It is difficult to measure the global market for falsified and substandard drugs, but there is good evidence that they are a problem in poor countries with weak drug regulatory systems. All classes of drugs are compromised, especially inexpensive antibacterial and antimalarial treatments. When fake antimicrobials contain sub-therapeutic doses of active ingredients, they encourage drug resistance, shortening the effective life of a drug and hastening the expense of new drug development. The trade in fake medicines erodes patient confidence in allopathic medicine and the public health system. The organized fraud that allows the drugs to circulate undermines all public institutions and conveys money and power to criminals.

Investment in drug manufacturing could improve drug quality in low- and middle-income countries, and development finance organizations are well positioned to make these investments. Changes to procurement practices could also help guarantee that honest manufacturers get the largest market share. Most of all, low- and middle-income countries need better regulatory systems. The first step to building these systems is developing a strategic plan for the agency improvement. Changes to the drug distribution system could protect the drugs supply. In the United States, licensing only wholesalers that meet National Association of Boards of Pharmacy accreditation standards would reduce the hazards of secondary wholesale, as would a congressionally mandated track-and-trace system. In developing countries, governments should use franchising, accreditation, low-interest loans, and task shifting to create an environment conducive to quality drug retail. There is also a need for sturdy and inexpensive detection technologies that can be used to detect fake medicines in the field. A WHO International Code of Practice on falsified and substandard drugs would facilitate international cooperation against falsified and substandard drugs.

The vocabulary people use to discuss the problem is itself a concern. The word counterfeit is often used innocuously to describe any drug that is not what it seems, but some NGOs and emerging manufacturing nations object to this term. These groups see hostility to generic pharmaceuticals in a discussion of counterfeit medicines. These groups see hostility to generic pharmaceuticals in a discussion of counterfeit medicines. Precisely speaking, a counterfeit drug infringes on a registered trademark, and trademark infringement in not necessarily a problem of public health consequence. Instead of talking broadly about counterfeit drugs, the WHO and other stakeholders should consider two main categories of drug quality problems. Falsified medicines misrepresent the product’s identity or source or both. Substandard drugs fail to meet the national specifications given in an accepted pharmacopeia or the manufacturer’s dossier. In practice, there is often considerable overlap between categories.

There is considerable uncertainty about the size of the falsified and substandard drug market. Improved pharmacovigilance, especially in developing countries, give a better picture of the scope of the problem. In the United States, tighter regulatory controls on the wholesale market and a mandatory drug tracking system would improve drug safety. In developing countries, development finance organizations should invest in small- and medium-sized pharmaceutical manufacturers, and governments should use tools such as franchising, accreditation, low-interest loans, and task shifting to encourage private sector investment in drug retail. Finally, the WHO should work with stakeholders such as the UNODC and the WCO to develop an international code of practice on falsified and substandard drugs.

Although President Obama won the election, Congress could choose not to fund key parts of the ACA, but it lacks the votes to repeal the Act. Many parts of the ACA, including the health insurance exchanges and high-risk pools for people with pre-existing conditions, were directly funded and, therefore, would require an act of Congress to de-fund. Other components, however, including many relating to health workforce expansion, quality improvement, and some prevention programs were not directly funded, so they could be starved of money through Congressional inaction.

Although not identical, it is instructive to compare Hurricane Katrina with the still unfolding events of Sandy. Unlike in Katrina, New York hospitals had more detailed emergency plans. What seemed to be missing, however, were clear and consistent criteria to guide evacuation decisions. Evacuation decisions are complex—a decision to evacuate prematurely places patients at risk, while waiting too long can have devastating consequences. Public officials, in collaboration with facilities, should decide whether to shelter in place or risk transfer of fragile patients. Governors should consider early emergency declarations, including request for a formal “public health emergency declaration”, to reduce legal concerns and regulatory constraints. Federal, state, and municipal authorities can better prepare for the next disaster and have a duty to do so.

The article outlines why there are strong moral reasons the law should require all adults in close supervision of children to report any individual who they have good reason to believe has abused a child and moreover outlines how to ensure prompt reporting of abuse, while still ensuring that respected individuals are not falsely accused.

The precise significance of the individual mandate to the proper functioning of the ACA remains to be seen, primarily because the penalties are small relative to the cost of insurance. The IRS also has little enforcement authority if individuals elect not to purchase insurance. The mandate remains the only mechanism for the ACA’s financial sustainability.

The importance of the Medicaid expansion cannot be overstated, as it is the sole means by which poor Americans will gain coverage. If states decline to participate there may be a social justice disaster in which disparities in access to health insurance in some states actually widen under the ACA as middle-class and well-off Americans gain access to insurance while the poor are left behind.

Justice Roberts sided with the Court’s conservative wing to espouse a narrow view of Congress’ ability to regulate under the Commerce Clause, which could create challenges as future Congresses seek to address national public health problems. Even so, we conclude that the Court’s decision leaves the United States immensely better off in that future debates will likely center around how to ensure access to health care for all, not whether to do so–that debate is over, and the nation should push forward on the path toward universal coverage.

The very concept of global health justice as conceived by JALI and the FCGH is to have the global campaign led by civil society, with the major conceptualization and advocacy coming from the Global South. This paper presents the African, particularly South African, perspective on global health justice.

