India has emerged as the world’s “surrogacy hub”. Infertile couples and, increasingly, gay couples and single women from different countries are paying Indian women to carry their embryos through to birth. While the surrogacy industry in India is extremely lucrative (worth more than $2.3 billion per year), the government has failed to regulate the practice since it became legal in 2002, leading to the adoption of unethical practices that put both surrogates and the babies they deliver at risk.
In an effort to protect Indian women from exploitation, the Indian government has introduced Surrogacy Bill 2016, which the Union Cabinet passed in late-August. If approved by Parliament, the law would completely ban commercial surrogacy, but would leave the door open for altruistic surrogacy – where no money is exchanged between the birthing mother and the commissioning parents. The bill has sparked a debate in India as to whether a complete ban on commercial surrogacy is the right way to protect women who act as surrogates from exploitation.
Public health, criminal justice, and economic justice are inextricably linked. Health in prisons and jails is a matter of ongoing public concern, as the vast majority of incarcerated people will return to the community at the end of their sentences. In this blog post, I want to draw further attention to incarceration as a public health issue and also urge that we respond to it as a labor issue.
Nearly 7 million people in the United States live under the jurisdiction of the criminal justice system, with more than 2.3 million people currently in prisons or jails, another 820,000 people on parole, and 3.8 million people on probation. The United States has the highest incarceration rate in the world, at more than 700 incarcerated persons per 100,000 of the national population.
Health disparities encountered in incarcerated populations are stark. The health of incarcerated people is almost always inferior to that of the general population. People in state and federal prisons and jails are more likely than the general population to report ever having a chronic medical condition or infectious disease. An estimated 40 percent have a current chronic medical condition, and more than 65 percent meet the medical criteria for substance abuse addiction. The rate of HIV infection among people in state and federal prisons is more than five times greater than the rate among people who are not incarcerated. Hepatitis C infections are also much higher in prisons and jails than in the general community. In addition, currently and formerly incarcerated people lack access to good health care.
The health and health care in prisons and jails are sometimes regarded as being of little concern to the general population, but over 95% of incarcerated individuals will eventually return to their communities and their health problems and needs will return with them. Adding to the public health challenge, incarcerated people often lack education and work experience and return to communities with weak connections to the formal labor market. Stigma associated with incarceration as well as outright employment bans further limit employment opportunities. These challenges lead to poor health outcomes and are barriers to seeking and accessing health and other services. Not surprisingly, employment challenges also perpetuate a vicious cycle of incarceration and re-incarceration.
Given this reality, it is important to look at prisons and jails through the lens of public health, but incarceration also needs to be understood as a labor issue. Incarceration is a labor issue in a number of ways. Not only do formerly incarcerated people find themselves locked out of the job market by employers who screen applicants for felony convictions, but they also work for pennies while in prison. Furthermore, correctional officers endure staggering downsides on the job, including modest pay for high-stress employment and a life expectancy around 59 years, compared with 77 years for the general population.
In fact, advancement on the labor front may be the key to prison reform and better health outcomes. The issue of incarceration has drawn the attention of the labor movement. The AFL-CIO, one of the largest unions in the United States with a long history of fighting for social justice, has pledged to reform the unfair criminal justice system and recently teamed up with John Legend to change the national conversation about mass incarceration. The outcome of the labor movement’s involvement is uncertain, but two things are clear.
First and foremost, labor unions represent correctional officers. While this can mean opposition to commonsense policies, it can also provide an opportunity for change. Improving the financial and job security of correctional officers could be a step toward changing the culture of prisons. With the support of labor unions, it may be possible to pursue models of correctional employment that discourage rather than encourage the mistreatment and dehumanization of incarcerated people. One potential model could be to rotate correctional officers to work placements outside of prisons and jails, possibly in social services, to promote a broader perspective and combat entrenched stigma.
Second, labor unions can support training programs for currently and formerly incarcerated people that result in union jobs. The Trades Related Apprenticeship Coaching (TRAC) program in Washington State involves unions and helps incarcerated people learn the building and constructions skills they will need to earn a union wage after they have served their time. Such programs are essential to preparing people for and linking them to jobs.
Incarceration must be recognized as one of the major public health challenges facing the United States. The need for innovative solutions to this pressing health concern necessitates addressing issues of labor and employment.
Last week, we learned that the sugar industry paid Harvard scientists to minimize the link between sugar and heart disease, blaming saturated fat instead. Unfortunately, scientific evidence isn’t the only thing the industry has been influencing: a soda company in Colombia has successfully pushed for the suspension of a television advertisement warning the public about the health effects of sugary beverages.
Last week, the Colombian government ordered an NGO, Educar Consumidores, to suspend a television advertisement on the health risks associated with drinking sugary beverages. The order to pull the ad followed a complaint from Colombia’s largest beverage company and Pepsi affiliate, Gaseosas Postobon, which claimed the ad misled consumers in breach of Colombian law.
