Tag: public health

Compass on a tree stump.

From Cooperation to Solidarity: A Legal Compass for Pandemic Lawmaking

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By Guillermo E. Estrada Adán

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This post proposes incorporating solidarity as a legal compass for international norms in a new international pandemic law agreement or reform.

The current model of global health governance espoused by the World Health Organization (WHO), based heavily on cooperation between states, has significant shortcomings. An approach that relies on solidarity, rather than cooperation, would better advance states’ responsibilities to ensure the protection and enjoyment of each individual’s rights. Read More

Concept: An ounce of prevention is worth a pound of cure.

The Paradoxical Legal Treatment of Preventive Medicine

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By Doron Dorfman

Preventive medicine is a tool used by individual patients, primary care physicians, and governmental agencies to preempt illnesses rather than to treat them after they have arisen. Despite this salubrious aim, stigma, shame, and fear often are attached to the use of preventative care.

The stigma around preventive medicine can arise from the tendency to view such measures as a proxy for risky or otherwise socially marginalized behavior or lifestyle. Why would someone use a preventative measure if they are not at high risk as a consequence of their own choices?

Consider, for example, what I call “sexually charged” preventative health measures like the human papillomavirus vaccine or Pre-Exposure Prophylaxis (PrEP). PrEP is a highly effective daily drug regimen that prevents HIV infection, which has become specifically popular with gay and bisexual men.

As I discuss in a forthcoming paper, PrEP has been viewed by policymakers and health care professionals as a “license for promiscuity” due to the fear of risk compensation, meaning the adjustment of risky behavior by those who take PrEP to potentially have sex with more partners and with no condoms. Such views are reflected in Kelley v. Becerra, a case pending before the U.S. District Court of the Northern District of Texas, where plaintiffs wish to purchase insurance that excludes coverage for PrEP and contraception, to which they object to on religious and moral grounds.

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Euros, U.S. dollars, and pounds.

Who Will Pay for COVID-29? (Or, Who Will Pay to Avert It?)

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By Sebastián Guidi and Nahuel Maisley

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Pandemics have very real costs. When they hit, these costs are obvious and dramatic — people fall ill and die, businesses go bankrupt, children are kicked out of school. When they don’t, it’s very likely because we have already taken extremely costly measures to prevent them.

These costs are inevitably distributed — through act or omission — by international law. As the international community discusses a new pandemic treaty, complementary to the International Health Regulations, it bears emphasizing that any global framework that does not reckon with cost will fall short of an acceptable solution.

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(Institute for the feeble-minded, Lincoln, Ill. / Library of Congress)

Brittney Poolaw and the Long Tradition of State-Sponsored Control of Women and Their Fertility

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By Lauren Breslow

On October 5, 2021, a 20-year-old Native American woman, Brittney Poolaw, was convicted by an Oklahoma jury of manslaughter for the death of her 17-week-old, non-viable fetus.

Her conviction stands as a modern recapitulation of the historical violations that women, especially Black and Brown women, have endured regarding their fertility.

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Mexico City 03082021 Feminist march against gender violence, March 8 in Mexico thousands of women protest in the streets for safety and better living conditions, using banners.

Strengthening Global and National Governance for Gender Equality in Health Emergencies

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By Anna Coates

An international instrument on pandemic preparedness and response opens a much-needed space to highlight the centrality of gender inequality considerations in health emergency responses.

With an eye to inclusive governance, investment in gender expertise, and strengthening existing normative mechanisms and architecture for gender equality at global and national levels, a new intergovernmental instrument offers an opportunity for future health emergency preparedness and responses to meaningfully contribute to gender equality.

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Lady Justice blindfolded with scales.

Health Justice Can’t Be Blind

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By Daniel E. Dawes

“Justice is blind.” We have all heard this phrase before, and seen the iconic representation: the blindfolded Lady Justice.

That blindfold is supposed to symbolize impartiality. It represents our strict subscription to the notion that impartiality and objectivity are the principles upon which our system is built and by which it is protected. This notion that justice is blind is one rooted in equality.

But justice should not always be blind. Rather than prioritizing equal treatment, sometimes justice demands that we treat individuals differently to ensure equal outcomes. This notion of justice is rooted in the principle of equity.

Put simply, equity takes fairness as its aim. Where equality entails the equal (i.e., impartial) treatment of individuals, equity demands a nuanced approach to ensure equal outcomes.

To achieve justice in the realm of health, our focus must be on equity, and not on blind equality.

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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

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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

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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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Researcher works at a lab bench

Scientific Innovation in International Pandemic Lawmaking — Second Symposium Editorial

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By Pedro A. Villarreal, on behalf of the editors*

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Perhaps there is some Utopia where scientific research could immediately provide us all the accurate data on a novel disease´s severity and fatality rate. No doubt some (although not everyone) believe that such an ideal world would include mathematical models that could accurately predict both the disease´s pattern, as well as the effectiveness of the array of medical and non-medical tools to confront it. In this imaginary reality, data could tell us exactly to what extent restrictive public health measures are necessary in a given society to limit the spread of a pathogen, and it would be shared without constraints across the globe. Moreover, in this mythical world, there would be no distance between research and its application, as policymakers would simply need to draw from existing information to “make the right call.” Failsafe mechanisms would be in place to avoid the temptation of either altering scientific data, or using it for partisan motives. And, needless to say, in an ideal world, both research and the products of scientific innovation, including diagnostics, therapeutics and vaccines, would be available to everyone, globally, on the basis of need rather than ability to pay.

No such world is possible because science does not work that way. However, the broken world in which we find ourselves underscores the central imperative of reflecting on how lawmaking can be deployed to advance scientific innovation and equity.

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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

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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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