Freeway on-ramp

The Government Needs to Construct On, Not Off, Ramps to Combat the Latest Wave of COVID

By Jennifer S. Bard

Over the past two weeks, the news coming in about the spread of COVID-19 has been eerily familiar. Cases are rising all over Europe, not just in under-vaccinated Eastern European countries, but in England, the Netherlands, and Germany — all of whom have much higher rates of vaccination than the U.S. At the same time, cases across the U.S., including in cities like LA, DC, and Chicago have stopped falling, and are rising rapidly in the Mountain West, including the Navajo Nation. Hospitals in Colorado have already reached crisis capacity.

Whether the increase is attributable to the emergence of yet another variant, or perhaps is a natural artifact of waning immunity, it is very real and demands a level of attention from our federal government that, once again, it is failing to provide.

Yet in the face of now too familiar signs of resurgence, already being called a “Fifth Wave,” not only are the usual minimizers advocating reducing existing measures to prevent spread, but cities and states are rolling back what few protections remain intact. It is in the face of this foolish movement to drop our guard that the federal government is, again, failing to use the powers it has beyond vaccine mandates to create much needed on-ramps for mitigation measures as the country heads into winter.

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Checklist.

Casualties of Preparedness: Rethinking the Global Health Security Paradigm

By Manjari Mahajan

The calls for a new pandemic treaty, like the genesis of the International Health Regulations (IHR), have been anchored within a paradigm of “global health security.” Before undertaking new projects of international lawmaking, it behooves us to examine this dominant paradigm and assess whether it actually leads to the goal of pandemic preparedness across countries. At stake are the future contours of a global normative, legal and infrastructural machinery and whether its animating logics are historically informed, evidence-driven, and geographically equitable.

The prevailing global health security paradigm was institutionalized in international law through the IHR, a policy centerpiece that was most recently revised in 2005 in response to a series of new infectious diseases including AIDS, SARS, and Ebola. At its foundation, the schema identifies the problem at hand as outbreaks of emerging infectious diseases, which become global security threats as they travel across borders. The focus is very much on new and re-emerging infectious diseases, and not ongoing health-related problems in a population. Moreover, this framework is animated by a special anxiety about contagion from poorer, purportedly primordial and volatile countries in the global South to the North.

The emphases on new infections and preventing their travel from the South to the North have resulted in a politics of control and enforcement that carry with it particular normative and infrastructural demands.

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Senior citizen woman in wheelchair in a nursing home.

The Barriers to Aging in Place

By Renu Thomas and John Roth

The COVID-19 pandemic has highlighted the risks associated with institutionalized care for the elderly, and has further shifted sentiments toward a preference for aging in place. But most seniors and their loved ones don’t realize the barriers that make aging in place a difficult proposition until a crisis occurs and they’re faced with finding services.

Take our family, for example. My father was diagnosed with Parkinson’s disease and it was after his first fall and discharge from the hospital that our family realized my parents’ independence was severely limited. We knew their house was not wheelchair or walker accessible, but we also needed to address other issues as well; neither of them could drive anymore, so how would we get them to appointments, how would their prescriptions and groceries get picked up, and how could we prevent them from being socially isolated? Like many families, we do not live nearby, let alone in the same state, which made coordinating these services even more challenging.

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Gavel and stethoscope.

Symposium Conclusion: Health Justice: Engaging Critical Perspectives in Health Law & Policy

By Lindsay F. Wiley and Ruqaiijah Yearby

As our digital symposium on health justice comes to a close, we have much to be thankful for and inspired by. We are honored to provide a platform for contributions from scholars spanning multiple disciplines, perspectives, and aspects of health law and policy. Collectively with these contributors, we aim to define the contours of the health justice movement and debates within it, and to explore how scholars, activists, communities, and public health officials can work together to engage critical perspectives in health law and policy.

As we described in our symposium introduction, the questions we posed to contributors focused their work on four main themes: (1) subordination (including discrimination and poverty) is the root cause of health injustice, (2) subordination shapes health through multiple pathways, (3) health justice engages multiple kinds of experiences and expertise, and (4) health justice requires empowering communities, redressing harm, and reconstructing systems. Most of the contributions to this symposium cut across more than one of these themes, but we present them here in four broad categories.

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Illustration of a family and large clipboard with items in a list checked off. All are underneath a large blue umbrella

Churning Point: Lessons from Medicaid Pandemic Policies

By Cathy Zhang

During the COVID-19 pandemic, ensuring widespread health coverage took on a new sense of urgency, leading many states to implement policies to address the longstanding problem of Medicaid churn.

