A/HRC/44/46 stigmatization. Guarantees of equal opportunities must be context-grounded; they can only be properly enforced with the full participation of affected individuals and their representative organizations. C. Health systems 19. The principles and guidelines set forth an approach to the right of persons affected by leprosy and their family members to the highest attainable standard of physical and mental health that emphasizes the State’s responsibility in guaranteeing free or affordable medical assistance and treatment, access to free essential drugs and psychological and social counselling. In addition, the Special Rapporteur considers the lack of substantive equality, discrimination, the inaccessibility and inadequacy of health-care services, the lack of clinical and structural competence of the health-care workforce, the inaccessibility of public goods and services, the lack of community services and the lack of participation, accountability and transparency mechanisms as social determinants of leprosy that should be addressed within health-care systems. The Special Rapporteur’s conceptualization of the right to the highest standard of physical and mental health by persons affected and their family members is grounded in the provisions set out in the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights and in the work of the treaty bodies. She situates the enforcement of such a right on a continuum of medical and psychosocial care that encompasses the full spectrum of prevention, treatment 5 and rehabilitation and that should be fully addressed by effective referral within national health-care systems. 20. Article 12 of the International Covenant on Economic, Social and Cultural Rights defines the steps that States should take to progressively realize, to the maximum of their available resources, the highest achievable standards of health. Article 26 of the Convention on the Rights of Persons with Disabilities establishes as measures to be adopted by States the provision of quality and standard disability-sensitive health care on a nondiscriminatory basis, the guarantee of service delivery at the community level and the full respect of autonomy, dignity, informed consent and the needs of persons with disabilities by the health-care workforce. In its general comment No. 14 (2000) on the right to the highest attainable standard of health, the Committee on Economic, Social and Cultural Rights interpreted the right to health as interdependent with the realization of other economic, social and cultural rights, emphasizing that its proper implementation goes beyond a medicalized view. The general comment is key to understanding how a healthy life is dependent upon a complex set of socioeconomic conditions, binding the right to health with the right to an adequate standard of living. 21. The Committee on Economic, Social and Cultural Rights has established the following obligations of the State: access to health facilities, goods and services on a nondiscriminatory basis, especially for vulnerable or marginalized groups; access to the 5 6 According to Dr. Claudio Guedes Salgado at Pará Federal University, Brazil, and President of the Brazilian Society of Hansen’s Disease, the treatment of leprosy should be multidisciplinary, with the use of drugs, physiotherapy, occupational therapy, individual therapy and group therapy, surgery, orthotics and prosthetics and wound care. The drugs used are categorized into two groups, namely, antibiotics, which is the most well-known treatment, called multidrug therapy, and other substitute antibiotics, which can be used when a problem with multidrug therapy arises. Unfortunately, there is no drug to treat neurodegeneration, a major problem of leprosy, which continues to progress in many cases, even after the completion of treatment with antibiotics. Physiotherapy is aimed at preventing the progression of muscle loss and the maintenance of functions in the affected limbs and face; through occupational therapy, patients with physical impairments are taught new skills; and psychology addresses the emotional condition involved with leprosy, be it individual or familial. Surgery may be used to prevent the neurodegenerative process. The orthotics and prosthetics can be prepared in home mode, with simple material, to prevent burns, for example, or in orthopedic workshops, to return the loss of skills or movements, with the addition of the production of prostheses for amputees. Wound care should be done carefully and technically, with the use of materials that can prevent the evolution of the wound, and even promote its closure, avoiding major physical impairments.