A/62/214 Progressive realization and the obligations of immediate effect 79. The right to the highest attainable standard of health — and thus the underlying determinants of health, such as safe water and adequate sanitation — are subject to progressive realization and resource availability, in accordance with article 2, paragraph 1, of the International Covenant on Economic, Social and Cultural Rights. Put simply, progressive realization means that a State is required to be doing better in two years time than it is doing today, while resource availability means that what is required of a developed State is of a higher standard than what is required of a developing State. 80. This has a number of important implications. For example, States need appropriate indicators and benchmarks so they know whether or not they are progressively realizing the right to health (see human rights-based approach to health indicators set out in document E/CN.4/2006/48). But it also has an important qualification: the right to health includes some core obligations of immediate effect that are not subject to progressive realization. 45 These are obligations without which it is considered that the right would be deprived of its raison d’être. 46 Under the right to health, for example, States have an immediate obligation to avoid discrimination and ensure access to basic sanitation, 47 as well as the minimum essential amount of water that is sufficient and safe for personal and domestic uses to prevent disease. 48 81. In summary, while the State is required to progressively realize access to water and sanitation, it has a core obligation of immediate effect to make available and accessible the minimum essential amount of water that is sufficient and safe for personal and domestic uses, and basic sanitation, 49 throughout its jurisdiction. Retrogressive measures, which reduce people’s access to water and sanitation, are only allowed when a State is able to demonstrate that such measures have been adopted after full consideration of alternatives and are “duly justified by reference to the totality of the rights provided for in the Covenant in the context of the full use of the State party’s maximum available resources”. 50 Duties to respect, protect and fulfil 82. States have duties to respect, protect and fulfil the right to the highest attainable standard of health. These duties are equally applicable to medical care and the underlying determinants of health. For example, in the context of the underlying determinants of safe water and adequate sanitation, the duty to respect obliges the State to refrain from polluting water or arbitrarily interfering with a person’s access to water and sanitation. The duty to protect obliges the State to take __________________ 45 46 47 48 49 50 18 E/2001/22-E/C.12/2000/21, annex IV, general comment 14, para. 43. E/1991/23-E/C.12/1990/8 and Corr.1, annex III, general comment 3, para. 10. E/2001/22-E/C.12/2000/21, annex IV, general comment 14, para. 36. There is a difference between the water core obligation in general comment 14, para. 36 and general comment 15, para. 37 (a). Here, the more modest of the two is used, i.e. general comment 15, para. 37 (a). Basic sanitation is defined by the United Nations Task Force on Water and Sanitation as “the lowest-cost option for securing sustainable access to safe, hygienic and convenient facilities and services for excreta and sullage disposal that provide privacy and dignity, while at the same time ensuring a clean and healthful living environment both at home and in the neighbourhood of users”. E/2001/22-E/C.12/2000/21, annex IV, general comment 14, para. 32. 07-45379