A/HRC/39/25 V. Conclusions and recommendations 42. Most child deaths are witnessed in the most marginalized communities and regions. Preventing child mortality therefore requires effectively tackling health inequality and overcoming the barriers and multiple forms of discrimination that exist in health systems and communities. Children face heightened risk in certain circumstances, such as migration or displacement, and at critical life-stages, particularly when they are newborn. Child mortality increases sharply in situations of conflict and humanitarian crisis, and underlying determinants — such as exposure to hazardous substances and waste, or lack of access to clean water and sanitation — can cause mortality rates to rise substantially. 43. There is growing evidence that a human rights-based approach to health care, as well as being an obligation of States under international law, contributes to improved child mortality outcomes. The case studies presented at the meeting indicated that such an approach can guide health planners and support health workers in improving the quality of care. Awareness of human rights or their implementation by health practitioners is, however, limited. A strengthened evidence base is required to convey the value of a human rights-based approach to preventing child mortality. There is a need for monitoring health outcomes on the basis of disaggregated data, including qualitative data on human rights indicators, such as the accessibility and acceptability of care. A life-cycle approach in which women are engaged and empowered at all stages and gender-based violence is tackled as a priority is critical. 44. The links between legal frameworks and policy plans should be strengthened, alongside greater investment in children’s health. Existing health resources can be maximized by tackling corruption and supporting social accountability. As political will, incentives and power structures — including commercial interests — are key factors, legal and political action should be pursued in parallel in order to bring about transformative results. 45. Taking concrete measures to ensure accountability and participation improves the quality of care. Quality of care benchmarks in health systems, greater participation of patients, particularly women, and accessible and effective mechanisms for redress all contribute to accountability. Quality improvement tools for maternal, newborn and paediatric care recently developed by WHO integrate principles and standards relating to children’s rights; their application is expected to provide a greater insight into how human and child rights can make a positive contribution to respectful and dignified care for children and their caregivers. 46. Any attack on health facilities in conflict is a grave violation of child rights, and the increase in such attacks violates the right to life and the right to health for children. An international protection system should be established for health workers and facilities in conflict and situations of humanitarian crisis. 47. Non-medical factors can have a major impact in exacerbating child mortality rates; a focus on the underlying determinants of health, including social norms, is therefore crucial. In certain circumstances, addressing underlying determinants requires challenging practices adopted by the private sector, for example, in the marketing of breast-milk substitutes, the privatization of access to clean water and the management of hazardous substances and toxic waste. In this respect, States have an obligation to ensure that private actors fulfil their responsibility to respect children’s rights. 48. States could consider establishing a United Nations inter-agency working group to take forward the key recommendations made at the meeting with respect to the application of a human rights-based approach to address mortality and morbidity among newborns and children under 5 years of age. 13