A/HRC/18/37 America showed that older persons with limited literacy had a higher risk of death, compared to those with adequate literacy.17 28. International human rights law proscribes discrimination and ensures equality on a number of grounds and for a variety of groups, including older persons. Older persons are further identified by general comment No. 14 as a group especially vulnerable to violations. Treaty bodies, including CESCR, have identified older persons as a vulnerable or marginalized group, one that is potentially more susceptible to discrimination and violence.18 According to general comment No. 14, it is important to ensure the functionality and autonomy of older persons (E/C.12/2000/4, para. 25). This implies promotion of individual choice with respect to models of care, insofar as this is possible. 29. Older women are often more disadvantaged because they may suffer from a combination of both gender and age discrimination. Ageing women make up a significant proportion of the world’s population, with the majority of older women living in developing countries. A number of life-course events adversely affect the health of women in older age, including discrimination against infant girls in the provision of food and care, barriers to education, low incomes and poorer access to decent work, care-giving responsibilities as mothers and wives, domestic violence (during childhood, adulthood and elder abuse), widowhood, and cultural traditions and attitudes towards health care. 19 Lower incomes, disruptions to work due to family responsibilities, and discrimination in access to the labour force during women’s working life mean that women often have less retirement savings and are therefore more financially vulnerable in older age. 30. The right-to-health requires active and informed participation in policy decisions by those populations that are affected by them (E/CN.4/2006/48, para. 25). Effective provision of health services can only be assured if the participation of affected populations is secured by States (E/C.12/2000/4, para. 54). It is notable that the United Nations Principles for Older Persons encourages the participation of older people in the formulation and implementation of policies which affect them. 31. The Special Rapporteur notes the importance of monitoring progress in ensuring progressive realization of the right to health of older persons using indicators and benchmarks as part of the right to health framework. General comment No. 14 identifies the failure of States to monitor the realization of the right to health at the national level, as well as the resulting insufficient or misallocated expenditure, as examples of violations of the State’s obligations (E/C.12/2000/4, para. 52). 32. Accountability is one of the central features of the right to health. It requires effective, transparent and accessible monitoring and accountability mechanisms. Accountability requires the incorporation of continuous monitoring into all aspects of policy development and implementation.20 In the context of the right to health, accountability is the process that provides individuals and communities with an opportunity to understand how the government has discharged its right to health obligations, while providing the government with the opportunity to explain what it has done and why (A/63/263, paras. 817 18 19 20 Sudore et al. “Limited literacy and mortality in the elderly: the health, aging and body composition study”, Journal of General Internal Medicine, vol. 21, No. 8 (2006). See E/C.12/2000/4 and E/1996/22. For a more comprehensive list of where age has been recognized as a vulnerability, see: OHCHR, Human Rights of Older Persons: International Human rights Principles and Standards: Background Paper Expert Group Meeting (OHCHR, Geneva, 2010). WHO, 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 Helen Potts, “Accountability and the right to the highest attainable standard of health”, University of Essex, 2008, p. 13, and see report of the Special Rapporteur (E/CN.4/2003/58, para. 59). 9