Litigation and Health Reform in Brazil: Balancing Access to Health with the Creation of a Durable and Equitable Health System

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This post was written by John Thorpe and originally published on Georgetown’s Human Rights Institute Blog, 1948: A Rights Forum on December 5, 2012.

Good health is a precondition for the enjoyment of most of the rights we cherish.  A young woman crippled by opportunistic HIV/AIDS infections faces significant challenges to vote, let alone to contest barriers to vote.  Good health ensures that we can work and work productively.  It also promotes early childhood education and gives children an opportunity to perform at their highest potential.  As The Global Network has noted, the broad negative social impact that neglected tropical diseases have on education, economic development, and women’s empowerment is illustrative of the fundamental nature of good health. 
Recognizing that the right to health is a pillar of individual and collective dignity, the international community enshrined it in article 12 of the International Covenant on Economic, Social, and Cultural Rights.  Yet historically, the right has lacked broad institutional support and reliable mechanisms for enforcement.  Recent codifications of the right to health into national constitutions are changing this by, among other things, opening up the possibility of litigation for individuals seeking access to care and medication.  Brazil serves as a good example.  Since codifying the right to health in its constitution, Brazil has witnessed a veritable explosion in health related litigation (in Brazil’s Rio Grande do Sul state, health related lawsuits filed against the state have increased over 1000% from 2002-2009).  Although this trend in litigation is raising a number of questions regarding sustainability and equity, one thing is clear: litigation is moving the public discourse from debate over the right to health’s epistemological validity in the rights framework to inquiries into pragmatic methods and optimal institutional structures to ensure its enjoyment in practice.  Litigation, while not a permanent answer to health inequity and in need of reform, is providing poor Brazilians with access to necessary medication and with an effective tool to claim their right to health where current distributional structures are failing.  

Posted in Human Rights;


Ending the AIDS Epidemic in the US and Abroad

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On November 29, the O’Neill Institute for National and Global Health Law’s Colloquium, moderated by Mark Dybul, O’Neill Institute Distinguished Scholar, and newly selected Executive Director of the Global Fund for AIDS, Tuberculosis and Malaria, focused on potential end-game strategies for HIV in the United States and across the world. 

Jeffrey Crowley, O’Neill Institute Distinguished Scholar and Program Director of the National HIV/AIDS Initiative, spoke about critical next steps for ending the HIV epidemic at home.  He gave particular emphasis to ensuring effective treatment for all, rethinking the criminalization of HIV, and refocusing efforts to address young gay men.

Thomas Quinn, Director, Johns Hopkins Center for Global Health, presented on the current feasibility of global efforts driving towards an “AIDS-free generation.”  He outlined the state of the science and potential opportunities.  Professor Quinn also noted Secretary of State’s Hillary Clinton’ recently announced “blueprint,” which would focus efforts towards prevention of mother-to-child transmission. 

A webcast of the session can be found here: http://apps.law.georgetown.edu/webcasts/eventDetail.cfm?eventID=1906.

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New Article on Implementation of Obamacare and Its Implications for Global Health

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This blog excerpts an articleOutlook for Obamacarepublished in the Fall 2012 edition of the Cairo Review of Global Affairs. In the article, my colleague at the Center on Health Insurance Reforms, Katie Keith, and I describe the changes ushered in by the Affordable Care Act, how states and the federal government have implemented the law to date, and how the law supports the global ethic of universal health coverage.

Universal health coverage is increasingly recognized as a global social norm and moral imperative. With the passage of the Patient Protection and Affordable Care Act (ACA), the United States looks to join an ever-growing number of countries with universal health coverage and embraces the potential for improved access to adequate and affordable health care. Yet, because the ACA adopts America’s existing federalist framework, states and the federal government have much to do to prepare for 2014, when the ACA’s most significant reforms take effect.  Because states play a prominent role in the United States’ complex federalist regulatory scheme, state decision-makers have the opportunity to shape how the ACA’s reforms will be enforced, how the insurance exchanges will be run, and whether Medicaid coverage is delivered as promised. If political opposition to the ACA continues and states refuse to adopt and enforce the ACA’s requirements, some of the law’s consumer protections and its promises of access to affordable, adequate, and accountable coverage could be at risk.

