Summary

In many countries health care is among the most corrupt sectors. This has significant implications for equality and non-discrimination, since it has a particularly marked impact on the health of populations in situations of vulnerability and social exclusion, in particular children and people living in poverty.

The present report focuses not only on those forms of corruption that are legally defined as breaking the law and should be brought to justice, but also on those practices which undermine principles of medical ethics and social justice, as well as an effective and transparent health-care provision.

Corruption originates from power imbalances and asymmetries, is perpetuated by non-transparent decision-making and reinforces ineffective and harmful policymaking and health services provision. It can have a devastating effect on good governance, the rule of law, development and the equitable enjoyment of all human rights, including the right to health. It threatens the sustainability of health-care systems worldwide.

The Special Rapporteur identifies domestic and global root causes of corruption, including some related to the pharmaceutical industry and some of which have resulted in “institutional corruption”. He points at the “normalization” of corruption in healthcare through practices which undermine the principles of medical ethics, social justice, transparency and effective healthcare provision. The expert points at the mental health sector as one particularly affected due to the lack of transparency and accountability in the relationships between the pharmaceutical industry and the health sector, including academic medicine.

Conclusions and Recommendations

The Special Rapporteur underlies that the right to health provides a valuable normative framework and further constitutes a legally binding imperative to analyse and address corruption affecting the right to health and occurring in and beyond the health sector. He calls on States to provide bold leadership to confront corruption and its severe impact on the right to health, including more protection for “whistleblowers” and empowering the public to report corruption.

He strongly encourages States to raise awareness among health care providers of unethical practices and situations of conflict of interest, and to empower users to report corrupt acts.

He also urges all relevant stakeholders to address corrupt practices taking place in all stage of the pharmaceutical value chain, including during research and development, manufacturing, registration, distribution, procurement and marketing of medicines.

The Special Rapporteur finally recommends the “rational” provision of health care services to prevent the costly and unnecessary use of specialized interventions by educating the general population against unnecessary use of medical tests, treatments and procedures.