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Privacy and metadata: The hidden threat to whistle-blowers in public health systems
Abstract
A high quality public health system relies as much on a robust, accountable and transparent governance framework as it does on the integrity, professionalism and skill of its practitioners and administrators. Patients have an expectation, grounded in human rights entrenched in international law, to a reasonable quality of care and to not be exposed to exploitation, abuse or unreasonable risks of harm. A well-functioning public health system will deliver therapeutic outcomes accordingly, but must also provide a front-line defence for the public against communicable diseases or pandemics, and should also strive to facilitate medical research and innovation. The modern age of digitized personal health information, facilitated by rapid advances in telecommunications and computing technologies, presents both opportunities and hazards for public health systems. Digital collection of data assists healthcare providers by facilitating instant access to consolidated health records, and provides an abundance of information for epidemiologists and health economists alike. However, such systems have also exposed individuals to significant breaches of privacy, and threaten the viability of the doctor–patient relationship upon which a public health system depends. In Australia, the medical profession and healthcare consumers have voiced concerns regarding the general collection, use and secure storage of personal information, including data and metadata. Both forms of personal information have been the subject of high profile privacy breaches, raising questions about the legal protection of confidences between healthcare providers and patients, and whether surveillance of a physician's actions burdens their fidelity to patients in their care. For example, a data breach of the Red Cross Blood Service exposed the names, gender, addresses, dates of birth and responses to questions about ‘at-risk sexual behaviour’ of over half a million Australian blood donors. Regarding metadata, the tension between individual privacy and regulatory overreach is illustrated by powers previously granted under the Telecommunications (Interception and Access) Act 1979 (Cth) (commonly referred to as Australia's Metadata Retention Laws) to the Australian Health Practitioner Regulatory Agency to examine the metadata of health practitioners under investigation, thus encompassing communication with all their patients, not simply those pertaining to a given complaint. This tension is also readily evident in the case study presented in this article of the Australian Federal Police's alleged warrantless access to a doctor's phone metadata to determine the identity of a suspected whistle-blower. In this case, an Australian doctor was being investigated on suspicion of having disclosed details without authorization pertaining to circumstances surrounding the death of an Iranian asylum seeker in August 2014 who was being held in an offshore detention centre on Manus Island. Media reports on evidence presented at the coronial inquest into the man's death in late 2016 allege that there were unreasonable delays in transporting the patient to a healthcare facility in Brisbane where he could have received life-saving treatment. While this example did not result in a prosecution, detention centre staff, including healthcare workers, who disclosed information about operations or matters within detention centres without authorization at that time, were potentially subject to a two-year jail term under the Border Force Act 2015 (Cth). As this case study illustrates, misuse of metadata for investigating and prosecuting doctors who act as whistle-blowers within the public health system is not an isolated concern and merits careful consideration. Doctors have an ethical duty to act as whistle-blowers (i.e., grounded in virtue ethics) in a range of situations, such as to report systemic failures, review clinical outcomes of both departments and individuals, or avoid catastrophic events. Indeed, whistle-blowing serves a crucial function to promote transparency of processes in health governance and thereby improve quality of care and patient safety. As such, doctors present a special case for legal protection when they act as whistle-blowers in good faith. Legal disincentives, such as punitive measures that purport to advance the aims of secrecy in government agencies, should be avoided. A failure to do so risks undermining the very foundations of the doctor–patient relationship, with consequent negative implications for patient safety and quality of care in public health systems.
... B EFORE the modern/information age, reliable and efficient public healthcare systems were judged on professionalism, the skill of their practitioners and strict administrative controls. In those days, healthcare systems were mainly meant to provide a front-line defense against communicable diseases or pandemics for the patients, facilitate medical research along with innovation and were also aimed at delivering therapeutic outcomes [1]. However, recent technical advances have witnessed the spread of communication networks across the globe which has brought drastic improvements in telecommunication infrastructure and computing technologies which have led to the digitization of personal health information. ...
... Such developments have added another facet in ascertaining a reliable health care system, i.e. how to secure digitized personal health information of an individual. Tomossy et al. [1] argue that while digital data assists healthcare providers in M.I. Malik instant access to consolidated health records, such systems are prone to significant breaches of privacy and jeopardizes the relationship between doctor and patient. ...
