Legal and Policy Contexts

The protection and security of health information is influenced by many public policy factors. In the United States, health information protection is generally divided into records systems operated by federal or state agencies and record-keeping systems operated by the private sector.1 At the federal level, privacy protections are found in constitutional law, the Privacy Act of 1974, and certain statutes that regulate narrow areas of data use. State health record laws generally define the types of information considered confidential and the circumstances under which health information may be disclosed without the patient`s consent (Table 2.1). Private sector archives resurfaced after the Conservatives` election victory in 1979. Those on the ideological right noted with interest the work of Charles Murray, who in 1984 published his now infamous book Losing Ground: American Social Policy, 1950-1980, a book that referenced the role of social policy in creating an underclass in the United States by providing support seen as an addiction. Murray`s ideas proved popular with conservatives, particularly those on the neoliberal end of the spectrum, and he was later invited by the Sunday Times to visit Britain in 1989 to see if similar social trends could be observed here. Subsequent work “confirmed” the emergence of a British subclass (Murray 1990, 1994) and contributed to debates aimed at justifying change. As discussed in Chapter 1, it is impossible to examine the concepts of individual vulnerability and vulnerable groups in socio-political terms without understanding the political environment in which these ideas were developed. Historically, there has been a shift in balance between explanations describing vulnerability due to the individual`s social or economic circumstances, which are largely beyond his or her control, or the individual`s inability to make the right moral choices and lead a responsible life. Politically, the former, which was influential during the post-war consensus on the British welfare state, is associated with the left, and the latter has become to a large extent the preferred explanation for the vulnerability of ideological rights and has become a growing feature of contemporary social policy. This chapter examines how these ideas have been translated into recent social policy developments and examines the general issues that have influenced current social policy reform. Explanations of vulnerability that focus on individual choices and lifestyles of how the poor have been perceived and treated.

These debates contributed greatly to subsequent social policy reforms introduced under the 1979-1997 Conservative government and the 1997-2010 New Labour government, and continue to justify the coalition`s recent social policy developments. To some extent, it could be argued that the Labour governments of the 1960s and the left called for the creation and expansion of the welfare state. Public policies should redistribute income and subsidize, if not provide, basic services such as education and health. The ideal was a society in which the inequalities associated with social class would disappear. Since 1970, the Law in Context series has been at the forefront of a movement to expand the study of law. The series is a vehicle for the publication of innovative monographs and texts that critically address law and legal phenomena in their cultural, social, political, technological, ecological and economic contexts. A contextual approach involves the broad treatment of legal disciplines using materials from other humanities and social sciences and any other discipline that helps explain the functioning of the particular area of law or legal phenomena studied in practice. This orientation should be more stimulating and informative as well as the mere presentation of legal rules.

The series includes original research monographs, textbooks and manuals that focus on contextual approaches and methods. The series includes and hosts books on the study of law in all its contexts, including national legal systems, European and international law, transnational and global legal processes, and comparative law. When preparing and implementing privacy laws and policies, decision-makers cannot ignore the possibility that individuals may be discriminated against because of certain diseases or conditions from which they suffer, or that sensitive or adverse information may be used in any way against an individual`s economic interests. For example, an employer may refuse to hire or promote someone with a history of lengthy and costly medical claims (or with the prospect of likely costly or chronic medical problems in the future due to family history). Policymakers must assume that this discrimination is likely to occur in the As these reports acknowledge, medical privacy legislation cannot focus solely on the doctor-patient relationship or where information is processed or stored. In addition, its own control over its health information cannot be complete, as this data is essential to the modern distribution of health services. In the computer age, health data is passing through more and more professional environments and organizations. The processing of personal data already plays a crucial role in the provision, regulation and financing of healthcare services by public and private entities. Beyond the traditional doctor-patient relationship and the provision of health services in hospitals, various public and private organizations are now using personal health data.

In addition, health care reform will further increase the extent to which health data is used and shared.