A/HRC/14/31 budget exercises can ensure that public resources are devoted to expanding social security, in particular to the most vulnerable. G. Ensuring the adequacy of the benefits 87. The financial affordability and sustainability of expanding social pension programmes have immediate implications on the determination of benefit levels. While States should bear in mind the need to expand the coverage of existing schemes, ensuring that the levels of pensions remain adequate for beneficiaries is also a major concern. In this context, the benefits must be high enough to enable older people to enjoy an adequate standard of living and afford the goods and services they require to realize at least the minimum core content of their economic, social and cultural rights. While the cost of schemes can be reduced by increasing the age of eligibility or decreasing the size of the benefit, a balance should be struck between reaching all those in need and providing a benefit that would allow older people a minimum subsistence level. 88. Considering limited fiscal resources, in some countries, it could be possible to begin with a universal pension offered at an advanced age (providing adequate level of benefits) and from there slowly extend the programme to include persons of a less advanced age. However, this should be carefully examined. While a high age requirement could reduce costs and help the programme to be implemented immediately and later scaled up, if the age requirement is too high it may be regressive, as it could predominantly benefit the better-off in society. 89. Social protection programmes should not be restricted only to monetary support. As addressed above, social pensions do not work in isolation – they must be complemented by various services. Older persons are rights-holders who require not only social security support, but a multitude of social services to ensure an adequate standard of living, including in particular access to health care. H. Ensuring access to health care 90. For older persons, financial security and health are closely linked: expenses for health care and medicines account for as much as three quarters of the income of the poorest groups.37 Under these circumstances, the positive impact of social protection initiatives on older persons’ standards of living can be nullified by the burden posed by health-care-related costs. 91. Social pensions should be planned and implemented in close coordination with other initiatives aimed at ensuring the enjoyment of the right to the highest attainable standard of health by older persons. In fact, providing pensions can be a clear opportunity to further integrate health services into social assistance. For example, in Mexico beneficiaries of cash transfers were given the chance to participate in health prevention and nutrition workshops as well as other social activities. 92. In accordance with the interpretation of the Committee on Economic, Social and Cultural Rights, the right to health must be understood as a right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of physical and mental health.38 This includes the obligation of 37 38 GE.10-12583 J. Randel et al. (eds.), “The Ageing and Development Report: Poverty, Independence and the world’s older people” (HelpAge International, 1999). See Committee on Economic, Social and Cultural Rights, general comment No. 14. 17