Category: Contributors

Climate Change and Health: Mobilizing Public International Law into Action

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This post launches a new Digital Symposium, Climate Change and Health: Mobilizing Public International Law into Action by Guest Editors Thalia Viveros Uehara and Alicia Ely Yamin. Check back for more posts twice a week!

The election of Donald J. Trump, who has called climate change a “hoax” and in his prior administration pulled the U.S. out of the Paris Agreement, has sent shock waves through government and civil society leaders gathered at COP29. Argentina has walked away from the negotiations. Meanwhile, top leaders from the world’s largest polluting nations have not attended. COP29 was supposed to mobilize commitments to finance climate action as well as solidify the growing “health turn” within the U.N. Framework Convention on Climate Change (UNFCCC), including WHO guidance on integrating health into Nationally Determined Contributions. But that progress seems now in jeopardy.

This digital symposium makes clear that stakes could not be higher for global health. Projections estimate that between 2030 and 2050, climate-related health impacts could lead to an additional 250,000 deaths per year, largely from undernutrition, malaria, diarrhea, and heat stress. Furthermore, mental health conditions are worsening as extreme weather, livelihood losses, and wildfire smoke increase trauma.

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Assisted Death for Psychiatric Suffering: Approaching Uncertainty with Humility

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by Zain Khalid

On May 22 this year, Zoraya Ter Beek, a 29-year-old woman from Netherlands, died by euthanasia on grounds of mental suffering. Zoraya had been diagnosed with chronic depression, borderline personality disorder, and autism and had struggled with self-harm and suicidal thinking for several year. She had tried numerous treatments, including 30 sessions of electroconvulsive therapy, until, as she reported her psychiatrist told her, “There’s nothing more we can do for you. It’s never going to get any better.”

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Ghost Networks and Mental Healthcare

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by Rebekah Ninan

A recent lawsuit in the Southern District of New York has alleged that the health insurance company Anthem Blue and Cross Blue Shield violated state laws and committed fraud by maintaining “ghost networks” of mental health providers. Ghost networks are directories for insurance companies that contain outdated or inaccurate information about providers covered by the insurance plan. The lawsuit alleges that only seven of the first 100 providers on the Anthem directory for the state of the New York were contactable, in network, or accepting patients. This aligns with findings by the New York Attorney General that 86% of mental health care providers listed on New York health plans’ networks were ghosts. Getting stuck in a ghost network, unable to find a covered provider, can stymie a patient’s efforts to find mental healthcare, producing dire consequences.

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What Type of Salt Should You Buy? Rethinking 1924 Food Fortification Policy in 2024

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by Jessica Samuels

For 100 years, food fortification, the practice of deliberately increasing the content of vitamins and minerals in a food, has been essential to combating public health crises. However, these practices have continued into the modern era. Because overconsumption of nutrients has been linked to toxicity and diseases, public health officials should continue to reflect on the benefits and risks of food fortification today.

History of Food Fortification

In the United States, food fortification (also known as enrichment) began in 1924 to address endemic goiter, enlargement of the thyroid gland. A physician in Cleveland suggested the use of salt since it was so commonly consumed to increase iodine consumption. After some persuasion, the Michigan State Medical Society studied the safety of iodized salt and launched the world’s first food fortification campaign. This was the first time food was deliberately manufactured with an eye towards addressing disease. However, while some members of the salt industry were excited by the potential to improve public health through their product, others were not. The Morton Salt Company argued that furnishing iodine to the populus properly belonged to large pharmaceutical companies. But the results were overwhelming: The incidence of goiter among children in Michigan decreased from 35% to 2.6%.

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Alabama’s Maternity Care Desert Crisis: An Evaluation of Potential Policy Reforms

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by Rupa Palanki

The United States increasingly faces a crisis in maternal and infant health care. Over 2.3 million American women of reproductive age live in maternity care deserts — counties with little to no access to birthing centers and obstetric care. These deserts often result from rural hospital closures, health care provider shortages, and long-standing structural inequalities. The absence of accessible maternity services contributes to higher rates of preterm births and inadequate prenatal care, placing both pregnant individuals and their children at risk. Low-income and minority communities are especially vulnerable.

In Alabama, recent hospital and birthing unit closures have intensified local concerns about the state’s maternal health landscape. Today, over one-third of Alabama counties are maternity care deserts, and over a quarter of Alabama women have no birthing hospital within a 30-minute drive. With one of the nation’s highest maternal mortality rates, Alabama’s need for action is urgent. Below, I evaluate the strengths and limitations of three potential reforms aimed at addressing the Alabama maternity desert crisis.

