The Trans Pacific Partnership Agreement negotiations and the health of Australians

The Trans Pacific Partnership Agreement has the potential to negatively impact the health of Australians by raising the cost of medicine and limiting the government\u27s ability to regulate tobacco and alcohol, argues this policy brief based on publicly available and recently leaked negotiating documents. Executive summary The purpose of this policy brief is to inform the debate from a health perspective in the final stages of the negotiations on the Trans Pacific Partnership Agreement (TPPA), particularly during meetings of chief negotiators and ministers in February 2014. This policy brief outlines the evidence about the potential health effects on the Australian community of actions related to the TPPA, based on publicly available and recently leaked negotiating documents. The purpose of the TPPA is to enhance each of the countries’ economic development and that this may lead to improved social and health development. However, although there may be positive impacts on the health and wellbeing of Australians resulting from economic growth, there are also many ways in which the TPPA has the potential to have negative impacts on the health of Australians. This policy brief examines the potential impact of provisions proposed for the TPPA on the health of Australians, focusing on two specific issues: the cost of medicines, and the ability of government to take major steps to improve the health of Australians by regulating the areas of tobacco and alcohol policy. In each of these areas we trace some of the pathways through which provisions that have been proposed for the TPPA may impact on the health of the Australian population, and the health of specific groups within the population. We highlight the ways in which some of the expected economic gains from the TPPA may be undermined by health and economic costs. Concerning the cost of medicine we focus on how proposed provisions in the TPPA could impact the affordability of medicines through several different routes: by delaying the availability of cheaper generic medicines, by altering the operation of the Pharmaceutical Benefits Scheme (PBS) making it more difficult to keep costs down, and by enabling pharmaceutical companies to sue the government over its pharmaceutical policies. These changes would increase the cost of the PBS for the government and taxpayers. Strategies to compensate for an increase in medication costs include increased cost-sharing, with patients assuming higher co-payments, or funding reallocation from other parts of the healthcare system. Provisions in the TPPA may impact the ability of Government to enforce existing policies and implement new policies that support public health. Australia is internationally recognised for the success of comprehensive strategies to reduce tobacco smoking. And more recently, there are multiple initiatives being proposed to achieve similar success to reduce harmful use of alcohol. We outline several of the many provisions in the TPPA that could affect tobacco and alcohol policies in Australia. Concerning tobacco these include an investor-state dispute settlement mechanism clause in the TPPA would provide more opportunities for tobacco companies to sue the Australian government over strong tobacco control measures. Rules about ‘indirect expropriation’ (i.e. depriving an investor of property, which, if broadly defined, can include intellectual property such as trademarks) and ‘fair and equitable treatment’ provide additional grounds for corporations to argue that their assets are being unfairly affected by government policies and laws. Provisions in the TPPA may impact the Government’s ability to implement effective alcohol control policies such as restrictions on liquor licences, bans or limits on alcohol advertising, and alcohol health warning labels. Concerning alcohol these include provisions in the Technical Barriers to Trade (TBT) Chapter of the TPPA which could limit possibilities for introducing innovative alcohol policies, such as requiring health warning labels. Provisions in the wine and spirits annex to the TBT Chapter may limit the options available to create a fully effective alcohol warnings scheme for wine and spirits. If Australia agrees to an investor-state dispute settlement (ISDS) mechanism applying to Australia, the alcohol industry will have access to a new legal channel to sue the Australian Government over alcohol policy decisions that adversely impact their investments. We conclude that while there is some potential for the TPPA to contribute to economic development, there is also significant risk that the economic gains which the TPPA may represent, as well as the health of the Australian community, will be threatened if certain proposed provisions are adopted for the TPPA. These include increased direct costs in terms of providing health care and increased use of hospitals, higher costs of obtaining pharmaceuticals, indirect costs associated with lost productivity across society, continuing or exacerbating inequalities in society, and worsening the health of Australia’s already vulnerable communities. Authored by: Katie Hirono, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Deborah Gleeson, School of Public Health and Biosciences, La Trobe University Fiona Haigh, Centre for Health Equity Training, Research and Evaluation, University of New South Wales Patrick Harris, Centre for Health Equity Training, Research and Evaluation, University of New South Wale

