National Health Equity Strategies to Implement the Global Promise of SDGs

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Pine Ridge Indian Reservation (Wikipedia, https://en.wikipedia.org/wiki/Pine_Ridge_Indian_Reservation)

Pine Ridge Indian Reservation in South Dakota. The land is beautiful, but life can be brutal, with a life expectancy of less than 50 years. Photo courtesy of  Wikipedia,

[This blog was originally posted in the Health and Human Rights Journal as parts of its series of blogs on the Sustainable Development Goals, and is re-posted here with permission.]

“No one will be left behind.” The bold promise at the heart of the Sustainable Development Goals (SDGs) must guide their implementation. This requires utterly transforming the lives and opportunities of those who are already furthest behind.

Such a transformation must occur through both national and global action, with a laser-like focus on equity. Inequities throughout the socioeconomic gradient must be addressed, with the greatest focus on those who are most disadvantaged and marginalized.

I propose one overarching idea, that every country develops a national health equity strategy. Each strategy would:

  •  Identify all populations that are subject to health inequities
  •  Identify and analyze, for each population, the nature of these inequities, including their extent and their causes
  •  Based on this analysis, develop plans that are specific to each population to end these inequities, with actions harmonized across the diverse and overlapping populations to capture cross-cutting issues and synergies
  •  Translate these plans into specific and time-bound actions, with adequate budgetary and other resource requirements
  •  Develop time-bound targets on reducing and ultimately ending inequities, based on the maximum of available resources and capacity, and
  •  Ensure strong information systems to collect data to monitor progress.

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


Vote Food 2016: An open letter to all candidates running for office

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Today, four of America’s preeminent voices in food policy published A National Food Policy for the 21st Century. In their memo to the next president, Mark Bittman, Michael Pollan, Ricardo Salvador, and Olivier De Schutter laid out a comprehensive framework for untangling the myriad laws, regulations, and social mores that make up America’s troubled food system.

Laying the foundation for a National Food Policy is predicated not only on a president who understands the significance of food on multiple facets of daily life, but also on leaders at all levels of government - local, state, and federal - who will support this goal.

We the people must elect these leaders. In 2016, Americans need candidates who are committed to improving America’s health, starting with our most basic necessity, food. Please share this letter widely, follow us on twitter @VoteFood2016, and stay tuned for more on this project.


Dear Candidates:

We urge you to pledge to improve America’s health by making food policy a central part of your campaign platform.

Food touches the life of every American every day.

  • Food is a household issue, accounting for 13 percent of personal household expenditures, behind only housing and transportation costs.[i]
  • The food sector is a major economic driver, contributing about $800 billion dollars annually to the S. economy.[ii]
  • Food is a labor issue, providing 17 million jobs in agriculture, food services, and manufacturing.[iii]

But food is increasingly also a public health issue.

  • Obesity costs Americans more than $300 billion dollars each year in medical and treatment costs and in decreased productivity.[iv]
  • Despite the abundance of food, one in seven Americans goes to bed hungry each night, including 12 million children.[v]
  • The widespread use of antibiotics in livestock intended for human consumption is leading to alarming rates of antibiotic resistance.[vi]

Today, we find ourselves at a critical juncture in the policies that affect our country’s food supply. Now, more than ever, Americans are paying close attention to what they eat, where it comes from, and how it affects their health. The number of consumers who favor organically grown and locally sourced products is increasing. Intolerance for the abundance of sugar, salt and, unhealthy fats in school lunches is spurring the creation of innovative menus. Responding to consumers’ demands for ethically raised and healthier meat products, multinational corporations are moving away from food raised with antibiotics and towards more humanely and sustainably sourced food. And, from overpriced produce to food deserts, Americans are beginning to understand the profound inequality our food system breeds and its systemic impact on the health of low-income communities. By recognizing food as a health issue, significant improvements in public health can be made.

As a candidate for public office, we call on you to improve America’s health by joining the growing movement for better food and pledging to make U.S. food policy part of your campaign platform.