Churn is a persistent problem in the U.S. health care system. Changes in health insurance coverage disrupt care and worsen self-reported health at significant rates, even for individuals who go from one insurer to another with no gap in coverage. Legislation enacted as a stopgap measure during the pandemic may present a path forward for securing more durable Medicaid coverage beyond the public health emergency.

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Patient receives Covid-19 vaccine.

The Target of Health Justice

By Sridhar Venkatapuram 

As we amplify, further develop, and advise in the realizing of health justice, there would be much benefit in clarifying the basic units of moral concern.

This call for more specificity relates to both who is the primary unit of moral concern (individuals, communities, nation-states, etc.) as well as what it is that we care about in relation to them (i.e., liberties, resources including health care, basic needs, respect, opportunities, capabilities, relationships, etc.).

In the current context of the COVID-19 pandemic, where vaccines have become the preeminent goods of value worldwide, I focus my discussion here on how distributing vaccines equitably at the level of geographical units such as districts or nation-states may obfuscate or tolerate injustices, as well as provide suboptimal control of the pandemic.

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A volunteer loads food into the trunk of a vehicle during a drive thru food distribution by the Los Angeles Regional Food Bank at Exposition Park on Saturday, Jan. 23, 2021, in Los Angeles.

How Community Organizations and Health Departments Can Partner to Advance Health Justice

By Sarah de Guia, Rachel A. Davis, and Kiran Savage-Sangwan

Health justice is not just a cause or an idea, but the way forward for public health agencies and communities alike.

Beyond focusing attention on measurable disparities, the term health justice provides a vision for a fair future that minimizes inequities and sends a clear and urgent call to change discriminatory policies, practices, and systems. To achieve this vision, governments and other large institutions must share power with partners of all kinds to change the structural, systemic, and institutional causes of health and wealth disparities. Otherwise, these disparities will continue to keep our communities from achieving their greatest potential to live healthy, prosperous lives.

Our organizations — ChangeLab Solutions, Prevention Institute, and the California Pan-Ethnic Health Network, with support from The California Wellness Foundation and The Blue Shield of California Foundation — came together to help guide California policymakers in centering health justice in their approaches to COVID-19 response and recovery. Our work analyzing community health efforts in California during the COVID-19 pandemic underscores the necessity of collaborative partnerships in advancing health justice. Most importantly, our findings revealed the indispensable role that community-based organizations (CBOs) played in responding to community needs during this time of crisis.

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NEW YORK, NEW YORK - APRIL 05: Emergency medical technician wearing protective gown and facial mask amid the coronavirus pandemic on April 5, 2020 in New York City.

Déjà Vu All Over Again

By Jennifer S. Bard

The COVID-19 pandemic has shown us time and time again that whatever progress we make in curbing transmission of the virus is tenuous, fragile, and easily reversed.

And yet, we continue on a hapless path of declaring premature victory and ending mitigation measures the moment cases begin to fall. We need only look back to recent history to see why relaxing at this present moment of decline is ill-advised.

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Washington, DC, USA - July 6, 2020: Protesters rally for housing as a human right at Black Homes Matter rally at Freedom Plaza, organized by Empower DC.

Building Power Across Movements for Health Justice 

By Solange Gould

At its core, public health is the radical concept that everyone has a fundamental right to the conditions required for health and well-being. To realize this vision of health justice, we must forge a strategy that moves beyond the pre-pandemic status quo and the broken systems that got us there.  

It’s time to re-envision and invest in a new public health infrastructure, one that is equipped and authorized to respond to the concurrent global crises we are facing: COVID-19; structural racism; White supremacy; climate change; and the failures of capitalism to provide for the basic human needs that are required for health. This infrastructure must center and build the power of those most impacted by structural inequity in order to truly advance justice. 

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Doctor Holding Cell Phone. Cell phones and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone.

Toward a Broader Telehealth Licensing Scheme

By Fazal Khan

Evidence generated during the first year the COVID-19 pandemic has called into question the need for many of the telehealth restrictions that were in effect prior to the pandemic.

The question many policymakers are asking now is: which of the telehealth regulatory waivers enacted during the pandemic should become permanent?

My forthcoming article proposes that the federal government use its spending power to incentivize states to adopt a de facto national telehealth licensing scheme through state-based mutual recognition of licensing and scope of practice reforms through a Medicaid program funding “bonus.”

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