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



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2.  States parties’ obligations 

General legal obligations 

30. 


While the Covenant provides for progressive realization and acknowledges the 

constraints due to the limits of available resources, it also imposes on States parties 

various obligations which are of immediate effect.  States parties have immediate 

obligations in relation to the right to health, such as the guarantee that the right will be 

exercised without discrimination of any kind (art. 2.2) and the obligation to take steps 

(art. 2.1) towards the full realization of article 12.  Such steps must be deliberate, 

concrete and targeted towards the full realization of the right to health.

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31. 



The progressive realization of the right to health over a period of time should 

not be interpreted as depriving States parties’ obligations of all meaningful content.  

Rather, progressive realization means that States parties have a specific and 

continuing obligation to move as expeditiously and effectively as possible towards the 

full realization of article 12.

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32. 



As with all other rights in the Covenant, there is a strong presumption that 

retrogressive measures taken in relation to the right to health are not permissible.  If 

any deliberately retrogressive measures are taken, the State party has the burden of 

proving that they have been introduced after the most careful consideration of all 

alternatives and that they are duly justified by reference to the totality of the rights 

provided for in the Covenant in the context of the full use of the State party’s 

maximum available resources.

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33. 



The right to health, like all human rights, imposes three types or levels of 

obligations on States parties:  the obligations to respectprotect and fulfil.  In turn, the 

obligation to fulfil contains obligations to facilitate, provide and promote.

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    The 



obligation to respect  requires States to refrain from interfering directly or indirectly 

with the enjoyment of the right to health.  The obligation to protect requires States to 

take measures that prevent third parties from interfering with article 12 guarantees.  

Finally, the obligation to fulfil requires States to adopt appropriate legislative, 

administrative, budgetary, judicial, promotional and other measures towards the full 

realization of the right to health. 

 

20

  See general comment No. 13, paragraph 43. 



21

  See general comment No. 3, paragraph 9; general comment No. 13, paragraph 44. 

22

  See general comment No. 3, paragraph 9; general comment No. 13, paragraph 45. 



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  According to general comments Nos. 12 and 13, the obligation to fulfil incorporates an obligation to 



facilitate and an obligation to provide.  In the present general comment, the obligation to fulfil also 

incorporates an obligation to promote because of the critical importance of health promotion in the 

work of WHO and elsewhere. 



 

 

 



 

 

                                                



Specific legal obligations 

34. 


In particular, States are under the obligation to respect the right to health by, 

inter alia, refraining from denying or limiting equal access for all persons, including 

prisoners or detainees, minorities, asylum-seekers and illegal immigrants, to 

preventive, curative and palliative health services; abstaining from enforcing 

discriminatory practices as a State policy; and abstaining from imposing 

discriminatory practices relating to women’s health status and needs.  Furthermore, 

obligations to respect include a State’s obligation to refrain from prohibiting or 

impeding traditional preventive care, healing practices and medicines, from marketing 

unsafe drugs and from applying coercive medical treatments, unless on an exceptional 

basis for the treatment of mental illness or the prevention and control of 

communicable diseases.  Such exceptional cases should be subject to specific and 

restrictive conditions, respecting best practices and applicable international standards, 

including the Principles for the Protection of Persons with Mental Illness and the 

Improvement of Mental Health Care.

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  In addition, States should refrain from 



limiting access to contraceptives and other means of maintaining sexual and 

reproductive health, from censoring, withholding or intentionally misrepresenting 

health-related information, including sexual education and information, as well as 

from preventing people’s participation in health-related matters.  States should also 

refrain from unlawfully polluting air, water and soil, e.g. through industrial waste 

from State-owned facilities, from using or testing nuclear, biological or chemical 

weapons if such testing results in the release of substances harmful to human health, 

and from limiting access to health services as a punitive measure, e.g. during armed 

conflicts in violation of international humanitarian law. 

35. Obligations 

to 

protect include, inter alia, the duties of States to adopt 

legislation or to take other measures ensuring equal access to health care and 

health-related services provided by third parties; to ensure that privatization of the 

health sector does not constitute a threat to the availability, accessibility, acceptability 

and quality of health facilities, goods and services; to control the marketing of 

medical equipment and medicines by third parties; and to ensure that medical 

practitioners and other health professionals meet appropriate standards of education, 

skill and ethical codes of conduct.  States are also obliged to ensure that harmful 

social or traditional practices do not interfere with access to pre- and post-natal care 

and family planning; to prevent third parties from coercing women to undergo 

traditional practices, e.g. female genital mutilation; and to take measures to protect all 

vulnerable or marginalized groups of society, in particular women, children, 

adolescents and older persons, in the light of gender-based expressions of violence.  

States should also ensure that third parties do not limit people’s access to 

health-related information and services. 

36. 


The obligation to fulfil requires States parties, inter alia, to give sufficient 

recognition to the right to health in the national political and legal systems, preferably 

by way of legislative implementation, and to adopt a national health policy with a 

 

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  General Assembly resolution 46/119 (1991). 


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