USING GLOBAL HEALTH LAW IN PUBLIC HEALTH ADVOCACY CAMPAIGNS
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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
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• 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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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