Just two days ago, on December 17, 2014, the United Kingdom’s Supreme Court ruled that two Catholic midwives did not have the right to conscientiously object to performing their supervisory duties in cases of abortion. As with many reproductive rights issues, the issue of conscientious objection in the context of abortion is highly polarizing. However, what is important to understand is that from a public health perspective, failing to set clear standards on who can conscientiously object and how can create serious obstacles in preventing maternal deaths, regardless of whether we are talking about a low-, middle-, or high-income country. For this reason, this long-awaited ruling has important implications on how the debate over conscientious objection and the protection of women’s lives and health will be shaped.
Many thanks to Sarah Roache, O’Neill Institute Law Fellow, for her invaluable insights into legal interventions to prevent NCDs.
In January 1959, after half a decade of armed revolution, Fidel Castro’s 26th of July Movement took control of Cuba from Fulgencio Batista, a president with increasingly dictatorial tendencies. Relations between the United States and Castro’s government, which was closely tied to the international Communist movement, quickly soured. More than 50 years later, the anachronistic sanctions against Cuba remain in place—causing profound harm to Cuba’s people. In October, 2014 the United Nations voted for the 23rd year in a row to condemn the sanctions. The resolution passed nearly unanimously (only the U.S. and Israel voted against).
All of this may soon change. On December 17, U.S. President Barack Obama announced a deal between the U.S. and Cuba to normalize relations between the two countries, including the establishment of a U.S. embassy in Havana and loosened sanctions. In the short time since it was announced, the deal has already encountered steep resistance from Republicans in the U.S. Congress. Read More
Each year, approximately 3.2 million people die due to physical inactivity. Physical inactivity can lead to obesity, and is a key risk factor for non-communicable diseases (NCDs), including heart disease, diabetes, and cancer.
Modern lifestyles, predominately in developed countries, but increasingly in less developed countries too, are sedentary. Watching television, playing video-games, elevators, escalators, and desk jobs, equate to less activity. Combined with high-caloric diets, we live in an increasingly obesogenic environment.
All around the world, governments are adopting innovative laws and policies to tackle the rising burden of physical inactivity, and resulting NCDs. Interventions take many different forms, including physical activity programs in primary care settings, institutions, and workplaces; zoning and planning laws to increase the accessibility and safety of parks and recreation facilities; mass media and public education campaigns; and economic measures such as tax incentives and financial rewards for engaging in physical activity, or achieving weight loss targets.
Alongside medical and scientific interventions, innovative laws and policies have great potential to counter sedentary lifestyles and their negative health consequences. As with all policy innovations, though, proponents face challenges, including building and assessing evidence, adapting policies for local contexts, ensuring equity, and fostering public and political support. This blog looks at three examples of innovative legal and policy approaches to promote physical activity, and some of the challenges they bring with them.
Physical activity on prescription
Medical professionals in New Zealand, Sweden, and Vietnam, are prescribing physical activity to prevent and treat symptoms and diseases. Under New Zealand’s Green Prescription (GRx) initiative, primary care doctors or nurses issue prescriptions to patients, setting out physical activity and nutrition plans to assist them to manage chronic conditions. Patients receive support and encouragement from their GRx Patient Support Person, through in person meetings, telephone calls, or group support in community settings. Patients’ progress is reported back to their health professional. Read More
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Katherine Shats, Dan J. Stein, and James Giordano
The United States’ Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative announced last year, seeks to infuse over $1billion (USD) to basic and clinical neuroscientific research agendas. Hailed as a “Big Science” agenda focusing on the “Grand Challenge” of furthering capabilities to both understand and affect the structure and functions of the brain, the US initiative joins ranks with the European Union’s multi-billion Euro Human Brain Project, to translate brain science into knowledge and tools that can be employed in a variety of fields of medicine (e.g. neurology, psychiatry, rehabilitation, pain care, geriatrics, etc.).
Neuroscience as a powerful socio-economic force: what does this mean for global equity?
