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Presentations

Sunday, November 5

Keynote Address: The Role of Law in Advancing the Public’s Health

  • Dr. Fran Scott, Associate Medical Officer of Health and Consultant, Planning and Policy, Toronto Public Health
  • Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada
  • Prof. Lawrence Gostin, Associate Dean and Professor of Law, Georgetown University, Professor of Public Health, Johns Hopkins University, Director, Center for Law & the Public’s Health

Welcome: Dr. Fran Scott; opening remarks: Dr. David Butler-Jones;

Dean Gostin discusses the law and ethics of population health. He defines public health law; shows why health should be a salient public value; and demonstrates the use of law as a tool to assure the conditions for people to be healthy. The presentation uses contemporary illustrations ranging from SARS and pandemic influenza to chronic diseases related to tobacco and obesity. The perspective is national and global, and the cross-cutting theme is social justice.

Monday, November 6

Plenary Session 1: Public Health Legal Preparedness: Are We Ready?

  • Jane Allain, General Counsel, Justice Canada and Public Health Agency of Canada
  • Allison Stuart, Director, Emergency Management Unit, Ministry of Health and Long-Term Care, Ontario
  • Dan Stier, Public Health Analyst, Public Health Law Program, Centers for Disease Control and Prevention

Protecting the public’s health in Canada is a shared responsibility between federal, provincial/territorial authorities. Each authority has access to a range of legal instruments to bring to bear on a public health emergency. The extent to which those instruments work in conjunction with each other is the topic for this session. Panelists bring an international, federal and provincial perspective to identify what legislative and regulatory instruments are in place at each level to respond to a public health emergency and using case studies or recent examples, examine where there are inconsistencies, gaps and intersecting or overlapping roles and responsibilities.

Plenary Session 2: Public Health Policy Development - The Role of Inquiries

  • Justice Roland Haines, Ontario Meat Regulatory and Inspection Review
  • Justice Horace Krever, Commission of Inquiry on the Blood System in Canada
  • Justice Robert Laing, North Battleford Water Inquiry
  • Justice Dennis O’Connor, Walkerton Commission of Inquiry

Public Health policy development in Canada owes a great deal to the work conducted by Inquiries and Reviews following major public health challenges. This approach has informed and even driven the eventual directions of public health policy provincially and federally. The panelists (a group of well known Commissioners of Inquiry) bring their unique perspectives to this process and share their observations on future public health policy development processes and challenges.

Concurrent Session A1: Drinking to Good Health: Public Health Law and Safe Small Water Systems

  • Jamie Benidickson, Professor of Law, University of Ottawa
  • Dr. Ray Copes, Medical Director of Environmental Health Services, British Columbia Centre for Disease Control
  • Jim Smith, Chief Drinking Water Inspector, Assistant Deputy Minister, Ontario Ministry of Environment

Chemical and microbial contamination of drinking water can pose one of the most serious threats to public health in Canada. Such contaminants in small water supply systems, in particular, present a formidable challenge to public health officials and government regulators. This panel provides participants with a unique historical perspective on the law of wells and a consideration of contemporary public health risks associated with small water supply systems. Ontario’s drinking water safety net is also discussed as a means to managing risks to public health in that province.

Concurrent Session A2: You Are What You Eat: Food and Public Health Law

  • Dr. Don Buckingham, Justice Canada
  • Jim Chan, Manager, Food Safety Program, Toronto Public Health
  • Ronald Doering, Partner, Gowling Lafleur Henderson LLP, Former President of Canadian Food Inspection Agency

Public health law as it applies to food is of the most importance to Canadians. There is growing interest in how to choose foods that better contribute to health and longevity. Furthermore, there is a grave concern over foodborne illness, one of the largest classes of emerging infectious diseases in Canada today. This panel provides an overview of the role of food labeling in promoting public health and food quality with a consideration of relevant national legislation and international influences. An overview of Canadian law that addresses foodborne disease is also given with attention to emerging issues such as traceability, fragmented jurisdiction, problems with conventional risk analysis and international trade implications. The panel concludes with a case study that highlights the challenges that local public health authorities face when an outbreak of foodborne illness occurs.

