Local Public Health Departments at the Intersection of Climate Change, Health Equity, and Public Health Laws and Policies.

Public health laws and policies are uniquely able to mitigate the adverse and inequitable health impacts of climate change. This article summarizes some key considerations in developing such laws and policies and a variety of approaches local public health departments are using to increase climate resilience and health equity.

Reclaiming Public Health Authority: Toward a Legal Framework that Centers the Public's Health, in the Courts and Beyond.

This paper summarizes key shifts in judicial decisions relating to public health powers during the pandemic and the implications of those decisions for public health practice. Then, it gives a preview and call for partnership in developing a legal framework for authority that guides public health to better activities, processes, and accountability in service of the public's health.

The reform of Irish mental health law: Aligning with human rights obligations?

This article critically examines the proposed reforms to Irish mental health law the Mental Health Act 2001 (2001 Act). The article will provide background to the 2001 Act and the lengthy law reform process, which has resulted in the publication of the Heads of Bill that propose significant amendments. The article assesses the suggested reforms, considering Ireland's 2018 ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD), which provides important context to the law reform process. The 2001 Act is the primary piece of legislation regulating mental health services and safeguarding the rights of persons subject to the legislation in Ireland. While passed in 2001, the legislation did not come into effect until 2006. The 2001 Act was seen as bringing Irish mental health law into compliance with international human rights law, in particular the European Convention on Human Rights (ECHR). However, Ireland's ratification of the CRPD has necessitated closer scrutiny of the legislation. This review has culminated in the publication of a Heads of Bill in July 2021 and pre-legislative scrutiny by the responsible parliamentary committee in 2022. The long title of the Heads of Bill explicitly states its goal of safeguarding individual autonomy and underscores its commitment to upholding and advancing the rights of people subject to the legislation. The analysis of the Heads of Bill addresses several key areas. These areas include a background to the long process of review, new guiding principles, the category of persons under the mental health legislation, mental health tribunals, consent to treatment, advance healthcare directives, provisions relating to children and young people, and independent advocacy. Based on this analysis of the Heads of Bill, recommendations are suggested which would strengthen respect for the human rights of persons subject to the legislation.

A história de construção das Portarias de Consolidação do Sistema Único de Saúde: um marco normativo / The history of the construction of the Consolidation Ordinances of the Unified Health System: a normative milestone / La historia de la construcción de las Ordenanzas de Consolidación del Sistema Único de Salud: un hito normativo

Apresentar, por meio de resenha analítica, a obra 'Consolidação, Simplificação e Revisão do Arco Normativo Infralegal da Saúde: um projeto, muitas vozes', publicado pelo CONASS e que narra a história biográfica de um projeto pioneiro e inovador da consolidação do arco normativo infralegal do Sistema Único de Saúde.

To present, through an analytical review, the work 'Consolidation, Simplification, and Review of the Infralegal Normative Arch of Health: one project, many voices', published by CONASS, which narrates the biographical history of a pioneering and innovative project in consolidating the infralegal normative arch of the Unified Health System.

Presentar, a través de una reseña analítica, la obra 'Consolidación, Simplificación y Revisión del Arco Normativo Infralegal de la Salud: un proyecto, muchas voces', publicada por CONASS y que narra la historia biográfica de un proyecto pionero e innovador en la consolidación del arco normativo infralegal del Sistema Único de Salud.

Nigeria mental health law: Challenges and implications for mental health services.

Background: The Nigerian mental health law titled the Lunacy Act of 1958 has been under scrutiny for violating the human rights of people with mental illness. The call to reform the obsolete Lunacy Act has garnered attention from the government, as the law has been unamended for over 60 years. Aim: This study presents the challenges and implications of the new mental health law to the mental health services of Nigeria. Methods: ScienceDirect, PubMed, and Google Scholar were used to find pertinent material. The implications and difficulties facing the new mental health law examined from the literature were discussed. Recommendations were made following an exploratory search for literature on mental health legislation in Nigeria. Results: The new Law in Section 5(6) saw the introduction of mental health services in primary and secondary healthcare. It also addresses critical issues such as non-discrimination, fundamental human rights, standards of treatment, access to information, confidentiality and autonomy, and the employment rights of persons with mental health and substance abuse-related disorders. The Law failed to include mental health services in the country's health insurance system. Conclusion: There is a need for legislation to meet people's mental health needs and encourage them to seek treatments, such as regulations that protect against discrimination and harsh treatment of people with mental illness. Contribution: Nigerian mental health services would benefit from the new mental health law if the key issues raised in this review are addressed.

