This post was inspired and informed by the collaborative research conducted by Ranit Mishori, Kevin FitzGerald, Sam Wu and Holly Hedley as part of the Georgetown Complex Moral Grant.
After a three year investigation, the UK’s Crown Prosecution Service (CPS) announced in late February of 2017 that it would not prosecute a surgeon and psychiatrist involved in a clitoris removal operation performed on an adult woman. Both physicians published a case study about the operation in 2012 and after reading it, another physician urged the CPS to investigate the case because it appeared to breach the UK’s law banning female genital mutilation/cutting (FGM/C). The case highlights some of the difficult questions that physicians and policymakers are currently considering as they struggle to reconcile a growing culture of female genital cosmetic surgery (FGCS) with the definitions included in well-established laws prohibiting FGM/C.
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 firstname.lastname@example.org.
“Obamacare is the law of the land,” spoke Paul Ryan late Friday afternoon, following the collapse of support for his proposed legislation, the American Health Care Act (AHCA), which would have massively reshaped the health care landscape. The Onion, admittedly a satirical newspaper, proclaimed, tongue-in-cheek, “GOP Makes Good On 2009 Promise To Block President’s Healthcare Bill.” The AARP proudly issued a statement: “Controversial Health Care Bill is Pulled: Voices of Americans were Heard.” Nancy Pelosi, House Minority Leader, forcefully opposed the proposed vote on her twitter account: “Every single Republican who votes for #TrumpCare will have this moral monstrosity tattooed to their foreheads forever. Every. Single. One.” She then celebrated the withdrawal of the AHCA, also on twitter: “This was a victory for all Americans. Democrats — united by our shared values — have stood strong against the disastrous #TrumpCare bill.” Even the Heritage Foundation, the standard-bearer for the Conservative movement, led with the headline: “Broad Conservative Criticism Mounts Against GOP Health Bill.”
What was the AHCA? Why was it so lampooned? And most importantly, what is the future of health reform in the United States?
Although it may seem like a harmless part of everyday life, high salt intake contributes to serious health risks that cause millions of deaths each year. This World Salt Awareness Week, we examine the health impacts of excess sodium intake, key sources of sodium in our diets, and an innovative regulatory intervention that can help reduce this “forgotten killer.”
Recommended levels of sodium
Most of the sodium we consume comes from salt. The World Health Organization (WHO) recommends that adults consume less than 2,000 mg of sodium, or 5 grams of salt, per day. This equates to less than one teaspoon of salt. The 2015-2020 Dietary Guidelines for Americans recommended that people aged 14 years and older consume less than 2,300 mg per day.
Globally, and within the United States, the majority of people consume too much sodium. Global average salt intake is estimated at 9 – 12 grams per day, double WHO’s recommended levels. In the United States, adults consume an average of more than 3,400 mg each day. Nearly 90% of US children consume more sodium than recommended.
Key sources of sodium
According to the CDC, more than 75% of sodium consumed by Americans comes from processed, prepackaged, and restaurant foods. More than 40% comes from 10 types of food, including bread, deli meats, pizza, poultry, and pasta dishes. Around 5% of dietary sodium is added during at-home meal preparation and 6% is added to food at the table. Read More
“Participating in the Health Rights Litigation course in September of 2013 granted me the opportunity to interact with some of the best minds on health and human rights in the world. I was among forty-four participants who were representative of twenty-four countries from around the world. I attended the course at a time when KELIN had a court case challenging the wrongful imprisonment of two TB survivors, who had interrupted their treatment. Plans were also underway to file a case to safeguard the rights of five women living with HIV who had been subjected to forced and coerced sterilization.
Listening to Manuel José Cepeda Espinosa, former Chief Justice of Colombia’s Constitutional Court, helped shape my thoughts on how to frame some of the remedies that I was seeking in relation to the two cases. Given that Colombia had similar constitutional provisions as Kenya, I could relate to the great talk by the learned Justice. The TB case was successful and some of the structural remedies that we included, based on what I learned, were granted by the court. I made connections with representatives of the International Community of Women Living with HIV- Global (ICW-Global), and they have since joined onto our ongoing cases as an interested party. Other global health professionals have joined onto the case as friends of the court. This is attributed to the global platform provided by this intensive but informative course. I recommend it to anyone keen to make a change in health by using the law.”