Americans need leaders in government who support the safety and integrity of our food supply, who will ensure that everyone is able to eat nutritious food, and who understand that America’s unsustainable food consumption and production habits are harming this nation’s health.

Food is at the center of American lives, and should be at the center of its policies. Thank you for your support.

Vote Food 2016

[i] Economic Research Service (United States Department of Agriculture), Ag and Food Sectors and the Economy

[ii] Id.

[iii] Id.

[iv] Pianin, E. “New Lifetime Estimate of Obesity Costs: $92,235 Per Person” The Fiscal Times, May 15, 2015

[v] Feeding America

[vi] National Antimicrobial Resistance Monitoring System (Centers for Disease Control) Antibiotic Resistance Threats Report and Foodborne Germs


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


What does the conclusion of TPP negotiations mean for global health law?

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trade-financeThis post was written by Alexandra Phelan, an Adjunct Professor in Global Health Law at Georgetown University Law Center and Doctoral Researcher with the O’Neill Institute for National and Global Health Law. She has previously examined the possible implications of the TPP on global health law based on previous leaked drafts of the TPP here (access to medicines) and here (methods of treatment patents).

In the early hours of Monday October 5th in Atlanta, delegates from 12 Pacific Rim countries – the United States, Japan, Canada, Australia, Malaysia, Mexico, New Zealand, Peru, Brunei, Singapore, Chile, and Vietnam – announced the conclusion of negotiations for the Trans-Pacific Partnership (the TPP).

The scope of the TPP is massive, covering more than 40% of the global economy. The agreement aims to lower barriers to trade and promote investment between TPP countries by slashing tariffs, setting minimum standards in intellectual property, environmental, and labour laws, as well as allowing the direct resolution of disputes between investor companies and TPP countries (aka Investor State Dispute Settlement - or ISDS - provisions).

As a regional agreement, the TPP imposes minimum standards above those already set out under international trade law, such as the World Trade Organization’s General Agreement on Trade and Tariffs (GATT) and the Trade Related Aspects of Intellectual Property Agreement (TRIPS), leading to descriptions of the TPP’s intellectual property chapter as a “TRIPS++” agreement.

The inclusion of increased intellectual property minimum standards, along with ISDS provisions, has greatly concerned the global health community with Médecins sans Frontières (MSF) declaring previous drafts of the TPP reveal “a terrible deal for access to affordable medicines”.

Following extensive negotiations between the Australian and United States lead negotiators, Andrew Robb and Mike Froman, the TPP appears to provide important compromises for public health. However, in response to the TPP’s agreement, MSF responded that while the text “has improved over the initial demands, the TPP will still go down in history as the worst trade agreement for access to medicines in developing countries” and may become “a dangerous blueprint” for future trade deals.

Read More

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The Global Migration Crisis, International Law, And The Responsibility To Protect Health

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This post was written by Lawrence O. Gostin, University Professor at Georgetown University and O’Neill Institute Faculty Director and Anna Roberts, O'Neill Institute Law Fellow.  It was originally published in the Health Affairs Blog on September 29, 2015, and the excerpt is posted here with permission of the authors.  The views presented here are their own. Any questions or comments can be directed to gostin@law.georgetown.edu.

The world is experiencing the greatest forced migration crisis since World War II — originating in fragile states in the Middle East and Africa and now spilling over to Europe. Nearly 60 million asylum seekers, refugees, and internally displaced persons (IDPs) have fled their homes to escape conflict, violence, and starvation.

This global migration crisis shows no sign of abating, with intense political discord in host countries compounded by a failure of the international community to develop appropriate and sufficient strategies to assist the displaced. A divided European Union (EU) voted to distribute 120,000 asylum seekers, even though it currently hosts some half-million asylum seekers. The United States plans only to raise its annual refugee cap from 70,000 to 100,000 by 2017, which won’t make a dent in assisting the outpouring of humanity crossing international borders daily.

