A/HRC/18/37 should also note the importance of the use of evidence-based guidelines and establishment of minimum standards of health care for common chronic conditions, and integration of their management into primary health care. 37. The Committee on Economic, Social and Cultural Rights reiterated that primary health care essentially falls under the core obligations accrued by States in fulfilling the right to health (E/C.12/2000/4, para. 43). General Comment 14 places special emphasis on the care of older persons as a vulnerable group, which requires an “integrated approach combining elements of a preventative, curative, and rehabilitative health treatment” (ibid, para. 25). It also specifies that such measures ought to include periodic check-ups and measures aimed at maintaining physical and psychological functionality. Thus, the right to health requires a constellation of activities, programs, and interventions to address primary health care of older persons as a core obligation under that right. Improving availability, accessibility, acceptability and quality of primary care is essential in particular in achieving better results in the management of chronic illnesses. 38. Several obstacles have been identified in relation to older persons’ access to primary health care and to the quality of health-care services provided. Discrimination against older persons on the basis of their age is a major barrier to access primary care and prevention of chronic illness. . There is a pernicious and deeply ingrained notion that once a person ages, he/she becomes incapable of contributing to society, chronically ill and/or frail. Such prejudices often lead to a conclusion that not much can be done to assist them. 39. It is essential that the actual vulnerabilities of older persons are recognized, and prejudicial perceptions and attitudes are addressed, so that goods and services are designed in such a manner to overcome actual, rather than perceived, barriers in accessing healthcare. Discriminatory attitudes of medical professional towards older persons could also undermine meaningful communication with their patients with direct consequences on the accuracy of diagnosis and quality of treatment. 40. Access to primary healthcare services is also impeded by both physical and financial obstacles. Healthcare facilities might be situated too far from older persons’ place of residence, with transport proving to be too expensive, inadequate, or simply unavailable. Compounding this problem is the limited mobility of older persons. They may be unable to drive, have no access to transportation, or have physical impairments that reduce their movement. Physical difficulties to access health for older persons are further reinforced by their socio-economic vulnerability, especially as access to health care is often subject to receiving a pension or to paying out–of-pocket fees. Living in poverty can also be a root cause of deterioration of older persons’ health: with limited access to safe drinking water or adequate nutrition, older persons face a high risk of contracting diseases. Even where health services are accessible to older persons, they are not always adapted to their needs.26 41. Improving the quality of care provided by primary care physician to older patients remains a challenge which is exacerbated in rural areas, where rural general medical practitioners have fewer opportunities to partner with geriatricians to deliver care to their catchment area. Dissemination of information from specialty areas into primary care should be encouraged in all areas, but is particularly important in respect of older persons, given the suitability and cost-effectiveness of the management of chronic diseases within the primary care setting. 42. It is also important that primary care and prevention of chronic illness is promoted and strengthened in the developing world. A paradigm shift is necessary to detect diseases early and mitigate their effect, rather than wait until the onset of health problems. More 26 World Health Organisation, “Towards age-friendly primary health care”, 2004, p. v 11