Publications

2016
Hoffman, S.J., et al., 2016. The UN Convention on the Rights of Persons with Disabilities and its Impact on Mental Health Law and Policy in Canada, Toronto: Lexis Nexis. BookAbstract

Mental health issues pose critical challenges for Canada's systems of justice and health care. Problems with mental health are common, but often neglected due to stigma and the vulnerability of those living with these conditions. This is evident within our legal system. Every day in our courts we see played out the struggle to protect the human rights and dignity of individual Canadians with mental health challenges, to access adequate mental health care and social support, and to provide genuinely helpful responses to criminal behaviour associated with mental health problems. Law and Mind: Mental Health Law and Policy in Canada provides a comprehensive analysis of the most important cases and key debates at the intersection of mental health law and policy.

Written by a group of Canada's leading experts on mental health law, this volume provides practitioners, researchers and policy-makers with valuable insight into this challenging and important area of the law.

Features and benefits
Law and Mind: Mental Health Law and Policy in Canada is an important resource for understanding the complexities of mental health law and related policy issues in Canada.

Law students, practising lawyers and policy-makers alike will benefit from the broad range of topics covered in this comprehensive text. Topics addressed include the law surrounding the funding and administration of mental health care in Canada, the principles of mental health law related to hospitalization and consent to treatment, the components of the criminal law of mental disorder, and mental health issues in the policing and correctional contexts. In addition, the authors offer focused treatment of mental health law issues facing specific populations, including children, the elderly, refugees and ethnic minorities.

This text is written by leading mental health law experts who bring years of practice, research and expertise to provide readers with a comprehensive resource which:

  • Presents the legal issues related to mental health in a comprehensive manner
  • Enables students and lawyers to learn this challenging subject matter quickly and effectively
  • Analyzes recent changes and developments in the law
  • Provides current information so lawyers can properly advise their clients
  • Discusses pressing and emerging mental health issues that are relevant to practitioners and their clients

Essential reading
This new release will be particularly useful for:

  • Health lawyers advising clients and in-house lawyers at health service providers as it is an up-to-date resource on mental health law and policy
  • Students looking for a comprehensive resource on mental health law written by leading academics
  • Government health workers and policymakers who need to consult a reliable reference volume
  • Law libraries that want to stock essential guides for lawyers and students
Gulati, N., et al., 2016. Using International Instruments to Address Antimicrobial Resistance S. J. Hoffman & L. Sritharan, ed., Ottawa: Global Strategy Lab. PDFAbstract

Antimicrobial resistance (AMR) is a global health concern that poses a serious threat to the control of infectious disease. A continuous increase in rates of AMR poses a challenge to the global community and impedes progress previously made in improving health outcomes. This report examines how AMR can be addressed using international instruments, and the appropriate role of the World Health Organization (WHO) in this task. It is recommended that global collective action on AMR be achieved by implementing a Treaty under Article 19 and a Regulation under Article 21 of the WHO’s Constitution. This suite of international instruments can be used to address the greatest proportion of issues that currently impede AMR’s resolution and can mobilize the most effective action. This report further establishes that the WHO has legal authority under its Constitution to create these international instruments to address AMR.

Fafard, P. & Hoffman, S.J., 2016. Health ministers must spend smarter and negotiate wiser. The Hill Times. Article
Groux, G. & Hoffman, S.J., 2016. Why Zika matters to Canada. The Toronto Star. Article
2015
Årdal, C., et al., 2015. International cooperation to improve access to and sustain effectiveness of antimicrobials. The Lancet , 387 (10015). PDFAbstract

Securing access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. WHO alone will not be able to drive these actions. It will require a multisector response (including the health, agriculture, and veterinary sectors), global coordination, and financing mechanisms with sufficient mandates, authority, resources, and power. Fortunately, securing access to effective antimicrobials has finally gained a place on the global political agenda, and we call on policy makers to develop, endorse, and finance new global institutional arrangements that can ensure robust implementation and bold collective action.

Gopinathan, U., et al., 2015. Conceptual and Institutional Gaps: Understanding How the WHO can Become a More Effective Cross-Sectoral Collaborator. Globalization and Health , 11 (46) , pp. 1-13. PDFAbstract

Background: Two themes consistently emerge from the broad range of academics, policymakers and opinion leaders who have proposed changes to the World Health Organization (WHO): that reform efforts are too slow, and that they do too little to strengthen WHO’s capacity to facilitate cross-sectoral collaboration. This study seeks to identify possible explanations for the challenges WHO faces in addressing the broader determinants of health, and the potential opportunities for working across sectors.

Methods: This qualitative study used a mixed methods approach of semi-structured interviews and document review. Five interviewees were selected by stratified purposive sampling within a sampling frame of approximately 45 potential interviewees, and a targeted document review was conducted. All interviewees were senior WHO staff at the department director level or above. Thematic analysis was used to analyze data from interview transcripts, field notes, and the document review, and data coded during the analysis was analyzed against three central research questions. First, how does WHO conceptualize its mandate in global health? Second, what are the barriers and enablers to enhancing cross-sectoral collaboration between WHO and other intergovernmental organizations? Third, how do the dominant conceptual frames and the identified barriers and enablers to cross-sectoral collaboration interact?

Results: Analysis of the interviews and documents revealed three main themes: 1) WHO’s role must evolve to meet the global challenges and societal changes of the 21st century; 2) WHO’s cross-sectoral engagement is hampered internally by a dominant biomedical view of health, and the prevailing institutions and incentives that entrench this view; and 3) WHO’s cross-sectoral engagement is hampered externally by siloed areas of focus for each intergovernmental organization, and the lack of adequate conceptual frameworks and institutional mechanisms to facilitate engagement across siloes.

