Food Sovereignty is a vibrant discourse in academic and activist circles, yet despite the many shared characteristics between issues surrounding food and public health, the two are often analysed in separate frameworks and the insights from Food Sovereignty are not sufficiently brought to bear on the problems in the public health discourse. In this paper, I will introduce the concept of 'self-organised community viability' as a way to link food and health, and to argue that (...) what I call the 'Health Security' paradigm requires a 'Health Sovereignty' response modelled on Food Sovereignty. (shrink)

ArgumentThis article analyzes for the first time the earliest western maps of diseases in China spanning fifty years from the late 1870s to the end of the 1920s. The 24 featured disease maps present a visual history of the major transformations in modern medicine from medical geography to laboratory medicine wrought on Chinese soil. These medical transformations occurred within new political formations from the Qing dynasty (1644–1911) to colonialism in East Asia (Hong Kong, Taiwan, Manchuria, Korea) and hypercolonialism within China (...) (Tianjin, Shanghai, Amoy) as well as the new Republican Chinese nation state (1912–49). As a subgenre of persuasive graphics, physicians marshaled disease maps for various rhetorical functions within these different political contexts. Disease maps in China changed from being mostly analytical tools to functioning as tools of empire, national sovereignty, and public health propaganda legitimating new medical concepts, public health interventions, and political structures governing over human and non-human populations. (shrink)

The idea of food sovereignty has its roots primarily in the response of small producers in developing countries to decreasing levels of control over land, production practices, and food access. While the concerns of urban Chicagoans struggling with low food access may seem far from these issues, the authors believe that the ideas associated with food sovereignty will lead to the construction of solutions to what is often called the “food desert” issue that serve and empower communities in (...) ways that less democratic solutions do not. In Chicago and elsewhere, residents and activists often see and experience racial and economic inequalities through the variety of stores and other food access sites available in their community. The connections between food access, respect, and activism are first considered through a set of statements of Chicagoans living in food access poor areas. We will then discuss these connections through the work and philosophy of activists in Chicago centered in food sovereignty and food justice. Particular focus will be placed on Growing Power, an urban food production, distribution, and learning organization working primarily in Milwaukee and Chicago, and Healthy South Chicago, a community coalition focused on health issues in a working class area of the city. (shrink)

The concept of autonomy as self-sovereignty is developed in this essay through an examination of the thought of American transcendentalist philosophers Emerson and Thoreau. It is conceived as the quality of living in accordance with one’s inner nature or genius. This conception is grounded in a transcendentalist moral anthropology that values independence, self-reliance, spirituality, and the capacity to find beauty in the world. Though still exerting considerable popular and academic influence, both the concept of autonomy as self-sovereignty and (...) the underlying anthropology diverge in important ways from counterparts that are prominent in contemporary bioethics. Autonomy as self-sovereignty calls into question the manifold ways that patients (and citizens) are brought to heel by institutional (and political) values they do not themselves affirm. It also emphasizes the inevitable deep plurality of moral visions of health and appropriate healthcare, rejecting tendencies (strong in mainstream bioethics) to regard “health” as a univocal concept or healthcare as a basic need, to attempt to conform “reasonable” clinical decision-making to a single model, and to appoint government as a guarantor of access to healthcare or a regulator of healthcare standards. Autonomy as self-sovereignty, like its competitors, can justify itself only in question-begging terms. Still, bioethics might do well to recognize it within the mix of moral visions. (shrink)

'Food sovereignty' plays an increasingly important political role as a focus for grassroots agri-food organisations, such as La Via Campesina, in their attempts to contest the social injustices, health impacts and ecological damage resulting from the increasing global dominance of corporate/industrial agriculture. While not seeking to detract from the successes of such movements, there remain ethical, political and ecological concerns about just how the 'sovereignty' in food sovereignty is to be interpreted and what, if any, its (...) relation to previous histories, definitions and applications of political sovereignty might be. Sovereignty's role, for example, in settler colonialism and environmental destruction is rarely addressed in the food sovereignty literature, with advocates focusing instead on its definitional malleability and contemporary political utility. Yet critical appropriations of Schmitt's infamous definition of sovereignty help to specify its colonial, anti-political and anti-ecological modus operandi, and make clear certain dangers inherent in uncritically adopting the term. (shrink)

Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and (...) builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management. (shrink)

It is an article of almost religious faith in the United Kingdom that the National Health Service is far superior to a competitive market in health care services. In this brief and informal paper I show that the opposite is true. In contrast to market provision, the existence of the National Health Service entails the following. First, consumer sovereignty is virtually destroyed, since what services the consumer receives and how much he pays (through taxation) are determined (...) by the government of the day in consultation with vested and ideological interests. Second, a person may be denied a life-saving service despite having contributed more than his fair share to National Health Service over the course of his working life. Third, people often spend less on health care than they would like to spend, because any additional contributions (via increased taxes) are not linked to any benefit specifically for the person who makes them. Fourth, provision of services free at the point of need which is not linked to what a person pays encourages a wasteful misuse of resources. Fifth, absence of competition between health care providers leads to high cost and poor quality of service and a tendency to produce a standardised service rather than a tailored one; and government attempts to address this problem usually make it worse. Sixth, people’s freedom to engage in particular activities or lifestyles is likely to be curtailed because the costs of those activities are artificially socialised. I also point out that issues of inequality or poverty are much better addressed by means other than a nationalised health service. (shrink)

This paper presents my personal convictions, as an Evangelical, regarding the absolute impropriety of doctor-assisted suicide for Christians. They have been “bought with a price” and are owned by Another. Hence, they must always strive to glorify God in their bodies, both in life and in death. Although they crave the well-being of temporal health, when they are ill seek healing or relief, and may well recoil even from the thought of suffering and dying, they should realize that their (...) values and priorities must be rooted in biblical truths and that their well-being is eternal and not temporal, spiritual and not material. As Christians, their attitudes and responses to suffering and dying must be molded by the reality that their Creator and Sovereign will cause all things to work together for their good and that their Lord has called them into a fellowship of His suffering in which they are sustained by dependence upon Him. Hence, for Christians to take their lives in order to escape from the trials and testings ordained by Him would be a failure of love and a breach of trust. (shrink)

Critics of international trade agreements often cast them as threats to human health, and they can point to some sobering warnings from world history. Infectious diseases have swept across political boundaries, carried by traders, colonists, and other agents of globalization. Transnational epidemics have laid economies low, undermining political stability. The spread of viruses and bacteria to peoples previously unexposed and therefore lacking immunity has decimated populations and changed the political course of continents. Trade, exploration, and warfare have repeatedly produced (...) encounters between peoples at different levels of agricultural and technological development. Often, the results have been devastating for the disadvantaged group — economic marginalization, loss of sovereignty and culture, and collapse of public health. Yet the rise of civilization — plant and animal domestication, division of labor, technology, and resulting prosperity — was powered in large part by movement of products and knowledge along routes of trade and migration. (shrink)

Critics of international trade agreements often cast them as threats to human health, and they can point to some sobering warnings from world history. Infectious diseases have swept across political boundaries, carried by traders, colonists, and other agents of globalization. Transnational epidemics have laid economies low, undermining political stability. The spread of viruses and bacteria to peoples previously unexposed and therefore lacking immunity has decimated populations and changed the political course of continents. Trade, exploration, and warfare have repeatedly produced (...) encounters between peoples at different levels of agricultural and technological development. Often, the results have been devastating for the disadvantaged group — economic marginalization, loss of sovereignty and culture, and collapse of public health. Yet the rise of civilization — plant and animal domestication, division of labor, technology, and resulting prosperity — was powered in large part by movement of products and knowledge along routes of trade and migration. (shrink)

