Public Health Law Research Trends: Q&A With Lawrence Gostin
Lawrence Gostin wrote two of the founding books on public health law and developed some of the most influential public health model policies of our time. NewPublicHealth spoke with Lawrence Gostin, JD, Linda D. and Timothy J. O’Neill Professor of Global Health Law at the Georgetown University Law Center and director of the O’Neill Institute for National and Global Health Law, about his keynote address at this week’s Public Health Law Research (PHLR) Annual Meeting and emerging trends in public health law.
>>NewPublicHealth will be covering the PHLR Annual Meeting all week, including Q&As with some of the top researchers and influencers who are presenting. Follow our coverage here.
NewPublicHealth: What do you plan to speak about at the PHLR meeting?
Lawrence Gostin: I’m going to speak about global health law and global health governance. The idea is to talk about something that’s innovative and exciting and I have a proposal for a Framework Convention on Global Health, which is a global health treaty that the UN Secretary General has endorsed and many countries now are on board. So it’s an exciting, fascinating and vital time for global health. We’re really expanding the horizons beyond America to how we can make sure that all the world’s people have good health, and particularly those who are poor and vulnerable.
NPH: That’s very interesting. What is the treaty about?
Lawrence Gostin: We’ve had an unprecedented increase in global health assistance in the last ten years. There are two observations—the first is that that increase won’t last because of the financial crisis. At the same time, we’re facing a whole network of harms to the health of the global population, including famine and food insecurity and the increase of food prices, climate change and emerging infectious diseases like novel influenzas, which are placing a real strain on countries, not to mention the ongoing epidemics of AIDS, tuberculosis and malaria and now the burgeoning of non-communicable diseases like heart disease and diabetes. Developing countries are now facing a duel burden of both infectious and non-infectious chronic diseases that threatens to really harm the health of the global community.
We’re facing a time of enormous peril. At the same time, even the ten-fold increase in global health aid has done very little of anything to markedly improve the health of the world’s population. Disparities between the rich and poor in terms of health are greater than they’ve ever been. The status quo simply won’t work. We’ve got the wrong priorities. The Framework Convention on Global Health places responsibilities on all states, from the richest to the poorest, to devote a reasonable percentage of their resources on health systems and to develop health capacities and really concentrate on public health and health care for their populations.
At the same time, it places a responsibility on the international community to provide global health assistance. We don’t like the idea of global health aid, because that makes it seem like there are certain donors who are giving charitably and certain recipients who are beggars. In fact, global health at the international level benefits both the rich and the poor, and they should have legal responsibilities. We also want to make sure that all the intersecting regimes from climate change and the environment to humanitarian law, law of armed conflict, food security, refugee law—all of those things place great stresses on human health, and we want to see health at the center of global law and governance. We formed a global coalition called the Joint Action and Learning Initiative on National and Global Responsibilities for Health, and the coalition is building the intellectual and other capacities needed to push for a global health convention. We have partners from all over the world working on this.
NPH: You mentioned that this approach to global health benefits all countries involved, from the richest to the poorest. Why is this?
Lawrence Gostin: It’s literally impossible now for any single country, no matter how rich and powerful, to protect itself from health threats in isolation, because health threats are now global. People travel at unprecedented levels and speed. Food and commerce, vaccines and pharmaceuticals are international, and even lifestyles are international. The U.S. cannot insulate itself from these global forces. Think about the fact that such a high percentage of our food and drug ingredients are imported from China, Latin America. In many cases we’ve had counterfeit drugs, food that’s contaminated, drugs that are contaminated, huge scarcity of vaccines. All of these are global problems and the U.S. can’t just sit on the sidelines. We need to lead, for our own people’s benefits as well as for the benefits of the global community.
NPH: What are some of the biggest issues and concerns in public health law research right now?
Lawrence Gostin: There’s so much we don’t understand about what works and what doesn’t work, in terms of law and regulation. Law can be a tool for the public’s health, but it can only be a tool if we know what’s maximally effective. We can’t know that without good, sound knowledge and research. [See a related report from the Institute of Medicine, and the NewPublicHealth interview with the chair of the report committee.]
NPH: Tobacco is a good example of public health research spurring policy change. How can public health law researchers target their projects so that their results can influence advocates and policymakers who have the ability to make large-scale changes on behalf of the public’s health?
Lawrence Gostin: Tobacco is a great illustration, not only because of the obvious fact that it causes the greatest preventable burden of disease and the fact that law has played such an important role in stemming its effects, but it’s also because tobacco is both a national and an international problem, and they intersect with one another. We need to fight tobacco both on a domestic and a global front.
NPH: In the midst of the anthrax letter scare in Fall 2001, you developed the Model State Emergency Health Powers Act, in an effort to more effectively control epidemics and respond to bioterrorism. What are some of the ways laws and policies can help us to be better prepared in the event of an emergency?
Lawrence Gostin: CDC asked my center to do that in response to 9/11 and the anthrax attacks. It’s been adopted in whole or part in something like 40 states. It’s a real example of how public health law can be successfully reformed by an academic-policymaker partnership.
NPH: Can you also tell us about the Model State Public Health Act?
Lawrence Gostin: The Robert Wood Johnson Foundation funded my center to draft a model public health act. It took about two years; it was a really ambitious, far-reaching public health project. Unfortunately, many states have not adopted it yet. We’re hoping the new IOM report on public health law will change that, because it’s recommended that all states consider the Model Public Health Act. They recommend all states review their current laws and see how they can advance them using the tool of the Model Public Health Act. The Act requires that all states have all the powers they need, that they have good protections of privacy and non-discrimination, that they have the core capacities and expertise in human resources for a sound public health system. It talks about the entire essential public health services, and that states should ensure that their statutes make provision so that all health departments have the capacity, legal power, funding and resources to efficiently and professionally carry out all of the public health essential services.
NPH: Do you expect that national public health department accreditation could have an impact on adoption of some of the provisions of the Model State Public Health Act?
Lawrence Gostin: I’m personally in favor of accreditation, and as a member of the Institute of Medicine, we did recommend that as a good goal for public health agencies. It’s a controversial issue, but I believe we need to upgrade and professionalize public health. In the same way that we think of the professional health care system, we need to think of a highly professional public health system, and accreditation is one way of doing that. It needs to be done in a way that devotes the resources to it.
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