Gender and the Sharing Economy

While the sharing economy has been celebrated as a flexible alternative to traditional employment for those with family responsibilities, especially women, it presents challenges for gender equality. Many of the services that are “shared” take place in the context of intimacy, which can have substantial consequences for transacting, particularly by enhancing the importance of identity of both the worker and the customer. Expanding on previous research on intimate work — a critical area that exists largely in limbo between the law of the market and the law of the family — this Article, written for the Cooper-Walsh Colloquium, explores the significance of intimacy in the sharing economy and the implications for its regulation of the sharing economy and for sex equality. It argues that the intimacy of many sharing economy transactions heightens the salience of sex to these transactions, in tension with sex discrimination law’s goal of reducing the salience of sex in the labor market. But even if existing sex discrimination law extends to these transactions, the intimacy of the transactions again limits the law’s ability to promote gender equality in the same transformative way that it has in the traditional economy. The sharing economy thus raises serious concerns for proponents of sex equality

If They Can Raze it, Why Can\u27t I? A Constitutional Analysis of Statutory and Judicial Religious Exemptions to Historic Preservation Ordinances

In 1996, America almost lost a great piece of its history. The Cathedral of Saint Vibiana, located in Los Angeles, was in danger of being destroyed. The Baroque-inspired Italianate structure was completed in 1876 by architect Ezra F. Kysor. The cathedral is one of only a few structures from Los Angeles\u27 early history remaining. As an important part of history and a beautiful piece of architecture, the cathedral was listed on California\u27s register of historic places. In 1994, an earthquake damaged part of the building. After an inspection by the building and safety department in 1996, the only portion of the cathedral found to be potentially structurally unsound was the bell tower. The archdiocese began demolition of the cathedral anyway, without the demolition permits required by the building and safety department as a stipulation to an abatement order decreeing that the bell tower was an imminent danger. The archdiocese desired to build a larger facility on the land. The archdiocese believed that the historic cathedral was outgrown and not worth repairing. As a result of the dire situation, the cathedral was listed as one of the National Trust for Historic Preservation’s 11 most endangered places in 1997. This listing sparked further concern from the preservationist community and they came to the rescue. Because the cathedral was on California’s register of historic places, an environmental impact report had to be completed before the building could be razed. When the demolition was started before the church obtained permits, at the urging of preservationists, a judge issued a temporary restraining order to halt the demolition. The cathedral was saved when the wrecking crane was literally 20 feet away. Because of the prevention of immediate demolition, the city and the archdiocese were able to enter into negotiations that resulted in the sale of the cathedral instead of its demolition. The cathedral is now used as a performing arts complex and library. Sadly, California has moved in the direction of not protecting historic religious properties. Although state laws still apply, California now completely exempts religious institutions from local historic preservation ordinances. Historic structures located in other parts of the country are also in danger due to similar religious exemptions

Law and Policy of Tobacco Regulation in Japan

2008-2011 JSPS Research Grants (B) "Law and Policy of Tobacco Regulation" (No. 20730007

Duties of Candour in Healthcare:The truth, the whole truth, and nothing but the truth?

The creation of professional and statutory duties of candour has formalised the requirement for clinicians and healthcare organisations to be honest with patients and families when treatment has gone wrong. This article explains the background to creating both duties, analyses the concept of candour, the role of apologies, and considers evidence about compliance. It argues that making candour a statutory requirement appropriately reflects the ethical imperative of telling the truth about harm and is a powerful signal for honesty. However, being candid is not easy in the context of complex professional cultures, the realities of delivering care in under-funded health systems, and in the shadow of possible legal and regulatory proceedings. Proposals in the current Health and Care Bill to create investigatory ‘safe spaces’ which prohibit the disclosure of information submitted to the Health Service Safety Investigations Body undermine candour. This article argues against such proposals, which are both wrong in principle and highly problematic in practice. Candour should be respected as a cardinal principle governing not only the conduct of those providing care, but also those who investigate such incidents. Harmed patients and their families deserve to know the whole truth

