Meeting Basic Survival Needs of the World\u27s Least Healthy People: Toward a Framework Convention on Global Health

This article searches for solutions to the most perplexing problems in global health - problems so important that they affect the fate of millions of people, with economic, political, and security ramifications for the world\u27s population. There are a variety of solutions scholars propose to improve global health and close the yawning health gap between rich and poor: global health is in the national interests of the major State powers; States owe an ethical duty to act; or international legal norms require effective action. However, arguments based on national interest, ethics, or international law have logical weaknesses. The coincidence of national and global interests is much narrower than scholars claim. Ethical arguments unravel when searching questions are asked about who exactly has the duty to act and at what level of commitment. And international law has serious structural problems of application, definition, and enforcement. What is truly needed, and which richer countries instinctively do for their own citizens, is to meet what I call basic survival needs. By focusing on the major determinants of health, the international community could dramatically improve prospects for good health. Basic survival needs include sanitation and sewage, pest control, clean air and water, tobacco reduction, diet and nutrition, essential medicines and vaccines, and functioning health systems. Meeting everyday survival needs may lack the glamour of high-technology medicine or dramatic rescue, but what they lack in excitement they gain in their potential impact on health, precisely because they deal with the major causes of common disease and disabilities across the globe. If meeting basic survival needs can truly make a difference for the world\u27s population then how can international law play a constructive role? What is required is an innovative way of structuring international obligations. A vehicle such as a Framework Convention on Global Health (FCGH) could powerfully improve global health governance. Such a Framework Convention would commit States to a set of targets, both economic and logistic, and dismantle barriers to constructive engagement by the private and charitable sectors. It would stimulate creative public/private partnerships and actively engage civil society stakeholders. A FCGH could set achievable goals for global health spending as a proportion of GNP; define areas of cost effective investment to meet basic survival needs; build sustainable health systems; and create incentives for scientific innovation for affordable vaccines and essential medicines. This article first examines the compelling issue of global health equity, and inquires whether it is fair that people in poor countries suffer such a disproportionate burden of disease and premature death. Second, the article explains a basic problem in global health: why health hazards seem to change form and migrate everywhere on the earth. Third, the article inquires why governments should care about serious health threats outside their borders, and explores the alternative rationales: direct health benefits, economic benefits, and improved national security. Fourth, the article describes how the international community focuses on a few high profile, heart-rending, issues while largely ignoring deeper, systemic problems in global health. By focusing on basic survival needs, the international community could dramatically improve prospects for the world\u27s population. Finally, the article explores the value of international law itself, and proposes an innovative mechanism for global health reform - a Framework Convention on Global Health

A Mental Patient\u27s Right to Vote: An Analysis of the \u3ci\u3eWild\u3c/i\u3e Case

This article is an analysis of the Wild case that was heard on 15 June 1976 by Judge Lloyd Jones of the County Court, Warrington. In order to vote, the person\u27s name must appear on the register of electors as a resident of a particular locality. Any place where the elector legitimately resides (even a hostel, a general hospital or a university) may be used as an address which qualifies a person for entry onto the register. The one exception is found in section 4(3) of the Representation of the People Act 1949, as amended by the Mental Health Act, 1959, which prevents a patient from using a psychiatric hospital as his place of residence for electoral purposes. Section 4(3) states: A person who is a patient in any establishment maintained wholly or mainly for the reception and treatment of persons suffering from mental illness (or other form of mental disorder), or who is detained in legal custody at any place, shall not, by reason thereof, be treated for the purposes aforesaid as resident there. Therefore, patients in a psychiatric hospital or mental nursing home can only register as voters if they have homes outside the hospital. An informal (voluntary) patient who has no home is disenfranchised because a psychiatric hospital, according to the law, is not a home. Approximately 50,000 informal patients in hospitals for the mentally ill and handicapped have no right to vote for this reason alone. A person suffering from some form of mental disorder is not disqualified from voting on residential grounds alone. It appears from the Burgess case that the name of an \u27idiot\u27 (now termed a severely subnormal person) should not be allowed to appear on the electoral register. However, a \u27lunatic\u27 (now termed a person suffering from mental illness or some minor form of mental disorder) may vote during his lucid intervals. The returning officer is entitled to take the vote of a person who is registered and who is sufficiently compos mentis to discriminate between the candidates and answer the statutory question-- Are you the person whose name appears in the Register of Electors

The “Conscience” Rule: How Will It Affect Patients’ Access to Health Services?