Farm to school programs have been positioned as interventions that can support goals of the global food sovereignty movement, including strengthening local food production systems, improving food access and food justice for urban populations, and reducing distancing between producers and consumers. However, there has been little assessment of how and to what extent farm to school programs can actually function as a mechanism leading to the achievement of food sovereignty. As implemented in North America, farm to school programs (...) encompass activities not only related to school food procurement, but also to the development of student knowledge and skills under the framework of food literacy. Research on farm to school initiatives has largely been conducted in countries with government-supported national school feeding programs; this study examines farm to school organizing in Canada, where there is no national student nutrition program. Using qualitative fieldwork and document analysis, we investigate the farm to school movement in British Columbia, in a context where civil society concerns related to education and health have been the main vectors of farm to school mobilization. Our analysis suggests that, despite limited institutional infrastructure for school meals, the British Columbia farm to school movement has contributed toward realizing goals of food sovereignty through two main mechanisms: advocacy for institutional procurement of local and sustainable foods and mobilizing food literacy for increased public engagement with issues of social justice and equity in food systems. (shrink)

Political philosophers often formulate the problem of distributive justice as the problem of how the government ought to distribute different types of goods—for example, income or health care—to its citizens. They therefore presuppose that the government is a unitary agent that governs its citizens directly. However, although a number of governments are unitary in this way, many are federations, exhibiting a division of sovereignty between two or more levels of government having independent grounds of authority. In contrast to (...) unitary states, therefore, within a federation, two or more levels of government directly govern their citizens and are directly accountable to them. Because of the way in which different levels of government in a federation can separately affect the distribution of goods in society, federations face resource allocation problems that are far more complex than those of unitary states. In addition to determining what a just distribution of goods is, federations must also determine (1) whether distributive justice is a shared responsibility amongst different levels of government, and, if so, (2) how this shared responsibility should be allocated between them. (shrink)

Public health responses to emerging infectious disease rarely try to interrupt the mobility of goods and information. Rather, designed under the rubric of ‘‘public health security,’’ they extend the rationale of free circulation through efforts to intensify movement and communication between international agencies, national health departments, and the pharmaceutical industry. In this way, public health security extends postliberal modes of transnational regulation. This article examines an unfolding scenario which is testing public health’s fidelity to the (...) ethos of international trade agreements: Indonesia has withdrawn from the World Health Organization’s ‘‘virus-sharing’’ scheme because WHO has facilitated the use of Indonesian samples of H5N1 for the commercial development of potentially profitable vaccines without consultation with the Indonesian labs in which they originated. It has been argued that the Indonesian move is one that contests the current securitization of global health. However, I argue that what we are witnessing is the process of emergence of a distinct form of biological sovereignty in the form of rival global health security aggregates, each working to inject a new form of postliberal sovereignty into the field of global public health. (shrink)

The current SARS-CoV-2 crisis raises questions about the challenges faced by nation states and international organisations in offering a coordinated international response to the pandemic, and reveals the great vulnerability of European countries, which are implementing lockdown measures and imposing restrictions on international travel, for the most part on a unilateral basis. Such measures run counter to the prevailing approach of the previous two centuries that developed an international public health space. This article examines the measures adopted by European (...) states in order to contain 19th-century cholera pandemics, which took shape through the development of an international maritime quarantine system, based primarily on the implementation of national regulations and local decision-making. This regime was quickly viewed as ineffective and out of step with liberal ideas that urged a “laissez-faire” approach to public health matters. In its stead, a long-term trend developed towards easing quarantine measures. Nation states supported the internationalisation of the fight against pandemics, which chiefly consisted of externalising quarantine measures to the East in order to eliminate them in Europe. This process was based on a subtle dialectical relationship between the construction of an international public health space and the affirmation of state sovereignty, and continued into the 20th century with the progressive creation of international institutions responsible for advancing global health. (shrink)

