Costa Rica -- Days 3 & 4: The lived experience of migrant indigenous peoples

Days 3 and 4: Over the past two days, we’ve had the opportunity to enrich our understanding of the lived experience of indigenous communities in the south of Costa Rica and the rights-based approach of the government to health and other interventions. The Casa de la Alegría program in Costa Rica offered a great example of an intervention that addresses the interrelated nature of children’s rights and the rights of their parents. In addition, our visit to La Casona, an indigenous territory, provided important insights into how health and human rights interventions can be adapted to meet communities where they are and ensure respect for local culture.

Many thanks to the following: Carlos Faerron Guzmán, from whom we learned so much; the other individuals who joined us for various parts of these two days and shared their knowledge; the communities that gave us the opportunity to visit and learn from them; and the Organization for Tropical Studies for hosting us.



NEW PUBLICATION: Child Trafficking: Issues for Policy and Practice


Child Trafficking: Issues for Policy and Practice

V. Jordan Greenbaum, Katherine Yun, Jonathan Todres

Journal of Law, Medicine, and Ethics, 46(1): 159-163 (2018)


Efforts to address child trafficking require intensive collaboration among professionals of varied disciplines. Healthcare professionals have a major role in this multidisciplinary approach. Training is essential for all professionals, and policies and protocols may assist in fostering an effective, comprehensive response to victimization.

Click here for the full article.

Human Rights and the Social Determinants of Health

Guest Blog on HealthLawProf Blog:

Poor people live shorter lives, substantially shorter in certain impoverished communities. A recent New York Times article highlighted the significant gaps in life expectancy among different counties in Virginia: “Residents of Fairfax County are among the longest-lived in the country: Men have an average life expectancy of 82 years and women, 85, about the same as in Sweden. In McDowell, the averages are 64 and 73, about the same as in Iraq.”

The poor are less likely to have access to needed health care and more likely to smoke, be overweight, and to live with constant stress, which we now know is harmful to the human body.  It is at this critical juncture (as well as others) that public health and human rights meet. As public health professionals focus on the social determinants of health, relatively few approach these issues through a human rights framework or in partnership with human rights advocates. Likewise, human rights activists miss opportunities to partner with, and build upon the work of, public health. 

The social determinants of health implicate human rights, and visa versa....

Click here for the full article.

Tobacco Related Harms Extend to Children Who Harvest It

Guest Blog on HealthLawProf Blog:

This year marks the 50th anniversary of the release of the Surgeon General’s first report on the health consequences of tobacco.  Since that report was published in 1964, more than 20 million Americans have died prematurely as a result of cigarette smoking.  The annual total economic costs to the U.S. economy are now estimated to be $289 billion. This year’s Surgeon General’s report, The Health Consequences of Smoking--50 Years of Progress, contains some good news.  The prevalence of cigarette smoking among adults has declined from 42% in 1965 to 18% in 2012 (though progress has slowed in recent years).  And, perhaps more important, we know how to solve this problem; as the Surgeon General’s report details, “[t]he evidence is sufficient to conclude that there are diverse tobacco control measures of proven efficacy at the population and individual levels.

The harms of tobacco use are well known by anyone with interest in health care issues.  Less well known are the harmful effects of tobacco production on the many children who work on tobacco farms in the United States today.  In a report released earlier this month -- Tobacco's Hidden Children: Hazardous Child Labor in United States Tobacco Farming, Human Rights Watch found that:

Children working on tobacco farms in the United States are exposed to nicotine, toxic pesticides, and other dangers. Child tobacco workers often labor 50 or 60 hours a week in extreme heat, use dangerous tools and machinery, lift heavy loads, and climb into the rafters of barns several stories tall, risking serious injuries and falls.

The investigation also found that many children involved reported symptoms “consistent with acute nicotine poisoning.” In non-agricultural workplaces, labor laws prohibit the employment of children under 18 years old in hazardous occupations (such as excavation, manufacturing explosives, mining, and operating many types of power-driven equipment).  Yet the same protections do not exist for children working on farms. As the Human Rights Watch investigation uncovered, this is not just a labor issue, but a health issue and a children’s rights issue.  It merits much more attention.

In the United States, children under 18 years old are not permitted to buy tobacco products. We draw this line, as we do in many other areas of the law, because we recognize that children are entitled to special protections.  The harmful consequences of tobacco use demand that we make every effort to prevent children from taking up smoking.  Similarly, the dangers of tobacco production should convince us to end the practice of using children on tobacco farms.

First published on HealthLawProf blog.

Incorporating Experiential Learning in Health Law Courses

Guest Blog on HealthLawProf Blog:

As law schools continue to contemplate curricular reforms, health law courses offer a particularly rich area for exploration.  Employers increasingly want new graduates to be “practice ready.”  Setting aside the larger debates on legal education, I believe that the breadth of health law creates opportunities to foster the development of students’ skills for many types of law practice.  Though clinics at many schools are an obvious space for that development, doctrinal courses can offer significant opportunities. 

