E/C.12/UZB/CO/1 page 4 28. The Committee is concerned about the degree of environmental degradation in the country, which has an extremely negative impact on the health of the whole population, in particular women and children. 29. The Committee is concerned that the transition from a free to a prepaid health system and the introduction of private insurance-based medical care in the State party may impact negatively on low-income groups and the rural population. 30. The Committee is concerned that the annual per capita spending on public health has been in decline despite the rise in GDP. 31. The Committee is concerned about the high incidence of malnutrition in the State party, in particular in Karakalpakstan. 32. The Committee is concerned about persistent reports that, in addition to being a country of transit, the State party is increasingly becoming a country of destination and consumption of illegal drugs, and that illicit preparation, storage and sale of narcotics have been on the rise since 1991. 33. The Committee is concerned that the incidence of HIV/AIDS is on the increase in the State party. 34. The Committee is concerned about the absence of adequate health care and the poor hygienic conditions in prisons that lead to frequent tuberculosis infections of detainees. 35. The Committee is concerned about the frequent use of confinement in psychiatric institutions in the State party, as a means of treatment of mental health problems, without review bodies, including courts, systematically reassessing confinement. E. Suggestions and recommendations 36. The Committee draws the attention of the State party to its general comment No. 9 on the domestic application of the Covenant and invites the State party to include information concerning case law on the application of the Covenant in its next periodic report. 37. The Committee stresses the importance of an independent judiciary for the enjoyment of all human rights, including economic, social and cultural rights. The Committee strongly urges the State party to take all necessary measures to ensure the independence and integrity of the judiciary and the availability of effective remedies in cases of violation. 38. The Committee recommends that the State party consider establishing a national institution for human rights in accordance with the Paris Principles (General Assembly resolution 48/134, annex). 39. The Committee strongly recommends that the State party consider the possibility of becoming a party to the 1951 Convention relating to the Status of Refugees and its Optional Protocol (1967), given the large number of refugee persons and their families living in the State party.