The “Tomala en Serio” ad campaign
The “Tomala en Serio television ad” shows a man drinking sugary beverages throughout the day: a bottled juice in the morning, an iced tea at lunch time, and sodas in the evening. The images are accompanied by graphics showing how many teaspoons of sugar are in each drink.
A voiceover tells consumers that seemingly harmless beverage consumption “adds up to a lot of extra sugar that can cause serious health problems including obesity, which causes diabetes, heart disease, and some types of cancer.” The ad includes graphic images depicting these health conditions.
The ad concludes by urging the public not to harm themselves by drinking sweetened beverages and recommends drinking water, milk or tea (without sugar) instead.
The Colombian ad is based closely on NYC’s “Do you drink 93 sugar packets a day?” television advertisement that was aired as part of its “Pouring on the Pounds” campaign. A very similar ad, “No te hagas daño tomando bebidas azucaradas” aired in Mexico in 2013.
The decision suspending the “Tomala en Serio” ad campaign
The decision from the Superintendent of Industry and Commerce found that the ad contained inaccurate and misleading information about the health impacts of consuming sugary beverages. The superintendent found that the ads messages were not supported by scientific evidence, noting a lack of scientific certainty in terms of the causal relationship between sugar consumption and diabetes, obesity, heart disease, and certain types of cancer.
Industry’s interference with scientific evidence also undermines legal decisions
Just as these ads say, sugary beverage consumption is a significant contributor to weight gain and overweight and obesity are important risk factors for type 2 diabetes, heart disease, cancer, and premature death. The superintendent’s decision, which was reached without a hearing, is based on an incorrect understanding of the scientific evidence. The decision to suspend the ban is based heavily on the superintendent’s finding of “lack of evidence,” rendering the decision flawed. Unfortunately, the decision doesn’t stop there; the order requires Educar Consumidores to seek pre-approval for future ads concerning sugary beverages.
Educar Consumidores should consider its options for challenging the superintendent’s decision in court, with a view to reinstating the “Tomala en Serio” advertisement and ensuring that the association can continue its efforts to educate the public on the dangers of sugary beverages. The government’s restraint of current and future noncommercial educational campaigns is particularly concerning. Clear arguments could be made based on the right to health, freedom of expression, and consumer protection.
It is unacceptable that the superintendent has relied on consumer protection laws, namely the consumer’s right to information, to ban an advertisement that provides clear and accurate information on the health effects of drinking sugary beverages. Following in the footsteps of tobacco, Big Soda is co-opting human rights arguments, courts, and quasi-judicial making bodies to undermine a fundamental human right: the right to health.
This post was written by Katie Keith, Adjunct Professor at Georgetown Law. Any questions about this post should be directed to Katie.Keith@georgetown.edu.
Controversy around the more than 400 percent increase in the price of EpiPens is just the latest in a year filled with stories of dramatic drug price gouging. Indeed, health headlines have been dominated by everything from $84,000 for a 12-week course of treatment for Hepatitis C to a more than 5,000 percent increase in the price of Daraprim, a drug used primarily by people living with HIV/AIDS. Even older brand-name drugs and generic drugs have not been immune from significant price increases.
Despite the headlines—and congressional hearings, investigations, and proposed policy solutions—consumers are bearing the burden of high drug prices in the form of higher insurance premiums and cost-sharing. In 2015, nearly one-quarter—24 percent—of people taking prescription drugs reported having a difficult time affording their medication.
High out-of-pocket costs also impact patient health: consumers with higher drug cost-sharing are more likely to fail to start, to abandon, or to delay treatment. And many consumers take matters into their own hands by reducing the dosage and regularity of their drug intake, asking providers to prescribe less-expensive medications, or using alternative therapies to offset high out-of-pocket costs. Unsurprisingly, this reduced drug adherence can result in potentially worse health outcomes and higher health care costs.
Posted in Global Health;
This post was written by Andrew Hennessy-Strahs, a 2017 Global Health Law LL.M. Candidate at Georgetown University Law Center. Any questions or comments can be directed to email@example.com.
September 14, 2016 marks the twenty-six year anniversary of the first successful human gene therapy in the world. Doctors in the National Institute of Health, in Bethesda Maryland successfully completed the first gene transplant. The patient was a four year old, severely immunocompromised girl, who had adenosine deaminase (ADA) deficiency. She was powerless to fight off any infection. Doctors removed her white blood cells, and inserted the genes that coded for adenosine deaminase into her cells. They then infected her own cells with a virus, which delivered new genes into her cells… then transplanted her cells back into her body… and cured her… permanently. The cells replicated in her body and were able to produce the enzyme she previously could not produce. The potential of gene therapy was undeniable and from September 14, 1990 onward, gene therapy research exploded in an essentially unregulated environment. (The FDA convened a committee to evaluate gene therapy research proposals through the Recombinant DNA Advisory Committee, RAC, but ultimately stripped approval authority and slashed the membership from 25 to 15 members).
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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.