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The Global Health Security Agenda in an Age of Biosecurity
Get PDFHistorically, the Oval Office has been a leader in global health assistance. From the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI) under the Bush Administration, to the Global Health Initiative launched by President Obama in 2009. However, unlike PEPFAR and PMI, the Global Health Initiative met an untimely end with the launch of a bold new global health measure by the Obama Administration: the Global Health Security Agenda (GHS Agenda). The GHS Agenda aims to “accelerate progress toward a world safe and secure from infectious disease threats” through a US-led diplomatic collaboration with 30 countries, international organizations, nongovernmental organizations, and public/private entities.
The intertwining of global health and security follows a line of international agreements, including the revised International Health Regulations (2005), aimed at improving surveillance and response to public health emergencies of international concern. By mid-2012 however, only 22% of WHO member states had implemented the required core competencies. The GHS Agenda aims to address these global deficiencies in infectious disease preparedness. In doing so, the United States faces formidable obstacles including America’s lack of legal legitimacy in setting global norms, as well as the same domestic coordination difficulties that resulted in the dissolution of the Global Health Initiative, and the potential impediment of passing the President’s budget through a hostile Congress. While the securitization of global health has its criticisms, it also has the potential to be transformative, succeeding where international organizations have not always been able to, building a safer and healthier world
Healthy Living Needs Global Governance
Get PDFIt may seem counter-intuitive, but the same factors that drive the spread of infectious diseases also contribute to the dominance of non-communicable diseases (NCDs) in the global burden of disease—urbanization, global markets and harmonized cultures. NCDs have overtaken infectious diseases as the leading cause of morbidity and premature mortality worldwide, with deaths concentrated among the poor due to the growing availability and affordability of highly-processed, unhealthy foods, alcohol and tobacco.
The global response to NCDs has been slow and fractured, with the World Health Organization dedicating scant funding and the United Nations waiting until September 2011 to hold a high-level summit on prevention—despite previously holding three summits on HIV/AIDS. Yet, researchers have identified a suite of cost-effective NCD prevention measures. While tobacco control provides a model for international and national regulation of NCD risk factors, there are significant barriers to further action in prevention, including industry lobbying against strong government regulation, philanthropic action favoring swift wins in infectious disease control, and the framing of NCDs as an individual rather than collective problem.
Stronger global governance could spur national action by providing funding, creating stronger norms and holding states accountable. The UN’s comprehensive review on progress in NCD prevention, held in July 2014, offered an opportunity for the international community to take concrete steps in strengthening global prevention efforts. This article proposes four concrete steps for a long-term solution: creating a dedicated fund for NCD control and prevention; regulating industry to improve nutrition and restrict alcohol and tobacco marketing; altering the built environment to promote physical activity; and prioritizing prevention in all sectors of government and in the global regimes that govern NCD risk factors. Only through these steps can we ensure healthy, more vigorous lives for the entire global community
The Ebola Epidemic: A Public Health Emergency of International Concern
Get PDFOn August 8, 2014, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crises a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR).
The most affected West African states have attempted classic public health measures with varied success, including quarantine and isolation, social distancing, risk communication, and travel restrictions. These have involved a trade off between population health and human rights; sometimes to the disadvantage of both. At the same time, the countries’ health systems and human resources are fragile, impeding an effective response.
Beyond the public health and humanitarian implications, this crisis has raised controversial ethical issues concerning the withholding or providing early access to investigational therapies, the preference given to foreign aid workers, and the disproportionate impact of Ebola on domestic health care workers.
The WHO director-general’s declaration of a public health emergency of international concern underscores the urgency of a coordinated international response and the imperative of raising the health systems capacity of low-income states. However, the current outbreak demonstrates how global governance has suffered from a lack of binding international commitment to sustainable capacity building and technical assistance in low-income states
The Historic Role of Boards of Health in Local Innovation: New York City’s Soda Portion Case
Get PDFChildhood and adult obesity pose major risks for cancer, diabetes, and cardiovascular disease, with the poor and racial minorities suffering from disproportionately high burdens of obesity and chronic disease. With current policies failing, cities and states have moved forward with creative prevention measures–-with boards of health driving policy innovation in many local jurisdictions. The New York City Board of Board of Health’s (NYCBH) soda portion limit pushed the boundaries of innovation, but was struck down on June 26, 2014 by New York State’s highest court, which held that the Board trespassed on the City Council’s authority.
