By Dominique Mollet, LLM, PhD Candidate University of Groningen
s.d.mollet rug.nl

Health is increasingly in the spotlight since the outbreak of the COVID-19 pandemic and it made the importance of law increasingly visible. Legal questions that were commonly posed during the pandemic were, for instance, related to the competences of States to restrict freedoms of individuals, and a continuing discussion relates to a new pandemic accord for which negotiations will be resumed later this month. Health law is a broad field of study, and some topics that may come to mind beyond infectious disease control might be protection of personal health data, regulation of abortion and end-of-life decisions, the use of artificial intelligence in health care settings and patients’ rights. In this blog, I will introduce how I perceive public health law in my PhD research (substantive introductions can be found here and here; a pre-publish version of a recently accepted manuscript can be found here), in which I study law as a factor that shapes society and thereby impacts health, particularly the incidence of non-communicable diseases (NCDs).[i] We are facing a global, but invisible, epidemic of NCDs. Public health law has an important role to play.

Non-communicable diseases: the silent epidemic

NCDs are chronic diseases that are not (directly) transmitted from one person to another, including cardiovascular diseases, cancers and Alzheimer’s disease.  Each year, more than 70% of all premature deaths globally are attributed to this group of diseases, while those living with NCDs continue to experience a reduced quality of life.[ii] Besides genetic factors, environmental and behavioural risk factors, including tobacco use, alcohol consumption, unhealthy diets, and physical inactivity, are important factors increasing the risk of suffering from NCDs.[iii] Laws greatly impact these factors, as they shape our living environment. For instance, a study from Mexico suggests that the introduction of a sugar-sweetened beverage tax positively impacted oral health, including dental caries, the most common NCD globally. Research and WHO guidelines also suggest that price increases of alcohol products positively impact human health, particularly reduced risk of cancers associated with alcohol consumption. Although the Netherlands has climbed to the 3th place of the Global Tobacco Index Score and we saw an increase in the price of tobacco products (https://www.rijksoverheid.nl/onderwerpen/belastingplan/burgers/accijns-tabak-en-alcohol) in the Netherlands this month, the Dutch efforts for a healthy food environment have been deemed insufficient. A study published in 2023 demonstrates, among other things, that 80% of all food products in Dutch supermarkets and 97% of all food advertising to children did not support a healthy diet. Does such a food environment really allow us to make a free choice?[iv]

Law as a determinant of health

The above statistics make sense: laws clearly function as a determinant of human health, as they have the ‘power […] to address the underlying social and economic causes of […] disease’.[v] Laws establish norms and systems,[vi] which determine what our living environment consists of and looks like: higher prices can serve as an incentive not to consume certain products, while lowering prices make others more accessible to all; and increasing the share of healthy options in (local) supermarkets can change the default setting, while increased density of fast food outlets fosters the accessibility of such foods. Law does not only have such a regulatory power. Human rights law, especially the right to health, offers (normative) support in promoting health and preventing disease, as both are inherently connected to human dignity.[vii] Human rights law, including the right to health, does not only encompass a set of binding obligations, but it also offers relevant principles that can inform policies and foster implementation.[viii]

Law for health

There is a lot of room for improvement to foster human health, particularly by addressing NCD risk factors, via the law, including at the domestic- (Dutch) and European Union level. Lawyers play a vital role in enhancing research and practice here. Legal questions that are of interest (for me, and hopefully for others too) relate to, among other things, the legal possibilities to implement a mandatory front-of-pack labelling scheme such as the Nutri-Score; the effect of the new ‘sugar-sweetened beverage tax’ in the Netherlands; the prospective Dutch regulation of food advertising, which has been announced a while ago, but has not materialized thus far; the upcoming revision of the Tobacco Products Directive, related to which interesting questions arise regarding the regulation of e-cigarettes and vapes; and a (scientific) discussion on Article 16(4) of Regulation No. 1169/2011 on the provision of food information to consumers, which exempts beverages containing more than 1.2% of alcohol from some nutrition labelling obligations, particularly listing ingredients and a nutrition declaration.

Understanding how laws shape health and deploying them adequately are important components in NCD prevention strategies: we need lawyers and legal researchers to ensure the adequate understanding and deployment of law(s) for public health!

Cross-posted from Recht & Samenleving . It was originally published in Dutch as ‘Het recht als vormende factor voor gezondheid – de kracht van het volksgezondheidsrecht’ on 11 April 2024.

[i] More precisely, my research focuses on laws related to dental caries, particularly laws on sugars.

[ii] ‘Noncommunicable diseases’ (World Health Organization, 16 September 2023) < https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases> accessed 27 March 2024.

[iii] Ibid.

[iv] M Kamsma, ‘’Je mag ongezond leven, maar het moet je niet worden opgedrongen’’ (NRC, 6 August 2023) < https://www.nrc.nl/nieuws/2023/08/06/je-mag-ongezond-leven-maar-het-moet-je-niet-worden-opgedrongen-a4171261> accessed 20 March 2024.

[v] LO Gostin and others, ‘The legal determinants of health: harnessing the power of law for global health and sustainable development’ (2019) 393 Lancet 1857.

[vi] Ibid, p. 1861.

[vii] International Covenant on Economic, Social and Cultural Rights (adopted 19 December 1966, entered into force 3 Janaury 1976( 993 UNTS 3, preamble, Art. 12.

[viii] S Gruskin and others, ‘Noncommunicable Diseases and Human Rights: A Promising Synergy’ (2014) 104 Am J Public Health 773;