A/HRC/10/65 page 14 systems that cover essential medicines), and particularly by promoting the use of generic drugs. She also stated that the current challenge is to determine the most effective policy actions in a different context which, in her view, requires examination of country experiences. 61. The Chairperson-Rapporteur opened the floor to participants for the interactive dialogue. Representatives from Brazil, Chile and Malaysia and the Association of World Citizens and People’s Health Movement made statements. 62. The issue of access to essential medicine and health care should be discussed in tandem with such issues as the need for affordable technology, international cooperation and intellectual property rights in particular. It was pointed out that intellectual property rights are a barrier to access to essential drugs, especially for developing countries, since research and development is expensive and requires considerable investment. Intellectual property rights raise the final price of medicines, particularly in developing countries. At the same time, essential medicines, with the exception of anti-retroviral drugs, are in general off-patent, hence there is no real intellectual property barrier. In this context, support was expressed for wider dissemination of generic versions of essential medicines. Another speaker highlighted the urgent need to move beyond treating symptoms to address underlying structural determinants of health, for example, access to clean water. Speakers recalled the importance of the 1978 Declaration of Alma Ata on primary health care, which remains an objective still far from realization. Climate change 63. Theodor Rathgeber of the German Forum on Human Rights identified the negative effects of climate change, particularly the resulting forced migration and the threat to food and water security. He also stressed that climate change has a disproportionate impact on the poorest regions because they are least able to adjust to new conditions. Providing a number of examples of how different communities around the world perceive the changes, the speaker observed that, from the viewpoint of a grass-roots approach, a major problem seemed to be the lack of involvement of local people in decision-making processes and in the design and implementation of initiatives to address climate change at the national, regional and international levels. 64. Tomas Alarcon, President of the Comisión Jurídica para el Autodesarrollo de los Pueblos Originarios Andinos stated that, in his Andean region, water is diverted from the Andes to the cities for mining operations and industrialization, which negatively affects the overall ecosystem and sustenance of Amazonian biodiversity. In this context, he stressed the effective implementation of relevant international conventions, such as ILO Convention 169 and the Convention on Biological Diversity, particularly with regard to respect for traditional methods and knowledge, and obligations to obtain prior consent of local communities prior to any action affecting their livelihood. He also called for the creation of a mechanism for international monitoring of such implementation and for decriminalization of the de facto persecution of local movement and activities against action affecting climate change. 65. Ismail Elgizouli of the Programme on Climate of the High Council for Environment, Sudan, referred to the particular vulnerability of the Sudan to the effects of climate change because of the fragile ecosystem, weak infrastructure and economy, and the fact that 70 per cent of the country is reliant on climate-dependent resources for livelihood. The sectors affected by