Georgetown Law Professor Larry Gostin: Creating the Wave

October 27, 2017

Celebrating the 10th Anniversary of the O’Neill Institute: Executive Director Oscar Cabrera, University Professor and Faculty Director Larry Gostin, Dean William M. Treanor, Eric Rosenthal (L’92), Professor Angela Campbell and Priscila Rodriguez.

O’Neill Institute for National and Global Health Law Faculty Director and Founding O’Neill Chair in Global Health Law Larry Gostin says there are two global health narratives in the world: those told by the most influential people, such as Bill Gates and Dr. Margaret Chan, former director-general of the World Health Organization (WHO); and those told by poor children.

“They’re both true, but they’re completely opposite stories,” Gostin says. “One shows the enormous improvements in world health, while the other shows deep suffering and injustice.”

Gostin’s latest role, in addition to university professor and the Linda D. and Timothy J. O’Neill Professor of Global Health Law at Georgetown Law, is the director of WHO’s Collaborating Center on National and Global Health Law. The O’Neill Institute celebrates its 10th anniversary on October 26 with a special recognition as a World Health Organization Collaborating Center and an afternoon of discussions featuring the UN Special Rapporteur on the Right to Health and a Global Health Panel.

The O’Neill Institute, Gostin says, has “transformed me as a human being. I feel so fortunate in my life, and much of that has to do with the O’Neill Institute.” Gostin has also authored numerous books including Global Health Law (Harvard University Press, 2014)—which explores the vision of global health with justice. A Q&A follows.

Ten years ago, what did you envision for the O’Neill Institute for National and Global Health Law, and has it followed that trajectory?

The founding vision of the Institute is something I’m enormously proud of — it’s creating world-class scholarship to make a difference in the world. We’re not just an advocacy organization or a think tank, and we’re not just a scholarly society. Rather than sit in our ivory towers, we want to use the most innovative scholarship, thinking and ideas to improve people’s health and lives in the United States and around the world. We’ve exceeded all our expectations.

Among the O’Neill Institute’s accomplishments, of which are you most proud?

First, we were an important player in the passage of the Affordable Care Act (ACA). We obtained a major Robert Wood Johnson grant that was right in our sweet spot — our mandate was not to say what the ACA should be, but what it could be, constitutionally and legally. So we advised Congress and the White House, and our research became part of the Congressional Record. That has been a valuable domestic achievement, bringing health coverage to 20 million Americans.

On the global side, I’m proud of the fact that we’re the only WHO collaborating center on global law. We have partnered with WHO and the United Nations on major epidemics ranging from influenza to Ebola to Zika.

Finally, I’m proud of our work on aging and non-communicable diseases, including looking at how to prevent cancer, heart disease and diabetes.

What surprised you along the way?

The major surprise is just how transformative the O’Neill Institute has been. At the 2016 G7 summit of world leaders in Tokyo, there were thousands of people in the audience and five speakers: Bill Gates, head of the Gates Foundation; Prime Minister of Japan Shinzō Abe; WHO Director-General Chan; World Bank President Jim Kim and me, representing the O’Neill Institute. I could never have imagined having the opportunity to shape the global agenda for the G-7 Group of Nations.

How has the field of global health law changed since the Institute was created?

Before the Institute was formed, there wasn’t even a field of global health law. We really created the field and created enormous interest. Since then, there’s been a burgeoning interest in global health through issues like Ebola and Zika and non-communicable diseases like cancer, diabetes and heart disease. We’ve ridden that wave, but we’ve also created the wave.

How do you explain the connection — the role of law in solving health problems?

High-level people at WHO often ask me, what’s the role of law in promoting health? My answer is that it’s not just an important tool for public health, it’s the most important tool. The law has been a major force in every one of [the Centers for Disease Control and Prevention’s] 10 most important achievements of the 20th century. And the 21st century needs a dynamic role for law to achieve health with justice.

What experiences in the field remind you why this work is so important?

For the foreward to my book, I asked young people around the world — in China, Africa, Latin America, tribal reservations in the United States — tell me about an ordinary day in your life. They told stories of enormous suffering and injustice, poor health conditions, lives that were cruel and in some cases, short. But what struck me the most is that these children had lost hope — for their own lives and for the future. When a child loses hope due to extremely poor health and poverty, that injustice cries out for global action.

What are the most innovative ways the law has been used to improve health?

The law can incentivize the private sector and consumers to produce and consume healthier foods. If you go into any supermarket it’s virtually impossible to decide what’s healthy, because companies add sugar, salt and/or unhealthy fats to most packaged products. The “soda tax,” first enacted in Mexico and now in several U.S. cities, is one example to make health the easier choice. It has significantly reduced consumption of sugary beverages. Another example is the trans fat ban in New York City.

The law has also been used to significantly reduce tobacco use. In developed countries in the 1960s and ‘70s, smoking was an accouterment to a good life. Today, the prevalence of smoking has plummeted beyond anyone’s expectation, and smoking has itself become stigmatic. Tobacco control laws have made all the difference, including high taxes, bans on smoking in public spaces and graphic warnings on cigarette packs.

Injuries, surprisingly, may be the most preventable health hazard; “accidents” is a bad term, because it assumes the injuries are random and unpreventable. Creating seatbelt, DWI and airbag laws, for example, has made traffic fatalities plummet. We can do more to reduce those kinds of injuries, whether it’s concussions on the football field or safety in the coalmines.

What is most rewarding for you personally?

To see the improvement in health, particularly among poor and marginalized populations; to give the voiceless a voice; to fight for the human right to physical and mental health; and to show innovative ways to achieve health with justice. Both health and justice are not impossible, but well within our grasp.

How do J.D. and LL.M. students influence the direction of the Institute?

The students are the heart and soul of what we do. Many of our J.D. students go on to work at the Department of Health and Human Services, the Federal Drug Administration or community health advocacy groups. We have the only global health LL.M. in the world. If you’re a lawyer, passionate about health anywhere in the world, the O’Neill Institute is the only place you can come for a world-class education. Our students have populated many influential, such as in WHO, UNICEF and the Gates Foundation. They are literally building the future.