06.24.16

Philadelphia’s soda tax: a win for public health (and the city’s budget)

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soda taxOn June 16, despite vehement opposition from the beverage industry, the City of Philadelphia adopted a 1.5 cent per ounce tax on sodas. The tax will be applied to both regular and diet sodas and is predicted to raise over $90 million in the first year. Philadelphia’s tax is widely viewed as an important step towards addressing high levels of overweight and obesity Philadelphia and as laying the foundations for soda taxes in many other US jurisdictions. In this blog, I’ll explore 3 lessons emerging from the passage of Philadelphia’s new tax.

Big Soda is on a relentless quest to undermine soda taxes – but can be beaten

Mirroring their activities in Berkeley and San Francisco, California, the beverage industry unleashed a highly coordinated, heavily resourced campaign against Philadelphia’s proposed tax. In the four months prior to the City Council’s vote, the industry spent over $4 million on radio and television ads designed to turn the public against the tax. Members of the American Beverage Industry funded front group known as Philadelphians Against the Grocery Tax led protests against the tax outside City Hall. Following the passage of the tax, the American Beverage Industry announced it would continue the battle in court. Industry has begun foreshadowing a range of legal arguments, including that the tax runs foul of the Pennsylvania Constitution’s uniformity clause, which requires that all items in the same class must be taxed at the same rate. And while the City’s lawyers appear confident that the soda tax will withstand legal challenges, Big Soda will ensure that the City faces a long and expensive fight.

Narrative matters

Last Thursday’s vote was the third time the Philadelphia City Council had tried to pass a tax on sodas. Indeed, Philadelphia is one of just three US cities to levy such a tax, along with Berkeley, California, and Chicago. More than 40 other cities and states have tried and failed, in large part due to strong industry opposition. Many commentators are attributing Philadelphia’s recent success to Mayor Kenney’s narrative around the proposed soda tax as a source of revenue. Rather than discussing the tax as a public health measure, the Mayor has focused on using revenue from the tax to fund pre-kindergarten and improvements to city infrastructure including recreation centers and libraries. Industry is extremely well-versed at opposing public health-based taxes – claiming that the “Nanny State” should not tell Americans what to eat and drink. The case of the Philadelphia soda tax suggests that casting taxes as an opportunity to raise revenue makes it harder for industry to run its hallmark – and up until now relatively successful – “personal choice” campaigns.

An opportunity to evaluate taxation of diet sodas

In a last minute compromise, Philadelphia’s proposed soda tax was amended to include diet sodas. Ideally, the Philadelphia tax will result in consumers switching to non-taxed beverages – such as bottled water – which would be a public health success. On the other hand, by extending the tax to diet sodas, the City has removed the possibility of the tax encouraging consumers to switch from sugar-sweetened beverages to less harmful artificially-sweetened beverages – which is arguably an easier transition for some consumers.

Overall, the soda tax is good for Philadelphia’s health (and for its coffers). Given that Philadelphia’s tax extends to diet sodas the City – and public health advocates – have the opportunity to monitor and evaluate this configuration of a soda tax to make sure it is resulting in healthier beverage purchases and improved health.

Posted in Non-communicable diseases;

06.23.16

Obamacare Premium Increases – Time to freak out? Not so fast.

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As the individual marketplace health insurance exchanges enter their 4th year of operation, growing pains still abound. Insurance providers are still struggling to determine appropriate pricing for various plans and are requesting a wide range of pricing changes – including some substantial premium increases – from state insurance regulators. The following are 5 key points regarding the upcoming open enrollment period for 2016:

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Posted in National Healthcare, Updates;

06.15.16

A healthy dose of film at AFI DOCS Festival

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AFI DOCS, the nation’s capital’s biggest documentary film festival is back! This year, the festival created by the American Film Institute and the Discovery Channel in order to showcase the best in national and international documentaries, will run from June 22-26 in multiple venues in DC and Silver Spring, Maryland.  The festival has been providing us with thought-provoking films since 2003 and this years line up is no exception.

Although the festival will showcase over 40 films, I want to make a special emphasis on all of those documentaries that explore some highly relevant areas related to health. This year there are several films exploring issues related to sexual and reproductive rights, including abortion, sexual violence and LGTB rights. Other films look at patient care, disability rights and mental health. Finally—and perhaps in a less obvious way—are those films that show the importance of the social determinants of health, exploring problems of violence, poverty and incarceration.

The following is a list of health related documentaries that should not be missed at AFI DOCS:

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Posted in Uncategorized; Tagged: , , .

06.10.16

WHY THE FULL DECRIMINALIZATION OF SEX WORK IS IMPORTANT FOR ADDRESSING THE GLOBAL HIV/AIDS EPIDEMIC

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shutterstock_265442135

On May 25, 2016, Amnesty International released its long-awaited policy and supporting research in support of the decriminalization of sex work. The policy was based on evidence that the criminalization of sex work often makes sex workers less safe and provides impunity for abusers because sex workers are often too scared of being penalized to report crimes to law enforcement. Amnesty concluded that laws on sex work should focus on protecting people from exploitation and abuse, rather than trying to ban all sex work and penalize sex workers. The policy also identified barriers to the realization of sex workers’ human rights and underlined states’ obligations to address them.

The controversy over Amnesty’s position on sex work started last summer, when delegates voted in favor of an initial recommendation to decriminalize. This recommendation drew support from sex workers’ rights groups as well as public health advocates and activists. At the same time, the recommendation was denounced by a number of groups and individuals who favor a system of partial criminalization known as the Swedish model (variously referred to as the Nordic Model or simply “End Demand”), in which those who buy sex are prosecuted, but those who sell sex are not. Now Amnesty has made a final determination against the Swedish Model.

