Health Policy Commons^™

In Search Of Safety, Negotiating Everyday Forms Of Risk: Sex Work, Criminalization, And Hiv/Aids In The Slums Of Kampala, Serena Cruz

FIU Electronic Theses and Dissertations

This dissertation offers an in-depth descriptive account of how women manage daily risks associated with sex work, criminalization, and HIV/AIDS. Primary data collection took place within two slums in Kampala, Uganda over the course of fourteen months. The emphasis was on ethnographic methodologies involving participant observation and informal and unstructured interviewing. Insights then informed document analysis of international and national policies concerning HIV prevention and treatment strategies in the context of Uganda. The dissertation finds social networks and social capital provide the basis for community formation in the sex trade. It holds that these interpersonal processes are necessary components for …

King V Burwell: Subsidizing Us Health Insurance For Low- And Middle-Income Individuals, Lawrence O. Gostin, Mary C. Debartolo, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

In King v. Burwell, the U.S. Supreme Court once again saved the Affordable Care Act (ACA) by upholding subsidies (tax credits) offered to low- and middle-income individuals for insurance bought on federal exchanges. A contrary opinion would have put at risk health insurance for 6.4 million Americans and threatened to destabilize insurance markets for millions more.

The ACA is supported by four interlocking reforms, each of which are necessary to realize its promise of expanding health care coverage: (1) guaranteed issue (prohibiting discrimination based on pre-existing conditions), (2) community rating (barring insurers from imposing higher premiums based on health …

Public Health, Universal Health Coverage, And Sustainable Development Goals: Can They Coexist?, Harald Schmidt, Lawrence O. Gostin, Ezekiel Emanuel

Georgetown Law Faculty Publications and Other Works

In her 2012 reconfirmation speech as WHO Director-General, Dr. Margaret Chan asserted: "universal coverage is the single most powerful concept that public health has to offer. It is our ticket to greater efficiency and better quality. It is our savior from the crushing weight of chronic noncommunicable diseases that now engulf the globe ". The UN General Assembly is currently considering proposals for Sustainable Development Goals (SDGs), succeeding the Millennium Development Goals. SDGs, focusing on health, specifically includes universal health coverage (UHC) among its targets. Unquestionably, UHC is timely and fundamentally important. However, its promotion also entails substantial risks. A …

Middle East Respiratory Syndrome: A Global Health Challenge, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

Beginning in May 2015, Middle-East respiratory syndrome (MERS) experienced its first publicly reported “super-spreading” event in South Korea. By mid-June, more than 120 cases and 11 deaths in South Korea had been linked to a businessman returning from travel to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia and Qatar. Globally more than 1200 had been infected of whom more than 450 died—a high fatality rate of 37%.

What are the most effective legal, social, and public health responses to MERS and other emerging diseases? First, the World Health Organization’s International Health Regulations (IHR) did not effectively guide the …

Improving Rhode Island’S Health Care System: Lessons From The Cuban Model, Sarah R. Moffitt

Senior Honors Projects

Improving Rhode Island’s health care system: lessons from the Cuban model

Cuba is world renowned for its health care system. In regards to international health crises, Cuba is a leader in sending workers abroad and training doctors from all over the world. Within its own borders, the Cuban model provides free access to all citizens in which every individual has a primary care provider. Cuba boasts high vaccination rates, a long life expectancy, low infant mortality rate, and a population that is one of the healthiest in the western hemisphere.

The purpose of this research project is to evaluate the …

2015 Massachusetts Family Impact Seminar, Emily M. Douglas Ph.D., Melinda Gushwa Ph.D., Licsw, Martha J. Henry Ph.D.

Mosakowski Institute for Public Enterprise

Mission Critical: Reforming Foster Care and Child Protective Services is the sixth Massachusetts Family Impact Seminar. It is designed to emphasize a family perspective in policymaking on issues related to reforming foster care and child protective services in the Commonwealth. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Strengthening The Detection Of And Early Response To Public Health Emergencies: Lessons From The West African Ebola Epidemic, Mark J. Siedner, Lawrence O. Gostin, Hilarie H. Cranmer, John D. Kraemer

Georgetown Law Faculty Publications and Other Works

Background

In the year since the World Health Organization (WHO) notified of an Ebola outbreak in West Africa, more than 24,000 cases have been reported and over 10,000 individuals have died. Moreover, countless non-Ebola deaths have occurred as a result of health system closings and an international aid effort in the $USD billions has been invested in control efforts. While the international response to the West African Ebola virus disease epidemic eventually exemplified the great potential of the global public health community, the protracted early response also revealed critical gaps, which likely resulted in exacerbation of the epidemic. It is …

Law, Ethics, And Public Health In The Vaccination Debates: Politics Of The Measles Outbreak, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.

