1. 1 Modeling International Laws to Protect the Public’s Health: The WHO Framework of Essential Elements for Comprehensive National Legislation on the Health of the Public [with special attention to the MDGs] April 11, 2006 James G. Hodge, Jr., J.D., LL.M. Associate Professor, Johns Hopkins Bloomberg School of Public Health; Executive Director, Center for Law & the Public’s Health at Georgetown and Johns Hopkins Universities

2. 2 Principal Objectives Briefly Introduce the Millennium Development Goals [MDGs] Assess the Challenges to Accomplishing MDGs Framework of Essential Elements for Comprehensive National Legislation Introduce the WHO Framework of Essential Elements for Comprehensive National Legislation Discuss Major Challenges and Next Steps

3. 3 The Millennium Development Goals [MDGs] The product of the United Nations Millennium Summit of 2000 Heads of 147 member states adopted a series of goals to address extreme poverty while promoting education, gender equality, and environmental sustainability Subsequently endorsed by 189 countries Sets quantitative targets for 2015 (relative to 1990)

4. 4 The Millennium Development Goals [MDGs] 1. Reduce extreme poverty and hunger by 50% 2. Achieve universal primary education 3. Promote gender equality and empowerment of women

5. 5 The Millennium Development Goals [MDGs] 4. Reduce child mortality by 2/3. 5. Improve maternal health, including reducing maternal mortality by 75%. 6. Prevent the spread of HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

6. 6 The Millennium Development Goals [MDGs] In 2005, five years since the introduction of the Millennium Summit, the UN took its first major snapshot of international progress toward the accomplishment of the MDGs While some countries have made good progress on many fronts, virtually all nations need to more systematically address the goals According to Prof. Jeffrey Sachs, many of the world’s poorest regions, notably in sub-Saharan Africa, are “far off-track to achieve the goals.”

7. 7 The Millennium Development Goals [MDGs] Major Challenges FinancesInfrastructurePovertyEducationCapacitiesLawsPolicies

8. 8 WHO Framework of Essential Elements for Comprehensive National Legislation WHO recognizes that national or regional public health law can be vital to advance the health- related MDGs and other public health initiatives.

9. 9 WHO Framework of Essential Elements for Comprehensive National Legislation The premise is that improvements in the public’s health can be stimulated through the development of a comprehensive legislative approach that addresses essential elements of public health within a sound infrastructure and reflects core principles of human rights, ethics, science, and practice.

10. 10 WHO Framework of Essential Elements for Comprehensive National Legislation Key Objectives Demonstrate capacity to accomplish MDGs through modernized public health systems; Create a framework of public health legal issues that stimulates policy-making and implementation to effectuate health-related MDGs; Systematically guide countries in their efforts to examine the use of its health-related resources as part of ongoing reprioritization processes related to MDGs

11. 11 WHO Framework of Essential Elements for Comprehensive National Legislation The legislative approach is organized into four major parts, each of which includes various Articles and suggested content areas, as follows: Part I – Public Health Principles, Infrastructure, and Relationships Part II – Public Health Powers, Duties, and Responsibilities Part III – Key Areas to Protect and Promote the Public’s Health Part IV – Public Health and Health Systems

12. 12 WHO Framework of Essential Elements for Comprehensive National Legislation Part I – PH Principles, Infrastructure, Relations Article 1.1 – Purpose, Scope, and Definitions Article 1.2 – Fundamental Principles and Values + Human rights + Public health ethics + Sustainable development + Public health practice Article 1.3 – Intersectoral Partnerships and Coordination + Domestic relationships + International and foreign relationships

13. 13 WHO Framework of Essential Elements for Comprehensive National Legislation Part II – PH Powers, Duties, Responsibilities Article 2.1 – State’s Role to Protect the Public’s Health + Essential ph services and functions + Fundamental limits on ph services Article 2.2 – Planning for National Health Article 2.3 – Conditions of Public Health Importance + Public health activities and populations + Public health activities and individuals Article 2.4 – Public Health Emergencies Article 2.5 – Implementation of the Revised IHRs

14. 14 WHO Framework of Essential Elements for Comprehensive National Legislation Article 2.3 – Conditions of Public Health Importance A disease, syndrome, symptom, injury, or other threat to health that is identifiable on an individual or community level and can reasonably be expected to lead to adverse health effects in the community.

