Advancing the Right to Health—The Vital Role of Law

In Vietnam—a nation of motorbikes—legislation mandating helmets increased use by an astonishing 99%, with 1557 road deaths and 2495 serious injuries avoided in the first year.¹ Australia’s tobacco plain packaging law resulted in a 78% relative increase in requests for quitting assistance.² Independent inspections confirmed 90% compliance with regulations in British Columbia setting maximum levels for artificial trans-fatty acids in processed foods.³ These are just some of the dynamic ways in which law advances the right to health.

Law is a neglected but powerful tool to regulate hazardous products, strengthen health systems, encourage healthier behaviors, and ensure participatory and accountable governance. A new report, Advancing the Right to Health: The Vital Role of Law—developed by the World Health Organization (WHO), the International Development Law Organization (IDLO), and academic partners through a five-year expert consensus process—demonstrates the power of law to improve population health.⁴ Drawing on the report’s research and findings, we argue for a renewed focus on law to support the mission of public health, strengthen accountability, and leverage results.

LAW AS A TOOL

Advancing the Right to Health highlights legal tools and strategies for governments to discharge their public health responsibilities. Law builds public health infrastructure. It establishes a mission for public health agencies, defining their functions and granting them flexible powers while safeguarding rights and freedoms. In the United States, the Turning Point Model Public Health Act offers a blueprint for state law reform. China’s health care law extends coverage to rural areas, and the Danish health law enshrines equal access to treatment. Beyond erecting public health infrastructure, law can create the conditions for the public’s health and safety in several key ways.

First, taxing unhealthy products offers dual benefits, by generating revenue and discouraging consumption. WHO recommends taxes to raise sugary drink prices by 20%. Mexico’s one-peso-per-liter sugary drink tax reduced consumption by 7.6% over a two-year period, with larger reductions among the poor.⁵ Public support for taxes may be higher when tax revenue supports public health and community programs, as occurred in Philadelphia.

Second, governments can inform healthy choices through education, labeling, and warnings. Illustrations include health promotion for safer sex; nutrition information on food packages and menus; “traffic light” labeling (red, amber, and green) disclosing high, medium, and low levels of saturated fat, sugar, and salt in packaged food; and safety warnings on sales of pharmaceuticals. The European Union requires text-based and graphic health warnings covering 65% of tobacco packages; in the United States, packaged alcoholic beverages must bear warnings about driving while under the influence and drinking during pregnancy.

Third, public health is heavily influenced by where we live, work, study, and play. Laws can mandate safety standards for consumer products, in the workplace, and for vehicle and road design. Zoning can reduce the density of fast food outlets and incentivize fresh food markets. City planning laws can increase the number of bicycle and walking paths and green spaces.⁶ A South Korean law authorizes localities to designate school neighborhoods as “green food zones,” proscribing soda and junk food sales.

Fourth, public health laws regulate businesses, professionals, and individuals. Examples include prohibiting parents from smoking in vehicles with child passengers and requiring healthier foods, such as South Africa’s maximum salt levels for 13 food categories. Law also governs health professionals and institutions through licensing and certification.

Fifth, courts can fill gaps in health policy, as when South Africa’s Constitutional Court required the Health Ministry to provide antiretroviral treatment to pregnant women living with HIV/AIDS. The US “Master Settlement Agreement” ordered tobacco companies to pay billions of dollars in perpetuity and disclose internal documents. Litigation can hold companies to account for selling unreasonably dangerous products, such as toys that may harm children.

Occasionally, law can act as a barrier to advancing health, by entrenching discrimination or unduly restricting personal freedoms. Laws can stigmatize individuals on the basis of sexual orientation or prohibit distribution of sterile drug injection equipment. Travel restrictions during West Africa’s Ebola outbreak impeded medical personnel from entering affected countries. Tax codes permitting businesses to deduct advertising costs can incentivize junk food marketing to children. Dismantling legal barriers to health can be just as important as enacting evidence-based interventions.

INTEGRATING LAW INTO HEALTH GOVERNANCE

Although law is a powerful tool, its power is harnessed most effectively when supported by effective health governance systems. Advancing the Right to Health identifies a range of governance mechanisms that help promote effective public health laws, including the following.

Coordinated, Intersectoral Action

Health is multisectoral, requiring agencies across government (e.g., agriculture, trade, justice, and urban planning) to work together and in partnership with civil society. Laws can establish mechanisms for intersectoral collaboration. The National Health Council in Brazil is a “permanent collegiate deliberative body” that provides a forum for government, health workers, and patients to develop health policies. The National Prevention Council, chaired by the US surgeon general, convenes 20 federal agencies and tasks them with developing and monitoring government-wide, national prevention strategies.

Evidence-Based Laws

Laws should be evidence-based, building on the WHO “best buys” for high-priority, low-cost interventions.⁷ Public health laws should be effective in promoting healthy behaviors and improving health outcomes at a reasonable cost. They should also promote justice by narrowing major health disparities based on socioeconomic status.

Good Governance

Governments should ensure transparency, honesty (anticorruption), public participation, and accountability. The rule of law requires clear, transparent, stable, and just laws; full accountability by public officials and private actors for their actions and omissions; and competent, ethical administration and enforcement of laws.

Regulatory Capacity

Just as governments invest in public services, they should also invest in regulatory capacity. Public health and safety requires a sound legal infrastructure for developing, implementing, and enforcing health laws; this requires training and the allocation of adequate resources for robust legal systems.

Improving the Law

Enacting laws does not end the regulatory process. Rather, governments should continually monitor and evaluate interventions and their impacts, updating laws accordingly. Governments can borrow legal interventions from the best models elsewhere and tailor them for the local legal, economic, and social contexts. The international community should provide financial and technical assistance to lower-income states to disseminate experiences and research, and to support the development and enforcement of public health laws.

UNIVERSAL HEALTH COVERAGE: A CASE STUDY

The UN Sustainable Development Goals’ target of achieving universal health coverage encompasses preventive, curative, rehabilitative, and palliative health services; affordable access to essential vaccines and medicines; and protection from financial hardship. Law’s role in advancing health coverage includes regulating key actors, including health insurers, pharmaceutical companies, and health professionals, and requiring safe practices such as hospital infection control. Each year, 100 million people are pushed into poverty while 150 million face financial hardship due to out-of-pocket health care costs. An Iranian law caps out-of-pocket health care expenses at 30% of total cost. Ghana’s National Health Insurance Act creates a health insurance authority that regulates health insurers and reviews benefits packages. The US Affordable Care Act regulates the health insurance market and expands Medicaid to increase coverage.

The new report, Advancing the Right to Health: the Vital Role of Law, offers a renewed opportunity for countries to harness the power of law to promote the right to health. WHO, IDLO, and other development partners can assist states by building regulatory capacities, providing evidence-based guidance, and supporting shared learning. Public health law can bring enormous dividends for health, safety, and well-being while advancing the right to health and the UN Sustainable Development Goals.