The current SARS-CoV-2 crisis raises questions about the challenges faced by nation states and international organisations in offering a coordinated international response to the pandemic, and reveals the great vulnerability of European countries, which are implementing lockdown measures and imposing restrictions on international travel, for the most part on a unilateral basis. Such measures run counter to the prevailing approach of the previous two centuries that developed an international public health space. This article examines the measures adopted by European (...) states in order to contain 19th-century cholera pandemics, which took shape through the development of an international maritime quarantine system, based primarily on the implementation of national regulations and local decision-making. This regime was quickly viewed as ineffective and out of step with liberal ideas that urged a “laissez-faire” approach to public health matters. In its stead, a long-term trend developed towards easing quarantine measures. Nation states supported the internationalisation of the fight against pandemics, which chiefly consisted of externalising quarantine measures to the East in order to eliminate them in Europe. This process was based on a subtle dialectical relationship between the construction of an international public health space and the affirmation of state sovereignty, and continued into the 20th century with the progressive creation of international institutions responsible for advancing global health. (shrink)

The singular message in Global Health Law is that we must strive to achieve global health with justice—improved population health, with a fairer distribution of benefits of good health. Global health entails ensuring the conditions of good health—public health, universal health coverage, and the social determinants of health—while justice requires closing today’s vast domestic and global health inequities. These conditions for good health should be incorporated into public policy, supplemented (...) by specific actions to overcome barriers to equity. A new global health treaty grounded in the right to health and aimed at health equity—a Framework Convention on Global Health —stands out for its possibilities in helping to achieve global health with justice. This far-reaching legal instrument would establish minimum standards for universal health coverage and public health measures, with an accompanying national and international financing framework, require a constant focus on health equity, promote Health in All Policies and global governance for health, and advance the principles of good governance, including accountability. While achieving an FCGH is certainly ambitious, it is a struggle worth the efforts of us all. The treaty’s basis in the right to health, which has been agreed to by all governments, has powerful potential to form the foundation of global governance for health. From interpretations of UN treaty bodies to judgments of national courts, the right to health is now sufficiently articulated to serve this role, with the individual’s right to health best understood as a function of a social, political, and economic environment aimed at equity. However great the political challenge of securing state agreement to the FCGH, it is possible. States have joined other treaties with significant resource requirements and limitations on their sovereignty without significant reciprocal benefits from other states, while important state interests would benefit from the FCGH. And from integrating the FCGH into the existing human rights system to creative forms of compliance and enforcement and strengthened domestic legal and political accountability mechanisms, the treaty stands to improve right to health compliance. The potential for the FCGH to bring the right to health nearer universal reality calls for us to embark on the journey towards securing this global treaty. (shrink)

Bangladesh continues to experience stubbornly high levels of rural malnutrition amid steady economic growth and poverty reduction. The policy response to tackling malnutrition shows an overwhelmingly technocratic bias, which depoliticizes the broader question of how the agro-food regime is structured. Taking an agrarian and human rights-based approach, this paper argues that rural malnutrition must be analyzed as symptomatic of a deepening agrarian crisis in which the obsession with productivity increases and commercialization overrides people’s democratic right to culturally appropriate, good, nutritious (...) food. Using qualitative insights from a case study of three villages, this research illustrates how agricultural modernization and commercialization reproduce rural malnutrition by degrading local biodiversity and the rural poor’s access to nutrient-rich diets. In so doing, it undermines the official discourse’s simplistic and literal reading of malnutrition as a pathological health condition resulting from the mere absence of certain micronutrients in the human body, and thus questions the adequacy of the proposed solutions. Instead, this research suggests that solving malnutrition in large part involves facilitating the rural poor’s access to nutritious diets through democratizing and reorganizing the agriculture sector in a manner that is eco-friendly and unconstrained by market imperatives. It cautiously advances agroecology and food sovereignty as possible alternatives, while recognizing that overcoming the challenges agrarian class conflict, gender disparity and urban–rural divide pose would not be easy. (shrink)

Over the past 25 years, activists, farmers and scholars have been arguing that the industrialized global food system erodes democracy, perpetuates injustices, undermines population health and is environmentally unsustainable. In an attempt to resist these effects, activists have proposed alternative food networks that draw on ideas and practices from pre-industrial agrarian smallholder farming, as well as contemporary peasant movements. -/- This book uses current debates over Michel Foucault’s method of genealogy as a practice of critique and historical problematization of (...) the present to reveal the historical constitution of contemporary alternative food discourses. While alternative food activists appeal to food sovereignty and agrarian discourses to counter the influence of neoliberal agricultural policies, these discourses remain entangled with colonial logics. In particular, the influence of Enlightenment ideas of improvement, colonial practices of agriculture as a means to establish ownership, and anthropocentric relations to the land. In combination with the genealogical analysis, this book brings continental political philosophy into conversation with Indigenous theories of sovereignty and alternative food discourse in order to open new spaces for thinking about food and politics in contemporary Australia. (shrink)

