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

 

 

 

 

 

47. 

In determining which actions or omissions amount to a violation of the right to 

health, it is important to distinguish the inability from the unwillingness of a State 

party to comply with its obligations under article 12.  This follows from article 12.1, 

which speaks of the highest attainable standard of health, as well as from article 2.1 of 

the Covenant, which obliges each State party to take the necessary steps to the 

maximum of its available resources.  A State which is unwilling to use the maximum 

of its available resources for the realization of the right to health is in violation of its 

obligations under article 12.  If resource constraints render it impossible for a State to 

comply fully with its Covenant obligations, it has the burden of justifying that every 

effort has nevertheless been made to use all available resources at its disposal in order 

to satisfy, as a matter of priority, the obligations outlined above.  It should be stressed, 

however, that a State party cannot, under any circumstances whatsoever, justify its 

non-compliance with the core obligations set out in paragraph 43 above, which are 

non-derogable. 

48. 

Violations of the right to health can occur through the direct action of States or 

other entities insufficiently regulated by States.  The adoption of any retrogressive 

measures incompatible with the core obligations under the right to health, outlined in 

paragraph 43 above, constitutes a violation of the right to health.  Violations through 

acts of commission include the formal repeal or suspension of legislation necessary 

for the continued enjoyment of the right to health or the adoption of legislation or 

policies which are manifestly incompatible with pre-existing domestic or international 

legal obligations in relation to the right to health. 

49. 

Violations of the right to health can also occur through the omission or failure 

of States to take necessary measures arising from legal obligations.  Violations 

through acts of omission include the failure to take appropriate steps towards the full 

realization of everyone’s right to the enjoyment of the highest attainable standard of 

physical and mental health, the failure to have a national policy on occupational safety 

and health as well as occupational health services, and the failure to enforce relevant 

laws. 

Violations of the obligation to respect 

50. 

Violations of the obligation to respect are those State actions, policies or laws 

that contravene the standards set out in article 12 of the Covenant and are likely to 

result in bodily harm, unnecessary morbidity and preventable mortality.  Examples 

include the denial of access to health facilities, goods and services to particular 

individuals or groups as a result of de jure or de facto discrimination; the deliberate 

withholding or misrepresentation of information vital to health protection or 

treatment; the suspension of legislation or the adoption of laws or policies that 

interfere with the enjoyment of any of the components of the right to health; and the 

failure of the State to take into account its legal obligations regarding the right to 

health when entering into bilateral or multilateral agreements with other States, 

international organizations and other entities, such as multinational corporations. 

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Violations of the obligation to protect 

51. 

Violations of the obligation to protect follow from the failure of a State to take 

all necessary measures to safeguard persons within their jurisdiction from 

infringements of the right to health by third parties.  This category includes such 

omissions as the failure to regulate the activities of individuals, groups or corporations 

so as to prevent them from violating the right to health of others; the failure to protect 

consumers and workers from practices detrimental to health, e.g. by employers and 

manufacturers of medicines or food; the failure to discourage production, marketing 

and consumption of tobacco, narcotics and other harmful substances; the failure to 

protect women against violence or to prosecute perpetrators; the failure to discourage 

the continued observance of harmful traditional medical or cultural practices; and the 

failure to enact or enforce laws to prevent the pollution of water, air and soil by 

extractive and manufacturing industries. 

Violations of the obligation to fulfil 

52. 

Violations of the obligation to fulfil occur through the failure of States parties 

to take all necessary steps to ensure the realization of the right to health.  Examples 

include the failure to adopt or implement a national health policy designed to ensure 

the right to health for everyone; insufficient expenditure or misallocation of public 

resources which results in the non-enjoyment of the right to health by individuals or 

groups, particularly the vulnerable or marginalized; the failure to monitor the 

realization of the right to health at the national level, for example by identifying right 

to health indicators and benchmarks; the failure to take measures to reduce 

the inequitable distribution of health facilities, goods and services; the failure to adopt 

a gender-sensitive approach to health; and the failure to reduce infant and maternal 

mortality rates. 

4.  Implementation at the national level 

Framework legislation 

53. 

