A/HRC/18/37
upon their right to health. Examples include restrictions on the autonomy of older persons in
terms of definitions of capacity without an individual determination. The obligation to
protect deals with States’ duty to prevent third parties, such as corporations, from interfering
directly or indirectly with the right to health. This may be relevant, for example, where there
is systematic abuse of the elderly in private long-term care facilities. Finally, the obligation
to fulfil requires States to adopt appropriate legislative, administrative, budgetary, judicial,
promotional and other measures to fully realize the right to health.
24.
According to general comment No. 14, the right to health contains both freedoms
and entitlements. The freedoms include the right to make independent decisions about one’s
health, which is to say freedom from State interference. For older persons, freedoms regard
issues such as informed consent, autonomy and guardianship. Entitlements, which concern
positive obligations of the State may, for example, include the provision of primary health
care and social protection which recognizes and takes into account age-related elements,
States should recognize that ageing is a lifelong process; State policy and legislation should
reflect this reality. Investment in health services should be made at various stages of the life
course, when risks to well-being and windows of opportunity are greatest.16
25.
Under the right-to-health framework, health facilities, goods and services should be
made available, accessible, affordable, acceptable and be of good quality for older persons.
Availability refers to the fact that functioning public health and health-care facilities, goods
and services, as well as programmes, have to be available in sufficient quantity. In many
cases, older persons are affected by selective unavailability because of rationing of medical
care, i.e. allocation and prioritization of health resources, which often results in deprioritizing older persons for health treatment. Accessibility includes physical, financial and
information components. Older persons may be unable to access health care because of the
location of services or their limited physical mobility. Poverty may also exacerbate older
persons’ inability to access healthcare, particularly where social security does not exist.
Finally, information accessibility refers to the right to seek, receive and impart information
regarding health issues. With regard to older persons, it means that health-related
information should be tailored to suit their needs and communicated to them in an
appropriate, comprehensible manner allowing them to make fully informed decisions about
their health condition and treatment.
26.
States should take measures to ensure that older persons receive age-friendly health
care of a quality commensurate with that of other age groups. Examples of improved quality
goods, services and facilities for older people would include greater numbers of geriatricians
and improved training in geriatrics across all specialties to ensure that needs of older
persons are recognised and attended to. There is also a need for improved communication
across specialties, including allied health professions such as dentists, pharmacists etc in
order to adequately address the treatment needs of older persons with multiple chronic
illnesses.
27.
General comment No. 14 notes that the right to health should be understood in
broader terms, which include the underlying determinants of health, such as access to water
and sanitation, food and nutrition, education and housing. An example of this would be the
sub-optimal nutrition of older persons, which is commonly linked to circumstances under
which older persons are isolated, immobile and live in poverty. Education is another
relevant determinant for the health of older persons. A recent study in the United States of
16
8
Women, ageing and health: a framework for action: Focus on gender , Geneva, WHO, 2007.
Accessed at: http://www.who.int/ageing/publications/Women-ageing-health-lowres.pdf
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