This paper empirically supports school food as a site of contested values, where corporate interests can come into direct conflict with those of communities. This is a story about the experience of a small group of activist parents going up against a major food service corporation contracted by their school district. The analysis considers their experiences as dedicated and knowledgeable parent activists who, after years of trying to work with employees of the global food service corporation, grow weary, aim to (...) overthrow it, and finally, after a decade, succeed. In response to the parents’ struggles, I apply a food sovereignty lens to school food, introducing the concept of school food sovereignty. I propose that school food sovereignty requires community participation and consideration of the health and welfare of students, environmental sustainability, local economic benefits, cultural congruence, and attention to food-related justice. (shrink)

In “Obligations of the ‘Gift’: Reciprocity and Responsibility in Precision Medicine,” Lee rightly points out that disparities in health care access also lead to disparities in precision medi...

In her target article “Shared health governance” (AJOB 11(7): 32-45, 2011) and in her book Health and Social Justice (2009), Jennifer Prah Ruger defends an original model of governance dubbed “Shared Health Governance” (SHG). This model borrows elements from many other models of governance, and one may wonder what is the secret sauce that holds together these diverse ingredients. In response, Ruger would perhaps ultimately turn to public moral norms. My comment raises some concerns about the function (...) and content of these norms in her model and their connection to her claims about shared sovereignty within SHG. (shrink)

A moral right to health or health care is a special instance of a right to fair equality of opportunity. Nation-states generally have the capabilities to specify the entitlements of such a right and to raise the resources needed to satisfy those entitlements. Can these functions be replicated globally, as a global right to health or health care requires? The suggestion that “better global governance” is needed if such a global right is to be claimed requires (...) that these two central capabilities be present. It is unlikely that nation-states would concede these two functions to a form of global governance, for doing so would seriously compromise the authority that is generally included in sovereignty. This claim is a specification of what is often recognized as the “sovereignty problem.” The argument of this paper is not an “impossibility” claim, but a best guess about whether the necessary conditions for better global governance that supports a global right to health or health care can be achieved. (shrink)

Reforms in the German health care system in the attempt to bring more competition into health care have increased the sovereignty of the insured or patients, who have finally been allowed to make choices. “The start of a reorientation of the statutory health insurance system and hospital care are to be welcomed as first steps towards a supply of health services that reflects individual preferences.” The authors can be contacted care of Prof. Dr. Oberender at (...) Rechts‐ und Wirtschafswissenschaftliche Fakulät, Universität Bayreuth, 95440 Bayreuth, Germany, where Dr Oberender is Professor in the Faculty of Law and Economics, and Ansgar Hebborn is his Assistant. The authors wish to record their gratitude to Jan Hacker for translating this article. (shrink)

Reforms in the German health care system in the attempt to bring more competition into health care have increased the sovereignty of the insured or patients, who have finally been allowed to make choices. “The start of a reorientation of the statutory health insurance system and hospital care are to be welcomed as first steps towards a supply of health services that reflects individual preferences.” The authors can be contacted care of Prof. Dr. Oberender at (...) Rechts‐ und Wirtschafswissenschaftliche Fakulät, Universität Bayreuth, 95440 Bayreuth, Germany, where Dr Oberender is Professor in the Faculty of Law and Economics, and Ansgar Hebborn is his Assistant. The authors wish to record their gratitude to Jan Hacker for translating this article. (shrink)

