A/HRC/42/60/Add.1
dimensions, two each for health and education and six for living standards. 31 Each indicator
maps directly or indirectly on to human rights.
18.
Social determinants directly impact everyday lives. Reports and surveys on this is
evidence of the interrelationship between different dimensions of poverty and indicators of
poverty. The social determinants of health,32 for example, are defined as the conditions in
which people are born, grow, work, live and age and the wider set of forces and systems
shaping the conditions of daily life. These influence approaches to the sustainable
development goals, reflecting a holistic approach to health, education, reducing violence and
so on across the spectrum of rights and freedoms embedded in the SDGs. 33
19.
The Special Rapporteur has learned from the Minister for Health and Minister of
Social Affairs, Veterans and Youth Rehabilitation of the efforts being made in Cambodia to
guarantee accessible, affordable, quality healthcare for all through various programmes
including the Health Equity Fund, National Social Protection Fund and the National Policy
on Ageing 2017-2030. The Cambodian Sustainable Development Goals target 3.9 34 seeks to
achieve universal health coverage, defined as the number of poor protected by health equity
funds amongst the population living under the poverty line, measurable by the percentage of
the population covered by social health protection systems. This definition omits the near
poor and efforts will have to be intensified to ensure that the same quality of healthcare is
available to all.
20.
The Government has also stipulated a CSDG target 3.1 on an overall level of health
and wellbeing of Cambodian peoples measured by life expectancy at birth and fertility rates
through live births by reporting year.35 The Special Rapporteur has been informed of
additional financial support for women during a maternity period though she continues to
receive information from women who lose their jobs when pregnant (and consequently miss
out on the new enhanced maternity provisions). This is contrary to Article 46 of the
Constitution and Article 182 Labour Law.
21.
The Health Equity Fund operates to ensure that those who are unable to pay for
treatment secure free treatment. This strategy is linked to ID Poor which demonstrates
eligibility for free treatment. Case by case decisions can also be made. Whilst there is no
doubt that this fund has ensured access to healthcare for many, there remain inevitable issues
of corruption including the continuation of differentiations in healthcare for those who can
pay (and obtain faster, more comprehensive treatment) and those that cannot. Some
commentators have even argued for the abolition of all payments, indicating a tipping point
reached in the numbers accessing free healthcare which means determining eligibility is no
longer financially viable.
22.
Considering the social determinants indicate that a holistic approach is needed to
ensure that no one is left behind. Education (SDG4), reduced inequalities (SDG10), clean
water and sanitation (SDG6), decent work (SDG8), and zero hunger (SDG2) are especially
relevant and indicate the interrelatedness and indivisibility of both the goals and the
underpinning human rights. Improved access to clean water, sanitation and adequate
nutrition, achieved in part through education for example, will improve health and standards
of living as well as reducing some indicators of poverty. Improving completion rates and
quality of education, rendering it accessible to all (on merit for higher levels) will open up
work opportunities. Improving working conditions enhances health and wellbeing. Whilst
perhaps axiomatic, some groups of people remain disadvantaged, not benefitting from (or
much) from the improvements secured in health, work, education and so on. These people
are already being left behind.
23
Improving physical and mental healthcare, reducing violence in the home and outwith,
increasing education opportunities for all, ensuring decent work (and an adequate standard
31
32
33
34
35
8
https://ophi.org.uk/multidimensional-poverty-index/global-mpi-2018/.
http://www.who.int/social_determinants Commission chaired by Professor Sir Michael Marmot.
The 2011 World Conference on the Social Determinants of Health adopted the Rio Political
Declaration https://www.who.int/sdhconference/declaration/en/.
Maps to UNSDG 3.8.
CSDG Goal 3.1.
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