Jason W. Sapsin

How Litigation Can Promote Product Safety

Jon S. Ernick, Jason W Sapsin, Stephen I? Teret, and Julie Samia Mair or at least the past three decades, injuries have been recognized as an important public health F problem in the United States. In 2001, there were approximately 157,000 deaths due to injuries in the US. There were also almost 30 million non-fatal injury incidents.’ Injuries have been defined as: “...any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygenl’z Within public health, the field of injury prevention and control is dedicated to reducing the burden of injuries on the lives of people around the world. Injury prevention seeks to reduce injuries by: 1) identifying risk factors, 2) designing interventions to address the risk factors, 3) implementing those interventions, 4) evaluating their effectiveness, and 5 ) replicating those that work. As with many other public health problems, interventions can target factors associated with the human or host, vehicle or vector, and the physical or social environment.3 Injuries associated with consumer or other products are an important part of the injury problem. Motor vehicles alone are responsible for approximately 40,000 deaths in the U.S. each year.* There are a number of strategies that have been used to prevent product-related injuries. Legislation or regulation can be used to require manufacturers to change the design of the product itself to reduce risks for example, by requiring seat belts to be installed in all passenger cars. Education can also be used to attempt to modify the behavior of the user of the product to minimize the likelihood of injury for example, by using the media to encourage car occupants to wear their seatbelts. And the physical environment can be improved for example, by adding guard-rails to the roadway -

International Trade, Law, and Public Health Advocacy

ublic health science and practice expanded during the course of the 2Uh century. Initially P focused on controlling infectious disease through basic public health programs regulating water, sanitation and food, by 1988 the Institute of Medicine broadly declared that “public health is what we, as a society, do collectively to. assure the conditions for people to be healthy.”’ Coiiunensurate with this definition, public health practitioners and policymakers today work o n ;in enormous m g e of issues. The 2002 policy agencki of the American Public Health Association reflects positions on genomics’ role in public health; national health and safety standards for child care programs; socliiini in Americans’ diets; the health and safety of emergency rescue workers; and war in Central Asia and the Persian GuK2 International trade should also he on public health’s policy agenda. The development of a robust trade system a system of regulations, law and aclministrative stnictures established by nations to regulate the flow of goods, services and intellectual property between them has driven the vast cross-border flow of goods, services, environmental agents and populations which increasingly connects societies around the world. Trade’s ability to alter both the prodidservice mix and even the regulation of national markets deeply affects public health and compels public health panicipation to ensure the promotion of domestic public health agendas. The World Health Organization (“WHO”) recognizes this and has offered training to develop skills and knowledge, promote policy coherence and contribute to global public health in relation to trade since 20013 According to Dr. George Alleyne, the fomier Director of the Pan American Health Organization,

Globalization, Public Health, and International Law

There is an effort underway to build an international network for public health law in Asia. Public health law in Asia is a relatively new field and is developing at a rapid pace, given the recent experiences of managing international infectious diseases such as SARS and the avian flu. The establishment of a comprehensive public health law network could help to influence each nation in Asia to comply with global governance of public health issues. It could contribute to the creation of public health infrastructures which would help to maintain the health of Asia’s population, and in turn, the health of the international community. The World Health Organization (WHO) is currently in the process of reforming the long-standing International Health Regulations (IHR). When first established, the IHR were proposed as a means of providing “maximum protection” by “minimum restriction ...[ of] ... trade” and were primarily designed for the management of cholera, plague, and yellow fever. As the world community is faced with newlyemerging infectious diseases since that time, such as Ebola and AIDS, there is a newfound need for revising the regulations. As it stands today, host countries cannot be held to the regulations’ enforcement standards for outbreak alerts, dissemination of information, and disease management protocols. Political and economic disparities also contribute to the inconsistent and ineffective application of enforcement measures with daunting consequences. A revised version of the IHR can be adapted to take into account the desirability, feasibility, and clarity of health standards for all member states, particularly those dealing with newly-emerging public health concerns and disease outbreaks. Hence, it is imperative that the Pan-Asian region takes an active role in the revision of the IHR, given the key measures which defined the nature of the recent SARS outbreak and a lack of open communication networks from which to bring a swift and effective response. The new IHR can also take into account newlyrecognized individual human rights. It can specify individual entitlements, set science-based standards and fair protocols for public health enforcement measures, and require states to take measures to prevent public stigma and discrimination against diseased individuals. An international network of public health professionals can assist in the determination of these standards. An international public health system can help achieve both transparency and effective surveillance and response without creating a volatile atmosphere of rumor and inaccuracy, which risk both national security and individual liberties. The revision of the IHR is just one step in creating a model WHO that can provide significant technical and financial support for effective public health action.