Health Law and Policy Commons^™

Legal Issues And Outcomes Of A Medical-Legal Partnership For Cancer Patients, Allison B. Dowling, Abigail Sweeney, Megan E. Gordon, Lisa Kessler, Deborah Perry, Vicki W. Girard, Shreya Kalra

Georgetown Law Faculty Publications and Other Works

The medical-legal partnership (MLP) model is a multidisciplinary intervention with demonstrated success in addressing health-harming legal needs. We analyzed initial data from the Georgetown University Health Justice Alliance’s Cancer Legal Assistance and Well-being Project (Cancer LAW), an MLP between Georgetown University and MedStar Health serving cancer patients receiving care at an urban, safety-net hospital in Washington, D.C. The sample included 81 patients, who had an average of two legal issues, most commonly in the areas of Social Security, estate planning, housing, and health insurance. Data collected during legal representation captured both financial and non-financial benefits to patients. Patients who responded …

Promoting Public Health And Public Safety By Ending The Exclusion Of Incarcerated Children From Access To Medicaid, Eduardo R. Ferrer

Georgetown Law Faculty Publications and Other Works

This essay is a response to Professor Den Houter's article entitled Children are Not Inmates in which she effectively calls eliminating the exclusion of indigent incarcerated children from Medicaid coverage pursuant to the Medicaid Inmate Exclusion Policy (MIEP). This essay affirms and builds upon Professor Den Houter's recommendation. Part I of this response provides additional support for why ensuring system-involved youth receive timely, uninterrupted, high-quality behavioral health services is critical to improving both public health and public safety. Part II analyzes the benefits and risks attendant to excluding indigent incarcerated children from the MIEP. Part III proposes the implementation of …

Equitable Thriving: A Lifecourse Approach To Maternal And Child Health Justice, Yael Cannon

Georgetown Law Faculty Publications and Other Works

Black women are at least three times more likely to die due to a pregnancy-related cause than White women. Grave racial disparities also abound in severe maternal morbidity, or significant unexpected health consequences of labor and delivery. The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, eliminating the constitutional right to abortion, has only further restricted reproductive healthcare options and raised concerns that these disparities will grow even starker. Black, Indigenous, and Latine infants and children also experience unjust—and avoidable—health inequities. As a general matter, people of color are sicker across their lifespans and die younger in …

Formulating Public Pharma, Shweta Kumar

IPIPC Papers & Reports

In 2022, prices for both brand-name and generic drugs in the U.S. were nearly three times as high as prices in comparably industrialized nations, with the cost of insulin products in particular being nearly ten times as high. As a result, 3 out of 10 American adults cannot afford to take their medication as prescribed. Furthermore, in 2024 the U.S. experienced its worst drug shortage in over a decade, with more than 300 drugs in short supply. Generic drugs are particularly vulnerable to shortage, as manufacturers have poor economic incentives to produce drugs with slim profit margins. While the Biden …

Establishing A Perinatal Medical-Legal Partnership To Address The Health-Harming Legal Needs Of Pregnant And Postpartum Birthing People, Loral Patchen, Roxana Richardson, Lisa Kessler, Deborah Perry, Kimberly Martinez, Vicki W. Girard

Georgetown Law Faculty Publications and Other Works

This Report from the Field chronicles the establishment of Georgetown University’s Perinatal Legal Assistance and Wellbeing Project, a medical-legal partnership in Washington, D.C. It describes foundational steps, implementation strategies, and lessons learned, and reflects on impacts of addressing the unmet legal needs of birthing individuals.

How Should We Measure Effectiveness Of Medical-Legal Partnerships?, Prashasti Bhatnagar, Deborah F. Perry, Margaret E. Greer

HJA Scholarship

Medical-legal partnerships (MLPs) try to mitigate health inequity by uniting legal and health professionals to respond to legal determinants of patients’ health. While there is a long tradition of “patients-to-policy” work in MLPs, the current empirical evidence base has evaluated MLP effectiveness by assessing benefits to individual patients, clinicians, and hospital and legal systems. This article calls for future research to measure how community power, which includes shifting power to impacted communities to develop and lead equity-focused agendas, is built as both a process and an outcome of MLPs.