I am writing to offer my perspective as someone working on HIV law and policy issues. Criminalization of sex work, including laws that prohibit associated acts such as bans on buying, solicitation, and the general organization of sex work, is counterproductive to sexual and reproductive health and to an effective HIV response. From the perspective of combatting the global HIV/AIDS epidemic, there are good reasons to call for the decriminalization of all aspects of adult consensual sex work:

  1. Many sex workers and their clients engage in sex with multiple partners, putting them at risk for HIV infection if they do not use condoms or engage in other forms of risk reduction such as pre-exposure prophylaxis (PrEP). Regardless of whether we are referring to buying or selling sex, criminalization facilitates stigma and discrimination, making it harder to access health care services, including HIV prevention, care, and treatment services.
  2. Criminalizing clients may have the effect of pushing sex work underground, potentially making sex workers more vulnerable to violence and HIV/AIDS. In jurisdictions where police treat the fact that a person is carrying condoms as “evidence” of sex work, clients may pressure sex workers not to carry condoms, which would increase the risk for HIV infection.
  3. Criminalizing clients may be used as a justification for more policing and result in a greater number of interactions between police officers and sex workers, leaving sex workers vulnerable to stigma, discrimination, and other forms of criminalization (e.g., HIV criminalization, drug criminalization), which help potentiate the HIV/AIDS epidemic. In fact, a July 2012 report by the Global Commission on HIV and the Law found that in Sweden, where sex workers are not criminalized but clients are, resources had been diverted from social services for sex workers and toward policing, yet few prosecutions and convictions of clients occurred.
  4. Criminalizing clients may be used to target vulnerable populations, such as men who have sex with men (MSM) and people living with HIV.
  5. Arrest, prosecution, and incarceration that may result from criminalizing clients with HIV would operate as a direct barrier to obtaining and adhering to treatment.

Notwithstanding calls for the decriminalization of sex work, anti-human trafficking laws are still needed to prohibit and punish those who use force, trick, or coerce people (primarily women and girls) into commercial sex, or abuse migrant sex workers through debt bondage, violence, or deprivation of liberty. But countries should not deploy anti-human-trafficking laws so broadly that they conflate voluntary and consensual exchanges of sex for money with the exploitative, coerced, often violent trafficking of people for the purposes of sex.

As the debate over the decriminalization of sex work continues, it is important to understand the diverse considerations around this issue. Sex workers are in a subordinate position relative to their clients, often due to disparities in gender, income, and social class. We cannot ignore these real vulnerabilities. And sex work often occurs through exploitation and coercion and, therefore, is not consensual. Although the distinction between sex work and human trafficking is important, in a practical context it is hard to ascertain how exploitative or coerced a situation is. Many feminist groups have concerns that if there are no consequences for clients, trafficking will not be addressed at all. Moreover, many of the most prominent sex workers’ rights advocates live in high resource countries and come from relatively privileged backgrounds. Approaching the distinction between sex work and human trafficking may be different depending on the marginalized population at issue and the legal and economic context. None of these important considerations, however, make a convincing case for the Swedish Model. Decriminalization is the best way to promote health and human rights, but laws must also ensure protection from exploitation and abuse.

Posted in Uncategorized; Tagged: , , .

06.09.16

The right to health for all: Ending discrimination against undocumented migrants

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When will the light of rights shine upon all?(Image courtesy of the National Park Service)

When will the light of rights shine upon all? (Image courtesy of the National Park Service)

It is among the most – if not the most – prevalent form of formal discrimination when it comes to the ability of everyone to enjoy universally recognized human rights, embodied in the laws of most countries: discrimination against non-citizens, and above all, against undocumented immigrants, with respect to the right to health. Most countries deny equal health care rights to undocumented immigrants (or as they are often referred to, irregular migrants, or migrants without papers). They are often entitled – as in the United States – to emergency care, but that may be all (and even that may require payment). Even as ever more countries move towards what they – and the international community – calls universal health coverage, universal it is not.

Human rights law is clear, with non-discrimination a central command. The treaty containing the right to health, the International Covenant on Economic, Social and Cultural Rights (ICESCR), prohibits discrimination on grounds including “national or social origin” and “other status” (art. 2(2)). The UN committee that offers the authoritative interpretation of the ICESCR reads “nationality” as among the forms of “other status” upon which discrimination is prohibited. In describing this prohibited ground, the committee explains, “The Covenant rights apply to everyone including non-nationals, such as refugees, asylum-seekers, stateless persons, migrant workers and victims of international trafficking, regardless of legal status and documentation” (CESCR, General Comment 20, at para. 30). By way of example, the committee offers the example of children, including with undocumented status, receiving – as their right – education, health care, and adequate food. In other words, one health care regime for citizens and another, inevitably lesser, regime for non-citizens, including undocumented migrants, constitutes prohibited discrimination.

In the overall scheme of health care costs, bringing national law into conformity with international human rights law with respect to undocumented migrants is relatively low. In the most recent such estimate, the International Organization for Migration estimated that there are at least 50 million irregular migrants worldwide, less than 1% of the world’s population. While varying considerably by country, an average of less than 1% of the population, and so less than 1% of the average national health budget, seems eminently affordable – from the perspective of both public health and of developing a just, inclusive, rights-based society.

A small but growing number of countries are recognizing this, with their laws and policies ending discrimination against undocumented immigrants – perhaps the best proof that this discrimination is not inevitable and need not persist.

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Posted in Human Rights, National Healthcare; Tagged: , , , .

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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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