One is the national plane, where by a democratic process, the citizenry decides to give expression to the ESCER in its respective juridical order, incorporating also the international law on this matter, as occurs in the vast majority of the Member States of the inter-American system of human rights. In this context, it is the national courts that -within the scope of their competences- exercise their authority with respect to the interpretation and the justiciability of the ESCER, in accordance with their constitutions and laws. 17. Another plane, distinct -although complementary- is the international. As an international court, the role of the Inter-American Court on this plane is to decide whether a State, whose responsibility has been claimed, has violated one or more of the rights established in the Convention. In light of the normative design of and in accordance with Article 26, the Court is authorized to declare the State’s international responsibility if it has not complied with the obligations of progressive development and non-regression, but not of the ESCER considered individually. 18. This affirmation is in line with what was expressed in previous opinions, 12 since the proper doctrine that the Court should follow is precisely to consider the economic, social, cultural and environmental dimensions of the rights recognized in the conventional norms and to exercise its adjudicative jurisdiction by means of connectivity. With respect to the right to health, that was the manner that the Court employed in fourteen cases prior to the judgment in Poblete Vilches v. Chile (2018), the first case in which the Court declared the autonomous violation of the right to health on the basis of Article 26 of the Convention. The adjudication of the responsibility through connectivity was the path followed in cases such as Villagrán Morales et al. (Street Children) v. Guatemala (2004), “Juvenile Reeducation Institute” v. Paraguay (2004), Yakye Axa Community v. Paraguay (2005), Ximenes Lopes v. Brazil (2006), Artavia Murillo et al. v. Costa Rica (2012) and I.V. v. Bolivia (2016. Needless to say, the declaration of responsibility on the basis of connectivity in no way empowers the Court to declare the violation of rights not recognized in the text of the Convention. That procedure simply allows establishing the necessary relationship between ESCER and civil and political rights recognized in the Convention. 19. Finally, the judgment proposes that it is possible to distinguish two dimensions of the right to health. First, a general obligation to protect health related to the obligation to ensure quality medical care 13 and, second, an obligation related to the individual right to health. 14 In line with the previous paragraph, it is possible and desirable that the right to health in its individual aspect be analyzed in connection with the rights to life or to personal integrity (linking Articles 4 or 5 with Article 26 of the Convention) and their general and progressive aspects in the light of Article 26, read in conjunction with Article 1(1) of the Convention. This would allow the Court to determine when deficient sanitary care has produced a harm to the life or to the personal integrity of an individual (as precisely happened in this case) and when the benefit offered by the State or, in other terms, the implemented public health policy does not attain the level of its commitment to progressivity and to non-regression in the terms of Article 26. 20. In fact, it was thought necessary to make a statement in the judgment on the State’s obligations “in providing health services during pregnancy, childbirth and post-partum and its relationship to the guarantee of the rights to life and 12 13 14 See para. 3 of this opinion. Cf. Para. 61. Cf. Para. 60. 4

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