Robyn Martin

Pandemic influenza control in Europe and the constraints resulting from incoherent public health laws.

BackgroundWith the emergence of influenza H1N1v the world is facing its first 21st century global pandemic. Severe Acute Respiratory Syndrome (SARS) and avian influenza H5N1 prompted development of pandemic preparedness plans. National systems of public health law are essential for public health stewardship and for the implementation of public health policy[1]. International coherence will contribute to effective regional and global responses. However little research has been undertaken on how law works as a tool for disease control in Europe. With co-funding from the European Union, we investigated the extent to which laws across Europe support or constrain pandemic preparedness planning, and whether national differences are likely to constrain control efforts.MethodsWe undertook a survey of national public health laws across 32 European states using a questionnaire designed around a disease scenario based on pandemic influenza. Questionnaire results were reviewed in workshops, analysing how differences between national laws might support or hinder regional responses to pandemic influenza. Respondents examined the impact of national laws on the movements of information, goods, services and people across borders in a time of pandemic, the capacity for surveillance, case detection, case management and community control, the deployment of strategies of prevention, containment, mitigation and recovery and the identification of commonalities and disconnects across states.ResultsResults of this study show differences across Europe in the extent to which national pandemic policy and pandemic plans have been integrated with public health laws. We found significant differences in legislation and in the legitimacy of strategic plans. States differ in the range and the nature of intervention measures authorized by law, the extent to which borders could be closed to movement of persons and goods during a pandemic, and access to healthcare of non-resident persons. Some states propose use of emergency powers that might potentially override human rights protections while other states propose to limit interventions to those authorized by public health laws.ConclusionThese differences could create problems for European strategies if an evolving influenza pandemic results in more serious public health challenges or, indeed, if a novel disease other than influenza emerges with pandemic potential. There is insufficient understanding across Europe of the role and importance of law in pandemic planning. States need to build capacity in public health law to support disease prevention and control policies. Our research suggests that states would welcome further guidance from the EU on management of a pandemic, and guidance to assist in greater commonality of legal approaches across states.

Health governance : law, regulation and policy

Original editorial can be found at: http://www.sciencedirect.com/ Copyright Elsevier [Full text of this paper is not available in the UHRA]

The role of law in the control of obesity in England : looking at the contribution of law to a healthy food culture

Obesity levels in England are significantly higher than in much of the rest of Europe. This article examines aspects of the physical and cultural context of food consumption in England, and the evolution of government policy on obesity, as a background to an analysis of how law might play a role in obesity prevention. Research suggests that individual food choices are associated with cultural and socio-economic circumstances and that they can be manipulated by advertising, food packaging and presentation. This suggests that there might be ways of using law to manage the influences on food choices, and of using law in support of strategies to redirect food choices towards healthy food products. Law is a particularly useful tool in the protection of the individual against the economic power of the food industry, and there is much that law can do to change the physical, economic and social environment of food consumption.

The role of law in pandemic influenza preparedness in Europe.

Summary The European Union (EU) is composed of 27 states with widely varying histories, economies, cultures, legal systems, medical systems and approaches to the balance between public good and private right. The individual nation states within Europe are signatories to the International Health Regulations 2005, but the capacity of states to undertake measures to control communicable disease is constrained by their obligations to comply with EU law. Some but not all states are signatories to the Schengen Agreement that provides further constraints on disease control measures. The porous nature of borders between EU states, and of their borders with other non-EU states, limits the extent to which states are able to protect their populations in a disease pandemic. This paper considers the role that public health laws can play in the control of pandemic disease in Europe.

Public Health Policy and Law for Pandemic Influenza: A Case for European Harmonization?

This article provides a critical portrait of the current state of public health policies and laws governing pandemic influenza prevention and control in Europe. It examines the role of and relationship between national public health policy and national communicable disease legislation as tools for the prevention and control of pandemic influenza, the role of Europe in pandemic disease preparedness, and the concept of harmonization across European states, including an overview of supranational initiatives and powers created to enhance harmonization of national pandemic disease policy. Short case studies epitomize important concerns around harmonization in Europe. The article considers opportunities and impediments to further harmonization. Particular attention is paid to the essential role of law as a tool to underpin and implement preparedness policies and to protect individual rights against unjustified state intervention.

Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law

The issue of detention as a public health control measure has attracted attention recently. This is because the threat of strains of tuberculosis that are resistant to a wider range of drugs has been identified, and there is renewed concern that public health is threatened. This paper considers whether involuntary detention is justified where voluntary measures have failed or where a patient poses a danger, albeit uncertain, to the public. We discuss the need for strengthening evidence-based assessments of public health risk and suggest that we should reflect more profoundly on the philosophical foundations upon which our policies and practices are grounded.

Science review in research ethics committees: Double jeopardy?

Research ethics committees ‘(RECs) members’ perceptions of their role in regard to the science of research proposals are discussed. Our study, which involved the interviewing of 20 participants from amongst the UK’s independent (Phase I) ethics committees, revealed that the members consider that it is the role of the REC to examine and approve the scientific adequacy of the research – and this notwithstanding the fact that a more competent body will already have done this and even when that other body has the legal responsibility for this function. The problematic nature of this situation, tantamount to double jeopardy, is considered: it can delay research and so add to costs whilst offering no countervailing benefits, or the double jeopardy may be just the cost society imposes, through its RECs, on researchers as the price for research on human subjects.

Medical Dominance within Research Ethics Committees

Qualitative research is reported which explores the perceptions of members of the U.K.’s independent Phase I ethics committees (IECs) about key issues identified following a literature review. Audio-recorded interviews were conducted with ten expert and ten lay members from all IECs except the one to which the lead author was attached. Transcripts were thematically analyzed following a broadly hermeneutical approach. The findings—dealing with such matters as recruitment strategies and length of service; attitudes towards member categories, published ethics guidelines, and the adequacy of insurance; levels of training and views on achieving a recognised level of competence—have an intrinsic interest, but it is when the findings are considered collectively using Freidson’s theory of professional dominance that they reveal the influence the medical profession can have in shaping ethics review.

Diverging Common Law —Invercargill goes to the Privy Council

‘The definitive version is available at: www3.interscience.wiley.com.’ Copyright Blackwell Publishing. DOI: 10.1111/1468-2230.00068 [Full text of this article is not available in the UHRA]

Law and public health policy

Two of the most important tools that assist states in protecting their populations against threats to health are public health policy and public health law. Policy can exist without recourse to law, but where policy has been designed for a long-term purpose, and where voluntary compliance has not proved successful, policy may need the heavier hand of law for implementation. However, law is not always an appropriate mechanism for achieving public health objectives. This article explores the boundaries of public health policy and public health law, and examines how they might work as dual mechanisms for public health.