Despite this uncertainty at the domestic level, the law brings the United States one step closer to the global ethic of universal health coverage. While much of the international community has been confounded by the political furor over universal health coverage in the United States, the ACA represents a remarkable shift in the way that private insurance is regulated by taking pains to enable every American—including the sick—to access coverage. While imperfect in many ways, the ACA could generate additional momentum for improvements in universal access to coverage around the world as other countries look to the United States because of its prominent role in striving to improve global health. The law could also lend additional credibility to the United States in its leadership role at the WHO and in the global health arena where it has often supported universal health coverage policies while failing to pursue these reforms on its own soil. Finally, with the aim of securing near universal health coverage for its residents, the ACA helps align American domestic policy with long-standing foreign policy and support for universal health coverage, particularly in developing countries.

For more, please be sure to check out the full article here.


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Accepting Applications for 2013-2014 O’Neill Institute Fellowship

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The O’Neill Institute for National and Global Health Law is seeking exceptionally qualified candidates to serve as O’Neill Institute Law Fellows. Housed at Georgetown University Law Center in Washington, D.C., the O’Neill Institute is a leading research institute for health law. For more details about O’Neill and its ongoing work please visit www.oneillinstitute.org.

Law Fellows are based at the O’Neill Institute and report to the O’Neill Executive Director and Faculty Director.  Fellows work on academic legal research and scholarly projects.  Duties include working closely with faculty to produce scholarly works for publication, in some cases leading to joint publication.  Allocation of time is primarily determined by O’Neill Institute faculty needs; additionally, limited time may be allocated to independent research and O’Neill Institute projects. 

Fellowship terms are one year, with possible extension to two years, and will begin in Fall 2013.  Fellows receive an annual salary of $65,000 with outstanding benefits.

Candidates must have a J.D. degree (or the equivalent), exceptional academic credentials including publications, and health law-related research interests in areas like public health law, global health law, domestic health care law, empirical studies, regulatory impacts on health, health and human rights.  Successful candidates will have knowledge and/or experience in aspects of national and/or global health law and ethics.  A post-graduate degree (M.P.H., LL.M.) or significant work experience is preferred.

Applications must include: CV, cover letter, writing sample, professional references, official law school transcripts and other graduate school transcripts (if applicable).  The application deadline is Friday, February 22, 2013.  Any questions about the position should be directed to oneillinstitute@law.georgetown.edu.

You can also download the PDF of the fellowship posting.  Read more and apply online.

APPLICATION DEADLINE: Friday, February 22, 2013

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Ambassador Mark Dybul, O’Neill Institute Co-Director of the Global Health Law Program and Distinguished Scholar, Appointed Executive Director of the Global Fund for AIDS, Tuberculosis and Malaria

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November 15, 2012 – The O’Neill Institute for National and Global Health Law at Georgetown University congratulates Ambassador Mark Dybul, O’Neill Institute Co-Director of the Global Health Law Program and Distinguished Scholar, on his appointment as the next Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.  He will join the Fund in early 2013. 

“This is a wonderful day for the field of global health, and we are extremely proud of Mark.  We have no doubt that he will be transformative in his new role at the Global Fund,” said Lawrence O. Gostin, Faculty Director of the O’Neill Institute.  “Mark is an invaluable member of our leadership team and we are very thankful for his contributions to the mission of the institute,” added Oscar A. Cabrera, Executive Director of the O’Neill Institute.

At the O’Neill Institute, he co-directs the Global Health Law Program and is also a Distinguished Scholar. He is also the Global Health Fellow at the George W. Bush Institute. Ambassador Dybul has also served as chair of the Joint United Nations Programme on AIDS’ coordinating board and as a member of the board of trustees of the Woodrow Wilson International Center for Scholars. Read More

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