Why are the law and human rights important to population and public health?

According to Sofia Gruskin, JD, MIA, professor of population and public health sciences, the pandemic raised awareness of inequalities around human rights and social justice issues—especially their intersection with public health. The director of the USC Institute on Inequalities in Global Health expresses, “we’ve been doing this work for so long, and it’s taken the pandemic and the overturn of Roe v. Wade for many people to realize the need to address law to improve health and the importance of this work.”

Her own realization began in the 1980s at the height of the AIDS pandemic. She witnessed numerous human rights violations around the provision and access to health care and other services. “I was already involved in legal support work when the critical nature of the epidemic convinced me that I needed to go to law school and get training in public health,” she reveals. Prior to this, she had been working with Amnesty International. Over time, her collective experiences and commitment to addressing inequalities would expand into other health topics including reproductive and sexual health, and pandemics more broadly. These efforts have been recognized, including most recently recognition as among the Best Legal Scientists of 2023.

“One of the things we often talk about in public health are structural factors. This includes the legal environment and the impact it has on people’s well-being,” she explains. “If we are offering HIV testing services but criminalizing drug-use, then people who use drugs may not come forward for services or tests available to them, because they know the system will not support them,” she advises. The law and human rights dimensions are important because unsoundlaws result is poor health outcomes. “The law not only impacts the way we live our lives, but also what services are available to us—and sadly this now all intersects with policy and politics,” she assesses.

Much of her research has focused on assessing the harmful effects of flawed laws. “This is done through methodological, rigorous, and scientific processes that include publication in peer-reviewed journals,” she indicates. “After this, we often then work with local partners to translate these findings into advocacy strategies for use with parliamentarians and policy makers.” It is for maximum impact, that IIGH often collaborates with United Nations agencies, who have an entry point and access to governments and civil society organizations across the world. Recently, the Institute partnered with UNAIDS to publish “A Framework for Understanding and Addressing HIV-related Inequalities.” The report is designed to support countries in their efforts to identify and address HIV-related inequalities. It offers a systematic approach to addressing the issues that undermine progress and threaten to reverse advances in curtailing HIV infections around the world.

A related facet of this work is shining a light on important issues for health and well-being that have been overlooked. In a recent article published in the Lancet, Equity in decline: fair distribution in a worse-off world, Gruskin and colleagues highlight the waning progression of health and social outcomes. “The metrics we use in global health, have always been about performing better, assuming a common baseline, but we’ve begun to witness a decline,” she discloses. This has been the result of multiple confounding global crises, destabilizing health advances made in the last century.  Persistent threats include social and political instability as well as global warming, food insecurity, limited access to health care services, and growing health disparities. She notes that traditional models, while valuable, are insufficient to navigate the challenges of sustained global decline. Gruskin’s work calls for research and action to construct metrics that make sense going forward to evaluate equity in a world of declining resources.

Gruskin’s mission is to continue to support and strengthen evidence-based policies and programs, across numerous health issues. As legal environments become increasingly challenging in the United States and around the globe, the implications of her work have increasing impact. “We have the technical skills to be able to do this work in ways that can helpful. We can bring concrete attention to health equity in ways that can matter not only for research but for policy,” she concludes.