A/HRC/44/46/Add.2 persistent social inequality that hinders the access of a substantive part of the population to fundamental rights and freedom from want. Despite the impressive efforts of government authorities to promote health education, train health workers and develop high-quality technical guidelines, the critical gaps with regard to addressing the social determinants of Hansen’s disease in a country where a significant number of people live below the poverty line keep the disease very much alive and compromise the rights and well-being of those who are affected. The permanent rotation of health workers within the public health system in the more remote areas of the country, which are not as attractive to health workers as the central areas, was also pointed out as a determining factor in the diminished capacity of the system to diagnose and treat the disease on time. 36. In accordance with the evidence gathered during her visit, the Special Rapporteur recalls that guideline No. 11 of the principles and guidelines for the elimination of discrimination against persons affected by leprosy and their family members provides for guidance to States on the enforcement of the right to health of persons affected by leprosy and their family members. This reflects the core provisions of article 25 of the Universal Declaration of Human Rights, article 12 of the International Covenant on Economic, Social and Cultural Rights and articles 25 and 26 of the Convention on the Rights of Persons with Disabilities, all of which Brazil has ratified. Of particular importance to understand the obligations of Brazil to protect, promote and fulfil the right to health is general comment No. 14 (2000) on the right to the highest attainable standard of health of the Committee on Economic, Social and Cultural Rights. In that general comment, the Committee interprets the right to health as both the right to the enjoyment of a variety of facilities, goods and services, and to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, and healthy occupational and environmental conditions. The Committee also draws attention to article 25.1 of the Universal Declaration of Human Rights, which affirms that everyone has the right to a standard of living adequate for their own health and that of their family, including food, clothing, housing and medical care and necessary social services. B. 1. Discrimination Institutionalized and interpersonal discrimination 37. Although there are no discriminatory laws against persons affected by Hansen’s disease and their family members in Brazil, institutionalized discrimination is reported in the administration of the State, as is interpersonal discrimination against persons affected by Hansen’s disease and their family members. 38. The Special Rapporteur received reports about ongoing discrimination at the hands of public services both in high-burden and low-burden states. Reports submitted by civil society organizations provided two examples (one from Pará and one from Maranhão) of discriminatory practices in hiring policies for public jobs, in which Hansen’s disease was considered an eliminatory criterion. Another discriminatory practice was reported in the State of Mato Grosso, where patients undergoing medical treatment for Hansen’s disease were forced to sign an agreement committing not to stop their treatment under threat of being prosecuted under article 267 of the Brazilian Penal Code. 39. During several of her meetings with persons affected by Hansen’s disease, the Special Rapporteur also heard testimonies of discriminatory practices within public health and social assistance services, most of which reflect a lack of knowledge about the disease among civil servants. This is exacerbated by bureaucratic procedures that are impenetrable or difficult for marginalized groups to comply with. One striking example is that of a woman who, having been diagnosed with Hansen’s disease while pregnant, was advised by her health team to terminate the pregnancy because of the disease. 40. Enduring institutionalized discrimination appears to be based on harmful stereotypes (see A/HRC/41/47) which, despite all the efforts made in previous decades, continue to result in stigmatization. The Special Rapporteur received reports of good practices for raising awareness which, instead of making use of medicalized language and a top-down approach, encourage cooperation between health workers, persons affected by Hansen’s disease, traditional leaders and healers. The aim is to provide the public with key 9