Efforts to encourage healthy behaviour often fail to bring about sustained changes in people’s lifestyles. New approaches to tackling chronic disease include the use of financial incentives: rewards paid to individuals conditional upon their achieving some pre-specified target, such as losing weight or quitting smoking. Incentives may provide an extra motivation to adopt healthy lifestyles, and structure behaviour change efforts in ways more conducive to success. Health incentives have, however, provoked controversy, attracting accusations of ‘bribing people to be healthy,’ ‘rewarding bad behaviour,’ and ‘wasting taxpayers’ money.’ It remains unclear how viable health incentives could be as a tool for health promotion; but, even if effective, their contentious nature may still give reason for hesitancy. Here, I explore whether such ethical concerns present us with convincing reasons not to use health incentives. I begin by looking at the nature of the criticisms of incentives in the media, and grouping these arguments into more general themes for discussion. I then proceed to consider each of these in turn, beginning first with debates about the requirements for the state to act efficiently without overstepping its legitimate sphere of influence. I then move on to concerns relating to the potential for incentives to undermine liberty and autonomy. Next, I discuss whether health incentives are unjust insofar as they are undeserved, and how this relates to agent freedom and responsibility for adopting healthy lifestyles. Finally, I consider the worry that using money as a healthcare intervention could corrupt certain values that we care about. In concluding, I seek to give an overall idea as to the ethical permissibility of health incentives, and identify some key features that are likely to render incentives more or less acceptable as a means of improving health.

<p> Since 2014, voters in four California cities approved ballot measures seeking to levy a penny-per-ounce tax on sugar-sweetened beverages (SSBs). Prior to these instances of success, over 128 local and state SSB tax proposals in the U.S. failed passage since 2009. The recent success of SSB tax passage in California presented an opportunity to explore factors associated with SSB tax passage, and to explore if John Kingdon&rsquo;s Multiple Streams Approach (MSA) applied in cases where the tax passed. The study also identified how Kingdon&rsquo;s theory may be modified in cases involving local governments. </p><p> I conducted a retrospective qualitative analysis using primary and secondary data collection to compare the outcome of SSB tax proposals across California cities. I interviewed 22 individuals using semi-structured telephone interviews to learn about each city&rsquo;s SSB tax proposal and process. Successful and unsuccessful SSB tax proposals were compared to learn from both passage and failure. </p><p> Five key themes or patterns were associated with cases of success including: (1) advanced planning, (2) building support, (3) voter engagement, (4) messaging, and (5) media. Cities that failed to pass the tax did not achieve consensus about the problem, or the proposed solution. A policy that is perceived as technically unfeasible has reduced chances of survival. The MSA provided a useful framework for analyzing factors associated with SSB tax success, however it remains unclear how much independence there is between the three streams at the local policymaking level. Based on the results from this study, I proposed a modification to the <i>problem stream</i> by adding a typology of events to further analyze factors associated with why a policy alternative may rise or fall on an agenda. </p><p> The results from this project have the potential to broaden the application of the MSA theory. The findings from this study will be useful to policymakers and advocates in cities that utilize direct or representative democracy, and may lead to other local level SSB tax adoption in the future. Policy entrepreneurs play an important role in shaping the course of how a problem is perceived. Problems and solutions that resonate with voters are more likely to rise on an agenda. This project also demonstrates the value of learning from policy failures. In some cases, iterating a strategy after a failure may be the only way to innovate towards a successful outcome over time.</p><p>

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Public health law is in the midst of a crisis of public confidence, which, this paper contends, has resulted from the lack of a thorough normative framework to ground public health law. This paper attempts to fill this gap by articulating a normative framework for public health law, situating it within a rule of law tradition in a limited, democratic state. This paper proceeds in three parts: it begins with a descriptive analysis of public health law; it examines the normative theories of rule of law and liberty; and, it examines public health law in light of the normative theories. This paper concludes that public health law, conceived as government interference, is consistent with rule of law and liberty and that rule of law and liberty help provide public health law with a normative framework.

Diss., Univ. Regensburg, 2009.

This thesis investigates the impact of international organizations on the making of international law by applying insights on how international organizations work—or fail to work—to the process of institutionalized treaty making. Specifically, I probe the relationship between the World Health Organization (“WHO”) and international infectious disease law, focusing in particular on the 2005 International Health Regulations (“2005 IHR”), which was negotiated, adopted, and is now being implemented under WHO’s auspices. The 2005 IHR is the most recent development in international infectious disease law, the history of which extends back to the beginning of international health cooperation in the mid-nineteenth century, before any international health organization was formed. Relying on secondary sources, WHO documents, archival materials, and personal interviews, I chronologically trace the evolution of international infectious disease law across changing institutional settings. I first examine the incremental growth of the older “barrier” approach to infectious disease regulation, initially developed in the absence of any international health organization and then with the aid of one of WHO’s predecessor organizations. I then analyze the decline of the barrier approach and the rise of the new “epidemiological” approach embodied by the 2005 IHR, with the aid of WHO. Based on my empirical analysis, I conclude that WHO has radically changed the process of making international infectious disease law as well as its content. On its own initiative and without member state demand, WHO’s permanent staff experimented with novel practices that subsequently became the basis for the 2005 IHR. WHO’s work reduced the length of formal negotiation needed to arrive at a new agreement and the uncertainty associated with adopting a novel regulatory system. Its influence also raises normative questions about the proper role of international organizations in making international law—questions that require further exploration.