This article explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” …

Why Healthy Behavior Is The Hard Choice, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Our society is structured to encourage unhealthy diets and physically inactive lifestyles, which are key risk factors for chronic diseases including diabetes, heart diseases, and cancers. We are bombarded with advertisements for hyperprocessed foods laden with saturated fat, salt, sugar, and refined carbohydrates, “low-fat” foods often contain high amounts of sugar and salt, and parks and recreation spaces are often inaccessible or unsafe.

Four simple ideas - taxes on unhealthy products, product reformulation, improving the informational environment, and increasing healthy food accessibility - could make healthy behaviors the “default” choice for most consumers. First, taxes on unhealthy products, such as …

Law’S Power To Safeguard Global Health: A Lancet–O’Neill Institute, Georgetown University Commission On Global Health And The Law, Lawrence O. Gostin, John T. Monahan, Mary C. Debartolo, Richard Horton

Georgetown Law Faculty Publications and Other Works

The law-–global, national, and subnational–-plays a vital, yet often underappreciated, role in safeguarding and promoting the public’s health. In this article, we launch the Lancet-O’Neill Institute, Georgetown University Commission on Global Health and the Law. Commissioners from around the world will explore the critical opportunities and challenges of using law as a tool, while evaluating the evidence base for legal interventions. The Commission aims to define and systematically describe the current landscape of law that affects global health and safety.

Commissioners were chosen from disciplines that range from health, policy, and law to economics and governance. The Commission aims …

An O'Neill Institute Briefing Paper: Ebola, The World Health Organization, And Beyond: Toward A Framework For Global Health Security, Lawrence O. Gostin, Eric A. Friedman, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and …

Indonesia Has It Backward: It's Not E-Cigarettes That's The Problem But Smoking, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Indonesia has announced it will be banning e-cigarettes. But that would do nothing to reduce smoking, which should be the main target of those interested in reducing tobacco use deaths and harms. Rather than ban e-cigarettes, it makes more sense to regulate them effectively so that they can serve as a useful anti-smoking tool. The availability of e-cigarettes to smokers can also make much more aggressive anti-smoking strategies more practically and politically viable-–perhaps even paving the way for banning cigarettes, instead.

The Normative Authority Of The World Health Organization, Lawrence O. Gostin, Devi Sridhar, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The World Health Organization (WHO) was born after the devastation of World War II, as a normative agency endowed with unprecedented constitutional powers. But even as it has achieved stunning successes, such as the eradication of smallpox, it has failed to live up to the exalted expectations of the postwar health and human rights movement e exemplified most recently by its inadequate response to the Ebola epidemic. Our aim is to offer innovative ideas for restoring the Organization to its leadership position by exercising its normative authority, even as it faces a crowded and often chaotic global health architecture. Before …

A Retrospective And Prospective Analysis Of The West African Ebola Virus Disease Epidemic: Robust National Health Systems At The Foundation And An Empowered Who At The Apex, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic is a pivotal moment for the global health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership demand innovative reforms. This analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilization, ill-defined responsibilities, and insufficient coordination. The scope of the reforms must address the failures evident in the Ebola response, as well as entrenched weaknesses that enabled the epidemic to reach its heights, transforming the existing inchoate, organically developed global health …

The Americans With Disabilities Act At 25: The Highest Expression Of American Values, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Enacted in 1990, the Americans with Disabilities Act (ADA) is a watershed piece of legislation which enshrines in law a social promise of equality and inclusion into all facets of life, while offering an inspiring model that much of the world has come to embrace. This editorial launches JAMA’s theme issue on the 25th anniversary of the ADA by detailing the Act’s history, main provisions, and far-reaching impacts on health, providing a context for the three Original Investigations and six scholarly Viewpoints that make up the theme issue. The editorial begins with a discussion of the ADA’s history, highlighting …

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Faculty Publications By Year

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

Toward Coherent Federal Oversight Of Medicine, Patricia J. Zettler

Faculty Publications By Year

The conventional wisdom in U.S. health law and policy holds that states regulate medical practice – the activities of physicians and other health care professionals – while the federal government regulates medical products. But relying on states as the principal regulators of medical practice has, at times, driven law and policy in directions that are problematic from a public health perspective, as demonstrated by a deadly 2012 outbreak of fungal meningitis that was linked to a state-regulated practice known as drug compounding. This Article argues that the federalism concerns underlying the conventional wisdom are misplaced. It demonstrates that, contrary to …