Soon after the measles outbreak originating in Disneyland became widely publicized in the media, the satirical newspaper The Onion published a “commentary” titled: “I Don’t Vaccinate My Child Because It’s My Right To Decide What Eliminated Diseases Come Roaring Back.” Yes, The Onion’s content is meant to be humorous and, as Wikipedia describes it, “surreal or alarming.” And yet, this “commentary” quite accurately captures not only the anti-vaccination parent attitude, but also the extremely dangerous outcomes of their actions.
I am a lawyer trained in global health law—I work at the intersection of public health and the law. It was not until I was at Georgetown Law pursuing the masters in laws (LL.M.) in Global Health Law that I came to appreciate the value of vaccines and to understand that we are part of a population, and that our actions can have wide implications for the health of others. The measles outbreak could have easily been prevented. The disease was eradicated in the United States in 2000 through a widespread vaccination campaign, but while eliminated, the unvaccinated still run the risk of contracting the disease from anyone entering the country who is infected. The current measles outbreak has grown to 95 cases across California, Michigan, Arizona, Utah, Washington, Colorado, Oregon, Nebraska, and even Mexico. Read More
On January 22, President Obama stated in regards to marijuana legislation “What I am doing is asking my Department of Justice just to examine generally how we are treating nonviolent drug offenders. Because I think you’re right, what we have done is instead of focusing on treatment, the same way we focused say with tobacco or drunk driving or other problems where we treat it as a public health problem, we've treated this exclusively as a criminal problem. And I think that it’s been counterproductive and it’s been devastating in a lot of minority communities. It presents the possibility at least of unequal application of the law and that has to be changed.”
This statement follows the trend that some states have been setting in legalizing recreational marijuana. On January 1, 2014 –a little over a year before this statement—Colorado became the first state to sell recreational marijuana, followed closely by Washington in July. These states will soon be followed by Oregon and Alaska who passed similar legislation in the November elections. While it may be too soon to judge the success of Colorado’s policy, we can analyze the initial implementation and start looking for the elements needed for a smooth transition in drug policy from criminalizing to approaching it from public health and regulatory lenses. Read More
By Tanya Baytor, Katherine Shats and James Giordano
In the midst of playoffs games for the National Football League (NFL), last weekend a New York Times article highlighted recent rule changes designed to protect quarterbacks and receivers from debilitating injuries like concussions. And on Monday, questions arose as to whether Seattle’s quarterback played through a concussion during Seattle’s comeback win over Green Bay in the NFC Championship. Although much of the focus is on mitigating the incidence and prevalence of concussive injuries in professional football, more attention should be devoted to similar rule changes and ways to prevent and address traumatic brain injuries in collegiate athletics.
In November, the body of Kosta Karageorge, an Ohio State University football player and wrestler who had sustained several concussions, was found in a dumpster. Police believe he shot himself. In a text sent to his mother just days before his death, he wrote “Sorry if I am an embarrassment, but these concussions have my head all f...ed up”.
On January 8th, Connecticut’s Supreme Court ruled that a 17-year-old named Cassandra does not have the right to refuse cancer treatment that her doctors believe will save her life. Cassandra learned from the doctors at Connecticut Children’s Medical Center in Hartford that she had Hodgkin’s lymphoma, a form of cancer that is common in children, in September 2014. According to her doctors, Cassandra has an 85% chance of survival if she receives chemotherapy, but that she will not survive more than two years without it.
However, Cassandra has consistently expressed her desire to forego chemotherapy, voicing her concerns about the long-term effects of the treatment, including in an interview with a local Connecticut TV station. Her mother, Jackie Fortin, has supported Cassandra’s decision. After Cassandra missed several appointments for treatment, Connecticut’s Department of Children and Families (DCF) removed her from her mother’s care and put her into temporary state custody, where she began to receive chemotherapy.
Despite strong evidence of carcinogenicity, despite increasing skin cancer rates, and despite harrowing stories of young people dying, the US lags behind many countries in the regulation of tanning beds. At a minimum, federal and state governments should ban the use of tanning beds by minors in the United States. In their 2014 review of the effectiveness of existing state indoor tanning laws, Guy et al confirm that “age restrictions, in particular, may be effective in reducing indoor tanning among female high school students.” This supports Mayer et al’s 2011 findings that bans (as opposed to less stringent requirements such as parental consent) are the most effective way to reduce high rates of indoor tanning among adolescent girls.
