A/HRC/17/43 to medicine index of 2008,4 which ranked 20 pharmaceutical companies according to their performance in ensuring access to medicines, and which demonstrated a high variation among them. 16. In conclusion, Mr. Laing recommended that Governments should incorporate a rights-based approach to national health policies, emphasizing the importance of collecting disaggregated data. He furthermore called upon States to specify their obligations relating to provision of health-care services and access to essential medicines. He also urged Governments to endorse a selection of essential medicines to be covered by social security, to establish monitoring and accountability mechanisms and mechanisms of redress, and to report regularly on the progressive realization of the right to health. 17. The presentation delivered by Dr. Zafar Mirza (WHO) focused on essential medicines for non-communicable diseases. He emphasized that essential medicines were a major component of the treatment of diseases, such as cardiovascular disease, diabetes, asthma, many types of cancer, tobacco dependency, depression and epilepsy. Recent surveys in over 40 low- and middle-income countries showed that generic medicines for the treatment of acute diseases were only 56.1 per cent available in the public sector and 65.6 per cent in the private sector. For chronic diseases, the figures were even lower: 36 per cent were available in the public sector, and 54.7 per cent in the private sector. The main causes for low availability in the public sector were lack of public resources or under-budgeting, inaccurate demand forecasting and inefficient procurement and distribution. This in turn forced patients to buy these medicines from the private sector at a much higher price. 18. Dr. Mirza raised concerns about the increasing presence of counterfeit or falsified medicines for chronic diseases on the market owing to unregulated Internet sales used by patients treated for chronic diseases. He also noted the need to develop evidence-based clinical guidelines for non-communicable diseases, including diagnostic standards and international agreements on when to start medicine treatment. Since such diseases had a long-term market potential for chronic treatments, the pharmaceutical industry was heavily engaged, and potential conflicts of interest between the industry, patient organizations, professional associations, health insurance and public sector organizations needed to be carefully identified and adequately addressed. This also applied to low- and middle-income countries, where many locally produced “branded generics” were aggressively marketed. 19. Parra Vera, Senior Attorney from the Inter-American Court of Human Rights, noted that litigation could and should be used to improve access to medicines, and emphasized the importance of having in place mechanisms for monitoring and accountability. Colombia and other Latin American countries had tried to reform their health sectors in the 1990s by unifying two systems of distribution of health services and medicines, to those in the labour market versus those who had no means to pay. This distinction had led to discriminating effects, and thus forced the poor to resort to legal redress in order to have access to health care. For example, in Colombia, between 1999 and 2008, more than 600,000 cases were filed to ensure access to medicines and health care. As a result of the litigation, judges ordered the State to provide funds for certain medicines. In some countries, the prices of medicines were exorbitant, as the State had left prices up to the market. In Colombia, the deregulation of price controls over medicines in 2006 (letting pharmaceutical industries establish their own price according to market laws) was ultimately paid by the State budget. There was thus a need for oversight and control over the price of medicines on the basis of international law. Moreover, health rights litigation played an important role, but if the protection implied greater entitlements of those already covered in the health system, it could lead to inequitable protection. Legal protection had to be harmonized, as distinctions 4 6 See www.accesstomedicinesindex.org. GE.11-11842