-Allan Maleche, Executive Director of KELIN
“Attending the Health Rights Litigation course on sexual and reproductive health and rights (SRHR) litigation in November of 2014 enabled me to engage with advocates with different political contexts and legal backgrounds from other countries and regions. As an SRHR advocate in Brazil and Latin America, I was able to deepen my knowledge of the historical and political differences and controversies between the sexual rights and the reproductive rights movements, share lessons learned at a historical moment, following the ICPD beyond 2014 review process, and discuss major gains and challenges remaining 20 years after the adoption of the Cairo Program of Action. We were also able to learn about pioneering legal research on the impact of SRHR litigation in different countries, advances in comparative law, new and emerging SRHR themes, and successful litigation strategies employed in countries like India, Colombia and Argentina.
In the months following the course, through my organization Ipas and with key support from the organizers of the Health Rights Litigation course and other regional partners such as Promsex and CLACAI, I was able to organize a regional workshop directed towards legal scholars and advocates from different countries in Latin America and aimed at sharing lessons learned and promoting the use of strategic litigation on SRHR based on recent progressive decisions from national and regional courts, building on decades of political struggle, mobilization and advocacy in the region.”
-Beatriz Galli, Senior Regional Policy Advisor for Latin America at Ipas
Applications for the 2017 Health Rights Litigation Intensive are available here and are due April 10, 2017.
President Trump’s budget blueprint slashes several social programs, including eliminating the 21st Century Community Learning Centers Program, which provides after school care to students of high-poverty and low-performing schools including snacks and meals, and cuts to funding for meals on wheels. Office of Management and Budget Director Mick Mulvaney defended the cuts to after school programs: “They’re supposed to help kids who don’t get fed at home get fed so they do better in school. Guess what? There’s no demonstrable evidence they’re actually doing that. There’s no demonstrable evidence they’re actually helping results, helping kids do better in school.” This blog argues that this charge runs contrary to the results of the program, and that investing in nutrition is economically and socially sound policy making.
The State of the Nation
Mulvaney’s utilitarian statement is amiss in a nation facing obesity and malnutrition side by side. One in three adults are thought to have obesity, including 1 in 2 adults experiencing extreme obesity. Further, 1 in 6 children aged 6-19 have obesity. Obesity is not merely an individual concern, but affects the society at large; in 2008 the medical costs associated with obesity were estimated at $147 billion. This does not include indirect costs of an estimated $3.38 billion. At the same time, in 2015 it was estimated that 12.7 % of households were food insecure, i.e. had difficulty at some time during the year providing sufficient food due to resources. While these numbers have declined in recent years, cuts to social programs may reverse this trend.
Results of Afterschool Programs
Further, the attack on after school programs runs contrary to available evidence. The 2013-14 performance report of the 21st Century Community Learning Centers Program demonstrates that 2.2 million children were served by the program, with 36.5% reporting improved math grades and 36.8% reporting better English grades. Teachers were also pleased with the program, with almost half reporting improvement in homework completion. Further, Mr Mulvaney’s charge is at odds with existing evidence that shows that a clear connection between students’ diets and school success.
The Societal Impact of Meals on Wheels
Meals on wheels provides meals to 2.4 million American senior citizens, including 500,000 veterans. While it not primarily dependent on federal funding (it mostly relies on individual contributions), these, and expected future cuts, are likely to have an impact on local service provision. As to the results of the program, reviews have found that meals on wheels improves recipients’ diets and increases food intake. The program can help avoid costly heath care bills and lower rates of nursing home care. Finally, meals on wheels can, in some cases, provide needed social contact.
These are just some of the proposed cuts that will harm vulnerable families if implemented. For now, the proposals run contrary to the nutritional deficiencies facing millions of Americans. Indeed, although President Trump seeks to beef up military, he may struggle to recruit in a nation facing diet-related disease. However, we won’t know the full specifics until the budget is finalized.
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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.