It is common sense for everyone to purchase health insurance and thus gain security against the potentially catastrophic costs of treating a serious illness or injury. However, Congress’ method of ensuring that everyone has health insurance is actually novel. It appears that Congress has never before mandated that individuals enter into a contract with a private company. Although some scholars have pointed to precedents—such as the requirement that everyone pay into the Medicare system—these appear distinguishable—in the case of Medicare, for example, it is a public program, albeit with private aspects.

The very idea that Congress could exercise this unprecedented power has provoked mostly (but not only) conservatives to recite a parade of horribles, ranging from mandatory purchase of things that are good for individuals (buy broccoli, a fitness club membership) or good for society (buy electric cars to stimulate environmentally friendly industry sales). Fundamentally, critics believe that individuals have the right to be left alone—to opt out of commerce (buy no insurance) and self-insure or simply accept the consequences if they fall ill.

Prior to Tuesday’s arguments, I believed that the Supreme Court would uphold the health insurance purchase mandate by a comfortable margin. But now I believe that health care reform hangs in the balance. Here are the key arguments on which the future of President Obama’s health care reform depends: a greater freedom, cost-shifting, the health care market, acts versus omissions, limiting principles, the population-base approach, and what is necessary and proper. If the Court strikes down the individual mandate, everyone’s premiums for health insurance could rise inexorably. Is that what a decent society would want or accept?

The states challenging the ACA maintain that the purchase mandate uniquely penalizes individuals for failing to purchase insurance. Uninsured individuals, however, rarely do nothing. Instead, they self-insure, rely on family, and cost-shift to hospitals, the insured, and tax payers. Because most uninsured people will eventually require uncompensated care, they impose costs on everyone through higher taxes and insurance premiums. Further, although the ACA’s mandate is unusual, it is not unprecedented. Mandatory worker contributions to Medicare, for example, are a compelled purchase of health insurance. The necessary and proper clause, which permits Congress to pass laws rationally related to the exercise of federal powers, may be the best argument in favor of the mandate because the mandate is necessary for the other insurance market reforms to work.

If the Court were to strike down the mandate, it would then have to determine whether the mandate is severable from the rest of the ACA. Although the ACA did not explicitly state that if part of the act were deemed unconstitutional the rest would survive, most ACA reforms are severable because they are unrelated to the mandate, such as funding for public health and community health centers. The more difficult question is whether the mandate is so intertwined with the ACA’s still unimplemented market reforms that the Court must strike them down.

The Court will also review the constitutionality of expanding Medicaid to all individuals with household incomes below 138% of the federal poverty level. The states argue that Medicaid expansion is unduly coercive because they could lose all Medicaid funding and not just the funding related to the expansion. The Court, however, is unlikely to uphold the coercion theory because state participation in Medicaid has always been optional and some states have openly discussed exercising their option to discontinue the program.

Finally, the Court will hear technical arguments concerning the Anti-Injunction Act (AIA), which prohibits lawsuits “for the purpose of restraining the assessment or collection of any tax.” The Court is unlikely to invoke the AIA because neither the administration nor the states contend that it applies.

The ACA will achieve near universal coverage, something that seemed unimaginable just a short time ago. Health reform envisages a social contract in which everyone shares the cost, recognizing that virtually everyone will become ill one day. The ACA and its individual mandate are not unjustified limits on freedom, but rather are vital to a decent society.

The Patient Protection and Affordable Care Act of 2010 (ACA or the Act)1 reflects the dominance of health care over public health. As its name suggests, the statute’s primary goal is to improve access to health care services through insurance system reforms. In contrast, politicians neglected the goal of improving the population’s health in this monumental overhaul of our health system. Although the ACA does little to mandate health system integration, various opportunities exist within the Act’s implementation for decision makers to improve coordination between health care and public health.

In the first part of this article, we argue that the key purpose of health reform should be the improvement of health. Evidence indicates that public health efforts — health promotion and disease prevention — contribute more to reductions in morbidity and mortality than improved access to health care services. We then argue that optimal gains in health status will occur through effective and efficient integration of public health and health care services. In the third part of the article, we explore the ACA’s contribution to the goal of improving the population’s health. Specifically, we critically analyze the extent to which the Act facilitates integration between public health and health care. Drawing from the health policy literature, we discuss strategies for advancing integration, with a view to guiding the Act’s implementation and future health care debates. We conclude by advocating for a broad approach to integration — a Health in All Policies Approach — which would integrate health considerations into all areas of government policy.

The PIP Framework seeks to improve pandemic influenza preparedness by addressing virus and benefit sharing on an equal footing and establishing mechanisms to achieve more equitable access to benefits. To facilitate virus sharing, the PIP Framework encourages WHO member states to share influenza virus specimens. It also creates a virus tracking mechanism that features two standard material transfer agreements to increase transparency concerning the use of shared viruses. This mechanism represents the Framework’s most significant contribution to strengthening pandemic influenza surveillance and response.

The Framework’s benefit-sharing system contains many components, but its most notable accomplishment for increasing equitable access to benefits is the pharmaceutical industry’s agreement to provide monetary and in-kind contributions. The PIP Framework is a landmark for global governance for health because it is the first international agreement facilitating influenza virus and benefit sharing. However, the Framework is not legally binding, avoids intellectual property issues that complicated the negotiations, does not include commitments from developed countries to donate portions of influenza vaccines they purchase, and faces implementation challenges in an increasingly difficult global health environment.