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