While the potential medical benefits of brain research may be obvious, let’s not overlook that neuroscience and neurotechnology are also powerful socio-economic forces. Occupying a greater than $160 billion annual market share, neurotechnology has been classified as one of the fastest growing – and most influential – fields of the 21st century. Current estimates predict a 60-70% growth in neuroscientific enterprises in Asian and Pacific Rim nations, so that Asian presence in the neuroscience and technology market will surpass that of the United States and Europe by 2020.
As investment in the technologies grows, its development, use and any potential benefits will be shaped by the priorities of these investor nations – and their economic, social and international agendas. Existing asymmetries between developed and non-developed countries may become more evident, and impact how the technology is developed, used and how any potential benefits are distributed. The cultural contexts within which the technology develops will also dictate the direction it takes – including why, how and for whom it is created. Read More
In 1983, during the beginning of the AIDS epidemic, the FDA introduced a lifetime exclusion of sexually active men who have sex with men (MSM) as prospective blood donors. At this time, the ascertainment of HIV status was not possible and not a lot was known about the disease. More than three decades later, we now know how the virus is transmitted and the most modern screening tools can detect HIV in less than 2 weeks after transmission. The lifetime ban, however, remains.
On Tuesday, an FDA advisory panel met to discuss whether or not the federal government should reverse its policy banning gay men from donating blood. The Blood Products Advisory Committee — the group of outside advisors to the FDA — said scientific testing of blood has become far more precise and is adequate to ensure that donated blood remains safe. If the FDA were to lift the ban, gay men would be allowed to give blood if they abstained from sexual encounters with men in the past 12 months. At this point the FDA has not indicated when it would make a decision on changing the ban.
The possibility of change comes amid growing calls from medical groups, gay rights activists and lawmakers to abandon the ban as outdated and discriminatory. The American Red Cross, America’s Blood Centers and the American Association of Blood Banks have opposed the ban as “medically and scientifically unwarranted”. In June 2013, the American Medical Association issued a statement calling on the FDA to change the policy, stating that “The lifetime ban on blood donation for men who have sex with men is discriminatory and not based on sound science.”
With Thanksgiving just right around the corner, there is no better time to highlight the work of Bikers Against Child Abuse International, Inc. (B.A.C.A.), a group that deserves utmost recognition and praise for what they have pledged to do. Embracing the very stereotype that has been created for them, this group of bikers creatively use their image to empower children who are victims of abuse.
In the United States, over 6 million children are victims of child abuse. Approximately 3 million reports are made annually, and they sometimes involve multiple children—one report is made every 10 seconds. What is more, greater than 80% of the cases involve the parent as the perpetrator. In addition to the physical harm, children who are victims of abuse also suffer psychological harm—much of which can be permanent. Such conditions include depression, withdrawal symptoms, anti-social behavior (e.g., personality disorders and violent behavior). It has also been observed that children who are abused are more likely to abuse alcohol or drugs.
Last week, the International Neuroethics Society had its Annual Meeting in Washington, DC. Neuroscientists, ethicists, lawyers and policy makers from around the world gathered to discuss a broad range of topics, from groundbreaking neuroscientific research, to artificial intelligence, neuroscience in healthcare, and the significant investment in brain sciences by the US BRAIN Initiative and the European Human Brain Project. And surprisingly, subsidized housing.
So how did housing become a major focus of a human rights panel at a neuroscience conference?
Recognizing the enormous burden that neurological and psychiatric disorders place on individuals, families and society, one of the major goals of the BRAIN Initiative is to develop better tools to understand how the brain functions in health and disease. This investment is much needed, as the global burden of neurological disorders is recognized by the WHO as one of the greatest threats to public health.
But what are we doing about preventing some of the neurological damage from occurring in the first place? Building on a seminal book from 2000 titled From neurons to neighborhoods, Dr Mariana Chilton, Director of the Center for Hunger-Free Communities, suggested that the most effective solution is safe and affordable housing.