How Is Access To Legal Resources And Advocacy Foundational To Health Justice?, Yael Zakai Cannon

Georgetown Law Faculty Publications and Other Works

Health justice as a movement incorporates research about how to more effectively leverage law, policy, and institutions to dismantle inequitable power distributions and accompanying patterns of marginalization that are root causes of health inequity. Legal advocacy is key to health justice because it addresses patients’ health-harming legal needs in housing, public benefits, employment, education, immigration, domestic violence, and other areas of law. In medical-legal partnerships, lawyers and clinicians are uniquely positioned to jointly identify and remove legal barriers to patients’ health, advocate for structural reform, and build community power.

Bridging Silos: Environmental And Reproductive Justice In The Climate Crisis, Sara A. Colangelo

Georgetown Law Faculty Publications and Other Works

The climate crisis is a perilous yet underexamined example of the intersection of environmental injustice and reproductive injustice. The physical manifestations of the climate crisis affect key elements of reproductive justice: women’s rights to have children, to not have children, and to parent children in healthy, sustainable communities. Reams of studies document climate disaster-driven gender violence, loss of access to healthcare and reproductive services, as well as direct and deadly health effects of climate change on maternal health, fetal development, infants, and children. Despite these profound impacts, the environmental and reproductive justice movements remain largely siloed, particularly in the legal …

The Health And Human Rights Impact Assessment: The Preeminent Value Of Equity, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

The Health and Human Rights Journal launched 30 years ago at the dawn of the era of health and human rights. Health and human rights were more often viewed as being in tension than in harmony, and there was little guidance on the right to health itself. With the unabashed discrimination against people living with HIV/AIDS in the name of public health at the forefront of our minds, Jonathan Mann and one of us (LOG) sought to provide practical guidance on when and how human rights could be limited in the name of public health, developing the first health and …

Safeguarding The Pandemic Agreement From Disinformation, Alexandra Finch, Kevin A. Klock, Lawrence O. Gostin, Sam F. Halabi, Sarah A. Wetter

Georgetown Law Faculty Publications and Other Works

Complicating the negotiation of a global pandemic treaty has been a sustained disinformation campaign worldwide to undermine the agreement by making and amplifying spurious assertions about what it intends to accomplish and how it will do so. Central to the disinformation campaign are erroneous claims about national sovereignty and forcible takings of pandemic countermeasures. Further, legitimate and unfounded unease concern weakened intellectual property (IP) and speech rights. Having followed the negotiations and provided technical assistance to the World Health Organization's (WHO's) leadership, we set the record straight in several key areas.

Compounding Inequities Through Drug Ip And Unfair Competition, Shweta Kumar

IPIPC Papers & Reports

In 2024, the United States experienced its worst drug shortage in over a decade—more than 300 drugs are in shortage, leaving patients without access to lifesaving medicines. Luckily, drug manufacturers are not the only source of drugs. Through drug compounding, licensed pharmacists can create medications that are not commercially available due to discontinuations, shortages, or other supply chain issues. The recent slew of severe drug shortages has forced patients and physicians to rely on compounding pharmacies to make critical drugs for patients—particularly vulnerable patient populations, including pediatric, disabled, and transgender patients—such as mixed amphetamine salts (sold as Adderall), semaglutide (sold …

Seventy-Five Years Of Global Health Lawmaking Under The World Health Organization: Evolving Foundations Of Global Health Law Through Global Health Governance, Benjamin Mason Meier, Alexandra Finch

O'Neill Institute Papers

The World Health Organization (WHO) has been shaped by global health law throughout its history. Drawing from the post-war establishment of global governance under the United Nations (UN), the modern foundations of global health law were laid by the WHO Constitution, which provided WHO with a range of normative authorities to realize its mandate as the UN’s directing and coordinating authority in global health. Yet WHO has faced political challenges in exercising these normative authorities to advance global health law, revealing the limitations of law as a foundation of global health governance. This article chronicles the 75-year evolution of global …

Designing And Developing A Medical-Legal Partnership To Address Cancer Patients' Health-Harming Legal Needs, Allison B. Dowling, Vicki W. Girard, Megan E. Gordon, Abigail Sweeney, Christopher M. Gallagher, Amy D. Ly, Lisa Kessler, Deborah F. Perry

Georgetown Law Faculty Publications and Other Works

The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer.

