Global Health Law: A Definition and Grand Challenges

It has been only recently that scholars have engaged in a serious discussion of public health law. This academic discourse examines the role of the state and civil society in health promotion and disease prevention within the country. There is an important emerging literature on the international dimensions of health, but no similar systematic definition and exposition of a field we call global health law. In this article we aim to fill this gap by defining global health law and characterizing the grand challenges. Given the rapid and expanding globalization that is a defining feature of today\u27s world, the need for a coherent system of international health law and governance has never been greater. We begin with a discussion of the health hazards posed by contemporary globalization on human health and the consequent urgent need for global health law to facilitate effective multilateral cooperation in advancing the health of populations equitably. We then offer a definition of the emerging field of global health law. After explicating the central features identified in our definition, we turn to an examination of the grand challenges – legal, political, and social – to reaching the full potential of global health law to advance human health in just and effective ways. Our definition of global health law follows, and the remainder of this section explains the salient aspects of the definition: Global health law is the study of the legal norms, processes, and institutions needed to create the conditions for people throughout the world to attain the highest possible level of physical and mental health. The field seeks to facilitate health-promoting behaviour among the key actors that significantly influence the public\u27s health, including international organizations, governments, businesses, foundations, the media, and civil society. Global health law should stimulate investment in research and development, mobilize resources, set priorities, coordinate activities, monitor progress, create incentives, and enforce standards. The field should be guided by the value of social justice, and seek equitable distribution of health services, particularly to benefit the world’s poorest populations. The domain of global health law primarily is concerned with (1) formal sources of public international law, including, for example, treaties establishing the authority and responsibility of states for the health of their populations and duties of international cooperation, and (2) formal subjects of international law, including states, individuals, and public international organizations. However, to be an effective global health governance strategy, global health law must evolve beyond its traditional confines of formal sources and subjects of international law. It must foster more effective collective global health action among governments, businesses, civil society and other actors. Accordingly, our definition of global health law is prescriptive as well as descriptive: it sets out the sort of international legal framework needed, but still unavailable, to empower the world community to advance global health in accordance with the value of social justice

A Systematic Plan for Firearms Law Reform

Tragedy after tragedy has drawn the nation’s attention towards gun violence. Yet the murder of 20 school children in Newtown, CT has done more to drive the national dialogue on gun control than any preceding mass shooting, not to mention the endemic murderous violence that plagues city streets day in and out. President Obama has responded by calling on Congress to (1) close background check loopholes; (2) ban assault weapons and high-capacity magazines; and (3) improve mental health services. All of these measures are necessary to curb gun violence. Yet, in a nation with more firearms per capita than anywhere in the world, they are not sufficient. Violence is depicted and even glorified in the media; law enforcement lacks the ability to track stolen or illegally traded arms; and the National Instant Criminal Background Check System is vastly deficient (and not always consulted before a sale). The public health threat of firearms—whether through inner-city violence, mass murders, suicides, or inadvertent firearm discharges—is tremendous, and reasonable firearm restrictions are both critical and in high public demand. Yet Congress has stalled comprehensive gun safety legislation for years (e.g., mandatory trigger locks, fingerprint and tracking technology, training requirements, limits on mass sales). Moreover, President Obama’s renewed call for change does not touch on these strategies. In short, federal, state, and city officials lack the basic tools needed to detect, prevent, and punish firearm related crime. Before Newtown becomes another sound bite, it must inspire the greatest bipartisan courage to at least stem the mass shootings and street killings that our newly found individual right to bear arms has made so prevalent

Improving Laws and Legal Authorities for Obesity Prevention and Control

This is the second paper in a two part series on the laws and legal authorities for obesity prevention and control. In this paper, the authors present the applicable laws and legal authorities that public health professionals and lawyers can consider implementing to close the legal gaps identified in the first paper (“Assessing Laws and Legal Authorities for Obesity Prevention and Control”). This set of legal action items encompass the federal, tribal, state, local, and community levels and should be considered when developing, implementing, and evaluating obesity prevention and control strategies and interventions. The paper organizes the action items within three key domains: healthy lifestyles, healthy places, and healthy societies. In the healthy lifestyles domain, the goal is to make the default environment one that fosters healthy lifestyles by making the healthy option the easier choice through actions such as altering farm subsidies to increase the affordability of healthy foods and the regulation of marketing practices targeting children. The healthy places domain recognizes that the surrounding community, workplace, and transportation options influence the ability to make healthy choices. Actions under this domain include the strategic use of zoning, the support of public transportation, and employer incentivization for healthy lifestyles at the workplace. The final domain of healthy societies addresses the complex societal causes and contributors to obesity, disparities, and discrimination. This domain includes actions such as the strengthening of public policies for school nutrition standards and increased physical activity, increasing access to health care (including preventative services), and addressing weight discrimination to ensure social justice and adequate care

