35 million people die annually of non-communicable diseases (NCDs), 80% of them in low- and middle-income countries — representing a marked epidemiological transition from infectious to chronic diseases and from richer to poorer countries. The total number of NCDs is projected to rise by 17% over the coming decade, absent significant interventions. The NCD epidemic poses unique governance challenges: the causes are multifactorial, the affected populations diffuse, and effective responses require sustained multi-sectorial cooperation. The authors propose a range of regulatory (...) options available at the domestic level, including stricter food labeling laws, regulation of food advertisements, tax incentives for healthy lifestyle choices, changes to the built environment, and direct regulation of food and drink producers. Given the realities of globalization, such interventions require global cooperation. In 2011, the UN General Assembly held a High-level meeting on NCDs, setting a global target of a 25% reduction in premature mortality from NCDs by 2025. Yet concrete plans and resource commitments for reaching this goal are not yet in the offing, and the window is rapidly closing for achieving these targets through prevention — as opposed to treatment, which is more costly. Innovative global governance for health is urgently needed to engage private industry and civil society in the global response to the NCD crisis. (shrink)
Most people think of preemption as a technical, constitutional doctrine, but it is pivotally important to health and safety and opens the door to broad judicial discretion. The Rehnquist and Roberts Courts’ jurisprudence, with its support for both business and preemption, has been distinctly antiregulatory, invalidating major state public health rules in occupational safety, tobacco control, and motor vehicle safety, among other things.1 And apart from these antiregulatory stances, the Supreme Court has also been maddeningly inconsistent. Consider three relatively recent (...) cases. In its 2008 decision in Riegel v. Medtronic, Inc., the Court held that federal law bars injured consumers from challenging the .. (shrink)
Despite evidence indicating that public health services are the most effective means of improving the population's health status, health care services receive the bulk of funding and political support. The recent passage of the Affordable Care Act, which focused on improving access to health care services through insurance reform, reflects the primacy of health care over public health. Although policymakers typically conceptualize health care and public health as two distinct systems, gains in health status are most effectively and cost-efficiently achieved (...) through their integration into a single health system. The Act does little to compel integration; however, there are numerous opportunities to encourage the coordination of public health and health care in the Act's implementation. (shrink)
On March 23, 2010, President Obama signed into law the nation's first comprehensive health care reform bill, the Patient Protection and Affordable Care Act. Within weeks, twenty states filed lawsuits challenging the constitutionality of its most politically charged feature—an individual purchase mandate. By 2014, the bill requires most individuals to have health insurance. With certain exceptions (pertaining to income level and religious objections), individuals without qualifying coverage will pay an annual tax penalty reaching the greater of $695 ($2,085 per family (...) maximum) or 2.5 percent of household income.1If anything, the tax penalty is too low compared with the cost of insurance, so it may not provide .. (shrink)
Developing country efforts to enforce basic public health standards are often hindered by limited agency resources and poorly designed enforcement mechanisms, including excessive reliance on slow and erratic judicial systems. Traditional public health regulation can therefore be difficult to implement. This article examines innovative approaches to the implementation of public health regulations that have emerged in recent years within the OECD countries. These approaches aim to improve compliance with health standards among the different actors while reducing dependence on the legal (...) system and the administrative resources of public health agencies in developing countries. Developing countries may find some useful lessons from these approaches that can be adapted for use in their own institutional settings. (shrink)
McDonough Hall, Room 508, 600 New Jersey Ave, NW, Washington, DC 20001, USA; Email: gostin{at}law.georgetown.edu ' + u + '@' + d + ' '//--> Abstract As a consequence of rapid globalization, the need for a coherent system of global health law and governance has never been greater. This article explores 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. It sets forth the first definition of the emerging field of "global health law." After explicating the central features identified in the definition, the article examines the "grand challenges" to reaching the full potential of global health law to advance human health in just and effective ways. CiteULike Connotea Del.icio.us What's this? (shrink)
In 1991, the CDC recommended that health care workers (HCWs) infectedwith HIV or HBV (HbeAg positive) should be reviewed by an expert paneland should inform patients of their serologic status before engaging inexposure-prone procedures. The CDC, in light of the existing scientificuncertainty about the risk of transmission, issued cautiousrecommendations. However, considerable evidence has emerged since 1991suggesting that we should reform national policy. The data demonstratesthat risks of transmission of infection in the health care setting areexceedingly low. Current policy, moreover, does (...) not improve patientsafety. At the same time, implementation of current national policy atthe local level poses significant human rights burdens on HCWs.Consequently, national policy should be changed to ensure patient safetywhile protecting the human rights of HCWs. This article proposes a newnational policy, including: (1) a program to prevent bloodborne pathogentransmission; (2) a responsibility placed on infected HCWs to promotetheir own health and well-being and to assure patient safety; (3) adiscontinuation of expert review panels and special restrictions forexposure-prone procedures; (4) a discontinuation of mandatorydisclosure of a HCW's inflection status; and (5) the imposition ofpractice restrictions if a HCW is unable to practice safely because of aphysical or mental impairment or failure to follow careful infectioncontrol techniques. A new national policy, focused on management of theworkplace environment and injury prevention, would achieve high levelsof patient safety without discrimination and invasion of privacy. (shrink)
The success of the health care system depends on the accuracy, correctness and trustworthiness of the information, and the privacy rights of individuals to control the disclosure of personal information. A national policy on health informational privacy should be guided by ethical principles that respect individual autonomy while recognizing the important collective interests in the use of health information. At present there are no adequate laws or constitutional principles to help guide a rational privacy policy. The laws are scattered and (...) fragmented across the states. Constitutional law is highly general, without important specific safeguards. Finally, a case study is provided showing the important trade-offs that exist between public health and privacy. For a model public health law, see www.critpath.org/msphpa/privacy. (shrink)
