A/HRC/15/41 and services and are thus particularly vulnerable to poverty.18 Having fallen into poverty, they are exposed to systematic stigmatization and discrimination on the grounds of their poverty which perpetuates their situation. Addressing discrimination requires a range of responses, since patterns vary across regions and within countries and can be both overt and covert. 23. While everyone is entitled to all human rights, persons living in extreme poverty face considerable interrelated and mutually reinforcing deprivations that prevent them from realizing their rights and strengthen the vicious cycle that perpetuates poverty through generations. For example, in addition to being exposed to underlying causes of ill health such as dangerous work conditions, unsafe housing and limited access to nutritious food, they have limited access to preventive health care, diagnosis and treatment. Their health problems often prevent them from undertaking a productive activity, meanwhile elevated health-care costs impact already meagre budgets. 24. Moreover, the health consequences of inadequate living conditions accumulate across the course of life and can be transmitted from one generation to the next. For example, children born to mothers living in extreme poverty are more than twice as likely to be born with a low birth weight, increasing their risk of future health and developmental problems.19 The result is a vicious cycle of social and economic disadvantages leading to ill health that in turn leads to further disadvantage. Similar challenges are faced with regard to education, as malnutrition or overcrowded conditions at home can be related to bad school performance and reduced attention and learning capacities, undermining the possibility of escaping poverty. 25. While persons living in extreme poverty do not constitute a homogeneous group, each having specific vulnerabilities and challenges, they commonly face obstacles in accessing government services and institutions, including physical, economic, administrative and other obstacles. Those who face discrimination on multiple grounds face even greater obstacles in overcoming extreme poverty.20 26. Physical obstacles are common challenges for persons living in extreme poverty. They are geographically remote from jobs, markets, resources, etc. They often have to travel a long way to access public services such as health care, education and sanitation facilities, and inhabit areas that have extremely limited access to transportation and roads. Government allocations for services and private investment typically vary according to the zone and the neighbourhood in which persons live: more affluent areas are usually provided with electricity, good roads, and water and sanitation infrastructures, whereas persons in deprived neighbourhoods often have little or inadequate access to similar services. To those experiencing extreme poverty time spent travelling to access services and job opportunities can represent a considerable loss of income, when they already earn little. 27. Persons living in extreme poverty face multiple economic obstacles, often paying proportionally more to access essential services such as water and electricity. Economies of scale mean that the more someone demands the less is spent per unit. Lower consumption levels by persons living in extreme poverty frequently lead to proportionally higher costs. Furthermore, user fees and the indirect costs of accessing essential services are often prohibitive for persons living in extreme poverty. 18 19 20 See Committee on Economic, Social and Cultural Rights, general comment No. 20 (2009) on nondiscrimination in economic, social and cultural rights. G. A. Kaplan, The Poor Pay More, Poverty’s High Cost to Health, September 2009, page 9. On the notion of “intersectionality”, see Committee on the Elimination of Racial Discrimination, general recommendation No. 32 (2009) on the meaning and scope of special measures in the International Convention on the Elimination of All Forms of Racial Discrimination, para. 7. 7