A/HRC/44/46/Add.2 for about 13 per cent of new Hansen’s disease cases detected globally and 93 per cent of new cases in the Americas. Brazil has the highest rate in the world by percentage of the population.1 7. Although there was an overall reduction in 2018 in the number of new cases detected in global priority countries compared to the previous year, the countries in which the new cases were detected included Brazil. New cases of Hansen’s disease are not distributed evenly in Brazil, with areas of higher risk mainly located in the Midwest, North and North-East regions. The prevalence of the disease has significantly decreased over the years.2 In 2018, Brazil had 1,107 more new cases than in 2017, which probably reflects the improved capacity of the health system to detect the disease.3 8. New cases of Hansen’s disease in patients diagnosed with severe and irreversible impairments4 point to the limited capacity of health-care systems to recognize and treat the disease on time. According to WHO, a decrease in the number of new cases with visible and irreversible physical impairments at the time of diagnosis was reported globally, which is consistent with the overall decrease in the number of new cases over the past 10 years. Nevertheless, in 2018 an increase was reported in a few countries, including Brazil, with 2,109 new cases diagnosed with irreversible physical impairments at the time of diagnosis. 9. Hansen’s disease is not only a significant endemic disease in Brazil. It has also been an important scientific subject in Brazilian medical history. In the context of Brazilian collective health, which since the 1970s has undergone a paradigmatic shift in terms of public health, much later adopted by WHO with the concept of social determinants of health, scientific research on the medical and historical aspects of Hansen’s disease has flourished. Evidence of this is the introduction in the 1960s of rifampicin 5 in the treatment of Hansen’s disease by the Brazilian doctor Diltor Vladimir Araújo Opromolla. 6 WHO subsequently included rifampicin in multidrug therapy7 in the 1980s. This involvement of the scientific community with Hansen’s disease has contributed greatly to framing the governmentality8 of the disease in Brazil. By the same token, the participatory profile of the 1988 Constitution paved the way for a politics of recognition headed by MORHAN, created in 1981, which also has significant corollaries in the governmentality of the disease in Brazil. 1 2 3 4 5 6 7 8 WHO, “Global leprosy update, 2018: moving towards a leprosy-free world”, Weekly Epidemiological Record, vol. 94, No. 35 (30 August 2019). Data on the prevalence of Hansen’s disease per 10,000 inhabitants, provided by the Ministry of Health. Available at http://portalarquivos2.saude.gov.br/images/pdf/2018/julho/13/Taxa-deprevalencia-de-hanseniase-1990a2017.pdf. Matheus Moreira, “Após 13 anos em queda, hanseníase volta a crescer no Brasil”, Folha de São Paulo, 13 July 2019. According to the grading system used by the WHO Global Leprosy Strategy to assess physical impairments caused by Hansen’s disease at the time of diagnosis, 0 means no impairment, 1 means loss of sensation in the hand, eye or foot, and 2 means visible impairment, including irreversible damage to the nerves, hands, feet, limbs and eyes. In the present report, the Special Rapporteur uses the term “impairment” to refer to the loss of function or the detriment to the health of persons affected by leprosy, and the term “disability” to refer to the social responses of discrimination and exclusion to leprosy-related impairments. This distinction is based upon the social model of disability, which is embraced by the Special Rapporteur in her work. Rifampicin is the most important drug in the medical treatment of Hansen’s disease and the only one with a bactericidal effect. L. de Souza Lima and D.V.A. Opromolla, “First results on the treatment of leprosy with rifampicin SV”, Chemotherapy, vol. 7, No. 6 (1963). Hansen’s disease is curable with a combination of drugs known as multidrug therapy, which WHO has been supplying free of charge since 1995. Governmentality, a concept introduced by the French philosopher Michel Foucault, encompasses not only formal government, but also all the related social practices, including rationalities and techniques, that regulate the subject, bodies and human conduct. 3