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Saving Lives and Decreasing Costs: The Economic Case for Health Justice

By Wendy Netter Epstein

Most proponents of health justice will tell you that health is a fundamental human right. They will say that there is a moral imperative to eliminate health inequities and to give all people equal opportunity to lead a healthy life. And they will be correct. Health justice as a framework is driven by this narrative — the laudable goals of health equity and social justice.

What you aren’t as likely to hear from health justice advocates, however, is that health justice is economically efficient. To the contrary, most health justice advocates see its framework as an alternative to the markets, efficiency, autonomy, and individual responsibility that are the hallmarks of conservative ideology.

Yet, there is no question that health inequities are costly to the individuals that bear them, in higher health care expenses, missed days of work, and fewer years lived. There are also significant costs to society — both direct and indirect. According to one analysis, disparities lead to $93 billion in excess medical care costs and $42 billion in lost productivity per year.

Making the economic case for health justice, and noting how it is inextricably linked to the moral case, is crucial. Because not only is the framework bolstered by notions of both fairness and efficiency, but also, as a practical matter, getting legislative and regulatory buy-in to fund initiatives to address health inequities requires making the economic case.

If health inequities could be ameliorated, government health spending and other safety net spending would be drastically reduced, workforce productivity would increase, and even healthy and wealthy Americans — who are the most likely to oppose the health justice framework — would benefit.

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globe.

Whose Global Health Security?

By Aeyal Gross

The current discussion within the World Health Organization (WHO) of a “pandemic treaty” aims at better solutions to “health emergencies.”

But, if this focus on “emergencies” comes at the expense of chronic and underlying issues, including the overall status of health systems, we risk replicating, with this legal instrument, the colonial legacy of international health supposedly left behind with the shift to “global health.” This points to the urgent need to rethink what is considered a “crisis” or an “emergency,” as part of the effort to “decolonize global health,” including global health law (GHL).

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Geneva, Switzerland - December 03, 2019: World Health Organization (WHO / OMS).

International Pandemic Lawmaking: Conceptual and Practical Issues — Launch Editorial

By Joelle Grogan, on behalf of the editors*

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This symposium, “International Pandemic Lawmaking: Conceptual and Practical Issues,” was convened with two primary aims: to shed light on the inequities and imbalances exposed by global pandemic response, and to advocate recommendations on which principles should guide the framing and drafting of a potential international instrument on pandemic preparedness and response.

However, while good principle can guide good action, to be effective it must be more than good principle; and more substance is needed than good design. Thus, these symposium posts published on Monday through Thursday on Bill of Health and the Verfassungsblog, along with our accompanying editorials, look not only to the design of such an instrument, but also its implementation and enforcement.

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Health Justice as the Lodestar of Incremental Health Reform

By Elizabeth McCuskey

Health justice is the lodestar we need for the next generation of health reform. It centers justice as the destination for health care regulation and supplies the conceptual framework for assessing our progress toward it. It does so by judging health reforms on their equitable distribution of the burdens and benefits of investments in the health care system, and their abilities to improve public health and to empower subordinated individuals and communities. Refocusing health reform on a health justice gestalt has greater urgency than ever, given the scale of injustice in our health care system and its tragic, unignorable consequences during the coronavirus pandemic.

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Abortion rights protest following the Supreme Court decision for Whole Women's Health in 2016

How Social Movements Have Facilitated Access to Abortion During the Pandemic

By Rachel Rebouché

Before the end of 2021, the U.S. Food and Drug Administration (FDA) will reconsider its restrictions on medication abortion. The FDA’s decision could make a critical difference to the availability of medication abortion, especially if the Supreme Court abandons or continues to erode constitutional abortion rights.

Under that scenario of hostile judicial precedents, a broad movement for abortion access — including providers, researchers, advocates, and lawyers — will be immensely important to securing the availability of remote, early abortion care.

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COVID-19 and the New Reproductive Justice Movement

By Mary Ziegler

The COVID-19 pandemic has transformed advocacy for reproductive rights and reproductive justice in what previously had been called an endless, unchanging, and intractable abortion conflict.

The pandemic — and the stay-at-home orders it required — finally shifted the movement’s focus to abortion access, rather than abortion rights, as exemplified by its emphasis on medication and telehealth abortion.

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3d rendering of a robot working with virtual display.

Artificial Intelligence and Health Law: Updates from England

By John Tingle

Artificial intelligence (AI) is making an impact on health law in England.

The growing presence of AI in law has been chronicled by organizations such as the Law Society, which published a forward-thinking, horizon-scanning paper on artificial intelligence and the legal profession back in 2018.

The report identifies several key emerging strands of AI development and use, including Q&A chatbots, document analysis, document delivery, legal adviser support, case outcome prediction, and clinical negligence analysis. These applications of AI already show promise: one algorithm developed by researchers at University College London, the University of Sheffield, and the University of Pennsylvania was able to predict case outcomes with 79% accuracy.

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We Need to Do More with Hospitals’ Data, But There Are Better Ways

By Wendy Netter Epstein and Charlotte Tschider

This May, Google announced a new partnership with national hospital chain HCA Healthcare to consolidate HCA’s digital health data from electronic medical records and medical devices and store it in Google Cloud.

This move is the just the latest of a growing trend — in the first half of this year alone, there have been at least 38 partnerships announced between providers and big tech. Health systems are hoping to leverage the know-how of tech titans to unlock the potential of their treasure troves of data.

Health systems have faltered in achieving this on their own, facing, on the one hand, technical and practical challenges, and, on the other, political and ethical concerns.

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doctor holding clipboard.

The Latest on Never Events in the NHS in England

By John Tingle

Never Events” — medical errors that should never occur — are a major and recurring problem in health care in England.

When they do occur, they sap confidence and trust in the health care system, and can result in significant injury or death to the patient. They can result in expensive litigation. There is also a significant financial cost to the NHS, which is always short of financial resources. The patient, their relatives, and all those involved in the incident bear emotional costs, too.

In the National Health Service (NHS), Never Events are defined and listed. The list includes such incidents as a foreign body being left in a patient, wrong implant/prosthesis, and wrong site surgery, among others. Sadly, the incidence of Never Events in the NHS is still too high.

Never Events are also a major patient safety metric that helps regulators such as the Care Quality Commission (CQC) and the public judge the safety of a hospital or other health care facility.

Recent publications highlight that Never Events remain a critical and a stubbornly persistent problem for the NHS to address.

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United States Capitol Building - Washington, DC.

Congress Should Insulate the Indian Health Service from the Next Government Shutdown

By Matthew B. Lawrence

Contributors to Bill of Health’s symposium on Recommendations for a Biden/Harris Health Policy Agenda have made a number of excellent suggestions. I have one more policy suggestion to add and endorse: Congress should adopt the Biden Administration’s recent proposal to insulate the Indian Health Service from future government shutdowns.

A service population of 2.5 million American Indians and Alaska Natives rely on the federally-funded Indian Health Service (IHS). The IHS is one of several trust obligations that the U.S. government owes Native peoples as a result “of Native Americans ceding over 400 million acres of tribal land to the United States pursuant to promises and agreements that included providing health care services,” as the U.S. Commission on Civil Rights put it.

Yet the IHS is dependent entirely on annual one-year appropriations from Congress. That means that the House and the Senate must come together, on time, every single year on an appropriations package, for the IHS to continue all its operations.

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