The world is on the verge of a technological evolution that will revolutionize Internet access across the globe using direct device-to-satellite links. Such direct global connectivity brings with it an opportunity for the medical community to have a new framework for the secure transmission of confidential personal medical information as well as clinical systems data. Such a framework has the potential to connect developed-country expertise with less-advanced health services in developing countries, remote communities, patients’ homes, or in disaster zones. This paper explores this emerging concept along with potential communication advancements in medical equipment and presents a conceptual view of implementing ever-demanding health-care services that can benefit the global population. Further, the paper elaborates upon cyber security challenges to digital health-care services. We provide evidence on the need to improve or develop encryption and hashing algorithms and how it can help meet the cyber security challenges faced by key stakeholders for e-Health. This will ensure fast, reliable and effective health-care services for both developing economies as well as remote locations in developed countries.
... Near and Miceli (2016) have revealed that there is a fear to discover whistle-blowing because the thought of retaliation in the form of insulation and other threats. Watkins, one of the three whistle-blowers in Tomossy et al. (2017) stated that the whistle-blowers feel and have diverse consequences; it can be positive and negative on their action. However, the predominant reaction is a negative reaction from colleagues. ...
The paper determines evolution of various macroeconomic indicators of the V4 with special focus on the field of business environment. The results highlight economic prognoses of the Visegrad region for the upcoming years, which are in harmony with general forecasts of international organizations (EU, OECD, UNCTAD, IMF or Eurostat). Objectives of the work are summarized in a SWOT analysis including major threats to the V4 macroeconomic stability. All in all, Visegrad countries belong to the most dynamic regions of the European Union and are predicted to progress smoothly. The crucial challenges include slowing export in the Czech Republic, political instability in Hungary, labour returns from the UK to Poland and overdependency on car and export industries in Slovakia. Furthermore, our findings revealed that negative FDI inflow will represent an obstacle for economic progress of the V4 Group.
Effects of advertising are conditioned by several factors. The presented report focuses on specification of the links between expectations of advertising and perception of advertising with emphasis on gender differences and age correlations. Conceptualization of the studied issue is based on the fact that, both in the context of expectations and the context of perception of advertising, every person creates their subjective cognitive image of these advertisement attributes. The report presents result of an analysis of data acquired from the sample of 206 respondents aged between 18 and 83 years, out of which 93 were men and 113 were women. Significant correlations between the selected attributes of expectations of advertising and the factors of subjective perception of advertising were specified. The research results also confirmed the significant differences in perception of advertising and expectations of advertising between men and women. Women pay more attention to the music and visuals of the advertisement and appreciate the humorous aspects in advertising. The have also greater expectations of advertising - they expect it to be memorable, informative, intelligent, genuine and visually stunning.
Large-scale data sets of human behavior have the potential to fundamentally transform the way we fight diseases, design cities, or perform research. Metadata, however, contain sensitive information. Understanding the privacy of these data sets is key to their broad use and, ultimately, their impact. We study 3 months of credit card records for 1.1 million people and show that four spatiotemporal points are enough to uniquely reidentify 90% of individuals. We show that knowing the price of a transaction increases the risk of reidentification by 22%, on average. Finally, we show that even data sets that provide coarse information at any or all of the dimensions provide little anonymity and that women are more reidentifiable than men in credit card metadata.
Copyright © 2015, American Association for the Advancement of Science.
The conception of the doctor-patient relationship under Australian law has followed British common law tradition whereby the relationship is founded in a contractual exchange. By contrast, this article presents a rationale and framework for an alternative model-a "Trust Model"-for implementation into law to more accurately reflect the contemporary therapeutic dynamic. The framework has four elements: (i) an assumption that professional conflicts (actual or perceived) with patient safety, motivated by financial or personal interests, should be avoided; (ii) an onus on doctors to disclose these conflicts; (iii) a proposed mechanism to contend with instances where doctors choose not to disclose; and (iv) sanctions for non-compliance with the regime.
Privacy is a fundamental human right recognized in all major international treaties and agreements on human rights. Nearly every country in the world recognizes privacy as a fundamental human right in their constitution, either explicitly or implicitly. Most recently drafted constitutions include specific rights to access and control one's personal information. There is a growing trend towards the enactment of comprehensive privacy and data protection acts around the world. Currently over 40 countries and jurisdictions have or are in the process of enacting such laws. Countries are adopting these laws in many cases to address past governmental abuses (such as in former East Bloc countries), to promote electronic commerce, or to ensure compatibility with international standards developed by the European Union, the Council of Europe, and the Organization for Economic Cooperation and Development. Many countries have also adopted Freedom of Information laws.This paper provides details of the state of privacy in over fifty countries around the world. It outlines the constitutional and legal conditions of privacy protection, and summarizes important issues and events relating to privacy and surveillance.
