The Nexus Between Health and Law. (Wait a sec…is there a nexus?)

When my peers ask me why I’m making the “jump” from medical research to law, I usually find myself caught between feeling frustrated and defensive. Sometimes it seems that, perhaps, the intimate entanglement between law and health is evident only to me. In truth, you really have to look no further than your newspaper or television screen to see how intertwined the two domains are.

Just last week, our neighbours to the south celebrated passing the Patient Protection and Affordable Care Act into federal law. (If you enjoy reading dense legal language or if you’re simply interested to take a gander at this document, here is a link to the PPAC – all 906 pages of it!) This law essentially mandates that all Americans not covered by employer or government provided health insurance maintain a minimum form of health insurance (with certain exceptions, of course.)

I really can’t think of anything that illustrates the beautiful marriage between health and law than the fruition of Medicare acts like this. When legislators, policy makers, and health professionals come together to create laws and policies like the PPAC or the Canada Health Act, expertise from all sorts of domains should ideally be instituted.

Here in Canada, we’re grappling with a range of health policy issues of our own. The topic on the front burner right now centres around Bill C-31 (formally titled, An Act to amend the Immigration and Refugee Protection Act, the Balanced Refugee Reform Act, the Marine Transportation Security Act and the Department of Citizenship and Immigration Act). This Act seeks to save the Canadian government $20 million annually by providing only basic medical care to refugees who arrive to Canada from countries that are deemed to be unsafe. In an earlier version of the Act, refugees with more complex health issues, such as pre-natal complications, were not eligible for those corresponding medical services and would lose all the supplementary benefits, including prescription drug coverage — unless the medication was for a disease that poses a “risk to public health.”

Ottawa has very recently backed-down on the health care cuts and made a distinction between re-settled refugees and asylum seekers. I’m still trying to stay abreast of the issue, but the crux of what is going on is an issue of access to health care that is contingent on one’s legal status in Canada.

This issue is wrought with medical, policy, legal, epidemiological, and public health implications. Since refugees, by their very nature, are fleeing some sort of persecution or harm, their health is generally poorer than that of the general population in which they are seeking to settle into. “On arrival, refugees have a high incidence of infectious diseases such as tuberculosis, syphilis, hepatitis B and gastrointestinal parasites, as well as mental health concerns.” (source: CJPH)

By actively limiting the access to medical care of an already disproportionately unhealthy population through such a policy, the ramifications can extend quite far. Issues of human rights, ethics (for example, health professionals disregarding policy and providing medical care to these populations “illegally”), and public health and safety (among a slew of other issues) are bound to arise. To me, this issue of refugee health is a battle cry for professionals to reach into other interdisciplinary domains so that policy makers do not continue to work within their ideological silos.

If this issue wasn’t already on the radar of Canadians, it certainly was after a press conference at the North York General Hospital where a doctor and a medical student aggressively confronted Minister Joe Oliver on the issue. You can see a video of this show-down below:

As I embark on a journey into a completely new academic domain this fall, my hope is that I’ll be able to carve out the niche that I’m envisioning in which public health and law not only co-exist, but also develop symbiotically. There are already some great scholars in the field from whom I can take notes; Jonathan Mann, Colleen Flood, Jennifer Leaning, and Nancy Krieger (among many, many others.)  Institutions in the nexus between health and law are even starting to pop up, such as Harvard’s Francois-Xavier Bagnoud Centre for Health and Human Rights. The FXB Centre is a prime example of a place where legal and medical scholars can collaborate. Even the World Health Organization now has a working group on health and human rights.

While I wait for this relatively young field to grow,  I’ll try to develop a more concise and satisfying response for my friends who will inevitably continue to ask me about my departure from epidemiology. In truth, it’s not really a departure from epidemiology at all! Ideally, health policy should be premised on  evidence and research rather than rhetoric and politics. But I usually can’t even muster out that phrase before I thrust my palm to my forehead and walk away from my well meaning friends, already flustered by their question.


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