CONTRIBUTIONS TO THE GENERAL COMMENT ON THE RIGHT OF THE CHILD TO ENJOY THE
HIGHEST LEVEL OF HEALTH (ARTICLE 24) CRC
AUTHORS:
Latin American Group for Health and Children's Rights,(“Southern Cone Initiative”) consisting of health
professionals and related professions of Argentina, Colombia, Chile, Paraguay, Dominican Republic and
Uruguay. Participants: Ernesto Durán ejdurans@bt.unal.edu.co (Universidad Nacional, Colombia), Javier
Diaz jjaviergdia@yahoo.com.ar
(Colombian Society of Pediatrics), Helia Molina Milman
hmolina@med.puc.cl (PUC, Chile ) Irene Melamed (dramelamed@gmail.com) and Raúl Mercer (FLACSO,
Argentina),
Contact: Raul Mercer raulmercer@gmail.com FLACSO (Latin American School of Social Sciences,
Argentina)
Child Rights Education for Professional-CRED-PRO-International Institute for Child Rights and
Development-IICRD-The University of Victoria, Canada.
Contact: Gary Robinson gdrobinsong@gmail.com.
Society for Equity and Child Health (SECH, U.S)
Contact: Jeffrey Goldhagen jeffrey.goldhagen@jax.ufl.edu, University of Florida, Department of Pediatrics,
COLLABORATORS: (*Members of the Southern Cone Initiative):
Villamizar, Hernando*. President, American Association of Pediatrics-ALAPE. hvillamizar@gmail.com
Sanabria Moudelle, Claudia*. Health Department of Children and Youth, Ministry of Public Health and
Welfare - Paraguay. sanabriamoudelle@hotmail.com
Mayorga, Clemencia*. Colombian Society of Pediatrics clemayorga@gmail.com.
Rubio Mesa, Maria Lucia*. Assistant Professor. School of Medicine. Pontificia Universidad Javeriana.
Bogota, Colombia. marialuciamesa@gmail.com
Posada Alvaro Diaz. Colombian Society of Pediatrics. Medellín. Colombia alpodi47@une.net.co
Leyton Barbara Cardenas* National Health Program in Childhood Life Cycle DIPRECE Department /
Secretariat of Public Health, Ministry of Health, Chile bleyton@minsal.cl
Moreno Lopez Janneth Diva, Adolescent Health Program, Bogotá, Colombia divajanneth@gmail.com
Tejeda P, Altagracia M*. National Health Advisory Plan International Dominican Republic
altagracia.tejeda@plan-international.org
Michelini, Maria Laura* Uruguayan Society of Pediatrics mlmichelini@gmail.com
Schön, Andrea*, National Pediatric Hospital Juan P. Garrahan, Buenos Aires, Argentina,
andrea.schon@gmail.com
Hammermüller, Erica*, Children's Rights Group, Argentine Society of Pediatrics, erihamm@yahoo.com
Cordero, Miguel*, mcordero@minsal.cl Ministry of Health, Santiago, Chile.
Bedregal, Paula*. Associate Professor, School of Medicine, P. Catholic University of Chile. Santiago,
Chile, pbedrega@med.puc.cl
Fernandez-Jacomet, Susana*. FLACSO Latin American School of Social Sciences, Buenos Aires,
Argentina susanafjacomet@yahoo.com
Nereyda Catalan, Concha*. Past President of Chilean Society of Pediatrics, Adjunct Associate Professor
of Pediatrics at Pontificia Universidad Católica de Chile, nconcha@med.puc.cl
Esquivel, Ida Liedtke*. Coordinator, Committee for Social Pediatrics, Paraguayan Society of Pediatrics
idaelpy@yahoo.com
González Fernández, Luis Felipe*, Director Chilean Society of Pediatrics, lufegonz@gmail.com
Gorodisch, Ricardo, Kaleidos Foundation, Buenos Aires, Argentina, ricgoro@gmail.com
Llobet ,Valeria, Equity for Children (http://www.equidadparalainfancia.org/) valeria.s.llobet@gmail.com
Fabbiani, Andrea, Ministry of Public Health, Uruguay. afabbiani@msp.gub.uy
Norato, Ximena, Director, Bureau of Communications, Journalism ally of children, social development and
research-Pandi-Colombia ximenanorato@agenciapandi.org
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RESPONSE TO SUGGESTED QUESTIONS
1. Basic premises about the right to health and guiding principles (Questions 1 and 2):
The right to health includes both the right to maintain health and the right to restore health. This right
applies to both individual health and collective health (public health). To ensure the right to maintain and
restore health States must take positive action. These include health promotion policies, universal provision
of services, legislative and policy measures to promote equity and universal access to health.
