Statement by Mr Dainius Pūras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health at the 32nd session of the Human Rights Council

14 June 2016

Mr President, Excellencies,
Distinguished Delegates,
Ladies and Gentlemen,

It is my pleasure to be here today to present two thematic reports to this Council, one on the right to health in adolescence (A/HRC/32/32), and another one on sport and healthy lifestyles as contributing factors to the right to health (A/HRC/32/33), as mandated by Resolution 26/18. 

I also present two reports on my country visit to Paraguay and on the joint visit to Nigeria that I conducted jointly with the Special Rapporteur on sale of children, child prostitution and child pornography, Ms. Maud De Boer-Buquicchio, and the Special Rapporteur on contemporary forms of slavery, Ms. Urmila Bhoola.  I am delighted that they are also here on the podium to be part of this dialogue.

Ladies and Gentlemen,

Adolescence is a life stage of intrinsic value, not merely a transition between childhood and adulthood.  It is also a life stage when inequities become more differentiated in terms of access to services, life decisions and future trajectories. Investing in the right to health of adolescents offers huge potential to capitalize on investments in early years, while providing the opportunity to compensate negative early experiences and building resilience to mitigate future harm.  

States should be guided by the principle that adolescence is a period of development towards increased capacity for independent decision-making. States should invest in empowering adolescents by respecting their rights and autonomy, recognizing their capacities and supporting their health and resilience.  While adolescents should be protected from violence, exploitation and other adversities, the nature of those protections and their application must take into account the emerging competencies and evolving capacities acquired throughout this period of life.

I urge States to meet their core obligation to recognize adolescents as rights holders by respecting their evolving capacities and their right to participate in the design, delivery and evaluation of policies and services that affect their health and well-being.  To this end, States should remove all legal barriers to access health facilities, goods and services that infringe upon the rights of adolescents to be heard and to be taken seriously and that, ultimately, limit their right to make autonomous decisions. 

Through a human rights lense, adolescent health demands a holistic approach not only to address the underlying and social determinants but also to balance curative service provision with investment in the resilience and autonomy of adolescents. Health services should ensure respect for adolescents’ rights to privacy and confidentiality, address their different cultural needs and expectations, and comply with ethical standards. 

The protection of adolescents from violence and neglect, including in family settings, should be guaranteed by upholding their right to confidential services and counselling without parental consent.  Support of the family environment is very important for the physical and mental health of children and adolescents. States should support families to increase the abilities of parents to raise children and adolescents in a competent and confident manner, and reinforce skills to manage situations in a non-violent way. 

Policies designed to protect families and family values should avoid measures that undermine the human rights of individual family members, including women, adolescents and younger children. Such approaches can be detrimental as they may, in the name of traditional values, condone violence, reinforce unequal power relations within family settings and, therefore, deprive adolescents from the opportunity to exercise their basic rights.

Foundations laid down during adolescence will have profound implications for the social, economic and political development not only of adolescents but of society as a whole. Therefore, the costs of failing adolescents are simply too high.

Mr President,

In my report on sport and healthy lifestyles as contributing factors to the right to health, I focus on sport and physical activity.  Healthy lifestyles have not traditionally been viewed as a human rights issue but their adoption is integral to realization of the right to health.

Sport and physical activity are a vital part of healthy lifestyles, and States and other actors incur important obligations to maximize individual capacity to exercise and to live healthfully. In this context, the core obligation to respect the right to health means that no one should be prohibited from participating in sport or physical activity. Therefore, States and international sporting bodies must immediately remove discriminatory laws and policies in sport, including those that hinder participation, and tackle discriminatory attitudes and practices.  States should incorporate sport and healthy lifestyles into their national health programming and take positive steps to ensure access to safe spaces in which all people can participate in sport and physical activity.

The rights of both professional and amateur athletes, including children, must be protected as abuse, violence and discrimination occur too frequently within sport.  Many rights violations stem from a “winning at all costs” mentality that is tolerated or encouraged by States, particularly in competitive sporting contexts. While a certain level of “healthy” sporting competition can foster participation, excellence and enjoyment, appropriate safeguards must be in place to ensure the protection of all amateur and professional athletes. 

