A/HRC/29/33 51. The Special Rapporteur is concerned about instances of unbalanced policies and practices which seriously undermine the full enjoyment of the right to health. Those imbalances can lead to an artificial hierarchy and a selective approach to human rights prioritizing one group of rights over another, or can set different human rights standards for different groups of the population. Some imbalances and power asymmetries are present within the different elements of health systems; for example, primary care often fails to compete for budget allocations with specialized medicine. These imbalances have also historically led to disparities in investing in physical and mental health. 1. No hierarchy within human rights 52. Lessons should be learned from past and present experiences, which demonstrate that any hierarchy among human rights, a prioritizing of one right or one group of rights over another, leads to detrimental outcomes and systemic violations of human rights. Selective approaches deprive certain groups of basic rights and undermine the meaningful participation and empowerment of all stakeholders. Such participation and empowerment are crucial preconditions for positive public policy outcomes, which are based on the particular attention given to those in vulnerable situations. 53. Many examples have been presented by the health and human rights movement of economic, social and cultural rights being neglected since they were perceived as not requiring immediate action based on erroneous interpretations of the fact that they were subject to progressive realization. That tendency to undermine importance of economic, social and cultural rights has led, and continues to lead, to a detrimental combination of poverty, inequalities and disempowerment of large groups of population, who will consequently suffer from poor health status and barriers to accessing health-care services. 54. The right to health approach, as a part of human rights-based approach, has emerged during recent decades as a powerful tool to reinforce the global goal of improving the health and well-being of populations. However, it can also be used to monitor and prevent those underlying health conditions and tendencies within health-care systems which may lead to violations of human rights and to a negative impact on the health of individuals and societies. 55. In this regard, the Special Rapporteur will continue highlighting the need to reduce poverty and inequalities, including those within and between regions and countries. He will do so by analysing the root causes of the gap between opportunities and reality, between evidence, policies and practices and between obligations of duty bearers and effective implementation. 56. A recent example of the detrimental effect of inequalities has been the Ebola epidemic in countries of Western Africa with weak health-care systems which were not able to adequately respond. One of the lessons learned from that and other epidemics is the importance of social medicine which, since the nineteenth century has highlighted that many diseases and epidemics are social diseases in their origin; therefore, primary prevention should properly address the social determinants of health and the context in which epidemics emerge. 57. The Ebola crisis has provided meaningful lessons with regard to many elements of the right to health. It has questioned our preparedness for emergencies at national, regional and global levels. It has raised important issues, such as access to information, trust in public authorities and safety of medical personnel, and it has reminded us of the importance of upholding the human rights of the affected populations in the context of public safety concerns. The Ebola crisis has once again raised issue of the responsibility and social accountability of key actors, including pharmaceutical companies, and the need for strong public leadership in addressing global health challenges. 10