Health is a social good which implies the possibility of enjoying well-being and quality of life that is greater
than the presence of any health condition or disease. Health is a social construct and does not depend on
any one person or any one sector of society. The health sector is an actor in ensuring the right to health,
but it also becomes important to be near children and families from pregnancy to the early years.
Guaranteeing children the right to health includes State actions on the determinants of health across the life
span (which is applicable to children's health act pre-conceptional period and during pregnancy). The State
shall guarantee equal access to all the basic determinants of health (save and balanced diet, nutrition and
quality housing provided with essential public services, decent work for parents, basic sanitation, including
water, healthy environment,-also includes polluting effect of industries, pesticides, mining-, education,
clothing and access to appropriate health services).
The right to health is closely linked not only to the right to life but to the right to a quality of life, which means
creating conditions that will ensure children and adolescents with an adequate standard of living for the
development of their optimal potential in their adult lives.
The right to health is interdependent with other rights. Thus, health depends on the effective guarantee of
other rights and is a fundamental enabling factor for the exercise of these other rights. Guaranteeing the
es
right to health is indivisible from the security
of all other rights for children and adolescents.
Although Article 24 expressly refers to the right to health, the text of the Convention deals with matters
relating to the right to comprehensive health care, specifically Articles 6, 12, 17, 18, 19, 20, 23, 24, 26, 27,
28, 29, 31, 32, 34, 36 and 42.
The health of children and adolescents is a fundamental right that cannot be restricted or limited by national
legislation, state or local, or subject to economic constraints. States should use their legal and political
authority to recognize the universal right to health.
The best interest of the child should be the guiding principle that guides all States’ decisions about health of
children and adolescents.
The principle of universality provides that States should ensure that policies, programs, plans, and
strategies aimed at both preserving and restoring health through universal coverage without discrimination
of any kind. For each of the services and of health promotion and prevention activities, four basic conditions
should prevail: availability, accessibility, acceptability and quality. In order to ensure the universality of
health there must be equity in access to health care and to the underlying determinants of health
throughout the State
States should ensure that respect for the right to health is continually progressing. This means that more
and more services are incorporated into health plans and the plan’s promotion, prevention, treatment and
rehabilitation activities. No State can be regressive in its guarantee of the right to health, nor may any
service be withdrawn, unless it has proven useless or potentially harmful. If the State has delegated the
provision of services to private actors the state should ensure that they comply with this principle.
Children and adolescents and their families have the right to participate actively in decisions affecting their
health in any way and their opinion should be taken into account with respect to these decisions.
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2. Obligations and responsibilities derived from Article 24
Article 24 establishes the obligation of States to make every effort to promote and safeguard the health of
all children and adolescents, and to ensure treatment and rehabilitation of patients. They should include:
public health policies that promote positive impact (and discourage any negative impact) on child health
through each public policy, ensure universal health services, primary health care, combat malnutrition and
disease, ensure clean water and unpolluted environments, ensure timely and appropriate pre-and postnatal
care, and provide information and health education to children, teens, parents and community.
States have the obligation to respect, ensure and protect the right to health, which include: not advancing or
promoting policies or actions (by any sector of the State) that adversely affect in any way the health of
children; provide resources and the means necessary to achieve the guaranteed right to health; ensure
through policies, plans, programs, strategies and actions of both the health sector and other sectors
involved in the promotion and care of child health; protect children and adolescents against any situation
that violates or affects their right to health by any member of society or the state itself; prevent
discrimination and adopt legislative means and differentiating political actions for the most vulnerable
groups; monitor compliance with its obligations of the other actors who share responsibility for child health:
the family and society and immediately restore rights when violations have occurred; discourage and
punish violations of the right to individual or collective health, committed by public servants, or by any
citizen, company or institution.
States should have universal coverage policies aimed at caring for, preserving and promoting child health,
preventing disease (which includes early detection of risks and acting on them), providing adequate and
timely care and rehabilitation of all children, and adolescents who need care.
Since there are major social and economic inequalities that significantly affect the health of poor children
and adolescents, States must prioritize health care for the most vulnerable and marginalized populations.
This means ensuring social inclusion of all children and adolescents, regardless of their health condition,
disability, cultural, religious, gender, socioeconomic status and age.
The promotion and prevention activities aimed at children and adolescents should be directed to:
• Promote and ensure all rights and specifically the rights to life, the quality of life, healthy environment and
the preservation of health.
• Promote health and growth and harmonious development.
• Promote self-care and health care by parents and caregivers.
• Identify protective factors and risk factors, increase the former first and control the latter.
