A/67/302 I. Introduction 1. Full realization of the right of everyone to the highest attainable standard of physical and mental health is contingent upon the availability of adequate, equitable and sustainable financing for health, at the domestic and international levels. The present report thus considers health financing in the context of the right to health. It discusses the obligation of States to ensure adequate, equitable and sustainable domestic funding for health and provides a conceptual framework for a right to health approach to health financing. In particular, it examines States’ obligations to: ensure that adequate funds are available for health and to prioritize funding for health in national budgets; ensure equitable allocation of health funds and resources; and cooperate internationally to ensure the availability of sustainable international funding for health. The report also explores a number of substantive issues in this regard, including taxation and international funding for health; pooling mechanisms, including social health insurance; and allocative concerns, such as allocation of health funds and resources among primary, secondary, and tertiary health care and the resource divide between rural, remote and urban areas. 2. The contemporary landscape of health financing is characterized by persistent deficits and recurring challenges in financing health systems throughout the world. Public spending on health is too low in many States because of low budget prioritization for health and, in some cases, the unavailability of adequate public funds in absolute terms. Deficits in governance are also central to many States’ failure to finance health adequately. Widespread corruption, tax loopholes and weak tax administration, characterized by high rates of tax evasion, often diminish States’ capacity to raise revenues and allocate adequate public funds towards health. Many States are overly dependent on out-of-pocket payments from users and international funding to finance their health systems. International funding for health, however, is unpredictable and unsustainable, as the recent financial crisis has demonstrated, and out-of-pocket payments for health goods and services disproportionately impact on the poor, who must pay considerably larger proportions of their income on health care than wealthy patients. As a result, poor households often experience financial catastrophe and impoverishment due to out-of-pocket payments, resulting in a chilling effect that discourages many from seeking health care in the first place. 3. The right to health approach to health financing recognizes that an appropriate balance must be achieved between public and private financing for health, as well as between public and private administration of health facilities, goods and services. However, the global trend towards privatization in health systems poses significant risks to the equitable availability and accessibility of health facilities, goods and services, especially for the poor and other vulnerable or marginalized groups. In many cases, privatization has led to increased out-of-pocket payments for health goods and services, disproportionate investment in secondary and tertiary care sectors at the expense of primary health care, and increased disparity in the availability of health facilities, goods and services among rural, remote and urban areas. 4. The right to heath approach to health financing is especially critical in the light of these global trends and challenges in financing for health. It provides a framework to ensure the prioritization of health in State budgets, strengthened by the active and informed participation of affected individuals and communities in the formulation, implementation, monitoring and evaluation of health budgets. The 12-46101 3