The Court’s decision ignored the critical role of local health agencies in responding to 21st century public health threats, including epidemics of obesity and chronic disease. The Court narrowly construed the NYCBH’s authority, characterizing its powers as administrative, and thus potentially stifling local innovation. The decision also obscured the fundamental truth that public health policymaking requires complex trade-offs and incremental action, as well as a multifaceted approach to reducing population weight gain. Policymaking often relies upon limited evidence, and agencies experiment with novel ideas while also transforming social norms and pushing the boundaries of public opinion. Although the portion rule would disproportionately affect disadvantaged individuals who drink the largest amount of soda, government’s failure to act represents a greater injustice. Enhancing opportunities to choose a healthy life path better serves the interests of justice, but the Court’s judgment takes us further away from realizing this social aspiration
Ebola: A Crisis in Global Health Leadership
Get PDFAt the core of the present Ebola crisis in West Africa is a lack of global health leadership. WHO should be the global health leader, following its constitutional charge, yet it is significantly under-resourced, having a direct effect on its rapid response capacity. The Organization\u27s response to this crisis has been constantly behind, from low funding appeals to its delay in declaring this outbreak to be a Public Health Emergency of International Concern under the binding International Health Regulations (2005) (IHR). The IHR themselves have proven insufficient, as countries have failed to cooperate in building the public health capacities that the IHR requires, reflecting the absence of incentives, sanctions, or a clear allocation of responsibility.
The United States and United Nations have sought to fill this leadership vacuum. The United States is deploying military assets to utilize their logistics, engineering, and similar capacities. Yet a single state cannot fill the significant governance gaps, mobilizing and coordinating global efforts. The United Nations has now assumed this leadership role. The UN Security Council\u27s resolution has raised the political profile in a way that WHO could not even as the resolution left unclear the exact duties required of states. The UN Secretary-General initiated the UN Mission for Ebola Emergency Response.
Going forward, the United Nations must maintain its leadership, from the Security-General identifying states that fail to contribute fairly to the global response -- or that strip other health and development funding to do so -- to the Security Council being prepared to pass another resolution, this one with unambiguous binding authority and clear allocation of responsibility. Looking further ahead, the Security Council should interpret its mandate for maintaining international peace and security broadly, encompassing human security. States should give WHO the funding and other support the Organization requires, as WHO undertakes reforms necessary for it to be a global health leader. The UN Secretary-General and WHO Director-General should establish an independent commission to comprehensively review the response and recommend what is needed to prevent future global health emergencies. National and institutional leaders must respond to Ebola by enacting the far-reaching reforms required for genuine global health leadership, exercising the political will and leadership whose absence enabled the current Ebola outbreak to turn into a global crisis
Delaware Public Benefit Corporations 90 Days Out: Who\u27s Opting In?
Get PDFThe Delaware legislature recently shocked the sustainable business and social enterprise sector. On August 1, 2013, amendments to the Delaware General Corporation Law became effective, allowing entities to incorporate as a public benefit corporation, a new hybrid corporate form that requires managers to balance shareholders’ financial interests with the besat interests of stakeholders materially affected by the corporation’s conduct, and produce a public benefit. For a state that has long ruled U.S. corporate law and whose judiciary has frequently invoked shareholder primacy, the adoption of the public benefit corporation form has been hailed as a victory by sustainable business and social enterprise proponents. And yet, the significance of this victory in Delaware is premature. Information about the number and types of companies opting into the public benefit corporation form has been preliminary and speculative. This article fills that gap. In this article, I present original descriptive research on the 53 public benefit corporations that incorporated or converted in Delaware within the first three months of the amended corporate statute’s effectiveness. Based on publicly available documents and information, I analyze these first public benefit corporations with respect to the following characteristics: (1) year of incorporation as a proxy for corporate age, (2) industry, (3) charitable activities, (4) identified specific public benefit, and (5) adoption of model legislation options not required by the Delaware statute. My analysis returns the following results: 75% of public benefit corporations are likely new corporations in their early stages of operation; 32% of public benefit corporations provide professional services (e.g., consulting, legal, financial, architectural design), the technology, healthcare, and education sectors each represent 11% of public benefit corporations, 10% of public benefit corporations produce consumer retail products; approximately 40% of public benefit corporations could have alternatively incorporated as a charitable nonprofit exempt from federal income taxes. This article discusses these and other findings to assist in understanding the public benefit corporation and how it has been employed within the first three months of its adoption