Abolition of coercion in mental health services - A European survey of feasibility.

BACKGROUND: In 2019, the Council of Europe agreed to urge member states to take steps toward total abolition of psychiatric coercive measures. AIMS: To test if this aspiration is perceived as realistic and what the alternative would be in the event of a total abolition, we surveyed members of the European FOSTREN network of mental health practitioners and researchers, which is specifically dedicated to exchanging knowledge on reducing psychiatric coercion to its minimum. METHODS: Web-based survey. Categorical responses were analyzed using frequencies, and free text responses were analyzed through thematic analysis. RESULTS: In total, out of 167 invitations to FOSTREN network members, 76 responded to the survey (Response Rate 45.5%). A minority (31%) of participating experts dedicated to the reduction of psychiatric coercive measures believed a total abolition to be an achievable goal. A commonly held belief was that total abolition is not achievable because mental health disorders are difficult to treat and may cause violence, necessitating coercion, and there is a need to protect the involved persons from harm. Those responding that complete abolition is achievable argued that the consequences of coercion outweigh any gains and indicated that use of advance directives are sufficient as alternatives to coercion. CONCLUSION: Of a European group of experts specifically dedicated to the reduction of psychiatric coercion who participated in this questionnaire study, a minority believed a total abolition be an achievable goal. The study adds to the empirical evidence of the feasibility of the aspiration to totally abolish involuntary measures in the mental health services from the perspective of experts.

Banning Engineered Stone: A Landmark Australian Public Health Law Reform.

Union activism, medical lobbying and occupational health and safety prosecutions led to a major public health initiative in Australia - the banning from 1 July 2024 of work with engineered/artificial stone, including manufacturing, supplying, processing and installing it. This editorial contextualises within the history of regulation of workers' exposure to risks of contracting silicosis the growing international awareness of the dangers posed by working with engineered stone, particularly in relation to making and installing kitchen and bathroom benchtops made from engineered stone. It argues that the Australian initiative is an important public health decision that has a sound justification, is likely to save many lives and should be emulated internationally.

Examining legal and ethical challenges in HIV/AIDS disclosure obligations and medical practices: a case study from China.

In accordance with China's regulations on the prevention and control of HIV/AIDS, individuals diagnosed with HIV are required to disclose their medical condition when soliciting medical care in Mainland China. Empirical field investigations, however, indicate that people living with HIV (PLHIV) predominantly comply with this mandate only under conditions of absolute necessity. The ensuing conundrum, juxtaposing the imperative of privacy against the duty of disclosure, has materialised into a recurrent vicious cycle in its practical application, intensifying the intrinsic trust disparities characterising doctor-patient interactions. A meticulous scrutiny of pertinent legal precedents, coupled with in-depth field studies, reveals that the genesis of these complications can be traced back to an unforeseen metamorphosis in the legislative intent underpinning HIV/AIDS prevention and therapeutic strategies. While the initial objective was risk mitigation, the effect of enactment in real-world scenarios has significantly decreased. Owing to factors including extensive media reporting as well as prevailing public discourse, PLHIV, rather than being perceived as rights-bearing entities in legal frameworks, are increasingly relegated to the restrictive and dehumanising labels of 'HIV/AIDS'. As these individuals navigate their rights through alternative non-regulatory channels, circumventing formal legal obligations, their efficacy in actualising these rights is concurrently undermined.

Teaching Global Health Law: Preparing the Next Generation for Future Challenges.

Following from sweeping law reforms across the global health landscape, there is a need to prepare the next generation to advance global health law to ensure justice for a healthier world. Educational programs across disciplines have increasingly incorporated the field of global health law, with new courses examining the law and policy frameworks that apply to the new set of public health threats, non-state actors, and regulatory instruments that structure global health. Such interdisciplinary training must be expanded throughout the world to prepare future practitioners to strengthen global health law - ensuring a foundation for global health in legal studies and law and global health studies. Meeting this imperative for global health law teaching - establishing academic courses and textbooks on global legal responses to shared health threats - will be necessary to support students to address the global health challenges of the future.