The purpose of this article is to understand how historical oppression has undermined health through environmental injustices that have given rise to food insecurity. Specifically, the article examines ways in which settler colonialism has transformed and contaminated the land itself, impacting the availability and quality of food and the overall health of Indigenous peoples. Food security and environmental justice for Gulf Coast, state-recognized tribes has been infrequently explored. These tribes lack federal recognition and have limited access to recourse (...) and supplemental resources as a result. This research fills an important gap in the literature through exploring the intersection of environmental justice and food insecurity issues for this population. Partnering with a community-advisory board and using a qualitative descriptive methodology, 31 Gulf Coast Indigenous women participated in semi-structured interviews about their healthcare experiences and concerns. Through these interviews, participants expressed concerns about (a) the environmental impacts of pollution on the contamination of food and on the health of tribal members; and (b) the impact of these changes on the land, such as negatively impacting gardening practices. The authors of this study document how environmental changes have compounded these concerns and contribute to the overall pollution of food and water sources and unviability of subsistence practices, severely effecting tribal members’ health. In conclusion, we show how social and environmental justice issues such as pollution, industry exploitation, and climate change perpetuate the goals of settler colonialism through undermining cultural practices and the overall health of Indigenous peoples. (shrink)

In 2009, health authorities from Taiwan formally attended the 62nd World Health Assembly of the World Health Organization as observers, marking the country’s participation for the first time since 1972. The long process of negotiating this breakthrough has been cited as an example of successful global health diplomacy. This paper analyses this negotiation process, drawing on government documents, formal representations from both sides of the Taiwan Strait, and key informant interviews. The actors and their motivations, along (...) with the forums, practices and outcomes of the negotiation process, are detailed. While it is argued that non-traditional diplomatic action was important in establishing the case for Taiwan’s inclusion at the WHA, traditional concerns regarding Taiwanese sovereignty and diplomatic representation ultimately played a decisive role. The persistent influence of these traditional diplomatic questions illustrates the limits of global health diplomacy. (shrink)

Governments, producers, and international free tradeorganizations like the World Trade Organization (WTO) areincreasingly confronted with consumers who not only buy (or don'tbuy) goods, but also demand that those goods are producedconforming to certain ethical (often diverse) standards. Not onlysafety and health belong to these ethical ideals, but animalwelfare, environmental concerns, labor circumstances, and fairtrade. However, this phantom haunts the dusty world of social andpolitical philosophy as well. The new concept ``consumersovereignty'' bypasses the conceptual dichotomy of consumer andcitizen.According to the (...) narrow liberal response to this newconstellation, with respect to food one should conceptualizeconsumer sovereignty as the right of the individual consumer toget information on food products and to make his or her ownchoice on the market of food products. In this conception, thereis a very strong emphasis on rules and principles with respect tothe autonomy of individuals.I argue that these narrow liberal concepts are not sufficient forappropriate public policy-making in democratic societies, andthat they only enable us to identify problems; they do not helpnon-experts (and experts, if it comes to that, as well) inweighing the different ethical claims. Besides, not onlyprinciples play a role in the outcome, but all kinds of ideals aswell, like roles, values, and norms. My principal argument isthat analysis or justification of norms or principles is notsufficient to get a synthesis or construction of ethicalsolutions: we need some value orientation to guide us inbalancing the different ethical claims by solving an ethicalproblem. Moreover, this balancing is something that requiressocial space and social time, i.e., public debates. With theconcept of public debates a whole new dimension enters ethicalanalysis, because the attention of ethicists shifts toformulating criteria of successful and rational public debates.However, in the broad liberal view these concepts aresupplemented with values, preferences, practices of care, andinvolvement. I argue firstly for a broadened perspective on foodas an integral part of life styles and not only as something thatpresents risks. That is the reason that food gets such intensiveattention from the public, which is summarized in the concept ofconsumer concerns. Secondly, I defend the argument that not only(rational) public debates, but intensive commitments of bothproducers and consumers in every link of the chain in so calledcare practices or consumer councils can enhance confidence in thefood production system and the way we extract our daily intakefrom nature. (shrink)