Private corporations and sporting organizations, including international sporting bodies, have a vital role to play in securing realization of the right to health through sport and healthy lifestyles. These entities should ensure that their policies and programmes, including those around major sporting events, do not undermine health rights, and are in line with international human rights law.

Ladies and Gentlemen,

Since I last reported to this Council, I have conducted three country visits to Paraguay, Nigeria and Algeria. I would like to extend my sincere appreciation to the Governments of these three countries for extending an invitation and for their cooperation before, during and after the visits.  I present two of these reports to you today.

Paraguay has made progress with regard to the realization of the right to health, particularly by improving basic health-related indicators and harmonizing the normative framework in line with its international human rights obligations. There have also been important achievements regarding the expansion of primary care. 

However, the Government should address a number of serious challenges that persist mostly connected to the implementation of the existing normative and policy framework, as well as with the prevalence of inequalities, discrimination and violence against certain population groups, in particular women and girls, children and adolescents, lesbian, gay, bisexual and transgender persons, people living with HIV/AIDS, and persons with psychosocial and intellectual disabilities. The national healthcare system also faces important challenges regarding structure and financing of the sector, primary care and universal coverage, and human resources.  

I would like to underline the situation of women and girls and the serious barriers they face in the enjoyment of their right to health, particularly those from groups in situations of poverty and vulnerability. In this connection, Paraguay should step up efforts to reduce the high rates of preventable maternal and neonatal mortality and morbidity, including through effective measures to address high rates of early pregnancies, many of them among very young girls. 

In my view, the existing legal, policy and institutional framework is failing to protect very young girls who have been victims of sexual abuse and are forced to continue high-risk pregnancies and motherhoods with long-lasting impacts on their physical and mental health.  In my report, I recommend specific changes in legislation, policies and practices based on scientific evidence and a human rights-based approach. 

Mr President,

The visit to Nigeria was the first joint visit with a very specific, technical aim, namely to examine the measures taken to rehabilitate and reintegrate the women and children, liberated from Boko Haram captivity and control.  The plight of these women and children is complex, multi-faceted and brings into consideration a broad spectrum of human rights considerations. 

Before I summarise our findings, I would like to express how happy we were when we learnt of the liberation of one of the Chibok girls a few weeks back.  This news has given us hope and reason for not slowing down our collective efforts to seeing all Chibok girls and the other civilians under Boko Haram control back with the families and communities.

Our report notes that all levels of Government have spared no efforts in putting in place measures to respond to this crisis, including the human rights abuses and humanitarian law violations that it has brought about. However, we also note that the extent of these challenges and the numbers of people in need remain overwhelming and well beyond the reach of current responses. Moreover, the crisis has exacerbated existing structural problems for the population of the North East, including poor access to services, vulnerability of certain groups to discrimination, violence and abuse.

We note gaps at various levels, including in collecting disaggregated data and monitoring; in ensuring security; in coordinating different interventions; in providing psychosocial support, health care and livelihood opportunities; in combating stigma; and in providing access to justice and remedy.  In our view, only a comprehensive, holistic and integrated approach will provide opportunities not only to reintegrate women and children affected by Boko Haram but also to strengthen the existing institutional system.  This is particularly the case when it comes to health and educational sectors which are crucial for peace, security and sustainable development.

In our view, the momentum could be turned for the better of the northeast population in Nigeria.  Rehabilitation and reintegration measures should be implemented with the aim to transform society by addressing the root causes, especially poverty, discrimination, lack of security and deprivation, stigma, exclusion and gender inequality.

Excellencies,
Ladies and Gentlemen,

I have presented these thematic and country visit reports, and recommendations contained therein, in a spirit of constructive dialogue and engagement with you. Me, and my colleagues, stand ready to continue providing assistance and technical advice in any follow up to these recommendations. 

I look forward to the dialogue today and thank you for your attention and support.