18 Nov 2019 - by Andrew MacKay

Identifying the Legal Determinants of Health and Tools to Achieve Good Health and Well-Being

Yasmin Batliwala, A4ID’s Chief Executive, joined Lady Hale of Richmond, President of the Supreme Court of the UK, and a panel of experts at Chatham House on 28 October 2019 to mark the launch of the Lancet-O’Neil Institute Commission on Global Health and Law’s report on ‘The legal determinants of health: harnessing the power of law for global health and sustainable development’.

The attainment of the UN Sustainable Development Goal (SDG) 3: Good Health and Well-Being is closely connected to the realisation of many of the other SDGs. From SDG 1: No Poverty and SDG 2: Zero Hunger to SDG 10: Reduced Inequalities, good health can only be achieved through improvements towards all social determinants of health. According to the World Health Organization’s International Covenant on Economic, Social and Cultural Rights, health is ‘a fundamental human right indispensable for the exercise of other human rights’. Thus, it is of vital importance that the law is exercised to protect health rights and reform insufficient laws that act as barriers to health.

Public health and welfare are critically impacted by the rule of law. Law can safeguard and promote health rights and is integral to the development of countries. However, law can also act as a barrier to health and well-being. For instance, intellectual property agreements, set up to protect business interests, can impede developments in the health industry by protecting high prices of medical supplies and preventing vulnerable people from accessing medical care. Speaking during the event, Dr Sharlfah Sekalala, Associate Professor at the University of Warwick, gave a specific example, where a mother and her unborn child died due to the state’s failure to provide the necessary resources (which she was unable to afford herself) for the birth of both her twins. The panellists agreed that existing international and national legislation and agreements can be difficult to work around, and it is vital for legal professionals to provide their support to help reform laws that inhibit progress towards the SDGs.

Overcoming legal barriers to health

Elaborating on the barriers that the law can present, Yasmin Batliwala drew on the work of A4ID’s partners to overcome legal obstacles to health. A third of the world’s population lack access to affordable medicine and this figure rises to half the population in the poorest parts of Africa and Asia. Patent laws allow pharmaceutical companies to protect the treatments they develop, preventing them from being widely supplied and keeping their price artificially high. Seeking to supply affordable and accessible diagnostic tests in the developing world, A4ID’s Development Partner, Médecins Sans Frontières (MSF), requested legal assistance to draft a patent agreement with the research institution, Institut Pasteur, which is carrying out research to develop the relevant biological tools.

A4ID quickly found specialised intellectual property lawyers at Dechert LLP to assist MSF in this project. They drafted a patent agreement with Institut Pasteur and helped MSF to find solutions to legal problems. The proficiency and hard work of the legal partners has helped MSF to secure unrestricted legal rights to new developments in diagnostics. This means that many more people in poorer countries have had access to these better techniques, improving the treatment and reducing the incidence of disease worldwide.

Establishing effective laws around environmental regulation, drug and alcohol regulation, improving road safety, tobacco controls and supporting vaccination development, are just some of the legislative areas that the speakers referred to. High quality, affordable, accessible and equitable health care is an ambitious target, but as The Lancet-O’Neil Institute report states, ‘offers a good illustration of the way in which law can translate vision into action on sustainable development’.

Advocating for health reform

Panellist, Lawrence O. Gostin, Director of the O’Neil Institute for National and Global Health Law, highlighted the six legal tools outlined in the report to achieve better health standards. The report advocates for the implementation of tax and subsidies to influence healthy consumer choices; the introduction of marketing regulation to ensure consumers are informed about the harmful or beneficial health impacts of products; the need to alter the socioeconomic environment to create more equitable societies, for example the introduction of social welfare policies; the introduction of direct regulation to enforce health standards, such as health and safety laws in the workplace or mandating the use of seatbelts in vehicles; the improvement of the built environment to create cleaner community spaces, reduce pollution and increase water quality and sanitation; and finally, the deregulation of laws that are detrimental to good health and well-being, such as the criminalisation of people with HIV.

While The Lancet-O-Neil Institute report lays out complex issues related to the rule of law and its implications on health for the global health and science community; A4ID’s Legal Guide to the Sustainable Development Goals explains the actions that the legal community can take to drive progress towards the realisation of ‘good health and well-being for all’, as well as achievement of the other SDGs. Together these two publications will complement each other and provide essential practical resources for the legal community, policymakers, healthcare professionals and civil society actors, acting as a catalyst for innovation in using the law to advance sustainable development. With just 10 years left until the 2030 deadline, it is more critical than ever that the health and legal sectors continue to pool their expertise and work together to achieve the SDGs.