Is this really a public health issue? Am I just tired of writing about Ebola and traditional non-communicable diseases that I’ve decided to make low back pain, something that we’ve all experienced, into a public health problem?
Maybe. Then again, did you know that low back pain is the leading cause of activity limitation and work absence throughout much of the world? In the US, it is the most common cause of job-related disability and a leading contributor to missed work days – approximately 149 million work days are lost every year because of low back pain, with total costs estimated to be US$100-200 billion a year. Low back pain is also the most frequently reported pain condition among adult Americans.
In a recent global burden of disease study (that is, a study looking at the burden of all disease in the world), low back pain ranked sixth in terms of overall burden of disease – right below stroke and HIV/AIDS, and above 291 other conditions surveyed, including road injury, depression, diabetes, TB, and all mental health conditions and cancers.
To get technical just for a moment, the burden of disease is measured by disability-adjusted life years (DALYs), which are calculated by combining years of life lost (YLL) due to premature mortality, and years lived with disability (YLD). Because nobody dies from low back pain, when you look just at the YLD, it actually ranks number one – ie the greatest contributor to disability in the entire world. Read More
The Medicaid block grant proposed as part of the Patient Choice, Affordability, Responsibility and Empowerment Act (“Patient CARE Act”) would radically transform Medicaid without the consent of states and would likely be considered unconstitutional, say two legal experts in a New England Journal of Medicine Perspective article published online today.
Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute School of Public Health at the George Washington University, and Timothy Westmoreland, JD, a professor from practice and senior scholar at the O’Neill Institute for National and Global Health Law, explain that the change proposed to Medicaid, a state-run program, appears to be a violation of the Tenth Amendment.
The Patient CARE Act is a bill proposed by leading Republican members of Congress, including the chairs of two of the major committees with jurisdiction over health issues, the authors explain. It would repeal the Affordable Care Act’s insurance reforms and significantly scale back premium subsidies. It would eliminate all federal funding for the ACA’s new adult expansion population; end Medicaid’s comprehensive coverage for low-income children, pregnant women, and families with dependent children; and end long-term care services and supports for elderly Medicaid beneficiaries as well as Medicaid beneficiaries with disabilities. Read More
The O’Neill Institute for National and Global Health Law at Georgetown University is pleased to announce the launch of the launch of The Lancet – O’Neill Institute, Georgetown University Commission on Global Health and the Law.
This commission's focus is that law should be viewed as a major determinant of health and safety and can be utilized as a powerful and innovative tool to address pressing global health concerns. In our introductory “Comment” published online in The Lancet, the Commission’s co-chairs Lawrence O. Gostin and John T. Monahan, along with the Commission’s project coordinator, Mary C. DeBartolo, and Richard Horton, Editor-in-Chief of The Lancet, say the aims of the Commission are to “define and systematically describe the current landscape of law that affects global health and safety” and that the group will “make the case for the power of law to improve health while revealing current opportunities and challenges under the status quo.”
Posted in FDA, Global Health, Health reform, Human Rights, National Healthcare, Tobacco, Trade, WHO; Tagged: Ebola, georgetown, globalhealthlaw, Gostin, governance, health, lancet, law, publichealth, WHO.
The other week I recalled a presentation I made a few years ago in a law school seminar on one aspect of the Patient Protection and Affordable Care Act (PPACA) or “Obamacare,” if you must. As I was a dual degree student in the School of Public Health, I wanted to focus my presentation on some of PPACA’s more traditional public health elements. To that point, most of the seminar’s material was focused on the health system/ individual health insurance market changes. As I began my presentation, however, I wanted to make one disclaimer – I “heart” modern medicine!
I love the power of cutting edge innovation and technology. I am the beneficiary of remarkable technology that has allowed friends and family to live healthier, longer and fuller lives. I realize I am incredibly fortunate that my love ones have had access to this beautiful modern technology. Therefore, this love poses complicated dilemmas for me as I work in public health.
Posted in Uncategorized;
We are all increasingly aware of the vast array of tactics employed by the tobacco, alcohol, and junk food industries to encourage us to consume their hazardous products. For decades, Big Tobacco deliberately deceived the public about the dangers of smoking and exposure to second-hand smoke. The alcohol industry targets products and advertising at young people. Junk food “children’s meals” are movie-themed and often packaged with toys for children to collect.
Policies and laws that address non-communicable diseases (NCDs) typically target four shared, modifiable risk factors (tobacco, the harmful use of alcohol, unhealthy diets, and physical inactivity) that are largely responsible for cardiovascular disease, cancer, respiratory diseases, and diabetes. While some policies and laws address underlying corporate drivers of NCD risk factors—for example, bans on soda and snack vending machines in schools and restrictions on cigarette advertising—most of the policy dialogue continues to emphasize individual behavioral factors rather than their underlying corporate drivers.