Concurrent Session A3: HIV/AIDS: The Role of Criminal Law in Public Health

  • Glenn Betteridge, Senior Policy Analyst, Canadian HIV/AIDS Legal Network
  • Ruth Carey, Executive Director, HIV and AIDS Legal Clinic
  • Jerry Wiley, Legal Counsel, Toronto Police Services

Regrettably, individuals who know or have reason to believe they are infected with HIV may engage in risky activities that expose others to threat of infection. When is it appropriate to use criminal law powers to punish such behaviour? What purposes do criminal prosecutions serve? In addition to punishment, do they help deter others? Or does use of criminal law serve to exacerbate stigmatization of persons with HIV? This panel will address these controversial questions on the role of criminal law in combating HIV/AIDS.

Concurrent Session B1: Communicable Disease and the Ethics of Confinement

  • Christine Lonsdale, Lawyer, McCarthy Tétrault LLP
  • Dr. David Salisbury, Medical Officer of Health, City of Ottawa
  • Dr. Ross Upshur, Canada Research Chair in Primary Care Research; Director, University of Toronto Joint Centre for Bioethics

In most jurisdictions, public health officials are authorized to take steps to detain individuals infected with a prescribed communicable disease if previous attempts to control the spread of the disease are unsuccessful. Panelists in this session review some of the sensitive issues associated with involuntary detention such as: finding the balance between the rights of individuals and the protection of the public, providing treatment without consent, using restraints and coordinating care for the complex medical patient.

Concurrent Session B2: The Law and Chronic Diseases

  • Cathy Anne Pachnowski, Information Security and Privacy Officer, Cross Cancer Institute, Alberta Cancer Board
  • Nola Ries, Professor, Faculty of Law, University of Victoria and Research Associate; Health Law Institute, University of Alberta
  • Barbara von Tigerstrom, Assistant Professor, Faculty of Law, University of Saskatchewan

The law can be an effective tool to assist in combating conditions that contribute to the incidence of chronic disease in society. At other times, law may be viewed as a barrier to measures that can contribute to population health. This panel focuses on the role of law in the contexts of obesity, tobacco control and cancer care and will include analysis of: the use of legal tools to address tobacco and their relevance in addressing the current public health epidemic of obesity; regulatory approaches to protect consumers from “obesity-promoting” foods; and legal issues related to information security and privacy in the context of cancer care.

Concurrent Session B3: Beyond Prohibition: Developing Public Health Based Models for Regulating Illegal Drugs – Lessons from Tobacco

  • Cynthia Callard, Executive Director, Physicians for a Smoke Free Canada
  • Dr. Brian Emerson, Medical Consultant, Population Health and Wellness Division, Ministry of Health, British Columbia
  • Eugene Oscapella, Barrister and Solicitor; Lecturer, University of Ottawa; co-founder Canadian Foundation for Drug Policy

This session outlines the problems with the current prohibition approach to illegal psychoactive substances, discusses regulatory options for a public health oriented approach within the current legislative regime, and describes recent models developed for a supply side approach to tobacco to stimulate discussion regarding a public health approach to regulating all psychoactive substances.

Tuesday, November 7

Plenary Session 3: Health Information Privacy and Public Health System Needs: Can They Coexist?

  • Manuela Di Re, Former Public Health Law Practitioner, Health Law Counsel, Information and Privacy Commissioner of Ontario
  • Elaine Gibson, Associate Director, Health Law Institute and Associate Professor, Faculty of Law, Dalhousie University
  • Frank Work, Information and Privacy Commissioner of Alberta

Legislative attempts to protect personal health information continue apace in both federal and provincial jurisdictions in Canada. At the same time, post-SARS reviews emphasize the need for improved flows of information for public health purposes, including surveillance and research. Further, as records of personal health information become digitized, numerous issues arise as to what information should be made available to the public health system and under what circumstances. Can privacy still be protected in this fast-changing world?

Concurrent Session C1: Perinatal HIV Testing

  • Dr. Dale Guenter, Professor, Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University
  • Lori Stoltz, Partner, Adair Morse LLP
  • Esther Tharao, Health Promotion Coordinator, Women’s Health in Women’s Hands

There is widespread agreement that HIV testing of pregnant women is a critical public health intervention to minimize the risk of perinatal HIV transmission. There is less widespread agreement about how to design and implement HIV testing programmes to achieve high uptake rates including, in particular, the role of the legal doctrine of "informed consent" and mandatory testing. This session reviews experience to date and considers these issues, with a view to assisting the development of effective and legally sound policies.

