their impact on global health inequity. 1 In 2011, States Members of the United Nations adopted the Rio Political Declaration on Social Determinants of Health, affirming a global political commitment to reduce health inequities by addressing social determinants. Similarly, in Goal 3 of the Sustainable Development Goals adopted by the General Assembly in 2015, 2 Member States recognize the interrelatedness and importance of social determinants of health to achieve “healthy lives and promote well-being for all at all ages”. 3. While some reference has been made to human rights in these global commitments, that reference has generally not been well developed, which has been acknowledged as a missed opportunity (see A/71/304). The work undertaken to develop and shape the right to health could more emphatically establish the critical role of the determinants of health. It is important that these two discourses – social determinants and human rights – continue to converge not only in theory, but also in policies and practice. The Special Rapporteur recognizes the amount of research and evidence that links the physical environment to health outcomes and to the enjoyment of the right to health. More research into the psychosocial environment is, however, needed from experts working on human rights and the social determinants of health. 4. Conceptualizing the determinants of mental health requires a focus on relationships and social connection, which demands structural interventions in society and outside the health-care sector. There is still a tendency to use individualized, causal models to identify determinants of mental health, such as youth violence and self-harm. That tendency results in interventions that focus on immediate, individual behavioural factors, rather than adequately addressing the structural conditions, which are the root causes. The system-wide change that is required, even if formulated well in policy documents, is not usually made in practice. Narrow conceptions of determinants, together with an overreliance on biomedical explanations of emotional distress and mental health conditions, deflect political attention away from rights-based policies and actions that promote health. This grossly neglected human rights issue requires urgent action. 5. The explanation of mental health inequities extends well beyond the biological and individual to the social, economic and political. People’s lives are often constrained by inequitable laws, structures of governance and power, and policies that stratify society, profoundly affecting human relationships and how people act throughout their lives. The 1 2 2 WHO, Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health (Geneva, 2008). See General Assembly resolution 70/1.