Mass forced migration poses major health hazards for those on the move, including increased risk of physical and sexual violence, mental distress, and scarcity of food, water, and shelter. The risk of epidemics is heightened through over-crowding, decreased hygiene, unsanitary conditions, and exposure to disease vectors (e.g., rats and mosquitos). Forced migrants also have limited access to preventative services such as vaccines, essential medicines, and basic health care, including safe childbirth. Lower-income states, with weak health systems, host the vast majority of migrants, which burdens their already fragile health and social security systems. However, even for those forced migrants who make it to high-income states, there are barriers to health care access such as culture, language, geography, and limited state benefits.

The full post can be accessed at Health Affairs here.

Posted in Global Health, Human Rights, Resources; Tagged: , , , .


Behind Recent Drug Price Gouging, a Bad CEO and an Even Worse Legal System

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Closeup Money rolled up with pills falling out, high cost, expensive healthcare

It’s been a rough week for bad executives. Volkwagen’s CEO, Martin Winterkorn, resigned after investigators discovered that the carmaker had installed software that allowed its vehicles to pass emissions tests, while during normal operation they spewed out pollutants far beyond legal limits. Another executive received a 28-year prison sentence for deliberately shipping tainted peanut butter that killed nine people—the longest sentence ever handed down in a food-safety case. And Martin Shkreli became the “most hated man in America” after his company, Turing Pharmaceuticals, raised the price for a lifesaving anti-parasitic drug, Daraprim, from $18 to $750 a pill. The condition Daraprim treats affects mostly people living with AIDS. He quickly reversed the decision in the face of enormous popular backlash.

Mr. Shkreli is almost comically unlikeable. An ex-hedge fund manager with a history of unethical business practices, he is currently under investigation for “such a vast number of suspected crimes it is difficult to know where to start.” He has been accused of failing to pay two of his employees and of harassing another’s family through social media. He was fired from the board of one pharmaceutical company after being accused “of using the company as his personal piggy bank.” When questioned about his motives for the price jump, he called a reporter a “moron” and, bizarrely, claimed the price increase was altruistic since the company could reinvest profits in research and development for neglected diseases (his previous business decisions make this claim especially dubious).

It is easy to vilify the individual, particularly someone as ripe for vilification as Mr. Shkreli. The more important lesson, however, is the nonsensical legal environment that allows access to lifesaving drugs to be determined by the whims of an unscrupulous CEO. Read More

Posted in FDA, National Healthcare; Tagged: , , , , .


Peanut Brothers Go to Prison. Lessons Learned.

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Today, food safety advocates are cheering the unprecedented magnitude of judicial sentences delivered against two company executives (who also happen to be brothers) who knowingly sent peanut butter tainted with salmonella into interstate commerce. A federal judge in Georgia sentenced one brother to 28 years in jail and the other to 20 years (a plant manager also received a five year jail sentence).

The case was brought under a rarely used power vested in the Food and Drug Administration to hold employees of corporations criminally liable for violations of the Food, Drug and Cosmetic Act (FDCA).

The sentence is being touted as a victory for food safety generally and brings some closure to the families who lost loved ones or suffered illness after eating the peanut butter. Most significantly, it is hoped that the sentences will serve as a deterrent against future instances of food fraud and adulteration.

Still, we can learn more than just deterrence from this case. I think it is safe to conclude that the majority of food-borne illness outbreaks do not happen quite so purposefully, but rather because of a breakdown in food safety controls at some point along the production line. What the food industry also needs to take away from this case is the significance of our food safety laws and the necessity of maintaining a robust and transparent system focused on preventative controls and communication. Just in the last few months, we have seen profound foodborne illness outbreaks in ice cream, more ice creamcilantro and cucumbers. In each case, food safety auditing, epidemiological surveillance and communication between government officials and corporate executives was the key ingredient in stopping the sale of the contaminated product. Tragically, the Parnell brother’s salmonella-tainted peanut butter slipped through the cracks. Hopefully their story will guide repair of any lingering holes in the system.



Posted in FDA, Uncategorized; Tagged: .


2016: The year of the science pledge?