On May 2, 2019, the US Department of Health and Human Services (HHS) and Office of Civil Rights (OCR) released a final rule that heightens the rights of hospitals and health workers to refuse to participate in patients’ medical care based on religious or moral grounds. The rule covers OCR’s authority to investigate and enforce violations of 25 federal “conscience protection” laws. Tied to the US Constitution’s spending power, the rule applies to state and local governments, as well as public and private health care professionals and entities if they receive federal funds such as Medicare or Medicaid. The rule applies to a range of important health services such as abortions, sterilizations, assisted suicide, and advance directives—extending to sex reassignment and HIV treatment

International Year of Disabled Persons: The Institution in England and Wales

A notable characteristic of American federalism is that domestic policy has been substantially determined by the courts. The judiciary has introduced its own social morality to ensure reasonable access to services for minority groups. The concept of judicial policy making has found no greater expression than in the field of mental retardation where the service provided has been largely mandated by judges

An Alternative Public Health Vision for a National Drug Strategy: Treatment Works

This article returns to a war waged virtually throughout this century--a war between the theories of punishment and rehabilitation in curtailing the drug epidemic. Today, the terms of the war are recast as supply-side policies based upon law enforcement; destroying crops in source countries; interdiction and increased sentencing; and demand reduction based upon prevention, education, and treatment. The war on drugs has reached a feverish pitch. New policies and statutes have tightened the grip of supply-side policies, with images of battle and hate mongering which go beyond the vilified drug lords and governments which harbor them, to the middle men, the dealers, and even the users. First this article reviews the set of current and proposed federal policies designed to punish users and to hold them strictly accountable for their addiction. Second, it proposes an alternative public health strategy for controlling the drug epidemic based upon social science research. Third, in demonstrating the efficacy and cost effectiveness of prevention and treatment, the article sets the parameters of a public health agenda in curtailing the drug epidemic

Foreword: Public Health & the Law—A Symposium Dedicated to Professor William J. Curran

This essay serves as the foreword to Public Health & the Law, a symposium dedicated to Professor William J. Curran held in 1987. During his career, Professor Curran chaired the Harvard School of Public Health Committee on Human Research; he directed the Program in Law and Public Health; and he was co-director of the Harvard Interfaculty Program in Medical Ethics from 1973 to 1980. He was also an advisor to the World Health Organization and spent two sabbatical periods in Europe with WHO organizations. He advised and lectured in countries throughout the world. At Harvard Law School and at the Harvard School of Public Health, Professor Curran educated three generations of lawyers who have gone on to hold varied positions of influence in the field of health law--from academia to private practice, from health care delivery and management to government leadership. His textbooks have been a bedrock of learning for students in schools of law, medicine and public health. He commands the respect of colleagues for his rigor and fairness in safeguarding the rights and dignity of human subjects. The American Society of Law and Medicine honored him, together with Professor Jay Katz of the Yale Law School, as the best health law teacher in the nation. The honor bestowed on Professor Curran is especially important because he has been chosen by other health law professors. Professor Curran\u27s work has had a striking influence on such areas as death and dying, risk management, mental health and public health. His concern is not with reducing medical malpractice claims alone, but with reducing risk for patients as well

Health Care Reform in the United States

The author presents a brief description of the design features and objectives of the health care reform package, together with the reasons to support reform of the health care system in the United States

A Tribute to Jonathan Mann: Health and Human Rights in the AIDS Pandemic

A tribute to Jonathan Mann, former head of the World Health Organization\u27s global AIDS program and a key figure in the early fight against HIV/AIDS. The author discusses Mann\u27s work in health and human rights, prevention of disease, and eliminating social injustice

The Constitutional Right to Free Communication of the Institutionalized Resident

This article comes from the notes and comments section of the North Carolina Central Law Journal from 1973. Justified by the generic first amendment protection to unabridged expression and association, a United States citizen cannot be unreasonably denied the right to communicate by mail; by telephone; with legal counsel; with the opposite sex; with others. In most states where such a citizen becomes mentally ill, the person may be involuntarily civilly committed. Although there is no justification for such a commitment beyond the fact that the individual is sick and is in need of care, often the individual\u27s first amendment freedoms are restricted while a resident of a mental institution. This article will focus on the extent to which such restrictions violate the constitutional right of free expression and association, e.g. by mail, by telephone, with legal counsel, with the opposite sex, by general visitation

Securing Health or Just Health Care? The Effect of the Health Care System on the Health of America

The author first analyzes why the prevention of illness and promotion of health provide the leading justification for the government to act for the welfare of the population. His analysis focuses principally on the foundational importance of health for human happiness, the exercise of rights and privileges, and the formation of family and social relationships. He explains why health care, although critically important; is not the only, nor even the most important, determinant of health. Most morbidity and mortality in the United States is attributable to environmental conditions, pathogens, and human behavior, which are all more responsive to population-based interventions than to medical treatment. Secondly, the author explores the importance of universal access to health care in achieving the health of populations. The number of persons in the United States without health insurance or with inadequate insurance is extraordinarily high and increasing, and this fundamentally inadequate access to health care services results in unnecessary sickness and death among large sectors of the population. Universal access to health care is justified not only by greater vitality among the currently uninsured, but also by social and economic benefits for all of society. Third, he examines the importance of equitable access to health care. The distribution of health care services is highly inequitable, with persons in lower socio-economic classes and ethnic minorities receiving substantially inferior care. The author states that the inequity in the distribution of health care services not only lowers the quality of life among those receiving inferior services, but also renders them poorer and more dependent on society. Inequitable access to health care extends the already wide gap between rich and poor in the United States, with worrying social implications. Fourth, the author explores the applicability of market theory and competition to health care services, stating that market theorists have the burden of demonstrating why a theory developed for consumer goods and services generally is applicable to health services that are essential to human flourishing. This burden is particularly strong when the empirical evidence shows that increased cost and inaccessibility have occurred in spite, and perhaps because, of competition in health care