General comment No. 14: The right to the highest attainable

 

 

 

 

 

                                                

control one’s health and body, including sexual and reproductive freedom, and the 

right to be free from interference, such as the right to be free from torture, 

non-consensual medical treatment and experimentation.  By contrast, the entitlements 

include the right to a system of health protection which provides equality of 

opportunity for people to enjoy the highest attainable level of health. 

9. 

The notion of “the highest attainable standard of health” in article 12.1 takes 

into account both the individual’s biological and socio-economic preconditions and a 

State’s available resources.  There are a number of aspects which cannot be addressed 

solely within the relationship between States and individuals; in particular, good 

health cannot be ensured by a State, nor can States provide protection against every 

possible cause of human ill health.  Thus, genetic factors, individual susceptibility to 

ill health and the adoption of unhealthy or risky lifestyles may play an important role 

with respect to an individual’s health.  Consequently, the right to health must be 

understood as a right to the enjoyment of a variety of facilities, goods, services and 

conditions necessary for the realization of the highest attainable standard of health. 

10. 

Since the adoption of the two International Covenants in 1966 the world health 

situation has changed dramatically and the notion of health has undergone substantial 

changes and has also widened in scope.  More determinants of health are being taken 

into consideration, such as resource distribution and gender differences.  A wider 

definition of health also takes into account such socially-related concerns as violence 

and armed conflict.

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  Moreover, formerly unknown diseases, such as human 

immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), and 

others that have become more widespread, such as cancer, as well as the rapid growth 

of the world population, have created new obstacles for the realization of the right to 

health which need to be taken into account when interpreting article 12. 

11. 

The Committee interprets the right to health, as defined in article 12.1, as an 

inclusive right extending not only to timely and appropriate health care but also to the 

underlying determinants of health, such as access to safe and potable water and 

adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy 

occupational and environmental conditions, and access to health-related education and 

information, including on sexual and reproductive health.  A further important aspect 

is the participation of the population in all health-related decision-making at the 

community, national and international levels. 

12. 

The right to health in all its forms and at all levels contains the following 

interrelated and essential elements, the precise application of which will depend on 

the conditions prevailing in a particular State party: 

 

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  Common article 3 of the Geneva Conventions for the protection of war victims (1949); Additional 

Protocol I (1977) relating to the Protection of Victims of International Armed Conflicts, article 75 (2) 

(a); Additional Protocol II (1977) relating to the Protection of Victims of Non-International Armed 

Conflicts, article 4 (a). 

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(a) Availability. 

 

Functioning public health and health-care facilities, goods and 

services, as well as programmes, have to be available in sufficient quantity within the 

State party.  The precise nature of the facilities, goods and services will vary 

depending on numerous factors, including the State party’s developmental level.  

They will include, however, the underlying determinants of health, such as safe and 

potable drinking water and adequate sanitation facilities, hospitals, clinics and other 

health-related buildings, trained medical and professional personnel receiving 

domestically competitive salaries, and essential drugs, as defined by the WHO Action 

Programme on Essential Drugs;

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(b) Accessibility. 

 

Health facilities, goods and services

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 have to be accessible to 

everyone without discrimination, within the jurisdiction of the State party.  

Accessibility has four overlapping dimensions: 

Non-discrimination:  health facilities, goods and services must be accessible to 

all, especially the most vulnerable or marginalized sections of the population, 

in law and in fact, without discrimination on any of the prohibited grounds;

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Physical accessibility:  health facilities, goods and services must be within safe 

physical reach for all sections of the population, especially vulnerable or 

marginalized groups, such as ethnic minorities and indigenous populations, 

women, children, adolescents, older persons, persons with disabilities and 

persons with HIV/AIDS.  Accessibility also implies that medical services and 

underlying determinants of health, such as safe and potable water and 

adequate sanitation facilities, are within safe physical reach, including in rural 

areas.  Accessibility further includes adequate access to buildings for persons 

with disabilities; 

Economic accessibility (affordability):  health facilities, goods and services 

must be affordable for all.  Payment for health-care services, as well as 

services related to the underlying determinants of health, has to be based on 

the principle of equity, ensuring that these services, whether privately or 

publicly provided, are affordable for all, including socially disadvantaged 

groups.  Equity demands that poorer households should not be 

disproportionately burdened with health expenses as compared to richer 

households; 

Information accessibility:  accessibility includes the right to seek, receive and 

impart information and ideas

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 concerning health issues.  However, 

 

5

  See WHO Model List of Essential Drugs, revised December 1999, WHO Drug Information, vol. 13, 

No. 4, 1999. 

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  Unless expressly provided otherwise, any reference in this general comment to health facilities, 

goods and services includes the underlying determinants of health outlined in paragraphs 11 and 12 (a) 

of this general comment. 

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  See paragraphs 18 and 19 of this general comment. 

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