A/HRC/38/36 Broad and sweeping public-health frameworks established by law limit the toolbox available to policymakers for addressing health challenges, making detention and confinement the dominant and most restrictive means for addressing health concerns that are, according to evidence, better responded to in supportive community environments; (c) The dominance of detention and confinement as a response to issues of public safety and public health has led to a monopolization of resources that should be redistributed to support the progressive development of robust health-care systems, safe and supportive schools, programmes to support healthy relationships, access to development opportunities and an environment free from violence; (d) Safeguarding the right to health once a person is incarcerated is a challenging task. Prison itself becomes a determinant of poor health as a result of poor conditions of detention, the provision of health care under surveillance and/or a lack of access to health care, the enormous psychosocial pain and hopelessness linked to being deprived of liberty, and untreated pre-existing health conditions attributable to the conditions of living in poverty.12 Mortality rates are high; in many cases, suicides and premature deaths in custody, almost all preventable, conclude harrowing tales of lives cut short; (e) Detention and confinement among young, low-income families who have lost breadwinners and primary care providers to incarceration have a devastating impact on the social fabric of communities. Upon release, people commonly receive no health-care support when reintegrating into society. Furthermore, without robust health-care systems in the community, deinstitutionalization may lead to tragedy. 13 Criminal records, post-release surveillance and commitment orders follow individuals into their political, social and working lives, lowering resilience, creating barriers to opportunity and integration and ultimately undermining the right to health. 20. In sum, the enjoyment of the right to health in the context of confinement and deprivation of liberty is conspicuous by its absence. B. Right-to-health framework 21. Human rights standards aimed at safeguarding persons deprived of liberty, or in confinement, against violations of their rights exist. However, the specificity of the normative scope and a lack of political will restrict the scope of responses to this highly complex social phenomena. A structural assessment, from a right-to-health perspective, of the “climate” of prison, detention and confinement, that is, how people experience life and survive once inside, how power is structured and organized and the structural factors that enable practices and institutions to persist, would help to broaden such responses.14 Obligations of the State 22. Under article 12 of the International Covenant on Economic, Social and Cultural Rights, States have the obligation to respect, protect and fulfil the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The Committee on Economic, Social and Cultural Rights has stated that, under the same article, States are obligated to refrain from denying or limiting equal access for all persons, including prisoners or detainees, to preventive, curative and palliative health services. 15 Other 12 13 14 15 6 Dora M. Dumont and others, “Public health and the epidemic of incarceration”, Annual Review of Public Health, vol. 33 (April 2012), and Ernest Drucker, A Plague of Prisons: The Epidemiology of Mass Incarceration in America (New York, New Press, 2013). See, for example, the joint urgent appeal, dated 28 November 2016 addressed to the Permanent Mission of South Africa to the United Nations Office and other international organizations in Geneva. Available from https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublicCommunicationFile?gId=22868. Tomas Max Martin, Andrew M. Jefferson and Mahuya Bandyopadhyay, “Sensing prison climates: governance, survival and transition”, Focaal, No. 68 (2014). See general comment No. 14 (2000) on the right to the highest attainable standard of health, para. 34.