The World Health Organization Was Born As A Normative Agency: Seventy-Five Years Of Global Health Law Under Who Governance, Lawrence O. Gostin, Benjamin Mason Meier, Safura Abdool Karim, Judith Bueno De Mesquita, Gian Luca Burci, Danwood Chirwa, Alexandra Finch, Eric A. Friedman, Roojin Habibi, Sam F. Halabi, Tsung-Ling Lee, Brigit Toebes, Pedro Villarreal

Georgetown Law Faculty Publications and Other Works

The World Health Organization (WHO) was born as a normative agency and has looked to global health law to structure collective action to realize global health with justice. Framed by its constitutional authority to act as the directing and coordinating authority on international health, WHO has long been seen as the central actor in the development and implementation of global health law. However, WHO has faced challenges in advancing law to prevent disease and promote health over the past 75 years, with global health law constrained by new health actors, shifting normative frameworks, and soft law diplomacy. These challenges were …

Teaching Global Health Law: Preparing The Next Generation For Future Challenges, Lawrence O. Gostin, Sarah L. Bosha, Benjamin Mason Meier

Georgetown Law Faculty Publications and Other Works

Following from sweeping law reforms across the global health landscape, there is a need to prepare the next generation to advance global health law to ensure justice for a healthier world. Educational programs across disciplines have increasingly incorporated the field of global health law, with new courses examining the law and policy frameworks that apply to the new set of public health threats, non-state actors, and regulatory instruments that structure global health. Such interdisciplinary training must be expanded throughout the world to prepare future practitioners to strengthen global health law — ensuring a foundation for global health in legal studies …

The Persistent Public Health Emergency, Yael Zakai Cannon

Georgetown Law Faculty Publications and Other Works

May 11, 2023 was ostensibly a day of celebration. With infections and deaths from COVID-19 down, the federal government announced the end of the official Public Health Emergency three years after its initial declaration. But the conclusion of the Public Health Emergency also signaled the termination of unprecedented health protection measures—outside the realm of healthcare—such as eviction and utility shutoff moratoria and emergency rental and utility assistance. These COVID-era measures successfully cut eviction filings nationally by more than half and provided people in many jurisdictions with the protections and assistance needed to maintain their electricity, heat, water, and gas. Now …

Financing Reforms To Meet A Pivotal Moment In Global Health, Kevin A. Klock, Alexandra Finch, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

2024 will be the most important moment for global health since the World Health Organization’s founding in 1948, but only if states give major reforms their full political and financial backing. Bold new commitments in disease surveillance, capacity building, and more equitable access to health products cannot be achieved without ample and sustainable funding. In this essay, we discuss major reforms found in the emerging pandemic agreement and reformed International Health Regulations and then explore the significant challenges and opportunities for financing them.

Safe Babies, Safe Moms: A Multifaceted, Trauma Informed Care Initiative, Loral Patchen, Asli Mccullers, Charmain Beach, Melanie Browning, Shy Porter, Aimee Danielson, Evelyn Asegieme, S. Roxana Richardson, Ali Jost, Caitlin S. Jensen, Naheed Ahmed

HJA Scholarship

Purpose

This report describes a multifaceted, trauma-informed initiative developed to address racial/ethnic maternal and infant health inequities in Washington, D.C.

Description

Structural racism and systemic oppression of marginalized communities have played a critical role in maternal and infant health inequities in the United States. Black birthing individuals are exponentially more likely to experience adverse birth outcomes, including preterm birth, low birth weight and maternal mortality. In response to these statistics, the Safe Babies Safe Moms (SBSM) initiative was developed to support patients of marginalized identities and improve health outcomes. SBSM Women’s and Infants’ Services Specialty Care (WIS-SC) is one component …

A Critical Juncture For Human Rights In Global Health: Strengthening Human Rights Through Global Health Law Reforms, Benjamin Mason Meier, Luciano Bottini Filho, Judith Bueno De Mesquita, Roojin Habibi, Sharifah Sekalala, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The 1948 Universal Declaration of Human Rights (UDHR), establishing a human rights foundation under the United Nations (UN), has become a cornerstone of global health, central to public health policies throughout the world. As the world commemorates the 75th anniversary of the UDHR on 10 December, this “Human Rights Day” celebration arrives at a critical juncture for human rights in global health, raising an imperative for World Health Organization (WHO) reforms to strengthen the right to health and health-related human rights.