A path-breaking analysis of the concept of privacy as a question of access to the individual and to information about him. An account of the reasons why privacy is valuable, and why it has the coherence that justified maintaining it as both a theoretical concept and an ideal. Finally, the paper looks into the move from identifying the grounds of the value of privacy to the different question of whether and to what extent privacy should be protected by laws. While privacy is a useful concept in social and moral thought, it may well be the case that it is relatively rare that it should be protected by the law in cases where its violation does not also involve infringement or violation of other important interests or values.
Whistleblowing has a tortured history in the NHS although it has been recognized by authoritative reviewers as making an important contribution to patient safety. In a highly critical 6th Report the House of Commons Health Committee stated ‘The NHS remains largely unsupportive of whistleblowing, with many staff fearful about the consequences of going outside official channels to bring unsafe care to light.' We recommend that the Department of Health (DH) bring forward proposals on how to improve this situation.Encouraging the medical profession to report poor care and to report incidents that occur in their practice has been problematical in modern healthcare although there are notable exceptions. This article discusses why a change in the attitude of the profession is required, what the benefits will be and how it can be achieved.
Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers’ agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical “coalfaces”.
Virtue ethics, emphasising techniques promoting an agent’s character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing.
The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.
Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.
Justice is so central to the mission of public health that it has been described as the field's core value. This account of justice stresses the fair disbursement of common advantages and the sharing of common burdens. It captures the twin moral impulses that animate public health: to advance human well-being by improving health and to do so particularly by focusing on the needs of the most disadvantaged. This Commentary explores how social justice sheds light on major ongoing controversies in the field, and it provides examples of the kinds of policies that public health agencies, guided by a robust conception of justice, would adopt.
It seems trite to say privacy is valuable. The Supreme Court of Canada has emphasized that privacy is worthy of constitutional protection. Scholars tend to agree that privacy is a fundamental moral and political concept. The consensus appears to end, however, when privacy in theory approaches privacy in practice. As a broad and evanescent concept, opinions differ as to what interests or values the protection of privacy is designed to achieve. The prevailing conceptions of privacy — six of which have been identified — fall prey to substantive criticisms from which, the author contends, they cannot recover. First, they suffer from intuitionism. That is, they offer an intuitive approach of what makes things "private" and incorrectly assume that we all approach privacy with a common understanding of the concept, or concepts, that the term "privacy" expresses. Further, the standing conceptions of privacy depend upon and serve the concept of privacy as liberty which itself is flawed. "Liberty" is seen as a form of licence, protecting — in its most crude form—an individual's right to do as he or she pleases. So viewed, it is not particularly surprising to see privacy attacked when competing "liberty" issues are at stake. Given the substantial criticisms with the prevailing conceptions of privacy, it may be worthwhile to reconsider the present paradigm against which privacy is conceived. It may be that privacy is better conceived of as an equality issue, not a liberty issue. The focus should shift away from conceptualizing privacy as a prerequisite for preventing invasions of various liberty interests to one of "maintaining conditions " that will make the exercise of those liberty interests possible. By limiting the ambit of privacy, we may indeed strengthen it.
Responding to the public concern caused by recent hospital scandals and accounts of unintended harm to patients, this author draws on her experience of analysing the health care systems of over a dozen countries and examines whether greater regulation has increased patient safety and health care quality. The book adopts a new approach to mapping developments in health care systems in Europe, North America and Australia and pieces together evidence of which regulatory strategies and mechanisms work well to ensure safer patient care. It identifies the regulatory bodies, the regulatory principles and the implementation strategies adopted to improve governance in health care systems and suggests a conceptual framework for responsive regulation. The book will be of interest to government actors, health care professionals and medico-legal scholars.
In this Article, Professor Solove develops a new approach for conceptualizing privacy. He begins by examining the existing discourse about conceptualizing privacy, exploring the conceptions of a wide array of jurists, legal scholars, philosophers, psychologists, and sociologists. Solove contends that the theories are either too narrow or too broad. With a few exceptions, the discourse seeks to conceptualize privacy by isolating one or more common "essential" or "core" characteristics of privacy. Expounding upon Ludwig Wittgenstein's notion of "family resemblances," Solove contends that privacy is better understood as drawing from a common pool of similar characteristics. Rather than search for an overarching concept, Solove advances a pragmatic approach to conceptualizing privacy. According to Solove, when we talk about privacy, we are really talking about related dimensions of particular practices. We should explore what it means for something to be private contextually by looking at privacy problems: instances of particular forms of disruption to particular practices. Solove demonstrates how practices involving privacy have changed throughout history and explains the appropriate way to assess the value of privacy.
