A/61/338 inequity in access to medicines remains the overriding feature of the world pharmaceutical situation.33 Average per capita spending on medicines in highincome countries is 100 times higher than in low-income countries: about US$ 400 compared with US$ 4. WHO estimates that 15 per cent of the world’s population consumes over 90 per cent of the world’s production of pharmaceuticals.30 38. Existing national and international policies, rules and institutions give rise to these massive deprivations and inequalities. National supply systems for medicines often do not reach those living in poverty. If they do, the medicines are often unaffordable. Historically, research and development has not addressed the priority health needs of those living in poverty. Alternative arrangements are feasible and reforms are urgently required. Indeed, they are demanded by legal and ethical duties, including those arising from international human rights law. 39. Millennium Development Goals, such as reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, depend upon improving access to medicines. Indeed, one of the Millennium Development Goal targets is to provide, in cooperation with pharmaceutical companies, access to affordable essential drugs in developing countries.34 Crucially, implementation of the right to the highest attainable standard of health can help to achieve the healthrelated Goals. 40. Medical care in the event of sickness, as well as the prevention, treatment and control of diseases, are central features of the right to the highest attainable standard of health.35 These features depend upon access to medicines. Thus, access to medicines forms an indispensable part of the right to the highest attainable standard of health. Numerous court cases, as well as resolutions of the Commission on Human Rights, confirm that access to essential medicines is a fundamental element of the right to health.36 Some of the cases also confirm that access to essential medicines issues are closely connected to other human rights, such as the right to life. 41. This chapter briefly examines the medicines component of the right to health. While the chapter focuses upon the responsibilities of States (see sect. A, paras. 4781 below), it also provides a brief introduction to the responsibilities of pharmaceutical companies (see sect. B, paras. 82-92). The chapter is offered as a preliminary contribution to far-reaching human rights issues of the first importance. 42. Since 2004, the Special Rapporteur has benefited from a number of substantive workshops and other meetings with numerous actors, including representatives of pharmaceutical companies, on the issues introduced in this chapter (see para. 86). With a view to being as practical and constructive as possible, he is preparing some draft guidelines for States and pharmaceutical companies on access to medicines. The draft aims to help States and pharmaceutical companies better understand and discharge their right-to-health responsibilities in relation to access to medicines. Section A addresses the responsibilities of States; section B the responsibilities of pharmaceutical companies. (The preliminary draft can be found at http:// www2.essex.ac.uk/human_rights_centre/rth/rapporteur.shtm.) 43. The Special Rapporteur will work further on this preliminary draft in the coming months with a view to finalizing the guidelines in 2007. He will consult widely on the draft and takes this opportunity to encourage all interested parties to provide him with their comments.37 06-51997 11