Concurrent Session C2: Mandatory Blood Testing

  • Dr. Maureen Baikie, Associate Chief Medical Officer of Health, Nova Scotia
  • Vince Bevan, Police Chief, City of Ottawa
  • Barbara Walker-Renshaw, Lawyer, Borden Ladner Gervais LLP

Recent changes to public health legislation in some Canadian jurisdictions authorize mandatory blood testing for HIV, Hepatitis B and Hepatitis C. While the procedures may differ, in most cases the legislation makes provision for taking blood samples from a source person when a victim of crime, emergency service worker or Good Samaritan has been exposed to the source person’s bodily substances. Panelists review the impact of this controversial legislation from the perspective of a Medical Officer of Health, a Police Chief and a Good Samaritan.

Concurrent Sessions C3: Access to Essential Medicines

  • Jillian Clare Cohen, Assistant Professor, Faculty of Pharmacy, University of Toronto
  • Richard Elliott, Deputy Director, Canadian HIV/AIDS Legal Network
  • Sarah Perkins, Project Manager, Access to Drugs Initiative, Faculty of Law, University of Toronto

Diseases such as HIV/AIDS, malaria, river blindness, sleeping sickness and tuberculosis can be treated effectively with medication. However, most of the developing countries where these diseases are rampant cannot provide them to their citizens. Access to essential medicines has become one of the most important international public health issues. Several initiatives try to address this enormous inequality in access to health care. Canada, for example, adopted legislation in 2003 allowing generic drug companies to produce patented drugs under license and export them to countries with insufficient pharmaceutical manufacturing capacity. The panel members explore why this legislative initiative has not yielded any results yet, and identify what changes are needed. They also discuss the successes and failures of other initiatives that aim at promoting access to essential medicines.

Concurrent Session D1: Public Health Law Challenges and Opportunities for Aboriginal Communities

  • Dr. Kim Barker, Public Health Advisor, Assembly of First Nations
  • Yvonne Boyer, Lawyer, Aboriginal Health and Policy
  • Dr. Valerie Gideon, Senior Director of Health and Social Development, Assembly of First Nations
  • Dr. Isaac Sobol, Chief Medical Officer of Health, Nunavut

This session provides a review of the current legal framework within which Public Health operates for First Nations and Inuit, including the challenges that exist in current constitutional law. Public health examples will are described in the context of jurisdictional challenges and potential options moving forward will be discussed.

Concurrent Session D2: Emerging Public Health Law Issues

  • Tim Caulfield, Canada Research Chair in Health Law and Policy, Research Director, Health Law Institute, University of Alberta
  • Trudo Lemmens, Associate Professor, Faculty of Law, University of Toronto
  • Tina Piper, Assistant Professor, Faculty of Law, McGill University

In this session, three ‘emerging issues’ associated with public health law are discussed: (1) how new genetic research creates interesting possibilities for public health but is also associated with social concerns, such as the possible dilution of important public health messages about lifestyle and the environment; (2) how pharmacological products can create serious public health concerns and whether the regulatory system can be improved to counter these concerns; and (3) patent-related issues that arose in the context of SARS and the avian flu threat, and potential approaches for limiting the negative public health implications of patent law.

Concluding Plenary Session: Finding the Balance: Tools for Promoting and Protecting the Public’s Health

  • Dr. Sheela Basrur, Chief Medical Officer of Health, Assistant Deputy Minister, Public Health Division, Ministry of Health and Long Term Care, Ontario
  • Dr. David Mowat, Deputy Chief Public Health Officer, Office of Public Health Practice and Regional Operations, Public Health Agency of Canada
  • Jane Speakman, Legal Counsel, City of Toronto
  • Dr. Ross Upshur, Canada Research Chair in Primary Care Research; Director, University of Toronto Joint Centre for Bioethics

The promotion and protection of the public’s health involves searching for a delicate balance between actions and interventions aimed at the protection and promotion of a collective interest and the recognition of individual rights and interests. It is also a search for balance in the choice of instruments or tools that can be used to promote and protect the public’s health. This panel, moderated by author and journalist Paula Todd, brings together experts from the field of public health, law and ethics to discuss the use of law in public health: when is it needed? when does it go too far? when does it not go far enough? and whether there are effective alternatives to the law. Using contemporary examples, the panelists will also consider how a balance can be found between the different tools available for promoting and protecting the public’s health, and what the essential ingredients are to achieve this balance.


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