Public health emergencies, including infectious disease outbreaks and natural disasters, are issues faced by every community. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve coordination and collaboration across jurisdictions. As sovereign entities, Tribal governments have the authority to create their own laws and take the necessary steps to prepare for, respond to, and recover from disasters and emergencies. Legal preparedness is (...) a key component of public health preparedness. This article first explains legal preparedness and Tribal sovereignty and then describes the relationship between Tribal Nations, the US government, and states. Specific Tribal concerns with respect to emergency preparedness and the importance of coordination and collaboration across jurisdictions for emergency preparedness are discussed. Examples of collaborative efforts between Tribal and other governments to enhance legal preparedness are described. (shrink)

Background: Although health is a right of all individuals without any distinction, the realisation of this right has remained very difficult for the marginalised populations of poor countries. Inequitable distribution of health opportunities globally is a major factor in explaining why this is the case. Whereas the Protection, Promotion and Fulfilment of the health rights of poor country citizens are a joint responsibility of both domestic and external governments, most governments flout their obligations. So far disproportionate effort (...) has been dedicated to reaffirming and interpreting these obligations as opposed to investigating the fundamental question regarding why these obligations have nevertheless remained largely unfulfilled. Further the normative question regarding what ought to be done about the shortcomings of current obligations has been largely ignored. Methods: We conduct a critical content analysis of existing literature on efforts towards the realisation of the health rights of marginalised populations in our attempt to ascertain their capacity to guarantee basic health opportunities to marginalised populations. In our analysis we treat issues of ‘health rights’ and ‘justice in global health’ as having unity of purpose – guaranteeing basic health opportunities to the marginalised populations. Results: We identify two sets of reasons for the failure of present obligations for global distributive justice in general: a set of ‘superficial reasons’ and a set of ‘fundamental reasons’ which account for the superficial reasons. Discussion: In order to overcome these reasons we propose a strategy which consists in specifying a number of minimum and less-demanding obligations for both external and domestic governments to guarantee to all individuals a certain threshold of health goods and services. We argue that these minimum obligations can be freely accepted and fully complied with or enforced with “a thin system of enforcement” without significant threat to national sovereignty and autonomy. Conclusion: The futility of countries’ obligations for the health rights of the global poor as is the case with global distributive injustice is because of lack of political will to specify and enforce such obligations. Minimum obligations should be specified and enforced with a “thin system” which is consistent with principles of national sovereignty and autonomy. (shrink)

Background: The objective of this research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. Methods: Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent (...) reviewers; results were discussed until consensus was reached. Results: We identified 107 papers published from 1986 through 2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. Conclusions: Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate (...) surrounding ACA was, and continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate (...) surrounding ACA was, and continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

We are, as of May 2019, witnessing yet another “caravan” of people fleeing violence in Latin America, bonding together to reach the territory of safer states in the North. Similarly, in the fall of 2015, Europe experienced the movement of many refugees fleeing war, persecution, and grave human rights violations in Syria. These new waves of people on the move have raised anew important questions about asylum and refuge: who should be able to claim asylum? Should the fear of persecution (...) be sufficient, or do asylum seekers need to show that they have actually suffered it? And maybe most controversially, how should asylum‐granting states respond to the plight of those asking for asylum on their territory?The moral principles guiding asylum and refuge are different from the rules usually regulating immigration, which are based on the principle of territorial sovereignty that allows nation‐states to discriminate and select among those who hope to immigrate. Asylum and refuge instead call upon nation‐states to provide refugees with a new home, protect human rights, and over time, provide access to the social, political and civic rights that characterize membership. Included in the list of human rights, I will argue, is the provision of the means for individual physical and psychological well‐being. (shrink)

Critics of mass culture often identify 1950s-style status competition as one of the central forces driving consumerism. Thomas Frank has challenged this view, arguing that countercultural rebellion now provides the primary source of consumerism in our society, and that ‘cool’ has become its central ideological expression. This paper provides a rearticulation and defense of Frank's thesis, first identifying consumerism as a type of collective action problem, then showing how the ‘hip consumer’ is one who adopts a free-rider strategy in this (...) context. (shrink)