The most appropriate feasible measures to implement the right to health will 

vary significantly from one State to another.  Every State has a margin of discretion in 

assessing which measures are most suitable to meet its specific circumstances.  The 

Covenant, however, clearly imposes a duty on each State to take whatever steps are 

necessary to ensure that everyone has access to health facilities, goods and services so 

that they can enjoy, as soon as possible, the highest attainable standard of physical 

and mental health.  This requires the adoption of a national strategy to ensure to all the 

enjoyment of the right to health, based on human rights principles which define the 

objectives of that strategy, and the formulation of policies and corresponding right to 

health indicators and benchmarks.  The national health strategy should also identify 

the resources available to attain defined objectives, as well as the most cost-effective 

way of using those resources. 

54. 

The formulation and implementation of national health strategies and plans of 

action should respect, inter alia, the principles of non-discrimination and people’s 

participation.  In particular, the right of individuals and groups to participate in 

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decision-making processes, which may affect their development, must be an integral 

component of any policy, programme or strategy developed to discharge 

governmental obligations under article 12.  Promoting health must involve effective 

community action in setting priorities, making decisions, planning, implementing and 

evaluating strategies to achieve better health.  Effective provision of health services 

can only be assured if people’s participation is secured by States. 

55. 

The national health strategy and plan of action should also be based on the 

principles of accountability, transparency and independence of the judiciary, since 

good governance is essential to the effective implementation of all human rights, 

including the realization of the right to health.  In order to create a favourable climate 

for the realization of the right, States parties should take appropriate steps to ensure 

that the private business sector and civil society are aware of, and consider the 

importance of, the right to health in pursuing their activities. 

56. 

States should consider adopting a framework law to operationalize their right 

to health national strategy.  The framework law should establish national mechanisms 

for monitoring the implementation of national health strategies and plans of action.  It 

should include provisions on the targets to be achieved and the time frame for their 

achievement; the means by which right to health benchmarks could be achieved; the 

intended collaboration with civil society, including health experts, the private sector 

and international organizations; institutional responsibility for the implementation of 

the right to health national strategy and plan of action; and possible recourse 

procedures.  In monitoring progress towards the realization of the right to health, 

States parties should identify the factors and difficulties affecting implementation of 

their obligations. 

Right to health indicators and benchmarks 

57. 

National health strategies should identify appropriate right to health indicators 

and benchmarks.  The indicators should be designed to monitor, at the national and 

international levels, the State party’s obligations under article 12.  States may obtain 

guidance on appropriate right to health indicators, which should address different 

aspects of the right to health, from the ongoing work of WHO and the United Nations 

Children’s Fund (UNICEF) in this field.  Right to health indicators require 

disaggregation on the prohibited grounds of discrimination. 

58. 

Having identified appropriate right to health indicators, States parties are 

invited to set appropriate national benchmarks in relation to each indicator.  During 

the periodic reporting procedure the Committee will engage in a process of scoping 

with the State party.  Scoping involves the joint consideration by the State party and 

the Committee of the indicators and national benchmarks which will then provide the 

targets to be achieved during the next reporting period.  In the following five years, 

the State party will use these national benchmarks to help monitor its implementation 

of article 12.  Thereafter, in the subsequent reporting process, the State party and the 

Committee will consider whether or not the benchmarks have been achieved, and the 

reasons for any difficulties that may have been encountered. 

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Remedies and accountability 

59. 

Any person or group victim of a violation of the right to health should have 

access to effective judicial or other appropriate remedies at both national and 

international levels.

30

  All victims of such violations should be entitled to adequate 

reparation, which may take the form of restitution, compensation, satisfaction or 

guarantees of non-repetition.  National ombudsmen, human rights commissions, 

consumer forums, patients’ rights associations or similar institutions should address 

violations of the right to health. 

60. 

The incorporation in the domestic legal order of international instruments 

recognizing the right to health can significantly enhance the scope and effectiveness 

of remedial measures and should be encouraged in all cases.

31

  Incorporation enables 

courts to adjudicate violations of the right to health, or at least its core obligations, by 

direct reference to the Covenant. 

61. 