In my Public Health Law course, I incorporate two drafting exercises during the semester.  Given the nature of topics we cover in the course (infectious disease outbreaks, tobacco, obesity, gun violence, bioterrorism, and others), the course lends itself to engaging students in legislative drafting exercises.  These assignments further strengthen skills taught in other parts of the curriculum and foster the development of new skills. This week, I share a few observations from my teaching on the value of incorporating skills exercises into a doctrinal class. 

Thinking like a lawyer. We say that teaching our students to “think like a lawyer” is a core skill that law schools nurture.  Drafting exercises advance students’ analytical skills, while introducing students to components of legal analysis not typically addressed by the case method – analysis in transactional law settings.  Transactional work requires lawyers to anticipate what might happen in the future and draft legal documents that account for that. Contracts and legislation, when well-crafted, anticipate and respond effectively to subsequent events.  In the drafting exercises, students get to engage in thinking ex ante about legal issues that might arise. Doing so, builds a side of “thinking like a lawyer” that is often underdeveloped in law school.

Write, write, write.  I have yet to meet a law professor who complains that we require students to write too much. Legal writing is one of the core skills needed for successful practice. Drafting exercises provide opportunities to do different types of legal writing.  These exercises also teach basic drafting skills that are relevant whether a student ends up drafting legislation, contracts, or settlement agreements.  In my class, we work on developing an appreciation for the precision needed to draft effectively.  I don’t expect students to be experts after two exercises, but their growth from the first to the second assignment alone demonstrates that they quickly develop an appreciation for key drafting concepts, learn what they need to pay attention to when drafting, and have a better sense of how to draft with precision and account for unintended consequences.

Risk/Benefit Analysis.  Drafting forces students to grapple with complex choices and analyze risk. Which party should bear the risk in a certain situation?  Should legislation detail exactly what is or is not permitted, or should that authority be delegated to a board of health? Whether drafting contracts or legislation, decisions need to be made as to risk.  Through these exercises, students gain experience identifying and assessing risk.

Risk/Benefit Analysis (for faculty).  When incorporating experiential learning exercises in doctrinal courses, there is often a fear that substantive law must be cut to make room for the exercises. In my experience, it’s not a zero sum game. Legal concepts can be reinforced and even taught through drafting exercises.  Due process and the void for vagueness doctrine are two areas that we grapple with in our drafting exercises.  Even if you are confronted with having to cut some reading materials, the payoff still makes it worth doing.  Every year, in mid-course evaluations (that I run), end-of-semester evaluations (run by the law school), and in feedback from former students in practice, students report that the drafting exercises were among the most valuable learning experiences.  Students want to develop tangible skills, and drafting exercises are a fun – yes, I said fun – way to help them do so. Health law offers wonderful opportunities to engage students in drafting and other experiential learning exercises that enrich their learning.

First published on HealthLawProf Blog.


Health Care and Human Trafficking

Guest blog on HealthLawProf Blog:

Human trafficking inflicts significant physical, mental, and emotional harm on its victims.  The health consequences are dramatic and, in some cases, even life threatening. Victims and survivors of human trafficking confront a range of health issues from physical injuries and sexually transmitted infections to PTSD, depression, anxiety and other illnesses. 

Although human trafficking has received increased attention in recent years, responses to the problem remain rooted primarily in criminal justice frameworks. Law enforcement is necessary but not sufficient.  Health care professionals can play a key role in addressing human trafficking. 

Victims of human trafficking present at a wide range of health care facilities, including hospital emergency departments, community health centers, primary care clinics, school clinics, specialty clinics (e.g., obstetrics/gynecology, psychiatry), health department clinics, dental clinics, and other service providers.  In an article on sex trafficking of children and adolescents published last month in the New England Journal of Medicine, Ellen Wright Clayton and I wrote that health care professionals can help identify at-risk and exploited youth, provide needed treatment to survivors, and ensure that these individuals are connected with appropriate services. These roles apply not only to assisting individuals trafficked into the sex trade but also in identifying and responding to labor trafficking victims. Recent research has reinforced the need to recognize and respond to all forms of trafficking. Labor trafficking, which frequently has been overlooked, implicates numerous industries and businesses, including hospitality and tourism, agriculture, construction, mining, fisheries, domestic service, hair and nail salons, and many others.  

It is critical that health care professionals and health law attorneys recognize that the health sector provides an important opportunity for early intervention and even prevention. For example, a pimp who is exploiting a teenage boy or girl might still take that child to an emergency department for treatment for various ailments. Likewise, a rural community health center or pharmacy might be able to identify trafficked agriculture workers who otherwise are housed in remote areas that make it difficult to identify them. Health care facilities must develop evidence-based protocols to respond effectively in these and other situations.  They must ensure that clinicians and others who might come into contact with human trafficking victims are trained to identify victims and respond appropriately. 

Finally, this area is one in which medical-legal partnerships could offer significant benefits. Many human trafficking victims confront a host of legal issues and need assistance navigating systems and accessing services.  Where partnerships exist already, health lawyers and clinicians would do well to explore how their medical-legal partnership could expand to account for human trafficking.  Where partnerships have not yet been formed, the pressing needs of survivors of human trafficking might provide the impetus to forge collaborative working relationships among health care professionals and lawyers to better serve vulnerable populations.


First published on HealthLawProf Blog.