Librarians have long recognized the importance of privacy to intellectual freedom. As digital technology and its applications advance, however, efforts to protect privacy may become increasingly difficult. With some users behaving in ways that suggest they do not care about privacy and with powerful voices claiming that privacy is dead, librarians may question whether privacy is worth protecting. This article reviews some of the extensive scholarly literature on privacy from disciplines outside the field of library science, including anthropology, law, philosophy, political science, psychology, and sociology, and it identifies fourteen reasons privacy matters to individuals, relationships, and to society. It also discusses the challenge of defining privacy and addresses the question of how the concept of privacy spans cultures. Librarians may find this broader understanding of the value of privacy useful in affirming and defending their commitment to the privacy of library users.
Privacy is a value so complex, so entangled in competing and contradictory dimensions, so engorged with various and distinct meanings, that I sometimes despair whether it can be usefully addressed at all. Jeffrey Rosen's courage in eloquently addressing the subject with the sweep and vigor evident in The Unwanted Gaze is entirely admirable.' He has composed a rich and useful book, filled with perceptive observations and nuggets of sound advice. But as to capturing the core concept of privacy itself, I find myself cautious and reserved.
In this brief Review Essay, I shall isolate and review three different and in some respects incompatible concepts of privacy that are each mentioned in the Prologue to The Unwanted Gaze. The first connects privacy to the creation of knowledge; the second connects privacy to dignity; and the third connects privacy to freedom. I shall argue that the first concept should not be understood as a question of privacy; that the second is a helpful way of apprehending privacy, but that it should focus our attention primarily upon forms of social structure; and that the third is best conceived as an argument for liberal limitations on government regulation.
Many information systems involve data about people. In order reliably to
associate data with particular individuals, it is necessary that an
effective and efficient identification scheme be established and
maintained. There is remarkably little in the information technology
literature concerning human identification. Seeks to overcome that
deficiency by undertaking a survey of human identity and human
identification. Discusses techniques including names, codes,
knowledge-based and token-based identification, and biometrics.
Identifies the key challenge to management as being to devise a scheme
which is practicable and economic, and of sufficiently high integrity to
address the risks the organization confronts in its dealings with
people. Proposes that much greater use be made of schemes which are
designed to afford people anonymity, or which enable them to use
multiple identities or pseudonyms, while at the same time protecting the
organization's own interest. Describes multi-purpose and inhabitant
registration schemes, and notes the recurrence of proposals to implement
and extend them. Identifies public policy issues. Of especial concern is
the threat to personal privacy that the general-purpose use of an
inhabitant registrant scheme represents. Speculates that, where such
schemes are pursued energetically, the reaction may be strong enough to
threaten the social fabric.
How would you like the government to have access to the records of every purchase you have ever made? Part I of this paper describes the trend toward more electronic and more traceable payments over time, and identifies some of the harms that can occur when an individual's transactions records are readily accessible. Part II introduces the metaphor of data entering a 'vault 600 feet down,' and uses that metaphor to understand the range of ways that data can 'reach the surface,' or become accessible. Part III systematically examines the advantages and disadvantages of government access to financial transactional data. Advantages come in administration of the tax system, in avoiding welfare and other benefits fraud, and in money laundering and other rules that seek to detect, deter and prove illegal activity. These advantages, however, can be offset by troublesome ways that government officials and unauthorized third parties might misuse financial data. Part IV expands the analysis to high-tech government surveillance more generally. The arguments developed in Part III apply to key escrow, tracking of cellular phone location, transaction-generated information for telephone calls, and other surveillance systems. One important conclusion is that the government should have a greater burden in order to get 'real time' access to data than to get 'audit trail' access after the fact.