Even more effective in protecting our youth, and all Americans, would be a population wide ban on commercial tanning beds. Population wide bans, like those in Brazil and the majority of Australian states, leave no room for lax enforcement of minimum age requirements, parental consent, and other restrictions.
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Yesterday the Bill and Melinda Gates Foundation launched an exhibit called The Art of Saving a Life. In collaboration with more than 30 artists, including photographer Annie Leibovitz, and writer Chimamanda Ngozi Adichie, the exhibition addresses perceptions about vaccinations through various art forms. Visual artist Vik Muniz in Behind the Scenes explained, “scientists are trying to describe phenomena, [artists] are trying to describe how we perceive phenomena.”
Public health workers are tasked with directing this perception. Understanding how the public perceives health challenges is crucial to designing a successful action plan. Consequently, ensuring positive outcomes typically requires fostering a positive and cooperative perception of the problem.
The exhibit is intended to reach individuals on a visceral level and (with any luck) elevate public understanding of the population-wide significance of vaccines. As Dr. Orin Levine, director of the vaccine-delivery program at the Gates Foundation, explained to the Wall Street Journal:
“[Vaccination is] often the kind of work that people don’t know about—they don’t talk about, they don’t understand well. From my standpoint, I thought it was a great opportunity to try and engage art and the art community to help us spark that conversation.”
“[T]he recent experience with Ebola reminds us that diseases anywhere can be a threat to everybody everywhere…vaccines have a really important impact on improving the quality of life for everybody around the world. And we should keep that in mind.”
These types of conversations are critical in making public health a more prominent global issue. 2014’s health-related headlines illustrate the tremendous influence of public perception on how health issues are, or are not addressed. Unwarranted fears of catching Ebola swept across the globe based on misunderstanding and mass hysteria. Patients continued to demand antibiotics from their doctors to treat viruses, threatening a post-antibiotic era. In the US, confusion surrounding access, delivery and cost challenged the promise of the Affordable Care Act.
This exhibit provides an excellent reminder that influencing the perception of issues in public health is a necessary step in achieving better outcomes. Enjoy the show.
Few coroners are likely to put “homelessness” as the cause of death. It is too bad, because we could use that level of honesty.
The omnibus appropriations bill that Congress passed last month to fund federal government operations and programs through the rest of the 2015 fiscal year (through September 2015) largely left out the Obama Administration’s proposed $300 million increase to the Department of Housing and Urban Development for permanent supportive housing units, part of the government’s effort to end chronic homelessness. The funding would have provided 37,000 new units of supportive housing by the end of 2016 (p. 2). Congress opted for a $30 million increase instead (fiscal year 2014 funding for these homeless assistance grants was $2.105 billion; the omnibus provided $2.135 billion), which is essentially only enough to keep up with inflation.
This omission will cost lives. Homeless people in the United States have a life expectancy 15 years shorter than the rest of us, 64 years compared to the U.S. average of 79. A study several years ago of Los Angeles’s homeless population had even more dire findings. The 2,815 members of this population who died from 2000 through 2007 had a collective life expectancy of 75 years (based on gender and ethnicity) – yet died, on average, when they were 48 years old. Latina women lived barely half their normal life expectancies. Such massive differences mirror findings in other studies.
How different this reality from the noble calls of the UN Secretary-General. The United Nations is approaching the homestretch in defining the Sustainable Development Goals (SDGs), the successors to the Millennium Development Goals (MDGs), which are due up this year. Last month, Ban Ki-moon issued his long anticipated synthesis report, bringing together the findings from a range of different consultation processes, meetings, and reports on the SDGs to feed into state negotiations, with the new goals expected to be finalized in September.
In his report (page 15), the Secretary-General insists that the new sustainable development agenda “must…address inequalities in all areas, agreeing that no goal or target be considered met unless met for all social and economic groups.”
What a remarkable change that would be, a concern about the worth of all of us, standing in sharp contrast to the politically expedient decision to sacrifice the homeless in the omnibus appropriations bill. Would the Secretary-General's proposal mean an end to homelessness?
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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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.