Post on 25-Feb-2016
description
USING GLOBAL HEALTH LAW IN PUBLIC HEALTH ADVOCACY
CAMPAIGNSPeter D. Jacobson, JD, MPH
Professor of Health Law and PolicyUniversity of Michigan School of Public
Health
29 April 2008
• Law as effective organizing tool Law as complement to advocacy/social movements Specific global health laws of interest Relationship between global and domestic health laws
Overview
LAW AS EFFECTIVE ORGANIZING TOOL
•Defining public health objectives
oPublic health preparednessoDeveloping public health systemsoReducing disease burden (i.e., AIDS, tobacco)
•Choosing the right legal tools
oDomestic lawoGlobal health lawoLegislative/administrative advocacy
USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY
ROLE: I
•Define ideal system given Brasil’s legal/political traditions
oCentralized vs. decentralizedoRole of government vs. private sectoroScope of public health issues to confrontoIdentity other domestic agencies for collaborationoIdentify international agencies for collaboration (e.g.. WHO, World Bank)
USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY
ROLE: II
•Build on Brasil’s primary care health expansion strategy to promote access to essential services
•Identify global models (not USA!) for population-level health activities
oOther middle income countries such as Thailand or Malaysia
USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY
ROLE: III
•Identify gaps in existing laws/recommend changes
oSurveillance authorityoMandated servicesoFunding streamsoAuthority to declare and report public health emergencyoPublic-private collaboration for preparedness
•Use global health laws
USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY
ROLE: IV
•Policymaking transparency oSeparate NGOs from dependence on governmentoConfront private donor dilemma (Global AIDS Fund dominates public health system)
• Local capacity building
oInformation (data collection, technology)oResource allocation
•Balancing population health and individual liberties
USING GLOBAL HEALTH LAWS: HUMAN RIGHTS--I
Not self-executing
o Useful in enacting domestic legislationo Effective complement to social movement approach
Right to health
o Government accountability for human rights (i.e., defining minimum level of health care expected)
o Frame policy choices with moral dimensiono Opponents’ may co-opt human rights
USING GLOBAL HEALTH LAWS: HUMAN RIGHTS--II
• Helsinki Accords
o Derided as give-away to Soviet Uniono Emerged as major breakthrough in human rightso International attention changed treatment of dissidents
• IESCR Comment 14—to fulfill right to health, states must:
o Refrain from interfering with right to healtho Prevent third parties from interfering with right to healtho Take positive action to realize right to health
USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH
REGULATIONS (IHR)--I Holding sovereign states responsible for:
o Core capacity to detect/treat disease outbreakso Disease reporting systems
Advocate for legislation to clarify central vs. local
responsibility for public health emergency
o Negotiated agreementso Resource allocation
USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH
REGULATIONS (IHR)--II Advocacy for improved public health system
o Designing system to meet IHR responsibilitieso Role of central vs. local governmentso Advocating for resources
Advocate for national guidelines and accountability measures
for
o Standard data collectiono Reporting obligations
USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH REGULATIONS (IHR)—III
Role of advocacy in Merck vs. Brasil
o Short-term access to ADIS Rx relative to long-term drug development/investment
o Hold government to promised free treatment for AIDS patientso Advocate for laws to impede spread of AIDS (i.e., needle sharing,
condoms, testing)
USING LAW TO REDUCE TOBACCO USE: I
Legislative change
o State and local no-smoking lawso Legal restrictions on youth access to tobaccoo Higher taxes
Litigation
o Individual and class action lawsuitso Forced tobacco industry to disclose damaging documents
• Helped raise cigarette prices
USING LAW TO REDUCE TOBACCO USE: II
Stimulated voluntary changes
o Smoke-free workplaceso Employers requiring employees to stop smoking
Stimulated social movements
o Local tobacco control coalitionso Legislative advocacy
Stimulated global Framework Convention on Tobacco
Control
CONCLUSION
•Law can be effective tool for advocacy •Domestic and global health law useful for organizing public health system
•No inherently correct way to organize public health system