A/HRC/7/11
page 12
43. Equality and non-discrimination are akin to the critical health concept of equity. There is
no universally accepted definition of equity, but one sound definition is “equal access to health
care according to need”.19 All three concepts have a social justice component. In some respects,
equality and non-discrimination, being reinforced by law, are more powerful than equity. For
example, if a State fails to take effective steps to tackle race discrimination in a health system, it
can be held to account and required to take remedial measures. Also, if a health system is
accessible to the wealthy but inaccessible to those living in poverty, the State can be held to
account and required to take remedial action.
6. Respect for cultural difference
44. A health system must be respectful of cultural difference. Health workers, for example,
should be sensitive to issues of ethnicity and culture. Also, a health system is required to take
into account traditional preventive care, healing practices and medicines. Strategies should be in
place to encourage and facilitate indigenous people, for example, to study medicine and public
health. Moreover, training in some traditional medical practices should also be encouraged.20 Of
course, cultural respect is right as a matter of principle. But, additionally, it makes sense as a
matter of practice. As Thoraya Ahmed Obaid, Executive Director of UNFPA, observes: “cultural
sensitivity ... leads to higher levels of programme acceptance and ownership by the community,
and programme sustainability”.21
7. Medical care and the underlying determinants of health
45. The health of individuals, communities and populations requires more than medical care.
For this reason, international human rights law casts the right to the highest attainable standard
of physical and mental health as an inclusive right extending to not only timely and appropriate
medical care but also the underlying determinants of health, such as access to safe water and
adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational
and environmental conditions, access to health-related education and information, including on
sexual and reproductive health, and freedom from discrimination.22 The social determinants of
health, such as gender, poverty and social exclusion, are major preoccupations of the right to the
highest attainable standard of health. In his work, for example, the Special Rapporteur has
19
An Introduction to Health Planning … (note 8 above), p. 64.
20
For the Special Rapporteur’s reflections on indigenous peoples and the right to the highest
attainable standard of health see, for example, A/59/422 and E/CN.4/2005/51/Add.3.
21
Culture Matters - Working with communities and faith-based organizations: Case studies
from country programmes, UNFPA, 2004, p. v.
22
See, for example, article 24 of the Convention on the Rights of the Child: Health care includes
dental care.
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