15. 15 WHO Framework of Essential Elements for Comprehensive National Legislation Part III – Key Areas to Protect and Promote PH Article 3.1 – Child and Adolescent Health Article 3.2 – Sexual and Reproductive Health Article 3.3 – Specific Communicable Diseases – TB, HIV/AIDS, Malaria Article 3.4 – Injury and Disability Control Article 3.5 – Health Promotion and Community Intervention

16. 16 WHO Framework of Essential Elements for Comprehensive National Legislation Part III – Key Areas to Project and Promote PH [continued] Article 3.6 – Healthy Environments and Sustainable Development Article 3.7 – Nutrition Article 3.8 – Safe Food Supply and Agriculture Article 3.9 – Worker’s Health

17. 17 WHO Framework of Essential Elements for Comprehensive National Legislation Part IV – Public Health and Health Systems Article 4.1 – Health and the Medical Care Systems Article 4.2 – Mental Health Services Article 4.3 – Medicaments and Medical Devices Article 4.4 – Veterinary Practices

18. 18 WHO Framework – Major Challenges Approach Scope Application Specificity Infusion Content Relevance

19. 19 WHO Framework – Major Challenges The Challenge of Approach – The draft is intended for use among countries with differing health systems and diverse legal approaches, cultural traditions, religious beliefs, and socio-economic conditions. Can one set of provisions address all of these factors?

20. 20 WHO Framework – Major Challenges The Challenge of Scope – To the extent that the draft moves beyond core or traditional public health functions, does it exceed the scope of a model international public health law?

21. 21 WHO Framework – Major Challenges The Challenge of Application – Even if the approach and scope of the document are on target, questions of its intended application arise. Is the model intended to be universal in its application, or are member states to be encouraged to deviate from its norms?

22. 22 WHO Framework – Major Challenges The Challenge of Specificity – While the draft presents generalized principles, guidance, and infrastructure, it also attempts to create provisions for specific conditions (e.g., HIV/AIDS, malaria, TB). Is specification necessary for addressing existing or emerging conditions?

23. 23 WHO Framework – Major Challenges The Challenge of Infusion – How extensively should a model public health act include core health services? Various drafts of the outline have increasingly infused core health services into the subject matter. The most current draft strongly explores components of individualized health services. Some reviewers suggest a need to better delineate public health vs. health services.

24. 24 WHO Framework – Major Challenges The Challenge of Content – What form should the content of the model act take? Can meaningful specific legislative provisions be drafted? Alternatively, should general principles of content simply be offered? Ultimately, the idea is to produce model language that highlights the specific content areas for national public health laws. Will this be enough to stimulate public health legislative reform?

25. 25 WHO Framework – Major Challenges The Challenge of Content [cont.] – Furthermore, how extensively will the provisions reflect legal, ethical, and human rights norms? The challenge is how to weave these norms into the model in a way that goes beyond aspiration. The key is how to craft provisions that require adherence to these standards.

26. 26 WHO Framework – Major Challenges The Challenge of Relevance – The presumption underlying the project is that legislative reform that seeks to improve public health infrastructure and equip it with meaningful and scoping powers will lead to positive public health improvements. Though logical, how can this presumption be proven? How can the relevance of model public health legal reforms be shown?

27. 27 WHO Framework – Major Challenges Next Steps Continued guidance from global experts within and outside of WHO Designation of content areas for initial drafting Selection of drafting contributors for various areas Systematic building of the model document through organized contributions across the globe

28. 28 Final Thoughts For more information about this project or to offer your comments concerning the draft, please contact me at jhodge@jhsph.edujhodge@jhsph.edu Thank you!