Judges and members of the legal profession should be encouraged by States 

parties to pay greater attention to violations of the right to health in the exercise of 

their functions. 

62. 

States parties should respect, protect, facilitate and promote the work of 

human rights advocates and other members of civil society with a view to assisting 

vulnerable or marginalized groups in the realization of their right to health. 

5.  Obligations of actors other than States parties 

63. 

The role of the United Nations agencies and programmes, and in particular the 

key function assigned to WHO in realizing the right to health at the international, 

regional and country levels, is of particular importance, as is the function of UNICEF 

in relation to the right to health of children.  When formulating and implementing 

their right to health national strategies, States parties should avail themselves of 

technical assistance and cooperation of WHO.  Further, when preparing their reports, 

States parties should utilize the extensive information and advisory services of WHO 

with regard to data collection, disaggregation, and the development of right to health 

indicators and benchmarks. 

64. 

Moreover, coordinated efforts for the realization of the right to health should 

be maintained to enhance the interaction among all the actors concerned, including the 

various components of civil society.  In conformity with articles 22 and 23 of the 

Covenant, WHO, the 

International Labour Organization, the United 

Nations 

Development Programme, UNICEF, the United Nations Population Fund, the World 

 

30

  Regardless of whether groups as such can seek remedies as distinct holders of rights, States parties 

are bound by both the collective and individual dimensions of article 12.  Collective rights are critical 

in the field of health; modern public health policy relies heavily on prevention and promotion which 

are approaches directed primarily to groups. 

31

  See general comment No. 2, paragraph 9. 

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Bank, regional development banks, the International Monetary Fund, the World Trade 

Organization and other relevant bodies within the United Nations system, should 

cooperate effectively with States parties, building on their respective expertise, in 

relation to the implementation of the right to health at the national level, with due 

respect to their individual mandates.  In particular, the international financial 

institutions, notably the World Bank and the International Monetary Fund, should pay 

greater attention to the protection of the right to health in their lending policies, credit 

agreements and structural adjustment programmes.  When examining the reports of 

States parties and their ability to meet the obligations under article 12, the Committee 

will consider the effects of the assistance provided by all other actors.  The adoption 

of a human rights-based approach by United 

Nations specialized agencies, 

programmes and bodies will greatly facilitate implementation of the right to health.  

In the course of its examination of States parties’ reports, the Committee will also 

consider the role of health professional associations and other non-governmental 

organizations in relation to the States’ obligations under article 12. 

65. 

The role of WHO, the Office of the United Nations High Commissioner for 

Refugees, the International Committee of the Red Cross/Red Crescent and UNICEF, 

as well as non-governmental organizations and national medical associations, is of 

particular importance in relation to disaster relief and humanitarian assistance in times 

of emergencies, including assistance to refugees and internally displaced persons.  

Priority in the provision of international medical aid, distribution and management of 

resources, such as safe and potable water, food and medical supplies, and financial aid 

should be given to the most vulnerable or marginalized groups of the population. 

Adopted on 11 May 2000. 

 

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Document Outline

• CESCR General Comment No. 14:  The Right to the Highest Attainable Standard of Health (Art. 12)
• 1.  Normative content of article 12
• Article 12.2 (a):  The right to maternal, child and reproductive health
• Article 12.2 (b):  The right to healthy natural and workplace environments
• Article 12.2 (c):  The right to prevention, treatment and control of diseases
• Article 12.2 (d):  The right to health facilities, goods and services 
• Article 12:  Special topics of broad application
  • Non discrimination and equal treatment
  • Gender perspective
  • Women and the right to health
  • Children and adolescents
  • Older persons
  • Persons with disabilities
  • Indigenous peoples
  • Limitations
• 2.  States parties’ obligations
  • General legal obligations
  • Specific legal obligations
  • International obligations
  • Core obligations
• 3.  Violations
  • Violations of the obligation to respect
  • Violations of the obligation to protect
  • Violations of the obligation to fulfil
• 4.  Implementation at the national level
  • Framework legislation
  • Right to health indicators and benchmarks
  • Remedies and accountability
• 5.  Obligations of actors other than States parties