USING GLOBAL HEALTH LAW IN PUBLIC HEALTH ADVOCACY CAMPAIGNS Peter D. Jacobson, JD, MPH Professor of Health Law and Policy University of Michigan School of Public Health 29 April 2008

Law as effective organizing tool  Law as complement to advocacy/social movements  Specific global health laws of interest  Relationship between global and domestic health laws Overview

LAW AS EFFECTIVE ORGANIZING TOOL Defining public health objectives o Public health preparedness o Developing public health systems o Reducing disease burden (i.e., AIDS, tobacco) Choosing the right legal tools o Domestic law o Global health law o Legislative/administrative advocacy

USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY ROLE: I Define ideal system given Brasil’s legal/political traditions o Centralized vs. decentralized o Role of government vs. private sector o Scope of public health issues to confront o Identity other domestic agencies for collaboration o Identify international agencies for collaboration (e.g.. WHO, World Bank)

USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY ROLE: II Build on Brasil’s primary care health expansion strategy to promote access to essential services Identify global models (not USA!) for population-level health activities o Other middle income countries such as Thailand or Malaysia

USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY ROLE: III Identify gaps in existing laws/recommend changes o Surveillance authority o Mandated services o Funding streams o Authority to declare and report public health emergency o Public-private collaboration for preparedness Use global health laws

USING LAW TO DEVELOP PUBLIC HEALTH SYSTEMS: ADVOCACY ROLE: IV Policymaking transparency o Separate NGOs from dependence on government o Confront private donor dilemma (Global AIDS Fund dominates public health system) Local capacity building o Information (data collection, technology) o Resource allocation Balancing population health and individual liberties

USING GLOBAL HEALTH LAWS: HUMAN RIGHTS--I  Not self-executing o Useful in enacting domestic legislation o Effective complement to social movement approach  Right to health o Government accountability for human rights (i.e., defining minimum level of health care expected) o Frame policy choices with moral dimension o Opponents’ may co-opt human rights

USING GLOBAL HEALTH LAWS: HUMAN RIGHTS--II Helsinki Accords o Derided as give-away to Soviet Union o Emerged as major breakthrough in human rights o International attention changed treatment of dissidents IESCR Comment 14—to fulfill right to health, states must: o Refrain from interfering with right to health o Prevent third parties from interfering with right to health o Take positive action to realize right to health

USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH REGULATIONS (IHR)--I  Holding sovereign states responsible for: o Core capacity to detect/treat disease outbreaks o Disease reporting systems  Advocate for legislation to clarify central vs. local responsibility for public health emergency o Negotiated agreements o Resource allocation

USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH REGULATIONS (IHR)--II  Advocacy for improved public health system o Designing system to meet IHR responsibilities o Role of central vs. local governments o Advocating for resources  Advocate for national guidelines and accountability measures for o Standard data collection o Reporting obligations

USING GLOBAL HEALTH LAWS: INTERNATIONAL HEALTH REGULATIONS (IHR)—III  Role of advocacy in Merck vs. Brasil o Short-term access to ADIS Rx relative to long-term drug development/investment o Hold government to promised free treatment for AIDS patients o Advocate for laws to impede spread of AIDS (i.e., needle sharing, condoms, testing)

USING LAW TO REDUCE TOBACCO USE: I  Legislative change o State and local no-smoking laws o Legal restrictions on youth access to tobacco o Higher taxes  Litigation o Individual and class action lawsuits o Forced tobacco industry to disclose damaging documents Helped raise cigarette prices

USING LAW TO REDUCE TOBACCO USE: II  Stimulated voluntary changes o Smoke-free workplaces o Employers requiring employees to stop smoking  Stimulated social movements o Local tobacco control coalitions o Legislative advocacy  Stimulated global Framework Convention on Tobacco Control

CONCLUSION Law can be effective tool for advocacy Domestic and global health law useful for organizing public health system No inherently correct way to organize public health system