Conclusion: There are a number of external and internal pressures on WHO which have created an organizational culture and operational structure that focuses on a narrow, technical approach to global health, prioritizing disease-based, siloed interventions over more complex approaches that span sectors. The broader approach to promoting human health and wellbeing, which is conceptualized in WHO’s constitution, requires cultural and institutional changes for it to be fully implemented.

Keywords: World Health Organization, United Nations, Global governance, Global health governance, Global governance for health, Social determinants of health, Health in all policies, WHO reform, Cross-sectoral collaboration

Fafard, P. & Hoffman, S.J., 2015. Five Things Justin Trudeau Can Do On Day One. National Post. Article
Hoffman, S.J., 2015. It's Time to End Canada's Ebola Visa Restrictions. Huffington Post. Article
Belluz, J. & Hoffman, S.J., 2015. Let's Stop Pretending Peer Review Works. Vox. Article
Tan, C. & Hoffman, S.J., 2015. Overview of Systematic Reviews on the Health-Related Effects of Government Tobacco Control Policies. BMC Public Health , 15 (744) , pp. 1-11. PDFAbstract

Background: Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.

Methods: An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.

Results: Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.

Conclusion: When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy’s effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

Hoffman, S.J., et al., 2015. Strategies for Achieving Global Collective Action on Antimicrobial Resistance. Bulletin for the World Health Organization , 93 (12) , pp. 867-876. PDFAbstract

Global governance and market failures mean that it is not possible to ensure access to antimicrobial medicines of sustainable effectiveness. Many people work to overcome these failures, but their institutions and initiatives are insufficiently coordinated, led and financed. Options for promoting global collective action on antimicrobial access and effectiveness include building institutions, crafting incentives and mobilizing interests. No single option is sufficient to tackle all the challenges associated with antimicrobial resistance. Promising institutional options include monitored milestones and an interagency task force. A global pooled fund could be used to craft incentives and a special representative nominated as an interest mobilizer. There are three policy components to the problem of antimicrobials – ensuring access, conservation and innovation. To address all three components, the right mix of options needs to be matched with an effective forum and may need to be supported by an international legal framework. 

Hoffman, S.J. & Silverberg, S.L., 2015. Training the next generation of global health advocates through experiential education: A mixed-methods case study evaluation. Canadian Journal of Public Health , 106 (6) , pp. 442-449. PDFAbstract

Objectives: This case study evaluates a global health education experience aimed at training the next generation of global health advocates. Demand and interest in global health among Canadian students is well documented, despite the difficulty in integrating meaningful experiences into curricula.

Methods: Global health advocacy was taught to 19 undergraduate students at McMaster University through an experiential education course, during which they developed a national advocacy campaign on global access to medicines. A quantitative survey and an analysis of social network dynamics were conducted, along with a qualitative analysis of written work and course evaluations. Data were interpreted through a thematic synthesis approach.

Results: Themes were identified related to students’ learning outcomes, experience and class dynamics. The experiential education format helped students gain authentic, real-world experience in global health advocacy and leadership. The tangible implications for their course work was a key motivating factor. While experiential education is an effective tool for some learning outcomes, it is not suitable for all. As well, group dynamics and evaluation methods affect the learning environment.

Conclusion: Real-world global health issues, public health practice and advocacy approaches can be effectively taught through experiential education, alongside skills like communication and professionalism. Students developed a nuanced understanding of many strategies, challenges and barriers that exist in advocating for public health ideas. These experiences are potentially empowering and confidence-building despite the heavy time commitment they require. Attention should be given to how such experiences are designed, as course dynamics and grading structure significantly influence students’ experience.

Key words: Experiential learning; education; global health; health policy.

Hutton, F.G., et al., 2015. Global Challenges: An Innovative Journal for Tackling Humanity's Major Challenges. Global Challenges. PDF
Hoffman, S.J. & Røttingen, J.-A., 2015. Global Challenges: Global Health. Global Challenges. PDF
Schäferhoff, M., et al., 2015. Rethinking the Global Health System, London: Chatham House (Royal Institute of International Affairs, UK). PDF
Frenk, J. & Hoffman, S.J. ed., 2015. Introduction. In: "To Save Humanity": What Matters Most for a Healthy Future, Oxford: Oxford University Press. Full BookAbstract

We edited this book to share powerful ideas from some of the world's most thoughtful persons because we believe our shared destiny depends on all of us, everywhere, being engaged and doing our part.

PDF
Hoffman, S.J., 2015. We Already Know How To Save The World. Now We Need A Strategy To Make It Happen. Vox. Article
Belluz, J. & Hoffman, S.J., 2015. When Disasters like Ebola Hit, The World Needs The World Health Organization. And It's Failing. Vox. Article
Hoffman, S.J., 2015. Why Critics Are Wrong About John Paulson's $400 Million Gift to Harvard. Vox. Article
Hoffman, S.J. & Ottersen, T., 2015. Addressing Antibiotic Resistance Requires Robust International Accountability Mechanisms. Journal of Law, Medicine & Ethics , 43 (2) , pp. 53-64. PDFAbstract

A proposed international agreement on antibiotic resistance will depend on robust accountability mechanisms for real-world impact. This article examines the central aspects of accountability relationships in international agreements and lays out ways to strengthen them. We provide a menu of accountability mechanisms that facilitate transparency, oversight, complaint, and enforcement, describe how these mechanisms can promote compliance, and identify key considerations for a proposed international agreement on antibiotic resistance. These insights can be useful for bringing about the revolutionary changes that new international agreements aspire to achieve.

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