A/HRC/43/45 of thousands of people are likely to be affected every year. In particular, “medical detention” for unpaid medical bills have been observed in various countries.50 44. Private household debt resulting from health-related expenses often leads to greater revenue for private actors, who convert access to health care and medicines into a highly profitable commodity and business model. The cost of essential medicines, when unregulated by the State or protected by patents and secret negotiations, and therefore left to “market forces”, is a major cause of the increase in health-related debt and a matter of serious concern from a human rights perspective.51 C. Education-related debt 45. Millions of households around the world make hard choices for the education of children and adolescents, often based on economic considerations and their total dependence on access to credit. In certain cases, households have to which member of the family is more “deserving” of education, which can at times mean only the eldest child or the boy rather than the girl. Despite the obligation of States to provide for free public education, 262 million young people aged between 6 and 17 were still out of school in 2017, and more than half of children and adolescents do not meet minimum proficiency standards in reading and mathematics (see A/HRC/41/37). 46. The call to prevent the risk of overindebtedness reflects a mounting situation around the world, and may often refer to debt for secondary education too. Student loans have also been on the rise, as the public education systems in many countries have faced austerity, private schools have expanded and the cost of education has grown rapidly.52 As the Special Rapporteur on the right to education highlighted, for-profit schools may seek to maximize profits through high fees or to cut costs by reducing the most expensive parts of the curriculum, expelling learners that need the most support, or not properly maintaining school premises (ibid.) 47. Student loans for tertiary education are usually perceived as a positive investment and “good debt”, as they could go a long way towards better educational qualifications and employment opportunities, and may provide financial stability for the individual and the entire household. Evidence suggests, however, that student loans no longer guarantee social mobility and financial stability. The increasingly concentrated labour market and stagnant wage growth mean that graduates often have difficulties finding employment that enables them to pay off debt.53 48. In Fiji, students receiving loans through the Tertiary Education Loans Scheme are expected to allocate 20 per cent of their gross salary upon employment to their repayment. 54 In Thailand, with a view to enhancing access to secondary and higher education for children of low-income families, the Government used a dedicated fund to provide loans to 2.9 million recipients from 1996 to 2007;55 challenges in debt repayment and debt default were, however, reported, including due to financial problems resulting from unemployment. 56 In Chile, at the university level, the interest on student loans has risen to 6 per cent, and thus may result in 50 51 52 53 54 55 56 The practice has been observed in Cameroon, the Democratic Republic of the Congo, Ghana, Kenya, India, Indonesia, Liberia, Nigeria, Uganda, and Zimbabwe, and; see Robert Yates, Tom Brookes and Eloise Whitaker, “Hospital Detentions for Non-payment of Fees: A Denial of Rights and Dignity”, Research Paper, Centre on Global Health Security, 2017. See https://msfaccess.org/secret-medicine-prices-cost-lives. Michael Lim, Mah Hui and Jomo Kwame Sundaram, “Transforming Society, Financialization Destroys Social Solidarity”, Inter Press Service, 4 June 2019. Michael Corkery and Stacy Cowley, “Household Debt Makes a Comeback in the U.S.”, New York Times, 17 May 2017. A/HRC/32/37/Add.1, para. 39. Piruna Polsir and al., “Thailand’s Student Loans Fund: An analysis of interest rate subsidies and repayment hardships”, in Shiro Armstrong and Bruce Chapman, Financing Higher Education and Economic Development in East Asia (Australian National University press, Canberra, 2011, p. 221. Amara Tirasriwat, “Analysis of Problems on Student Loan Defaults in Thailand and Guideline Solutions”, XIV International Business and Economy Conference, Bangkok, 5–8 January 2015. 11