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When AI Turns Miscarriage into Murder: The Alarming Criminalization of Pregnancy in the Digital Age

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by Abeer Malik

Imagine: Overjoyed at your pregnancy, you eagerly track every milestone, logging daily habits and symptoms into a pregnancy app. Then tragedy strikes—a miscarriage. Amidst your grief, authorities knock at your door. They’ve been monitoring your digital data and now question your behavior during pregnancy, possibly building a case against you using your own information as evidence.

This dystopian scenario edges closer to reality as artificial intelligence (AI) becomes more embedded in reproductive health care. In a post-Dobbs world where strict fetal personhood laws are gaining traction, AI’s predictive insight into miscarriage or stillbirth are at risk of becoming tools of surveillance, casting suspicion on women who suffer natural pregnancy losses.

The criminalization of pregnancy outcomes is not new, but AI introduces a high-tech dimension to an already chilling trend. At stake is the privacy and the fundamental right of women to make decisions about their own bodies without fearing criminal prosecution. Alarmingly, the law is woefully unprepared for this technological intrusion.

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TikTok, Tobacco, and Addiction, Oh My!

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by Jessica Samuels

On October 8, 13 states and the District of Columbia sued TikTok, alleging that the social media company’s algorithm is designed to “promote excessive, compulsive, and addictive use” in children. While each state’s complaint was filed separately in state court, the cases are coordinated around the claim that TikTok’s design is deliberately addictive, exploiting kids’  dopamine reward circuitry to reinforce their use of the platform

These claims stem from a public reckoning of the effects of social media on children. New research has also led the surgeon general to announce a mental health crisis among young people. The lawsuits, arising from the desire to hold platforms accountable for exploiting children’s susceptibility to rewarding stimuli during development, present a novel theory of liability based solely on an algorithm’s ability to cause addiction rather than adverse mental health outcomes. Holding TikTok liable could lead to major changes in social media algorithms, reducing mental health harm.

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Third Places: A Framework for Communities AND Crisis Care

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by Spencer Andrews

What makes a city livable? The answer, some say, is more “third places,” spaces distinct from one’s home (the first place) and one’s workplace (the second place). A third place, like a café, park, or library, fosters the sense of community and connection that makes a neighborhood great to live in. This imprecise yet uncomplicated framing effectively refocuses a complex set of social, economic, and urban design issues on a simple solution to the “livability” problem.

I believe that the “third place” framework also can usefully reframe another discipline: emergency mental health care. Individuals experiencing mental health crises lack an appropriate setting to receive care. Typically, individuals experiencing acute, emergency mental health crises-–whether related to substance use or not-–end up in one of two places: the hospital emergency room (ER) or a jail cell. The problem is that neither of these two places is well-equipped to treat someone in the midst of a mental health crisis. A third option is needed.

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Rethinking Mental Health Reform: A case for reviving community-based care

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by Zain Khalid

October 10th marked the first anniversary of California’s Senate Bill 43 (SB 43), a major revision of the landmark Lanterman-Petris-Short Act of 1967, a de-institutionalization era law designed to “end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders.” The law loosened eligibility standards for civil commitment by expanding the existing “grave disability” criterion, making it easier to detain and hospitalize persons with mental illness against their will.

New York City’s mayor, Eric Adams, enacted a similar initiative in November 2022, the same year 40-year-old Michelle Alyssa Go, was tragically killed after being shoved onto the subway by an unhoused man with a long history of mental illness and patchy treatment. New York’s plan authorized emergency medical workers and police officers to involuntarily remove people with severe mental illness from the streets to be evaluated for hospitalization. Mayor Adams framed his plan in terms of the city’s “moral obligation” to help mentally ill citizens and California Governor Gavin Newsom spoke of a “life-and-death urgency” in advocating for SB 43.

These controversial initiatives are among the highest profile of a growing national trend toward expanding civil commitment laws: Ohio, DC, Tennessee, Alabama and Florida have introduced similar legislation in just the past year. Across the U.S., this turn toward civil commitment is driven by a triple whammy of unmitigated housing crises, an increasingly visible unhoused mentally ill population, and rising violent crime. But is civil commitment a defensible strategy in tackling this Gordian knot of intersecting social crises? Or does it merely serve to keep unseemly realities away from the public eye? To understand the role of civil commitment in addressing these challenges, we must begin by looking at how we got here. Read More

Health Care, AI, and the Law: An Emerging Regulatory Landscape in California

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by Rebekah Ninan

This past month, California Governor Gavin Newsom signed a wave of artificial intelligence-related legislation into law. Much public debate has been focused on SB 1047, a proposal ultimately vetoed by Governor Newsom, which would have held AI companies liable for “catastrophic harms” from AI models. Comparatively little attention has been paid to three new laws aimed at health care-related AI and data privacy. Three laws are AB-3030, SB-1223, and SB-1120. AB 3030 requires that health care providers disclose when they have used generative AI to create communications with patients. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit. Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. This article seeks to summarize these developments in the law.

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