A/HRC/35/21 protecting and fulfilling the right to mental health requires concerted action to secure certain preconditions that are associated with mental health. 68. Various international and regional processes have helped to define the public health and social justice imperatives for addressing the social determinants of health. The final report of the Commission on Social Determinants of Health was a pioneering piece that brought greater visibility to social determinants. 48 Medicine, in particular its mental health component, is to a large extent a social science and this understanding should be used to guide its practice. To take full account of the evidence around the determinants of mental health, the right to those determinants must expand beyond inequities, discrimination and the physical environment to reflect the documented importance of healthy psychosocial environments (see A/70/213 para. 55 and A/71/304, paras. 16 and 19). 49 That includes developing public policies that promote non-violent and respectful relationships in families, schools, workplaces, communities and health and social services. VI. Shifting the paradigm A. The human rights imperative to address promotion and prevention in mental health 69. The recognition by WHO of the importance of developing rights-based strategies, which promote and protect the mental health of entire populations, is welcomed. 50 Individual and social factors, cultural values and the social experiences of everyday life in families, schools, the workplace and communities influence the mental health of each person. The fact that children spend a significant amount of time in schools and most adults at the workplace, means that rights-based action must promote healthy, safe and enabling environments that are free from violence, discrimination and other forms of abuse. Likewise, a person’s mental health affects life within those domains and is integral to shaping the health of communities and populations. Population-based approaches to mental health promotion move health systems beyond individualized responses towards action on a range of structural barriers and inequalities (social determinants) that can negatively affect mental health. 70. There exists an almost universal commitment to pay for hospitals, beds and medications instead of building a society in which everyone can thrive. Regrettably, prevention and promotion are forgotten components of mental health action. Harmful assumptions that goodwill and sacrifice alone will enable populations to achieve mental health and well-being have excused this inaction. 71. The obligation to secure social determinants to promote mental health requires cross-sectoral action to ensure a robust commitment from all relevant ministries. For example, suicide prevention strategies are traditionally targeted towards high-risk groups and address clinical depression as a biomedical phenomenon, while cross-sectoral programmes that address the social and environmental determinants of suicide through population-based approaches show more promise. Bullying in schools is another phenomenon to be considered as a global and national public health priority. States should first and foremost address emotional and psychosocial environments, targeting relationships rather than individuals. 72. An environment that respects, protects and fulfils human rights and is free from all forms of violence, including gender-based violence, is fundamental for effective health promotion. Public health and psychosocial interventions are essential components of a 48 49 50 16 Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health (Geneva, WHO, 2008). See also WHO, “Investing in mental health: evidence for action” (2013) and “Risks to mental health: an overview of vulnerabilities and risk factors”, discussion paper (2012). WHO Mental Health Action Plan 2013-2020.