• Promote humane rearing practices, good treatment and bonding.
• Promote knowledge, ownership and exercise of sexual and reproductive rights by children and
adolescents.
• Promote healthy lifestyles.
• Encourage breastfeeding, complementary feeding, balanced and healthy eating for all ages.
• Prevent illness and health problems, accidents and problems in growth and development.
• Identify and intervene early when there are physical, mental, emotional and sensory changes.
• Promote community participation and coordination with other sectors to promote overall health.
• Establish and monitor the conditions of health, growth and development of each child or adolescent.
States should guarantee the right to permanent adequate nutrition (balanced, comprehensive and quality),
and adequate livable conditions for all children and adolescents without exception.
The care of children and young patients should be comprehensive, timely, high quality and with warmth.
Such care should be directed to the speedy recovery of the highest attainable standard of health and the
prevention of any kind of relapse or injury. Health care facilities must be geographically and culturally
accessible for the entire population, without cost barriers that impede access. The care of children and
adolescents should be a priority within health systems.
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All health services and activities aimed at children and adolescents should be conducted in a holistic
framework of respect for their dignity and rights, which means respecting their autonomy, respect for their
privacy, respect for the right to remain with their family (they should not be separated from their family when
they are admitted to health facilities), respect their right to participate and comment so that their views are
taken into account, their right to information, their right to education and recreation and the right to be
protected from maltreatment, abuse, neglect and any form of exploitation.
States should provide the maximum possible resources to ensure the right to health by children and
adolescents. This means that the percentage of the budget for this purpose should never decrease and
should increase progressively, as the social and economic development of each State allows.
States must ensure timely and non-discrimination to all children and adolescents who have some degree of
permanent limitation (whether physical, cognitive, mental, sensory or otherwise) or a chronic disease with
significant impact to their health. They should have available rehabilitation services deemed necessary to
enjoy a dignified life in conditions of equality with others, and to help them reach their full potential and
participate actively in the community. States should eliminate any barriers to accessing health services for
these children and adolescents.
3) Priority concerns in Latin America
The trend of the processes of health sector reform that have occurred in Latin America have affected the
different countries of the region in different ways. In some cases it has privatized the management and
delivery of health services, making them a good, limited rights provisions in an established contract, and
deepened social inequities and limited nutritional health. The loss of the role of stewardship of health by the
States has generated disturbing corruption in the sector, with emergence of power groups with great
influence over the priorities, policies and actions on health.
As a consequence of the above, there has been a worrying fragmentation of health services. Health is not
considered as an integral theme today, but rather, one that is divided into different market niches, each of
which has its own particular interests. It is the obligation of States to have comprehensive policies that are
designed and implemented across sectors and that child health should be in all of these policies
Financial groups see the health sector as a business. As such they have monopolized the market for
vaccines, drugs and diagnostic and therapeutic support, leading to high costs that are not accessible to
most third world population. These private groups do not prioritize the most common diseases of childhood
and adolescence in their research, because high-cost chronic diseases are more profitable. The free trade
agreements have strengthened this scheme by promoting respect for product patents essential for child
health.
States’ investment in priority areas such as safety, rescuing the financial sector or external debt payments,
leaving child health and nutrition as a low priority investment.
Great social and economic inequities have generated health inequities and resulted in a condition where
most of the deaths of people under 18 are from health problems that are preventable. Poverty, malnutrition,
lack of access to basic services, inadequate housing, and unsanitary environments are the background to
most health problems in the population under 18 years of age. National averages hide large inequalities in
health within countries.
These inequities in health rather than be addressed by services provided by the State, often are increased
by new inequities in access and quality of health services and nutrition.
Although primary care has improved, it is limited in coverage, quality and timeliness. This has generated a
condition where most of the States’ resources are invested in addressing health problems that could have
been prevented. There are many primary care strategies that have been implemented in the region that
have an impact on child health (IAMI-IAFI, IMCI, Healthy Kindergartens, Healthy Schools, sexual and
reproductive health, adolescent-friendly services, etc..), These strategies do not currently receive sufficient
support from the States to turn the tide of inequitable health.
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Concern in the region is focused on the problems of malnutrition, anemia, micronutrient deficiencies,
overweight and obesity, low birth weight, congenital problems, perinatal problems, morbidity and mortality
from acute respiratory illness and acute diarrheal disease, oral problems, problems in development,
limitations and disabilities, mental health problems, accidents, violent deaths, maltreatment, abuse and
violence, teen pregnancy, psychoactive substance use, sexual and reproductive health of adolescents,
HIV-AIDS and other sexually transmitted diseases.