On November 11, an Indian surgeon used infected instruments to sterilize 83 women in about six hours, leaving 10 of them dead and another 69 hospitalized in the central state of Chhattisgarh. The doctor breached guidelines that limit surgeons from performing more than 30 sterilizations a day and also failed to disinfect the instruments before using them between patients. This is not an isolated case; according to India’s previous health minister, Harsh Vardhan, from April 2010 to March 2013 the government paid about 510 million rupees (US$8 million) for 15,264 deaths or failed surgeries.
This incident arises in the context of India’s efforts to control population growth and of its voluntary sterilization drives, where couples choose between a tubectomy or vasectomy.
However, this raises questions of whether these operations can really be regarded as voluntary and whether there is a genuine choice to opt for a vasectomy instead. The Indian statistics show that while 35.8% of women ages 15 to 49 in India have chosen sterilization, a marginal 1.1% of men have chosen the same. This is despite a vasectomy being a simpler procedure that receives more generous financial compensation; in most states, men who choose to have a vasectomy are paid $33 by the Indian government. Women, on the other hand, typically receive less than $23. The advantages of no scalpel vasectomy are many, doctors say; it is an outpatient procedure that can be done within five minutes and has no side effects. A woman who undergoes a tubectomy must be hospitalized for eight days and risks more side effects and future complications. Tubectomies are overall more expensive and much more invasive. Read More
November has been a busy month for the Affordable Care Act. On November 15, the second round of Healthcare.gov’s open enrollment will begin. And on November 7, the Supreme Court agreed to hear a case that threatens to undermine the law in the large majority of states. This blog explores these two issues, concluding with a discussion of two other near term challenges to Obamacare.
2015 Open Enrollment
Last year’s botched rollout of Healthcare.gov was a technological (and political) disaster for Obamacare. All indications are that this year’s open enrollment period will run more smoothly (the website was even made available early for users to preview plans, something that would have been unthinkable last year).
Assuming fewer technological problems, the focus this year will be on two key issues. First is the price of premiums. Because the Affordable Care Act bans price discrimination based on health status (with limited exceptions for tobacco use and age), critics of Obamacare have predicted that the cost of insurance premiums will spike as insurers cope with the new pool of sick enrollees. While early analysis suggests that a feared spike in premium prices has not materialized, more data will be forthcoming once open enrollment begins.
You may have missed this news from mid-October: Due to the plethora of humanitarian disasters demanding global resources, along with the diminishing international combat presence in Afghanistan, the World Food Programme (WFP) has been forced to cut food rations in Afghanistan, affecting up to 1 million people. With its funding appeal experiencing about a $150 million shortfall, the WFP determined that it had to cut rations from 2,100 to 1,500 calories per person to avoid having to cut off some people from food aid entirely. Incredibly, the United Nation’s Afghanistan humanitarian appeal is among the better funded appeals, at 61% funded as of November 10, compared to 46% for UN humanitarian appeals overall, with some appeals many months old still below 40% — and even below 30% — funded, including for the Republic of Congo, Somalia, Chad, Burkina Faso, Nigeria, and Iraq.
The major public health story of the past weeks continues to be the Ebola epidemic in Sierra Leone, Liberia, and Guinea, even as U.S. media coverage has been dominated by fears of Ebola in the United States, with states implementing quarantines and other highly restrictive policies — responses likely unconstitutional in their failure to be based in public health need. The crisis in West Africa persists, with very encouraging but also quite fragile indications of progress in Liberia, yet concerns of the epidemic worsening in Sierra Leone, and stable or worsening in Guinea.
Together, Ebola in West Africa and hunger in Afghanistan – in particular, as emblematic of a world that seems incapable of providing – or unwilling to provide – the required resources and policy focus on the current multitude of global humanitarian and health-related crises, hold a number of lessons for what needs to be incorporated into a more effective global governance for health. And as we will get to, a Framework Convention on Global Health could be a significant step towards embedding these into global governance structures.
Among the lessons are these eight: Read More
Posted in Global Health, Human Rights, WHO; Tagged: Ebola, fcgh, Framework Convention on Global Health, global governance, global governance for health, governance, health governance, health systems, One Health, right to health.
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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.