Conceptualizing corporate behavior as an underlying driver of NCDs and incorporating corporate behavior as part of the NCD policy dialogue are important steps towards reducing or eliminating these behaviors and addressing the NCD epidemic.
Adding corporate behavior to the pyramid of NCD risk factors
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This post was written by Lawrence O. Gostin, Faculty Director of the O’Neill Institute for National and Global Health Law and University Professor, Georgetown. It was originally published by news@JAMA on April 14, 2015. It is re-posted here with the permission of the author. Any questions or comments can be directed to email@example.com.
In September 2014, at the height of the West Africa Ebola epidemic, Margaret Chan, MD, DSc, director-general of the World Health Organization (WHO), downplayed the agency’s role in taking a lead in fighting the outbreak in an interview with the New York Times (http://nyti.ms/1ArLPqE). WHO “is a technical agency,” Chan said, adding that it is governments that “have the first priority to take care of their people.” In January 2015, the Chan again deflected responsibility, saying she was following protocol, leaving it to the WHO’s Regional Office for Africa (AFRO) to respond (http://nyti.ms/1ArxfO8). Yet, Guinea, Liberia, and Sierra Leone—among the world’s poorest countries—could not have contained the outbreak on their own.
In January, the WHO Executive Board proposed major reforms, which the World Health Assembly will consider in May (http://bit.ly/17z0ViG). The outcome of the reform movement could affect the WHO’s status and credibility for a generation. Here are 5 reforms I propose needed to uphold the WHO’s constitutional mandate (http://bit.ly/1BuNFtc) as “the directing and coordinating authority on international health work.”
Looking back over the public health books I’ve read in the last few months, I realized a noticeable slant towards infectious disease. In this post I will share some of my favorite reads from the past 6 months or so. These range from a page-turning beach read (The Demon in the Freezer) to a classic work of literature (The Plague). Happy reading!
Rabid – Bill Wasik & Monica Murphy
“It’s almost as if the very anachronism of rabies, to the Western mind, has rendered it even more intriguing to us. Like the vampire, rabies carries with it the musty whiff of a centuries-old horror, even as it still terrifies us in the present day.”
While I wasn’t sure how engaging I would find a book about rabies, I was very pleasantly surprised. The book is an exciting journey through the history of the disease and an exploration of how deeply embedded it is in our culture (what the authors refer to as “our dark fascination with rabies.”) For anyone with even a passing interest in public health, infectious disease, or the historic origins of our current obsession with vampires and zombies, I highly recommend the book. Read More
*you may want to wait until after you see these films to decide whether your popcorn of choice is safe to eat.
In Part I of this season’s film series, we will focus on the role of the food industry in shaping American eating habits. Big Food, Sugar, Human Rights are among the common themes explored in the documentaries described below. If you are a person living in the US who eats every day, then each of these documentaries is a must see. Don’t have time to watch the whole film? Get a taste of many crucial issues impacting America’s food supply by following the link to each film’s two minute trailer.
This film tells the story of the rise of the processed food industry and its tremendous influence on consumer preferences, health and well-being.
This documentary exposes the role of sugar and Big Food in creating the obesity epidemic now plaguing America.
This exposé chronicles a modern slavery network providing agricultural products for America’s supermarket industry. The narrative of the film follows the Coalition of Immokalee Workers - a group of tomato pickers from Southern Florida – who were once among the most exploited and abused laborers in modern American history. The film chronicles their story and triumph over a corrupt industry.
Caution: Each of these films may cause major behavioral changes in your general food consumption habits.
Stay tuned for Part II.
In Bolivia, knitting and weaving are ancient craft skills that have been developed over centuries and even predate the Incan Empire. Today, Bolivian women are knitting high-technology devices known as "occluders" to combat a type of congenital heart disease in children. Developed by cardiologist Franz Freudenthal, the device is an inexpensive alternative to the standard devices that are industrially produced. With Bolivia being one of the poorest countries in the Americas and with one of the highest infant mortality rates in the region, the device has the potential to save hundreds of children's lives.
You may have seen the January 2015 WHO Executive Board resolution on Ebola, which calls for many important things, including a global health reserve workforce, a contingency fund, and human resource management reform. All could help develop a smarter global health system.
But did you see this paragraph on humanitarian asssitance, which points decidedly in the wrong direction?
Emphasizing also the fundamentally civilian character of humanitarian assistance, and reaffirming, in situations in which military capacity and assets are used as a last resort to support the implementation of humanitarian assistance, the need for the use to be undertaken with the consent of affected States and in conformity with relevant provisions of international law,
Fortunately, this is in the preamble, and in the present context, has no impact. The countries affected by Ebola welcomed international support, including military capabilities; "consent of affected states" was not at issue. Yet this is a misleading statement as a matter of law that I believe ought not pass silently. It is a reminder of the struggle to ensure global priority of human rights over assertions of sovereignty, of the need of constant vigilance to ensure that old, destructive norms do not re-emerge. 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.