Religion and healthcare in the European Union : policy issues and trends

92 p. ; 24 cm.Libro ElectrónicoThe impact of religious doctrine on the law, policy and practice of healthcare is becoming increasingly significant for a whole range of issues – from euthanasia to fertility treatment; from belief-based exemption from performing abortion for doctors to the medication and dietary needs of religious patients; from organ donation to contraception; from circumcision to suicide. The relationship between religion and healthcare has a long history of evoking tension and debate in Europe. While developments in medical technologies and techniques question the religious beliefs of policy-makers, practitioners and patients across the European Union, research into the legal and policy responses by EU member states on such issues remains underdeveloped. The challenge of health policy, which is common across the European Union, is to balance fundamental human rights such as the right to equality, the right to health and the right to freedom of religion while adhering to secular principles. This report aims to map out the major issues at stake and to initiate a broader discussion on how the religious needs of the community, religious doctrine and religious practices across the European Union affect public health policy.Preface: The ‘Religion and Democracy in Europe’ initiative 7 About the authors 8 Introduction 9 Background 9 Purpose and conceptual framework 10 Terms, scope, methodology and structure 13 Summary of recommended main policy questions for further development 16 1 The legal and policy context in the European Union 17 1.1 European Union law 17 1.2 National law and policy 18 2 The influence of religion on national healthcare policy development 21 2.1 Conflict of duty in health‑service provision 22 2.1.1 Does national healthcare policy permit belief‑based exemption? 23 2.1.2 Scope and limits of belief‑based exemption in healthcare 23 2.1.3 Safeguards 27 2.2 Euthanasia 27 2.2.1 Active euthanasia 29 2.2.2 Passive euthanasia 30 2.2.3 Conflict of duty and safeguards related to euthanasia 32 2.3 Belief‑based patient decisions 34 2.3.1 Organ transplant and donation 34 2.3.2 Refusal of medical treatment 36 2.4 Emerging policy trends and outstanding policy questions 413 Healthcare policy and religious diversity 43 3.1 Healthcare policy and accommodating religious needs in hospitals 45 3.1.1 Religious assistance and faith space 45 3.1.2 Medication and dietary needs 47 3.1.3 The sex of the health practitioner and hospital clothing 48 3.1.4 After‑death issues: post‑mortem and burial 49 3.2 Healthcare policy and accommodating religion outside hospitals 50 3.2.1 Training of healthcare professionals 50 3.2.2 Substance abuse 52 3.3 Emerging policy trends and outstanding policy questions 53 4 Religion and sexual and reproductive healthcare 56 4.1 Contraception, HIV/AIDS and other sexually transmitted diseases 56 4.1.1 The influence of religion on contraception policy 57 4.1.2 The influence of religion on HIV/AIDS education and prevention policies 58 4.1.3 The4.1.3 The influence of religion on other STD policy 60 4.2 Abortion and sterilization 61 4.2.1 Some religious positions on abortion 61 4.2.2 National policy positions 62 4.2.3 Safeguards when abortion is denied 63 4.2.4 Sterilization 65 4.3 Fertility treatment and reproductive techniques 65 4.4 Circumcision 68 4.5 Female genital mutilation 70 4.6 Emerging policy trends and outstanding policy questions 71 5 Religion and mental healthcare 73 5.1 The European policy context and the influence of religious institutions 74 5.2 The influence of religion on mental illness 77 5.2.1 Diagnosis of mental illness 77 5.2.2 Treatment of mental illness 78 5.3 Emerging policy trends and outstanding policy questions 82 Conclusion 84 Appendix A Roundtable participants 86 Appendix B Belief‑based exemption from healthcare provision 87 Appendix C National policy on euthanasia in some EU states 88 Appendix D National policy on abortion in some EU states 8

Going Rogue: Mobile Research Applications and the Right to Privacy

This Article investigates whether nonsectoral state laws may serve as a viable source of privacy and security standards for mobile health research participants and other health data subjects until new federal laws are created or enforced. In particular, this Article (1) catalogues and analyzes the nonsectoral data privacy, security, and breach notification statutes of all fifty states and the District of Columbia; (2) applies these statutes to mobile-app-mediated health research conducted by independent scientists, citizen scientists, and patient researchers; and (3) proposes substantive amendments to state law that could help protect the privacy and security of all health data subjects, including mobile-app-mediated health research participants