Integrating Lawyers Into Perinatal Care Teams To Address Unmet, Health-Harming Legal Needs, Loral Patchen, Roxana Richardson, Asli Mccullers, Vicki W. Girard

Georgetown Law Faculty Publications and Other Works

Across the United States, historically imposed structural, social, and environmental variables are intimately connected to poor obstetric outcomes and high maternal and infant mortality rates among Black pregnancy-capable people. Efforts to diminish the effect of these variables include integrating screening for social determinants of health during the perinatal period and treating them with social services, mental health support, and other referrals, including connections to community-based resources. Although helpful, some of these social determinants cannot be overcome without legal advocacy. Medical–legal partnerships, which integrate lawyers into health care, fill this gap. This commentary by an interprofessional team of authors relies on …

Intellectual Property And “The Lost Year” Of Covid-19 Deaths, Madhavi Sunder, Haochen Sun

Georgetown Law Faculty Publications and Other Works

Protecting intellectual property (IP) is a question of life and death. COVID-19 vaccines, partially incentivized by IP, are estimated to have saved nearly 20 million lives worldwide during the first year of their availability in 2021. However, most of the benefits of this life-saving technology went to high- and upper-middle-income countries. Despite 10 billion vaccines being produced by the end of 2021, only 4 percent of people in low-income countries were fully vaccinated. Paradoxically, IP may also be partly responsible for hundreds of thousands of lives lost in 2021, due to an insufficient supply of vaccines and inequitable access during …

Making The World Safer And Fairer In Pandemics, Lawrence O. Gostin, Kevin A. Klock, Alexandra Finch

Georgetown Law Faculty Publications and Other Works

Global health has long been characterized by injustice, with certain populations marginalized and made vulnerable by social, economic, and health disparities within and among countries. The pandemic only amplified inequalities. In response to it, the World Health Organization and the United Nations have embarked on transformative normative and financial reforms that could reimagine pandemic prevention, preparedness, and response (PPPR). These reforms include a new strategy to sustainably finance the WHO, a UN political declaration on PPPR, a fundamental revision to the International Health Regulations, and negotiation of a new, legally binding pandemic agreement (popularly called the “Pandemic Treaty”). We revisit …

Abolition And Environmental Justice, Allegra M. Mcleod

Georgetown Law Faculty Publications and Other Works

During the coronavirus pandemic, movements for penal abolition and racial justice achieved dramatic growth and increased visibility. While much public discussion of abolition has centered on the call to divest from criminal law enforcement, contemporary abolitionists also understand public safety in terms of building new life-sustaining institutions and collective structures that improve human well-being, linking penal divestment to environmental justice. In urging a reimagination of public safety, abolitionists envision much more than decriminalization or a reallocation of police functions to social service agencies or other alternatives to imprisonment and policing. Instead, for abolitionists, meaningful public safety requires, among other things, …

Legal Needs And Health Outcomes For People With Cancer In Medical-Legal Partnership Programs: A Systematic Review, Allison B. Dowling, Caitlin Schille Jensen, Abigail Sweeney, C. Scott Dorris, Deborah F. Perry

HJA Scholarship

Medical-legal partnerships (MLPs) integrate lawyers into the medical team to address patients’ unmet legal needs that create barriers to good health and well-being (i.e., “health-harming legal needs”) and improve health outcomes. Given the growing popularity of MLP as an innovative healthcare model, this review has two objectives: to identify peer-reviewed literature measuring (1) cancer patients’ legal needs, and (2) outcomes for cancer patients after receiving MLP legal services. A systematic literature search was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for the period 2006- 2022. Four articles met the inclusion criteria for objective …

The Global Health And Care Worker Compact: Evidence Base And Policy Considerations, Eric A. Friedman, Robert Bickford, Charles Bjork, James Campbell, Giorgio Cometto, Alexandra Finch, Catherine Kane, Sarah A. Wetter, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Background During the COVID-19 pandemic, and recognising the sacrifice of health and care workers alongside discrimination, violence, poor working conditions and other violations of their rights, health and safety, in 2021 the World Health Assembly requested WHO to develop a global health and care worker compact, building on existing normative documentation, to provide guidance to ‘protect health and care workers and safeguard their rights’.