Supervised Injection Facilities: Legal and Policy Reforms

The US Centers for Disease Control and Prevention reported that more than 70 000 deaths from drug overdoses occurred in 2017, including prescription and illicit opioids, representing a 6-fold increase since 1999. Innovative harm-reduction solutions are imperative. Supervised injection facilities (SIFs) create safe places for drug injection, including overdose prevention, counseling, and treatment referral services. Supervised injection facilities neither provide illicit drugs nor do their personnel inject users. Supervised injection facilities are effective in reducing drug-related mortality, morbidity, and needle-borne infections. Yet their lawfulness remains uncertain. The Department of Justice (DOJ) recently threatened criminal prosecution for SIF operators, medical personnel, and patrons

Assessing Laws and Legal Authorities for Obesity Prevention and Control

This is the first paper in a two part series on the laws and legal authorities for obesity prevention and control, which resulted from the National Summit on Legal Preparedness for Obesity Prevention and Control in 2008. In this paper, the authors apply the “laws and legal authorities” component of the Centers for Disease Control and Prevention (CDC) legal framework on public health legal preparedness to demonstrate the essential role that law can play in the fight against obesity. Their analysis identified numerous laws and policies in the three vital domains of healthy lifestyles, healthy places, and healthy societies. For example, in terms of healthy lifestyles, governments can impact nutrition through: food subsidies, taxation, and bans; food marketing strategies; and nutritional labeling and education. With regard to healthy places, state and local governments can apply zoning laws and policy decisions to change the environment to encourage healthy eating and physical activity. Governments can promote healthy societies through laws and legal authorities that affect the ability to address obesity from a social perspective (such as antidiscrimination law, health care insurance and benefit design, school and day care for children, and surveillance). This paper describes instances of how current laws and legal authorities affect the public health goal of preventing obesity in both positive and negative ways. It also highlights the progressive use of laws at every level of government (i.e., federal, state, and local) and the interaction of these laws as they relate to obesity prevention and control. In addition, general gaps in the use of law for obesity prevention and control are identified for attention and action. (These gaps serve as the basis for the companion paper, which delineates options for policymakers, practitioners, and other key stakeholders in the improvement of laws and legal authorities for obesity prevention and control.

Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population\u27s Wellbeing

The Patient Protection and Affordable Care Act is a major achievement in improving access to health care services. However, evidence indicates that the nation could achieve greater improvements in health outcomes, at a lower cost, by shifting its focus to public health. By focusing nearly exclusively on health care, policy makers have chronically starved public health of adequate and stable funding and political support. The lack of support for public health is exacerbated by the fact that health care and public health are generally conceptualized, organized, and funded as two separate systems. In order to maximize gains in health status and to spend scarce health resources most effectively, health care and public health should be treated as two interactive parts of a single, unified health system. The core purpose of health reform ought to be the improvement of the population’s health. We propose five criteria that would significantly advance this goal: prevention and wellness, human resources, a strong and sustainable health infrastructure, robust performance measurement, and reduction of health disparities. Although the Patient Protection and Affordable Care Act includes provisions addressing these criteria, population health is not a central focus of the reform. In order to guide health reform implementation and to inform future health reform efforts, we offer three major policy reforms: changing the environment to incentivize healthy behavioral choices, strengthening the public health infrastructure at the state and local levels, and developing a health-in-all policies strategy that would engage multiple agencies in improving health incomes. Adopting these reforms would facilitate integration and dramatically improve the population’s health, particularly when compared to the health gains likely to be realized from a continued focus on access to health care services

What Will It Take? Terrorism, Mass Murder, Gang Violence, and Suicides: The American Way, Or Do We Strive for a Better Way?

The assertion that access to firearms makes us safe, rather than increases the likelihood that oneself or a family member will die, is contradicted by a large body of evidence. Gunshots kill more than 30,000 Americans each year. Homicide accounts for approximately one-third of these deaths, with the remainder involving suicides and accidental gun discharges. In fact, firearms put us at greater risk of death than participating in war; in four months, as many Americans were shot dead in the United States as have died fighting in Iraq for an entire decade. Given these grim statistics, it would be reasonable to expect swift legislative action. Living in a nation plagued by the highest gun death rate in the world should trigger public and political outrage. Yet, the country is in a state of political impasse. Despite public demand for reform, federal legislators have been unable to enact laws that would protect, at least in part, the public from gun violence. Partly to blame for this political standoff may be the public’s misperception that there are rigorous gun control laws at the federal and state levels, all of which in actuality are riddled with loopholes. State and federal legislators could significantly tighten gun control laws without infringing on the Second Amendment right to bear arms but repeatedly fail to do so. When proposed reforms are viewed cumulatively, it is clear that they would almost certainly prevent many firearm injuries and deaths, even if no reform can eliminate gun violence altogether