Lowering the Age of Consent for Vaccination to Promote Pediatric Vaccination: It's Worth a Shot.

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments.

From principles to practice: Clarifying new obligations under Victoria's Mental Health and Wellbeing Act 2022.

OBJECTIVE: To explain the new test for complying with the mental health principles under the Mental Health and Wellbeing Act 2022 (Vic). CONCLUSION: The principles carry over limitations from the previous Mental Health Act 2014 (Vic) while also containing new features. The 'all reasonable efforts to comply' and 'proper consideration' tests resemble the existing test under section 38(1) of the Charter of Human Rights and Responsibilities Act 2006 (Vic) that also apply to public mental health services. Taking these duties together, public mental health services, including hospital and community mental health boards, clinical directors and clinical governance processes, will need to show concrete evidence of specific rights and/or principles being deliberated in their decisions.

Review article: Patients who leave before care is completed: What does the legal duty to warn mean for emergency department clinicians?

Patients leave ED for a variety of reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet entered a treatment space. There is also a positive duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed. The form of that warning may vary based on what is known about the patient's condition and the associated risks at the time. Specific documentation of warnings given is essential.

Medical Law and Medical School Curricula: A Systematic Review.

Health law plays a crucial role in the field of medicine, as it dictates appropriate practices, regulations, and rights and responsibilities for healthcare professionals and patients. Despite this undeniable relationship, there is a lack of focus on health law, and an outdated hidden curriculum in medical education has perpetuated long-standing negative perceptions of the legal system. PubMed was searched for articles related to medicolegal education that were published from January 1950 to December 2022. The following search terms were utilized: "(medical student) AND (law OR legal OR medico-legal) AND (education)". Literature that directly or indirectly discussed the relationship between law and medicine as well as the role of medical student education within the medicolegal nexus were reviewed. Additional literature was identified from reference lists of systematic and literature reviews. The authors manually reviewed each included publication to determine key details, study populations, and conclusions. The PubMed search revealed 3,592 papers that were sorted for relevance. Forty-four articles published between 1971 and 2022 were reviewed and analyzed. Three main themes consistently emerged from the discussions in these articles. The first theme concerns the sentiment among medical students that they were ill-prepared to manage the legal aspects of healthcare. The second theme concerns the negative perception of health law by medical students. The third theme details the benefits of including medicolegal courses in medical school curricula. This study sheds light on the notion that medical students feel ill-prepared to handle the legal aspects of healthcare due to limited medicolegal education. Furthermore, negative perceptions of the legal field continue to exist amongst medical students due to a plethora of factors, including an outdated hidden curriculum. Incorporating medicolegal courses into medical school curricula can foster positive attitudes toward the field of law and lead to enhanced professional ethics, increased patient advocacy, and potentially improved patient outcomes.

Publicação em inglês: um novo marco editorial dos Cadernos Ibero-Americanos de Direito Sanitário / Publication in English: a new editorial milestone for Cadernos Ibero-Americanos de Direito Sanitário / Publicación en Inglés: un nuevo hito editorial de los Cadernos Ibero-Americanos de Direito Sanitário

Os avanços tecnológicos impactaram diretamente a forma como a ciência é comunicada, reduzindo fronteiras e conectando indivíduos, mas a barreira linguística ainda persiste como um obstáculo significativo para a colaboração entre pesquisadores e a disseminação do conhecimento. Publicações em inglês têm alcance ampliado, viabilizando a difusão dos resultados dos estudos e pesquisas dos periódicos nacionais. Os Cadernos Ibero-Americanos de Direito Sanitário (CIADS), na esteira dessa vanguarda, passam a publicar seus artigos originais, resenhas e comunicações breves em inglês, sem custo para o autor, além da manutenção do idioma original. Este importante passo marca uma inovadora trajetória editorial do periódico, rumo à sua internacionalização.

