A/69/299 whether measures were deliberate, concrete and targeted; whether non-discrimination and non-arbitrariness were ensured; whether allocation of resources was in accordance with international human rights standards; whether the policy utilized the least restrictive option; the time frame of the policy; and whether the situation of vulnerable groups was taken into account ( E/C.12/2007/1, para. 8). Vulnerable groups should not be limited to those specific groups mentioned in general comment No. 14, but should include any group that is disproportionately affected by a particular ailment or otherwise marginalized on account of its members’ political, social or economic exclusion; discrimination and stigmatization suffered by that group; restrictions in law or in practice on giving informed consent or exercising full autonomy by members of that group; or the group’s inability to enforce rights, gain access to State benefits or enjoy regulatory protection. 29. In reviewing whether a State has fulfilled its obligations under the Covenant, it is important to consider that even well-considered policies making use of a State’s maximum available resources may lead to poor health outcomes owing to external circumstances, such as an influx of refugees, an outbreak of an epidemic or an economic recession. Even in such cases of resource constraint, States should fulfil their core obligations and other immediate obligations without discrimination. States should not be allowed to use external circumstances as an excuse for retrogressive measures such as cutting certain health-related policies as part of a redistribution of funds from the health sector. IV. Enforcement of the right to health 30. Enforcement of a State’s obligations is essential to the enjoyment of the right to health. Unfortunately, many legal judgements on economic, social and c ultural rights are not fully implemented by States. To promote the implementation of judgements, adjudicators are encouraged to develop specific and targeted decisions that recognize the State’s capacity and include monitoring by the court and civil society participation. 31. Courts should be mindful of the context and objectives when designing specific directions for the implementation of judgements containing positive obligations. Judgements that provide a framework of specific processes for specific agencies may overcome barriers to implementation that a general judgement does not. This approach, rather than dictating specific objectives, can mitigate concerns of violating separation of powers. In the landmark T-760/08 judgement (2008) that led to systemic change of the Colombian health-care system, the Constitutional Court of Colombia did not dictate reforms but gave direction to policymakers to define objectives, develop appropriate policies, build institutional capacity and justify each decision with information. 19 With regard to progressively realizable obligations in particular, courts should consider that any reform must be sustainable in order to increase social acceptance of the judgement and ensure a sustainable health system. 20 __________________ 19 20 10/22 See Manuel José Cepeda-Espinoza, “Transcript: social and economic rights and the Colombian Constitutional Court”, Texas Law Review, vol. 89, p. 1703. Ibid., p. 1701. 14-59014