Agency Enforcement of Spending Clause Statutes: A Defense of the Funding Cut-Off
Get PDFThis article contends that federal agencies ought more frequently to use the threat of cutting off funds to state and local grantees that are not adequately complying with the terms of a grant statute. Scholars tend to offer four arguments to explain—and often to justify—agencies’ longstanding reluctance to engage in funding cut-offs: first, that funding cut-offs will hurt the grant program’s beneficiaries and so will undermine the agency’s ultimate goals; second, that federalism concerns counsel against federal agencies’ taking funds away from state and local grantees; third, that agencies are neither designed nor motivated to pursue funding cut-offs; and fourth, that political dynamics among state governments, Congress, the White House, and the agencies themselves make funding cut-offs difficult to achieve. This article argues that these critiques are deeply flawed. Among other problems, the critiques fail to account for the variety of types of grants, grant conditions, and rationales for grantee noncompliance; reflect lack of a nuanced understanding of the ways in which distinct federalism concerns play different roles at different times in the development and implementation of grant programs; and unrealistically assume static and unified agency incentives and political relationships. After debunking these critiques, the Article offers a new conception of the potential benefit of funding cut-offs in the enforcement of federal grant programs: the threat of a funding cut-off may be appropriate when it can promote change by the noncompliant grantee and when it can signal to other grantees that the agency is serious about enforcement, thereby increasing grantees’ compliance. The article concludes by assessing the implications of this argument for administrative regime design and judicial review. This work opens up new avenues for research in administrative law on the distinct features of the federal grants regime
Process, Practice, and Principle: Teaching National Security Law and the Knowledge that Matters Most
Get PDFThe meaningful application of national security law requires a commitment to substantive knowledge, good process, and a capacity to cope (and indeed thrive) under the prevailing conditions of practice. This paper describes how and why to teach these three essential elements of national security law from an academic and practitioner perspective.
The paper starts with substantive law, placing emphasis not just on the breadth of knowledge and interpretive skills required, but also on the importance of depth, perspective, theory, purpose, history, and legal values in teaching the law. Next, the paper describes the importance of timely, meaningful, and contextual process, explaining why mastery of good process leads to better security and legal outcomes.
The paper also recognizes that national security practice is difficult to teach in law school because it is impossible to replicate the personalities, conditions, and context of practice. To address this, the paper identifies four essential practice traits and techniques for nurturing those traits.
In sum, this paper provides a framework and a checklist against which law schools should evaluate their national security law offerings and programs (see Appendix A). What is appropriate will depend on context: a school\u27s mission, its size, its location, and its commitment to national security. Regardless of context, the paper offers critical lessons on how to more effectively prepare students for the national security field, or alternatively, to serve more meaningful and informed roles as citizen-lawyers as we address the security challenges ahead
All of This Has Happened before and All of This Will Happen Again: Innovation in Copyright Licensing
Get PDFClaims that copyright licensing can substitute for fair use have a long history. This article focuses on a new cycle of the copyright licensing debate, which has brought revised arguments in favor of universal copyright licensing. First, the new arrangements offered by large copyright owners often purport to sanction the large-scale creation of derivative works, rather than mere reproductions, which were the focus of earlier blanket licensing efforts. Second, the new licenses are often free. Rather than demanding royalties as in the past, copyright owners just want a piece of the action—along with the right to claim that unlicensed uses are infringing. In a world where licenses are readily and cheaply available, the argument will go, it is unfair not to get one. This development, copyright owners hope, will combat increasingly fair use–favorable case law.
This article describes three key examples of recent innovations in licensing-like arrangements in the noncommercial or formerly noncommercial spheres—Getty Images’ new free embedding of millions of its photos, YouTube’s Content ID, and Amazon’s Kindle Worlds—and discusses how uses of works under these arrangements differ from their unlicensed alternatives in ways both subtle and profound. These differences change the nature of the communications and communities at issue, illustrating why licensing can never substitute for transformative fair use even when licenses are routinely available. Ultimately, as courts have already recognized, the mere desire of copyright owners to extract value from a market—especially when they desire to extract it from third parties rather than licensees—should not affect the scope of fair use
An Assessment of Mayor Bloomberg’s Public Health Legacy
Get PDFAs New York City Mayor Michael Bloomberg’s last term was coming to an end, Professor Gostin wrote an article for the Hasting Center Report addressing Bloomberg’s public health legacy. Rodger Citron has edited that article into a question and answer format and also asked Professor Gostin to elaborate on a number of points made in that article