Los avances tecnológicos han impactado directamente la forma en que se comunica la ciencia, reduciendo fronteras y conectando individuos, pero la barrera lingüística aún persiste como un obstáculo significativo para la colaboración entre investigadores y la difusión del conocimiento. Las publicaciones en inglés han ampliado su alcance, facilitando la difusión de los resultados de estudios e investigaciones en revistas nacionales. Siguiendo esta vanguardia, los Cadernos Ibero-Americanos de Direito Sanitário (CIADS) ahora publicarán sus artículos originales, reseñas y comunicaciones breves en inglés, sin costo para el autor, además de mantener el idioma original. Este importante paso marca una trayectoria editorial innovadora del periódico hacia su internacionalización.

Technological advances have directly impacted the way science is communicated, reducing borders and connecting individuals, but the language barrier still persists as a significant obstacle to collaboration between researchers and the dissemination of knowledge. Publications in English have a wider reach, making it possible to disseminate the results of studies and research in national journals. Cadernos Ibero-Americanos de Direito Sanitário (CIADS), in the wake of this vanguard, is now publishing its original articles, reviews and short communications in English, at no cost to the author, in addition to maintaining the original language. This important step marks the journal's innovative editorial path towards internationalization.

Legal and regulatory instruments for NCD prevention: a scoping review and descriptive analysis of evaluations in OECD countries.

CONTEXT: Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries. METHODS: A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants. FINDINGS: We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness. CONCLUSIONS: Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

POLICY POINTS: Government regulation is reported as more effective than co-regulation, quasi-regulation or self-regulation. Voluntary approaches, including voluntary government regulation, are reported less effective due to low uptake and limited accountability. In public health law mandated government regulation should be strived for.Food and alcohol sectors are more likely to adopt self- or quasi-regulation and are frequently reported as ineffective. More work should be done to support government regulation in these areas.Many public health law evaluations are lacking critical design information for policy makers. This may make it difficult to learn from successes or failures and replicate interventions in other jurisdictions.

Using publicly available data to predict recreational cannabis legalization at the county-level: A machine learning approach.

BACKGROUND: There is substantial geographic variability in local cannabis policies within states that have legalized recreational cannabis. This study develops an interpretable machine learning model that uses county-level population demographics, sociopolitical factors, and estimates of substance use and mental illness prevalences to predict the legality of recreational cannabis sales within each U.S. county. METHODS: We merged data and selected 14 model inputs from the 2010 Census, 2012 County Presidential Data from the MIT Elections Lab, and Small Area Estimates from the National Surveys on Drug Use and Health (NSDUH) from 2010 to 2012 at the county level. County policies were labeled as having recreational cannabis legal (RCL) if the sale of recreational cannabis was allowed anywhere in the county in 2014, resulting in 92 RCL and 3002 non-RCL counties. We used synthetic data augmentation and minority oversampling techniques to build an ensemble of 1000 logistic regressions on random sub-samples of the data, withholding one state at a time and building models from all remaining states. Performance was evaluated by comparing the predicted policy conditions with the actual outcomes in 2014. RESULTS: When compared to the actual RCL policies in 2014, the ensemble estimated predictions of counties transitioning to RCL had a macro f1 average score of 0.61. The main factors associated with legalizing county-level recreational cannabis sales were the prevalences of past-month cannabis use and past-year cocaine use. CONCLUSION: By leveraging publicly available data from 2010 to 2012, our model was able to achieve appreciable discrimination in predicting counties with legal recreational cannabis sales in 2014, however, there is room for improvement. Having demonstrated model performance in the first handful of states to legalize cannabis, additional testing with more recent data using time to event models is warranted.

Whose experts? How federalism shaped psychiatry in the late Habsburg monarchy.

The late Habsburg period (1867-1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916.

Restrictive measure reduction in psychiatric wards: A snapshot of China's mental health law reform under the new era of disability rights convention.

This article examines the reasons behind the limited impact of China's mental health law reform in 2013 on reducing the use of restrictive measures in mental health services, focusing on the analysis of case law from Chinese courts. The analysis of collected rulings from the official database indicates that Chinese courts have adopted a lenient approach in scrutinizing the application of restrictive measures. Furthermore, the interpretation and application of the provisions related to restrictive measures in the law have led to service providers being held liable in numerous cases for not implementing such measures. Based on these findings, the article offers policy recommendations.