A/HRC/39/50 4. Right to health 61. Health is indispensable for the exercise by older persons of many other rights and for them to live a life in dignity. The right to health includes “preventive, curative and rehabilitative health treatment … maintaining the functionality and autonomy of older persons … attention and care for chronically and terminally ill persons, sparing them avoidable pain and enabling them to die with dignity”.25 It encompasses a spectrum of care that spans primary to palliative care. Its realization also involves the underlying determinants of health, such as access to water and sanitation, clean air, food and housing. 62. Older persons should be enabled to continue to live in their homes for as long as possible, to avoid both the physical and psychological disruptions involved in moving to an unfamiliar location (see A/64/127, para. 27). Depression, loneliness, anxiety and suicide rates increase in the occurrence of major life changes (A/67/188). Physical and mental health are interdependent and impact on each other. Social exclusion as a result of inaccessible community infrastructure, a lack of feeling of safety, the loss of social networks and other factors associated with urban regeneration, is detrimental to the physical health of older persons. It increases their exposure to risk, the absence of support and inadequate care and may lead to multiple pathologies and a reduction in life expectancy. 63. Urban planning in low- and middle-income countries often prioritizes vehicles and economic activity at the expense of safety and liveability, particularly for the most vulnerable street users.26 In those countries, older persons engage in street-based activities and often have to walk or cycle long distances through congested streets that offer little safety to individuals owing to car-oriented strategies. Urban planners need to take into account the needs of older persons to travel and provide safe and accessible streets and pedestrian zones. In addition, affordable transportation and localized retail and other necessary services can reduce unnecessary journeys for older persons. Gentrification may also induce heavy traffic and increase air pollution, which disproportionately affects the health of older persons.27 64. Policies should promote healthy ageing and tackle the key risk factors associated with urban living, including through awareness-raising, reducing air pollution and encouraging physical activity and affordable healthy food options. 28 Urban plans should include comprehensive health strategies to ensure that older persons have access to accessible, affordable, appropriate and good-quality health care, goods and services. In addition to providing services to address chronic conditions and acute illness, States should also develop local programmes to prevent the onset of disease and to offer rehabilitation. 65. State obligations also entail a duty to provide specialized geriatric care, as older persons have different patterns of disease presentation to younger adults and respond to treatments and therapies in different ways. They also frequently have complex social needs that are related to their chronic medical conditions and may contribute to their social exclusion. The provision of care services for older persons tends to be deprioritized because of prejudice and rationing. It is therefore important to integrate the needs of older persons in development plans to ensure that such services are available to the older population. 5. Right to independent living in the community 66. The right to independent living in the community derives from the right to an adequate standard of living and is interdependent with other rights. For example, older persons are unable to exercise their freedom of choice unless they have access to regular and adequate income through work or pensions. The enjoyment of this right does not only depend on personal autonomy and agency, but also on the social aspects of being part of a 25 26 27 28 14 See Committee on Economic Social and Cultural Rights, general comment No. 14 (2000) on the right to the highest attainable standard of health. See HelpAge International, “Ageing and the city: making urban spaces work for older people”, p. 9. Ibid. Ibid.