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It seems with every election cycle in the United States politicians are requested to sign various new types of pledges. Pledges not to raise taxes, pledges to support the eventual party nominee, pledges regarding campaign finance, etc. The concept of a pledge is not unique to the U.S. election cycle – other countries’ politicians take various campaign pledges. The pledges can take various forms, too – a written document signed, framed and publicly displayed, a written document hidden away in a safe, or an oral promise that fact-checkers will later review and confirm, as examples. With the 2016 election cycle beginning to kick up into high gear, I wonder if another pledge should potentially be considered by the candidates – a pledge to acknowledge scientific evidence and actively promote the concept of evidence-based policymaking. Read More

Posted in National Healthcare, Uncategorized;


Upcoming Global Health Law Leader: Estefania Palomino on Women’s Health and Social Justice

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A few weeks back, we welcomed our new class of students in our Global Health Law LL.M. Program. As the Director of the program, I could not be more enthusiastic about what this group of students will offer their communities and the world once they leave the program. As their advisor, I have the pleasure of getting to know them better and their life goals. There is passion, dedication, and commitment. They are eager to learn from their professors, but also from one another.

For these reasons, to the extent that I can use this medium to communicate to our readers the promise that these young leaders hold, I will. After all, the richness of our program derives from the experiences and dedication that its students bring to it.

Global Health Law LL.M. Student Estefania Palomino Doza at Aspen Ideas Festival (Spotlight Health)

From: Health Affairs Blog

This time around, I enthusiastically share with you the blog post that our Colombian student Estefania Palomino Doza has recently published in the Health Affairs Blog, following her participation in Spotlight Health at the Aspen Ideas Festival this past summer. As her post clearly conveys, Estefania is committed to social justice and improving women's health in her country and beyond.

Read More

Posted in Global Health, Global Health Law LL.M., Human Rights; Tagged: , , , , , , , , , .


Mustard Use by ISIL and the Chemical Weapons Convention

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This post was written by Sharon Jackson, an independent consultant.  Any questions about the post can be directed to sharonjackson@att.net.

It is a rare occasion that an arms control treaty can help in an ongoing public health crisis. The Islamic state’s use of toxic chemicals against civilians in Iraq and Syria has exposed noncombatants and contaminated environments; it is a clear violation of the Chemical Weapons Convention (CWC). Syrian government forces have also been accused of using toxic chemicals in battle. The treaty defines chemical weapons (CW) use as a deliberate and hostile attack with any toxic chemical for the purpose of inflicting death or injury to humans or animals regardless of whether the chemical was specifically formulated as a weapon. Medical relief workers and political activists in Syria and Iraq report the use of suspected mustard agent in Islamic state controlled areas. If the use of mustard is confirmed, the injuries to victims may be chronic and enduring and the environmental contamination may require remediation. Read More

Posted in Global Health, Human Rights; Tagged: , .


The World’s Fair – taking a stance on food sustainability towards the future

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Since the 19th century, World’s Fairs have gathered people from many parts of the world, allowing countries to show their most recent technological advances and their culture, as well as promoting their homelands. Ever since the first world’s fair in London in 1851, the goals of these events have been both high-minded as well as commercial. As times change, world expositions have changed to fit those times, providing a glimpse into the realities of the moment. They continue to try to reflect both the commercial needs of their times while presenting the ideals, hopes, and aspirations of people. World’s fairs have traditionally introduced many novelty products such as the telephone, outdoor electric lighting, motion pictures and the Eiffel Tower.

This year’s world fair, however, takes on a new approach. Previous expos looked to show expo-goers the latest glimpse at the “world of tomorrow”, but the focus this year is moving away from the space age and moving to the problems facing our world now. Expo Milano 2015, “Feeding the Planet, Energy for Life”, explores the importance of nutrition for the global population and the central role that people play. The idea of this fair—which started in on May 1st and is finishing up the 31st of October—is to open up a dialogue between international players, and to exchange views on the major challenges surrounding world hunger and the development of food sustainability. Read More

Posted in Global Health, Resources; Tagged: , , , , , , .

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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