Emergency department entrance.

Reflections on the United States Health Care System and the Right to Health

By Brianna da Silva Bhatia, Michele Heisler, and Christian De Vos

American health care too often fails to protect the right to health or promote health-related rights. Despite efforts to increase access to health care and to better incentivize high-quality, value-based care, the United States’ health care system remains fragmented, largely profit-based, and predominantly disease-focused rather than prevention-focused.

To design systems and policies that promote the right to health, a holistic and proactive approach is needed, one in which people, institutions, and corporations have a shared responsibility in promoting physical, mental, and social well-being. The Principles and Guidelines on Human Rights and Public Health Emergencies (the Principles), allow us to imagine a new future and help outline a path for how to get there. In this piece, we discuss how the Principles might be applied in a rights-based approach to address some of the core problems in the U.S. health care system.

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gavel and old papers on grey background.

Human Rights Principles in Public Health Emergencies: From the Siracusa Principles to COVID-19 and Beyond

By Eric A. Friedman and Lawrence O. Gostin

In 1984, the United Nations Economic and Social Council (ECOSOC) adopted the Siracusa Principles, which state that restrictions on human rights must meet standards of legality, necessity, and proportionality. States must use the least restrictive means available when putting in place rights-restricting measures.

One of us (LG) was involved in the drafting of the Siracusa Principles, which have become the chief international instrument governing permissible human rights limitations during national emergencies. Yet when COVID-19 – the greatest health emergency in a century – devastated the world, the Siracusa Principles seemed unequal to the task – too narrow, including with their remit limited to civil and political rights, not sufficiently specific, and above all, without sufficient accountability.

During the pandemic phase of COVID-19, human rights violations were widespread and spanned the full gamut of rights: from arbitrary detentions and suppression of free expression, to violations of the right to health, failure to ensure sufficient food and other necessities during lockdowns, quarantines, and isolations, and woefully inadequate international cooperation and assistance, including discriminatory travel and trade restrictions.

Extensive abuses of human rights during the pandemic led international experts to draft the Principles and Guidelines on Human Rights and Public Health Emergencies (HR Principles). Firmly embedding these principles in international law and creating accountability will be critical for realizing the HR Principles’ potential.

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LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

Non-State Actors and Public Health Emergencies

By Rossella De Falco

Strong, well-coordinated and resilient public health care services play a vital role in preventing and responding to public health crises. Under international human rights law, States have a positive, primary obligation to ensure that such health care services are of the highest possible quality and accessible to everyone, everywhere, and without discrimination.

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Making Explicit a Rights-Based Approach to Infodemic in a Public Health Emergency

By Calvin Wai-Loon Ho

With the mainstreaming of digital technology across many spheres of social life, infodemic management must be an integral part of public health emergency prevention, preparedness, response, and recovery.

While the Principles and Guidelines on Human Rights and Public Health Emergencies (the Principles) do not make explicit reference to infodemics, the application of digital technologies in response to a public health emergency is a clear concern. This article provides further elaboration and critique of the Principles and their treatment of this emergent phenomenon.

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Bill of Health - Globe and vaccine, covid vaccine

COVID-19 Showcased Failed Global Cooperation

By Kayum Ahmed, Julia Bleckner, and Kyle Knight

In mid-May, the World Health Organization officially declared  the “emergency” phase of the COVID-19 pandemic over. However, the deep wounds of the pandemic remain, compelling  those concerned about this pandemic and  future health emergencies to account for catastrophic failures by those in power. These reflections suggest that the public health crisis could have been addressed differently, both reducing COVID-19’s unprecedented magnitude of illness and death, and preserving human dignity.

The COVID-19 pandemic isn’t over, and the end of this pandemic’s emergency phase certainly doesn’t mean we accept the widely abysmal response as the model for the world’s reaction to the next one. Public health emergencies aren’t entirely preventable. We live in a complex world where health is increasingly affected by a changing climate, extraordinary levels of pollution, and inadequate preventive and responsive health services. Emergencies will happen. But when they do, responses that uphold human rights need to be the norm.

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Risograph clenched, raised fists with speech bubble and geometric shapes, trendy riso graph design.

Introduction to the Symposium: From Principles to Practice: Human Rights and Public Health Emergencies

By Roojin Habibi, Timothy Fish Hodgson, and Alicia Ely Yamin

Today, as the world transitions from living in the grips of a novel coronavirus to living with an entrenched, widespread infectious disease known as COVID-19, global appreciation for the human rights implications of public health crises are once again rapidly fading from view.

Against the backdrop of this burgeoning collective amnesia, a project to articulate the human rights norms relevant to public health emergencies led to the development of the 2023 Principles and Guidelines on Human Rights and Public Health Emergencies (the Principles).

This symposium gathers reflections from leading scholars, activists, jurists, and others from around the world with respect to the recently issued Principles.

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U.S. Supreme Court

Context Matters: Affirmative Action, Public Health, and the Use of Population-Level Data

By Wendy E. Parmet, Elaine Marshall & Alisa K. Lincoln

Last June, in Students for Fair Admissions (SFFA), the Supreme Court ruled that universities could not consider race in admitting students. In support of that decision, the Court dismissed the relevance of data about the varied experiences of racial groups, insisting that admissions decisions must be based solely on the experiences and merits of individual applicants. The Court’s rejection of group-level data evinces a critical misunderstanding about the uses and limits of such data that, if applied more broadly, portends troubling implications for health equity and health policy.

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United States Capitol Building - Washington, DC.

How Comparative Law Can Counter Threats to the ‘Most Successful Global Health Program in Modern History’

By Joelle Boxer

PEPFAR, the President’s Emergency Plan for AIDS Relief, is under threat. Some members of Congress are withholding reauthorization support while arguing, without evidence, that PEPFAR funds abortion.

This is untrue: U.S. law prohibits PEPFAR from funding abortion. That alone should resolve the current impasse and secure the program’s reauthorization. Should bad faith opponents require further reassurance, however, they need look no further than the local legal realities of the 25 countries and 3 regions where PEPFAR operates.

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Rome - statue of Cicero from facade of Palazzo di Giustizia.

Reclaiming Salus Populi

By Wendy E. Parmet and Elaine Marshall

I. Introduction: The Threat to Public Health

As we reach the COVID-19 pandemic’s third anniversary, the warning signs for the future of public health law are everywhere. In the past three years, courts, led by the Supreme Court, have endangered reproductive health and handcuffed governments’ capacity to meet a wide array of public health challenges. Along the way, courts have displayed an alarming disinterest in science or the impact of their decisions on the public’s health.

At the same time, many state legislatures have rushed to introduce bills to limit health officials’ ability to act to protect the community’s health. Between January 1, 2021, and May 20, 2022, at least 185 of such laws have been enacted.

In this climate, public health law needs introspection, imagination, and regrouping.

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