Privacy is a concept in disarray. Nobody can articulate what it means. As one commentator has observed, privacy suffers from an embarrassment of meanings. Privacy is far too vague a concept to guide adjudication and lawmaking, as abstract incantations of the importance of privacy do not fare well when pitted against more concretely-stated countervailing interests. In 1960, the famous torts scholar William Prosser attempted to make sense of the landscape of privacy law by identifying four different interests. But Prosser focused only on tort law, and the law of information privacy is significantly more vast and complex, extending to Fourth Amendment law, the constitutional right to information privacy, evidentiary privileges, dozens of federal privacy statutes, and hundreds of state statutes. Moreover, Prosser wrote over 40 years ago, and new technologies have given rise to a panoply of new privacy harms. A new taxonomy to understand privacy violations is thus sorely needed. This article develops a taxonomy to identify privacy problems in a comprehensive and concrete manner. It endeavors to guide the law toward a more coherent understanding of privacy and to serve as a framework for the future development of the field of privacy law.
Privacy law and conceptions of a right to privacy have, of course, evolved considerably since 1890 when future Supreme Court Justice Louis Brandeis and Boston attorney Samuel Warren penned their now ageless article, The Right to Privacy, 4 Harv. L. Rev. 193, in which they argued the law should recognize such a right and impose liability in tort for intrusions on it. But quite apart from any argument about how attenuated the link might be between Brandeis and Warren's specific proposals and the current state of privacy law, is it fair to say, as so many scholars and judges repeatedly do, that Brandeis and Warren's article give birth to its namesake in the lexicon and substance of American law? A review of the law and the secondary legal and historical literature from the late nineteenth century and early twentieth century strongly supports the argument that The Right to Privacy did indeed "give birth" to a right to privacy. The judicial opinions from1891 until 1911 that addressed claims of invasion of an alleged right to privacy almost invariably cited and discussed Brandeis and Warren's article, and the several opinions recognizing a right to privacy placed substantial reliance on the article as a form of authority. To be sure, Brandeis and Warren had a potent ally, as professional and popular opinion of the era were overwhelmingly and passionately in support of protecting people's privacy in the face of cramped urban conditions and the proliferation of amateur photography and gossip-mongering "yellow" journalism. But to effect change in the legal establishment, that ally needed a cogent and respected voice. The Right to Privacy achieved its early and generalized influence because its authors harnessed the public's outrage at the intrusive elements of the newly urban society, and channeled it into a forceful and well-reasoned appeal for change to the judicial and legislative establishment.
Privacy advocates often like to claim that all modern societies feel the same intuitive need to protect privacy. Yet it is clear that intuitive sensibilities about privacy differ from society to society, even as between the closely kindred societies of the United States and continental Europe. Some of the differences involve questions of everyday behavior, such as whether or not one may appear nude in public. But many involve the law. In fact, we are in the midst of major legal conflicts between the countries on either side of the Atlantic - conflicts over questions like the protection of consumer data, the use of discovery in civil procedure, the public exposure of criminal offenders, and more. Clearly the idea that there are universal human sensibilities about privacy, which ought to serve as the basis of a universal law of the protection of privacy, cannot be right. This article explores these conflicts, trying to show that European privacy norms are founded on European ideas of personal honor. Continental privacy, like continental sexual harassment law, prison law, and many other bodies of law, aims to protect the personal honor of ordinary Europeans. American law takes a very different approach, protecting primarily a liberty interest. These are not differences that we can understand unless we abandon the approach taken by most privacy advocates, since they have little to do with the supposedly universal intuitive needs of personhood. Instead, they are differences that reflect the contrasting political and social ideals of American and continental law. Indeed, we should broadly reject intuitionism in our legal scholarship, focusing instead on social and political ideals.
This paper deals with intercultural aspects of privacy, particularly with regard to differences between Japanese and Western
conceptions. It starts with a reconstruction of the genealogy of Western subjectivity and human dignity as the basic assumptions
underlying Western views on privacy. An analysis of the Western concept of informational privacy is presented. The Japanese
topic of ‘‘denial of self” (Musi) as well as the concepts of Seken, Shakai and Ikai (as analyzed by the authors of the companion piece on privacy in Japan) give rise to intercultural comparisons. The paper
addresses the question of privacy in cyberspace and mass media. Finally the question of freedom of speech is related to the
Japanese concepts of Ohyake and Watakusi.
Purpose
There are a lot of discussions about privacy in relation to contemporary communication systems (such as Facebook and other “social media” platforms), but discussions about privacy on the internet in most cases misses a profound understanding of the notion of privacy and where this notion is coming from. The purpose of this paper is to challenge the liberal notion of privacy and explore foundations of an alternative privacy conception.