Virus Sharing, Genetic Sequencing, and Global Health Security

The WHO’s Pandemic Influenza Preparedness (PIP) Framework was a milestone global agreement designed to promote the international sharing of biological samples to develop vaccines, while that ensuring poorer countries would have access to those vaccines. Since the PIP Framework was negotiated, scientists have developed the capacity to use genetic sequencing data (GSD) to develop synthetic viruses rapidly for product development of life-saving technologies in a time-sensitive global emergency—threatening to unravel the Framework. Access to GSD may also have major implications for biosecurity, biosafety, and intellectual property (IP). By rendering the physical transfer of viruses antiquated, GSD may also undermine the effectiveness of the PIP Framework itself, with disproportionate impacts on poorer countries. We examine the changes that need to be made to the PIP Framework to address the growing likelihood that GSD might be shared instead of physical virus samples. We also propose that the international community harness this opportunity to expand the scope of the PIP Framework beyond only influenza viruses with pandemic potential. In light of non-influenza pandemic threats such as the Middle East Respiratory Syndrome (MERS) and Ebola, we call for an international agreement on the sharing of the benefits of research – such as vaccines and treatments – for other infectious diseases to ensure not only a more secure and healthy world, but also a more just world, for humanity

The international right to health: what does it mean in legal practice and how can it affect priority setting for universal health coverage?

The international right to health is enshrined in national and international law. In a growing number of cases, individuals denied access to high-cost medicines and technologies under universal coverage systems have turned to the courts to challenge the denial of access as against their right to health. In some instances, patients seek access to medicines, services, or technologies that they would have access to under universal coverage if not for government, health system, or service delivery shortfalls. In others, patients seek access to medicines, services, or technologies that have not been included or that have been explicitly denied for coverage due to prioritization. In the former, judicialization of the right to health is critical to ensure patients access to the technologies or services to which they are entitled. In the latter, courts may grant patients access to medicines not covered as a result of explicit priority setting to allocate finite resources. By doing so, courts may give priority to those with the means and incentive to turn to the courts, at the expense of the maximization of equity- and population-based health. Evidence-based, informed decision-making processes could ensure that the most clinically and cost-effective products aligning with social value judgments are prioritized. Governments should be equipped to engage in and defend rational priority setting, and the priority setting process and institutions involved should be held accountable through an opportunity for appeal and judicial review. As a result, the courts could place greater reliance on the government's coverage choices, and the population's health could be most equitably distributed

Global rules for global health: why we need an independent, impartial WHO

Over the past few years the World Health Organization (WHO) has been undergoing substantial reform. The immediate trigger was a budget crisis in 2010 that spurred massive staff cuts. But at a more fundamental level, deeper systematic changes in global health governance have made reform imperative.1 Though WHO reform draws relatively little attention outside diplomatic circles in Geneva, at stake are critical concerns that will affect public health everywhere. The essential role of WHO is most often appreciated when outbreaks of infectious disease cross borders, such as the newly identified Middle East respiratory syndrome (MERS) coronavirus, which has infected 636 people since 2012 and has a death rate of about one in three.2 With an increasing number of cases being reported, fears exist that it could infect thousands of people, similar to the SARS (severe acute respiratory syndrome) coronavirus in 2002-03.3 The international response to MERS has been more rapid than to SARS at least partly because of global structures that have facilitated epidemiological assessment, international information sharing, and the development of potential treatments. In an increasingly interconnected and interdependent world, global rules negotiated among governments are crucial for facilitating international cooperation and for protecting the health of the world’s population. Sometimes adhering to these rules requires governments to forgo some of their sovereignty and to trust an international organisation to act impartially and independently for the common good. One of the fundamental reasons for the creation of WHO in 1948 was to ensure that governments would “compromise their short-term differences in order to attain the long-run advantages of regularized collaboration on health matters.”4 Although many global health problems can be dealt with outside of WHO, the negotiation, agreement, and monitoring of compliance with global health rules can realistically take place only in WHO’s main decision making body, the World Health Assembly. WHO possesses unique political legitimacy because its membership encompasses all countries in the United Nations. This legitimacy allows WHO to convene governments and others (such as civil society, experts, and business) to negotiate rules, resolve differences, and reach consensus—all key elements of stewardship, a core function of the global health system.5 MERS exemplifies at least three areas of global rule making that are crucial for protecting global health: rapid information sharing on new infectious threats, fair arrangements for access to drugs and vaccines, and research and development of technologies and other interventions