Public health – University of Copenhagen

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Public health – a challenge for the welfare society and the market

During the last 20 years there has been a rapid development in lifestyle diseases. It is estimated that approx. 60% of all global deaths can be attributed to lifestyle diseases. Even though this development is most marked in low and middle income countries (approx. 80% of all deaths), it also has significance for high income countries. On a global level development has been from epidemic diseases to an epidemic development of non-communicable diseases (NCD). This development alone will lead to rising health expenditure and together with the cost associated with an aging population; the general state of public health can be one of the welfare society’s greatest economic and practical challenges. International organisations, (e.g. WHO, OECD and EU), point to the implementation of several interventions, including the use of legal regulation, as a tool to improve public health. Others also react to the trend. This is true of workplaces and insurance and pension companies that can have their own (financial) interest in the state of the workforce’s health.

From a legal perspective, the development raises a number of questions. The increased use of legal regulation as a means of controlling the population’s health behaviour raises a number of general questions on the law’s role in the welfare society, including its ability to promote certain behavioural patterns. Moreover, the interventions (both legal and non-legal), that are pointed out as means to halt the epidemic development of lifestyle diseases, influence citizen’s existence and companies’ operations in a number of important ways. The introduction of screening programmes for certain types of cancer has significance for citizens’ rights as patients, the involvement of workplaces in general health promotion influences employment relationships between companies and employees, the introduction of healthy meal systems in kindergartens and schools may be important for children’s right to good health and children and parents right to privacy, and the ban on smoking and the regulation of marketing and labelling of tobacco goods raises questions about the state’s responsibility for ensuring the individual’s right to good health, the limits for intervention in citizens’ private life and the commercial companies freedom of speech. There is already a tendency to increase public regulation in order to control citizens’ health behaviour and companies’ market behaviour (e.g. the regulation of tobacco advertising). At the same time the market can be seen to react by finding new solutions, such as private health insurance. New actors are drawn into public health policy and private interests in public health also lead to new actors being drawn in. As a result new – and more complex – legal relationships and regulations come into being.

Research projects

The development will be illustrated from different perspectives and, at the moment, there are two different but overlapping research projects. The projects have been initiated in connection with the allocation of external funding.

Project 1: The law as an instrument of control and self-control in connection with the prevention of lifestyle diseases

The first project investigates the importance of the law as an instrument of control and self-control in connection with the prevention of lifestyle diseases. The effort to limit fatness and obesity is used as a case and the project will investigate how responsibility for prevention and treatment of fatness and obesity is reflected in the law. The central question is to what extent the legal regulation presupposes a personal responsibility for the prevention of fatness and obesity seen in relation to the public sector’s responsibility for establishing the framework for the population’s ability to live a healthy life (including intervention) to ensure the human rights protected right to good health. Another central question is the position of the law as to the stigmatization and discrimination of smokers, overweight persons and others with an unhealthy lifestyle within the central welfare area such as job market, health and social insurance.

Academic staff:

This project has researchers from the health law group (Mette Hartlev, Celine Brassart Olsen, Katharina O Cathaoir and Diana Nacea), labour law group (Jens Kristiansen) and the social law group (Kirsten Ketscher and Marta Carneiro).

Project 2: The role of the workplace

The second project will concentrate on the change in focus that has occurred in the area of working environment with the increase in workplace responsibility for employee health and, something new, with a certain amount of wider responsibility for general health. The project also includes an investigation of the relationship between work, tax and health in regard to private health insurance as a staff benefit, a provider of improved access to health services and as private financing of rising public health expenditure.

Academic staff:

This project has researchers from the labour law group (Jens Kristiansen, the tax and duty law group (Jacob Graff Nielsen) and the health law group (Mette Hartlev).