71. Without denying the progress achieved to date by the Inter-American Court in the indirect protection of economic, social, cultural and environmental rights and in connection with other civil and political rights —which has been the well-known practice of this InterAmerican Court—as I have stated in several previous judgments,92 in my view, this approach does not accord full efficacy and effectiveness to those rights, altering their essence. Moreover, it does not help to clarify the State’s obligations in this regard and, ultimately, results in overlaps between different rights, which leads to regulatory confusion at a time when we can see evident progress in the domestic sphere and in international human rights law. 72. From that perspective, this Judgment is of the utmost importance. In the first place, persons deprived of liberty have the right to serve their sentence in conditions that ensure dignity in confinement; this applies not only to the physical conditions of the place, but also means that States are required to adopt affirmative measures to guarantee a wide range of economic, social and cultural rights that, unfortunately, have not been prioritized. Regarding the “right to health” of persons deprived of liberty, adequate and timely medical attention plays a vital role in preventing an even greater adverse impact on the conditions of detention. Despite the foregoing, the standards issued, as well as the limitations on the right to health, have a direct impact on persons deprived of their liberty who, owing to circumstances have suffered some form of physical impairment upon admission to prison, or who, owing to internal or external factors, develop a disability in the course of their confinement. 73. The situation of María Inés Chinchilla is one of many such cases that exist in our Latin American region and is a clear example of how disabled persons who are deprived of their liberty are often denied the most fundamental human rights. The adoption of measures of accessibility and reasonable accommodation alluded to in this Judgment by the InterAmerican Court, is a way to claim and make visible the situation of individuals who are serving a sentence and are affected by some form of disability. 74. In international case law on health provisions for persons with disabilities detained in prison, the adoption of reasonable accommodation measures has been the focus of special attention in recent years. Nevertheless, in cases where, through failure to ensure a right as essential as the right to health, an individual finds himself facing a situation of physical limitation caused by a disease, this could result in a double violation: on the one hand, a violation of the obligation to ensure that the disabled person continues to enjoy the highest attainable standard of health and, on the other, the failure to guarantee the right to health which resulted in that disability. 75. For persons deprived of liberty with disabilities caused by diseases that can be treated and controlled, the right to health implies a reinforced obligation of protection; not only in terms of guaranteeing accessibility in buildings, as required by the CRPD, but also ensuring the design of reasonable accommodation to guarantee the enjoyment of the right to health in all its dimensions. 76. In this regard, guaranteeing the right to health has, in essence, a preventive role, ensuring that a person’s living conditions do not deteriorate. For example, General Comment No. 14 of the ESCR Committee emphasizes that the right to health care includes the creation See my Concurring Opinions in the Cases of Suárez Peralta v. Ecuador. Preliminary objections, merits, reparations and costs. Judgment of May 21, 2013, Series C No. 262; and Case of Gonzales Lluy et al. v. Ecuador. Preliminary objections, merits, reparations and costs. Judgment of September 1, 2015. Series C. No. 298. 92 27