Methods A review of existing international law and other normative documents was conducted. We manually searched five main sets of international instruments: (1) International Labour Organization conventions and recommendations; (2) WHO documents; (3) United Nations (UN) …

The Coalition For Epidemic Preparedness Innovations (Cepi) And The Partnerships Of Equitable Vaccine Access, Sam F. Halabi, Lawrence O. Gostin, Kashish Aneja, Francesca Nardi, Katie Gottschalk, John T. Monahan

Georgetown Law Faculty Publications and Other Works

This article highlights and evaluates the role of CEPI and its contribution to global equitable access to COVID-19 vaccines through its established partnerships for vaccine development. The article adds to the understanding of how and when such partnerships can work for public health, especially under emergency citations. The relatively spontaneous and effective cooperation between major international organizations shortly after the pandemic declaration played a significant role in reducing to a material extent COVID-19’s burden of disease and death. Future pandemic preparedness, prevention, and response will require that collaborations of this kind be sustained and effective going forward.

The Origins Of Covid-19 — Why It Matters (And Why It Doesn’T), Lawrence O. Gostin, Gigi K. Gronvall

Georgetown Law Faculty Publications and Other Works

When Health emergencies arise, scientists seek to discover the cause — such as how a pathogen emerged and spread — because this knowledge can enhance our understanding of risks and strategies for prevention, preparedness, and mitigation. Yet well into the fourth year of the Covid-19 pandemic, intense political and scientific debates about its origins continue. The two major hypotheses are a natural zoonotic spillover, most likely occurring at the Huanan Seafood Wholesale Market, and a laboratory leak from the Wuhan Institute of Virology (WIV). It is worth examining the efforts to discover the origins of SARS-CoV-2, the political obstacles, and …

Medical-Legal Partnership As A Model For Access To Justice, Yael Cannon

Georgetown Law Faculty Publications and Other Works

The United States is plagued with a “justice gap” that leaves many Americans with unmet civil legal needs. Americans with low income do not receive the legal help they require for as many as 92% of their substantive civil legal problems. The justice gap requires many legal aid agencies to triage, becoming “emergency rooms” for clients with unmet legal needs. This national crisis calls for new innovations so that access to justice (A2J) can function more like primary care, promoting better use of resources and preventing legal crises that can cause long-lasting harm.

Medical-Legal Partnerships (MLPs) embed lawyers in healthcare …

Advancing Equity In The Pandemic Treaty, Lawrence O. Gostin, Kevin A. Klock, Katherine Ginsbach, Sam F. Halabi, Taylor Hall-Debnam, Janelle Lewis, Vanessa S. Perlman, Katie Robinson

Georgetown Law Faculty Publications and Other Works

There is a broad consensus around equity’s importance. Even countries that hoarded supplies during the acute phase of COVID-19 seem to understand that the international community must find a means to ensure fairer allocation of medical resources when the next health crisis hits. But there has been little agreement about the concrete steps needed to operationalize fairer access and benefit sharing. That is, what are the workable mechanisms that could reduce the divide between richer and poorer populations? The World Health Assembly, the governing body of the World Health Organization, has appointed an Intergovernmental Negotiating Body to develop a pandemic …

Vaccine Politics: Law And Inequality In The Pandemic Response To Covid-19, Matthew M. Kavanagh, Renu Singh

O'Neill Institute Papers

International mechanisms failed to achieve equitable distribution of COVID-19 vaccines—prolonging and deepening the pandemic. To understand why, we conduct process tracing of the first year of international policymaking on vaccine equity. We find that, in the absence of a single venue for global negotiation, two competing law and policy paradigms emerged. One focused on demand and voluntary action by states and firms, while the alternative focused on opening knowledge and expanding production through national and international law. While these could have been complementary, power inequalities between key actors kept the second paradigm from gaining traction on the global agenda. The …