Of equal importance is the concern for effective guarantee of child rights in situations of natural or social
disaster. Adequate health care and nutrition of children in these situations leaves much to be desired.
States are not adequately prepared for these situations, which seemingly are repeated year after year.
International aid is limited in time and the ability to respond to the magnitude of these disasters leaving both
the rights and health of the child in a precarious and intolerable situation. Prevention and mitigation with a
gender and rights based a approach should be a priority for the States.
Practices persist that leave children and adolescents in situations of vulnerability that seriously affect their
health, development and physical and mental well-being, such as different forms of violence, abandonment,
child labor, slavery, begging, street life, sexual exploitation, linking criminal gangs and armed groups,
abduction, trafficking and use in the production and trade of narcotics.
Unwanted and unintended teen pregnancies persist and are complicated by the problems of lack of
adequate prenatal and postnatal care. This lack of adequate care generates a high incidence of low birth
weight, increased perinatal mortality. These detrimental consequences in the development and health of
the child will persist throughout the child’s lifetime.
The issues of child development and mental health continue to occupy a lower level of importance for
children, and while there has been an increased concern in recent years for early childhood care, it is more
focused on physical care than in the psycho- emotional and social health of the child or adolescent. The
mental health of school children and adolescents is a marginal issue that receives little attention and few
resources.
Social participation in health in the region is treated in a utilitarian manner through a series of consultative
councils, non-binding, which are aimed at controlling and monitoring the effective guarantee of the right to
health.
4) Specific measures to be put in place to implement Article 24
Updating legal frameworks so that they clearly incorporate health as a fundamental right with explicit
mandates on how it will be guaranteed.
Child health should be present in all policies. Inclusion of the social determinants approach in policies and
actions of the health sector and other sectors.
Reducing inequalities and poverty. Eradication of hunger and child malnutrition.
Reducing inequalities, barriers and lack of access to health services and all the underlying determinants of
health
Restriction on the privatization of health services and the segmentation of access to health services
according to ability to pay.
Increased resources for health promotion, prevention, care and rehabilitation for children and adolescents.
Design, development and support of new equitable and supportive models of health and universal social
security, and integrated health systems, aimed at the effective guarantee of rights for all.
Protection and care for all and for every expectant family.
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Promotion and facilitation of breastfeeding up to two years, exclusive breastfeeding until 6 months and
application of the International Code of Marketing of Breast Milk Substitutes.
Declaration of hunger and child malnutrition as a global emergency with the establishment of clear goals for
its eradication in this decade.
Universalization of common vaccination for all children and adolescents, expanding the currently existing
EPI. Childhood vaccines must be declared a good of humanity and limit the business imperative of the
availability of childhood vaccines.
Prioritization of prevention, early detection and proper management of health problems prevalent in
childhood and adolescence in the international agenda and national research. Creation of an international
fund dedicated to this issue.
Training for children and adolescents, their families and the community about health and nutrition rights.
Ensuring that all children and adolescents have access to clean water, adequate food, housing, education,
access to activities and promotion and prevention programs and access to quality health care and warmth.
Strengthening public health and primary health care aimed at pregnancy, early childhood, school children
and adolescents and respecting cultural diversity.
Strengthening information systems with a focus on rights, which allow monitoring the evolution of the health
indicators (negative and positive); disaggregated by gender, country, age and ethnicity,
Qualification and strengthening health care and child nutrition in cases of natural and social disasters.
Ensuring respect for all rights in all health sector activities. Development of different health services,
adapted to the needs of children and adolescents (friendly service).
Continuous training for all health personnel in a human rights approach to health, with mandatory content
and updating.
Development by international agencies, including the Committee [CRC] of the right to food and nutrition
security as a fundamental right of children and adolescents
Inclusion of child health as a right in the agendas of the regional and international human rights treaty
organizations.
Promotion of surveillance with social and citizen control of the guaranteed right to child health and nutrition.
Promotion of the right of children and adolescents to participate in decisions regarding their health,
advocacy, treatment and care and public sector policies affecting them.
The metrics used to measure the success of GC-or Article 24 must include its capacity to both prepare
States professionals and other stakeholders how to respond to root causes of contemporary child health
determinants, as well as prevent and mitigate future health issues, e.g., impact of globalization and climate
change on children.
Metrics used to evaluate the design, implementation and formative and summative outcomes of policies,
systems, programs and practices related to Article 24 should be structured as equity indicators –indicators
that identify and measure the full spectrum of the aetiologies of child health and well-being and outcomes of
systems and programs. General comment on Article 24 should explicitly move the science of measurement
from quantifying disparities to assessing the identification and mitigation of the root causes of disparities in
child health and well-being.
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