Design/methodology/approach
A typology of privacy definitions is elaborated based on Giddens' theory of structuration. The concept of privacy fetishism that is based on critical political economy is introduced. Limits of the liberal concept of privacy are discussed. This discussion is connected to the theories of Marx, Arendt and Habermas. Some foundations of an alternative privacy concept are outlined.
Findings
The notion of privacy fetishism is introduced for criticizing naturalistic accounts of privacy. Marx and Engels have advanced four elements of the critique of the liberal privacy concept that were partly taken up by Arendt and Habermas: privacy as atomism that advances; possessive individualism that harms the public good; legitimizes and reproduces the capitalist class structure; and capitalist patriarchy.
Research limitations/implications
Given the criticisms advanced in this paper, the need for an alternative, socialist privacy concept is ascertained and it is argued that privacy rights should be differentiated according to the position individuals occupy in the power structure, so that surveillance makes transparent wealth and income gaps and company's profits and privacy protects workers and consumers from capitalist domination.
Originality/value
The paper contributes to the establishment of a concept of privacy that is grounded in critical political economy. Owing to the liberal bias of the privacy concept, the theorization of privacy has thus far been largely ignored in critical political economy. The paper contributes to illuminating this blind spot.
The literature, both academic and judicial, on the intersection of law and health is pervasive. The subject of law and health is widely taught, practiced, and analyzed. The fields that characterize these branches of study are called health law, health care law, law and medicine, forensic medicine, and public health law. Do these names imply different disciplines, each with a coherent theory, structure, and method that sets it apart? Notably absent from the extant literature is a theory of the discipline of public health law, an exploration of its doctrinal boundaries, and an assessment of its analytical methodology. Public health law can be defined, its boundaries circumscribed, and its analytical methods detailed in ways that distinguish it as a discrete discipline—just as the disciplines of medicine and public health can be demarcated. With this book I hope to provide a fuller understanding of the varied roles of law in advancing the public’s health. The core idea I propose is that law can be an essential tool for creating conditions to enable people to lead healthier and safer lives.In this opening chapter, I offer a theory and definition of public health law, an examination of its core values, an assessment of state statutes in establishing the legal foundations of public health agencies, a categorization of the various models through which law acts as a tool to advance the public’s health, and, finally, a description of the current debate over the legitimate scope of public health. These are the questions I will pursue: What is public health law and what are its doctrinal boundaries? Why should population health be a salient public value? What are the legal foundations of governmental public health? How can law be effective in reducing illness and premature death? And what are the political conflicts faced by public health in the early twenty-first century?My definition of public health law follows, and the remainder of this chapter offers a justification as well as an expansion of the ideas presented: Public health law is the study of the legal powers and duties of the state, in collaboration with its partners (e.g., health care, business, the community, the media, and academe), to assure the conditions for people to be healthy (to identify, prevent, and ameliorate risks to health in the population) and the limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the common good. The prime objective of public health law is to pursue the highest possible level of physical and mental health in the population, consistent with the values of social justice.Several themes emerge from this definition: (1) government power and duty, (2) coercion and limits on state power, (3) government’s partners in the “public health system,” (4) the population focus, (5) communities and civic participation, (6) the prevention orientation, and (7) social justice.
In Overseers of the Poor, John Gilliom confronts the everyday politics of surveillance by exploring the worlds and words of those who know it best-the watched. Arguing that the current public conversation about surveillance and privacy rights is rife with political and conceptual failings, Gilliom goes beyond the critics and analysts to add fresh voices, insights, and perspectives. This powerful book lets us in on the conversations of low-income mothers from Appalachian Ohio as they talk about the welfare bureaucracy and its remarkably advanced surveillance system. In their struggle to care for their families, these women are monitored and assessed through a vast network of supercomputers, caseworkers, fraud control agents, and even grocers and neighbors. In-depth interviews show that these women focus less on the right to privacy than on a critique of surveillance that lays bare the personal and political conflicts with which they live. And, while they have little interest in conventional forms of politics, we see widespread patterns of everyday resistance as they subvert the surveillance regime when they feel it prevents them from being good parents. Ultimately, Overseers of the Poor demonstrates the need to reconceive not just our understanding of the surveillance-privacy debate but also the broader realms of language, participation, and the politics of rights. We all know that our lives are being watched more than ever before. As we struggle to understand and confront this new order, Gilliom argues, we need to spend less time talking about privacy rights, legislatures, and courts of law and more time talking about power, domination, and the ongoing struggles of everyday people.
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