A/HRC/23/42 health concern.9 While it is understandable that private pharmaceutical companies should follow such an approach, there is a growing need for States to balance that market-driven perspective by positioning access to medicines in the right-to-health framework. There is thus the need to shift the dominant market-oriented paradigm on access to medicines towards a right-to-health paradigm and reaffirm that access to affordable and quality medicines and medical care in the event of sickness, as well as the prevention, treatment and control of diseases, are central elements of the enjoyment of the right to health. 8. Ensuring access to medicines also requires a functioning health system that encapsulates the key elements of the right to health: availability, accessibility, acceptability and quality. As part of the State obligation to fulfil the right to health10 and with a view to the progressive realization of access to affordable and quality medicines,11 the Special Rapporteur urges States to adopt a detailed national plan of action on medicines. The plan of action should be backed by a strong political will and commitment that prioritizes access to medicines within the public health budget and allocates resources accordingly. This is particularly pertinent in the context of the current global economic crisis, where some States are increasingly taking retrogressive measures such as reducing spending on health by reducing national health budgets.12 The Special Rapporteur stresses that States have the burden of proving that deliberately retrogressive measures have been introduced after careful consideration of all alternatives and that they are justified under full use of the State party’s maximum available resources.13 9. National plans should also include principles of non-discrimination, transparency and participation. Participation of all stakeholders, including vulnerable groups, in healthrelated decision-making is the cornerstone of the right-to-health framework. Participation provides individuals with an opportunity whereby they can advance their health rights. It is through participation and empowerment that individuals, patient groups and communities can claim their right to health and achieve improvements in accessing such essential medicines. 10. Based on the submissions received from various stakeholders and following numerous consultations, the Special Rapporteur considers, henceforth, the main determinants of access to medicines in the context of the right to health. A. Local production 11. An efficient and functional health system is crucial to ensure the availability of medicines, particularly essential medicines, in sufficient quantities, at all times and in all public health facilities. Under the right-to-health framework, States have an immediate obligation to take legal and administrative measures to ensure that access to essential medicines for their populations is secured by all available means. However, a third of the world’s population, living mainly in developing countries, still do not have regular access 9 10 11 12 13 Patrice Trouiller et al, “Drugs for neglected diseases: a failure of the market and a public health failure?”, Tropical Medicine and International Health, vol. 6, No. 11 (November 2001), pp. 945-951, p. 946. E/C.12/2000/4, para. 36. Ibid., para. 31. Philipa Mladovsky et al, Health policy responses to the financial crisis in Europe (WHO and European Observatory on Health Systems and Policies, 2012), pp. 38-70. E/C.12/2000/4, para. 32; Committee on Economic, Social and Cultural Rights general comment No. 3 (1990), para. 9; International Covenant on Economic, Social and Cultural Rights, art. 2. 5