A/HRC/22/31 I. Substance use 63. An estimated 150 million young people, primarily in low- and middle-income countries, use tobacco, and alcohol consumption among young people, especially young males, is increasing;18 both tobacco use and alcohol consumption contribute to cardiovascular and other diseases in adulthood. Patterns of substance use established during adolescence tend to develop into chronic patterns of use, mortality and morbidity in later life. Children should be protected from solvents, alcohol, tobacco and illicit substances. 64. The ratification of the WHO Framework Convention on Tobacco Control 19 is an important step in controlling the use of tobacco among children. Interventions to ban tobacco advertising, to raise the price of tobacco products and to enact laws prohibiting smoking in schools and other public places reduce the number of people who start using tobacco products. Banning alcohol advertising, regulating access to it and providing counselling when alcohol use is detected are effective strategies to reduce alcohol use by young people. 65. Although in children the use of alcohol, cannabis, solvents and “club” drugs remain much more prevalent than injecting drug use, the latter is a serious concern. Children who inject drugs are often those in most difficult circumstances, including children in street situations and without parental care. Children who inject drugs are more likely than adults to share equipment with others and less likely to have access to needle and syringe exchange services. Sharing injecting equipment can lead to the transmission of blood-borne viruses, including HIV. Children and young people who inject drugs are also at greater risk of other preventable diseases and death from overdose.20 66. A rights-based, comprehensive approach to substance use should be adopted, and include harm reduction strategies to minimize the negative health impacts of substance abuse. V. Measures for implementation A. Accountability 67. Although States are the primary duty-bearers with obligations for realizing the right of the child to health, the engagement of a number of stakeholders is required, working at different levels, including public and private, governmental and non-governmental, development partners and funding organizations. The central role played by parents and other caregivers, including teachers, doctors, social workers and all those working with children, is critical. States have an obligation to ensure that all duty-bearers have sufficient capacity to fulfil their obligations and responsibilities, and that the capacity of children is sufficiently developed to enable them to claim their right to health. 68. Accountability is a key component for ensuring the enjoyment of the right of the child to health, and national accountability mechanisms must be effective and transparent. Adequate accountability mechanisms include complaint systems, judicial remedies and independent monitoring bodies. With the active engagement of the Government, communities, civil society and children, national accountability mechanisms must aim to 18 19 20 WHO, Global status report on alcohol and health, Geneva, 2011. Available from http://apps.who.int/iris/bitstream/10665/42811/1/9241591013.pdf. Submission by Harm Reduction International, available from www.ohchr.org/EN/Issues/Children/RightHealth/Pages/Contributionsreceived.aspx. 13