Lawrence O. Gostin

Public Health Ethics: Mapping the Terrain

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics.Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors — biological, behavioral, social, and environmental in developing effective interventions.

Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola

Harvard Global Health Institute (Prof A Jha MD, S Moon PhD, L R Woskie MSc, J A Leigh MPH), Harvard T.H. Chan School of Public Health (Prof A K Jha, S Moon, L R Woskie, J A Leigh), and Harvard Kennedy School (S Moon), Harvard University, Boston, MA, USA; University of Edinburgh Medical School, Edinburgh (Prof D Sridhar DPhil); Duke Global Health Institute, Durham, NC, USA (M A Pate MD); Bill, Hillary & Chelsea Clinton Foundation, New York, NY, USA (C Clinton DPhil); Medecins Sans Frontieres, New York , NY, USA (S Delaunay MA); Campaign for Good Governance, Freetown, Sierra Leone (V Edwin MA); Action Contre La Faim International , Monrovia, Liberia (M Fallah PhD); Indiana University Maurer School of Law, Bloomington, IN, USA (Prof D P Fidler JD); Council on Foreign Relations, New York, NY, USA (L Garrett PhD); University of California, San Francisco, CA, USA (Prof E Goosby MD); Georgetown University, Washington, DC, USA (Prof L Gostin JD); Chatham House, London, UK (Prof D L Heymann MD); Simon Fraser University, Burnaby, BC, Canada (Prof K Lee DPhil); Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Prof G M Leung MD); Center for Strategic and International Studies, Washington DC, USA (J S Morrison PhD); AIDS Executive summary The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confi dence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After diffi cult and lengthy deliberation, we concluded that major reforms are both warranted and feasible. The Panel’s conclusions off er a roadmap of ten interrelated recommendations across four thematic areas:

Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis

This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature.

Beyond the HIPAA Privacy Rule Enhancing Privacy Improving Health Through Research

This report contains the findings of a committee charged with reviewing the HIPAA privacy rule and its impact on health research. The committee found that the rule does not adequately protect the privacy of people’s personal health information and hinders important health research. It recommends that Congress authorize the development of an entirely new approach to protecting personal health information in research that applies privacy, data security, and accountability standards uniformly to information used in all health-related research regardless of who funds or conducts it.

The Built Environment and Its Relationship to the Public’s Health: The Legal Framework

The built environment significantly affects the publics health. This was most obvious when infectious disease was the primary public health threat during the industrial revolution; unsanitary conditions and overcrowded urban areas facilitated the spread of infection. However, even today in the age of chronic diseases there remains an important connection between population health and the built environment. Physical spaces can expose people to toxins or pollutants and influence lifestyles that contribute to diabetes, coronary vascular disease, and asthma. Public health advocates can help shape the design of cities and suburbs in ways that improve public health, but to do so effectively they need to understand the legal framework. This article reviews the connection between public health and the built environment and then describes the legal pathways for improving the design of our built environment.

Global health security: the wider lessons from the west African Ebola virus disease epidemic

Summary The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

The Ebola Epidemic A Global Health Emergency

On August 8, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crisis a “public health emergency of international concern,”1 triggering powers under the 2005 International Health Regulations (IHR). The IHR requires countries to develop national preparedness capacities, including the duty to report internationally significant events, conduct surveillance, and exercise public health powers, while balancing human rights and international trade. Until last year, the director-general had declared only one such emergency—influenza AH1N1 (in 2009). Earlier this year, she declared poliomyelitis a public health emergency of international concern and now again for Ebola, signaling perhaps a new era of potential WHO leadership in global health security.

The New International Health Regulations: An Historic Development for International Law and Public Health

The adoption of the new International Health Regulations (IHR) in May 2005 represents an historic development for international law and public health. This article describes the IHR revision process and analyzes why the new IHR constitute an advance in global health governance.

Human rights of persons with mental disabilities. The European Convention of Human Rights.

It is not necessary to recount the numerous charters and declarations ... to understand human rights.... All persons are born free and equal in dignity and rights. Everyone ... is entitled to all the rights and freedoms set forth in the international human rights instruments without discrimination, such as the rights to life, liberty, security of the person, privacy, health, education, work, social security, and to marry and found a family. Yet, violations of human rights are a reality to be found in every corner of the globe.

National HIV Case Reporting for the United States — A Defining Moment in the History of the Epidemic

Reporting of patients with AIDS by name (AIDS surveillance) has until now formed the cornerstone of the nations efforts to monitor and characterize the epidemic of human immunodeficiency virus (HI...