Daniela Fisichella University of Catania United Nations and World Health Organization engagement in treating global mental health, with a special focus on vascular dementia

Health and human rights WHO, Preamble of the 1946 Constitution → Health is a state of complete physical, mental and social well-being and not only the absence of disease or infirmity

International legal acts 1948 UN Declaration on Human Rights 1966 UN Covenant on Civil and Political Rights (CCPR) 1966 Covenant on Economic, Social and Cultural Rights (CESCR) → they form together the International Bill of Rights

WHO and CESCR Committee General Comment No. 14 WHO Constitution, art. 1 and General Comment No. 14 of the CESCR Committee (2000): health is considered a fundamental human right for the enjoyment and the exercise of all other human rights → implementation of health programmes developed by WHO or launch of national health policies

General Comment No. 14: content of the right to health It’s not the right to be healthy (CESCR art. 12, § 1) To make people reaching the highest attainable level of health, States are committed to: respect, protect, fulfil among obligation to fulfil they should: facilitate, provide, promote CESCR art. 2, § 1: States have to guarantee the right to health to the maximum of their available resources.

International regional instruments on human rights: the right to health European Social Charter as revised (1961) African Charter of Human and Peoples’ Rights (1981) Additional protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (1988)

1975 Declaration on the Rights of Disabled Persons a disabled person is any person unable to ensure by himself or herself, wholly or partly, the necessity of a normal individual and/or social life, as a result of deficiency, either congenital or not, in his or her physical or mental capability

1991 UNGA Resolution 46/119 on the protection of persons with mental illness and the improvement of mental health care ●Impairment and disability→ mental health ● Equality ● Non discrimination, but special measures to guarantee the rights of persons with mental illness (Principle 1, § 4)

Mental health as a disability In 1990’s a striking change of perspective on mental health: from health care to human rights guarantee 1993 Vienna Declaration and Programme of Action→ disability isn’t a discriminatory condition

1993 Standard Rules on the Equalization of Opportunities for Persons with Disabilities These Standard Rules represent the true change of mind on disabilities: protection is not exclusion, but introduction to social environment according to disabled persons’ diversity 1993 WHO Mental Health Care Law: Ten Basic Principles

CESCR Committee General Comment No.5 and 2006 Convention on the Rights of Persons with Disabilities ● Awareness Disability and non discrimination → equal rights Disability is not a status: access to medical care doesn’t exhaust political and social actors engagement in treating disability, mental health included. Diversity is a condition which shouldn’t hinder enjoyment of human rights

The principle of ‘reasonable accommodation’ Equal recognition before the law as a starting point A social model of disability → disability as an evolving concept 2006 Council of Europe Action Plan: “paradigm shift from patient to citizen”; ‘reasonable adjustment’ EU legal acts conform to UN principles on disability

WHO Mental Health Action Plan WHA65.4 Resolution on the global burden of mental disorders and the need for a comprehensive, coordinated response from health and social sectors at the country level Mental disorders → International Statistical Classification of Diseases and Related Health Problems 2010 WHO MH Gap Intervention Guide

Dementia and IL: a Public health Priority 2012 WHO Report: Promoting a dementia friendly society globally Making dementia a national public health and social care priority worldwide Improving public and professional attitudes to dementia Increasing investments in health and social systems and services

Dementia as a mental and neurological disorder still requiring a great level of assistance and implying a low level of social inclusion ● UNGA Resolution 70/1 of 10/21/2015, Transforming our world: the 2030 Agenda for Sustainable Development → from 8 MDG’s to 17 SDG’s and 169 targets