Review U.S. laws (federal laws, not state laws) that relate to public health.
Which public health laws surprised you, and why so?
Which laws did not surprise you?
Review current U.S. laws that relate to public health.
This paper is not bad but I had to make a lot of English corrections
Here is an idea
Public health system is often considered as including federal general public health and fitness organizations, although now is comprehended to incorporate the two different public-sector organizations such as colleges, Medicaid and the environmental security organizations, land-use agencies, and private-sector organizations whose actions have major penalties for the health of people. The training of public health might be looked at when it comes to the key processes in which professionals look for to spot, tackle, along with prioritize group or maybe population-wide medical problems along with assets as well as the results of these much more simple processes, public health’s interventions, plans, regulations, and services. The processes of public wellness are usually those that recognize along with handle medical problems as well as the plans along with services according to requires along with group focal points. Biomedicine is the effective use of the actual guidelines on the normal sciences, specifically biology in aIDition to physiology, to scientific medication.
Public health laws are laws and regulations which have important implications for the sake of the outlined populations. The public health law on drugs, alcohol and tobacco is most surprising. People have been given the liberty to consume products of alcohol and tobacco which harmful effects to those that directly consume them and also to the people who around the persons who consume the products. Like in the case of alcohol, a person will consume it then go ahead and drive under the influence risking their lives and the life of other drivers and pedestrians. With tobacco, the smoking of it increases the chances of the consumer getting laugh cancer. The consumption of these products is regulated by the government because they earn it a lot of revenue but what I think should be done is a total burn of the consumption as they create more harm than good.
“What Is the Public Health System? | HHS.gov.” United States Department of Health and Human Services | HHS.gov. N.p., n.d. Web. 9 Oct. 2013. <http://www.hhs.gov/ash/initiatives/quality/system/index.html>.
“Drugs, Alcohol and Tobacco.” Public Health Law Research. N.p., n.d. Web. 10 Oct. 2013.
Public health law is an emerging field in U.S. public health practice. The 20th century proved the indispensability of law to public health, as demonstrated by the contribution of law to each of the century’s 10 great public health achievements (Table 1) (2,3). Former CDC Director Dr. William Foege has suggested that law, along with epidemiology, is an essential tool in public health practice (4).
Public health laws are any laws that have important consequences for the health of defined populations. They derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies. Government agencies that apply public health laws include agencies officially designated as “public health agencies,” as well as health-care, environmental protection, education, and law enforcement agencies, among others.
Scope of Public Health Law
Law is foundational to U.S. public health practice. Laws establish and delineate the missions of public health agencies, authorize and delimit public health functions, and appropriate essential funds. The concept of public health law gained momentum early in the 20th century in James Tobey’s seminal volumes (1). Frank Grad’s practical guide, The Public Health Law Manual (5), and Lawrence Gostin’s treatment of public health law under the U.S. constitutional design followed (6). A CDC-related contribution to this literature emphasized the interdisciplinary relation between law and public health practice (7).
The concept of public health law has evolved into overlapping paradigms. One paradigm frames public health practice in relation to multiple sources of law (e.g., statutes and regulations) and to fields of law (e.g., constitutional and environmental law). The other, a more scholarly view, focuses on the legal powers and duties of government to ensure public health and limitations on government powers to constrain the protected liberties of individuals.
Integration of Public Health Law Within CDC and State Public Health Practice
Public health law at CDC and at many of its partner organizations has earned explicit recognition only recently. During CDC-sponsored workshops on public health law in 1999–2000, major public health stakeholders, including health officers, epidemiologists, public health lawyers, educators, and legislators, called for strengthening the legal foundation for public health practice. These stakeholders concluded that public health would benefit by aIDing legal skills and scientific knowledge about the impact of law on public health to the toolkits of public health practitioners. CDC consequently established its Public Health Law Program (PHLP) in 2000 with a mission for improving the public’s health through law (8).
Primary goals of PHLP are to enhance the public health system’s legal preparedness to aIDress emerging threats, chronic diseases, and other national public health priorities and to improve use of law to support program activities. PHLP focuses on these goals by 1) strengthening the competencies of public health professionals, attorneys, and other practitioners to apply law to public health; 2) stimulating applied research about the effectiveness of laws in public health; 3) fostering partnerships among organizations and professionals working in public health and law; and 4) developing and disseminating authoritative information about public health law to public health practice, policy, and other communities (8). PHLP does not provide legal advice to CDC programs; that remains the separate responsibility of the Office of the General Counsel of the U.S. Department of Health and Human Services.
State and local partners also are strengthening public health legal preparedness. CDC has stimulated this in part through initiatives such as “Public Health Emergency Law,” a course delivered nationally in state and local health departments (8). In some states, grassroots activities are increasing competencies of practitioners to use law and strengthening legal preparedness capacities of public health systems. For example, in California, the Public Health Law Work Group (comprising representatives of county counsel and city attorney offices) drafted a legally annotated health officer practice guide for communicable disease control (9). Related activities in California include a 2006 conference on legal preparedness for pandemic influenza, and a series of forensic epidemiology joint training programs for public health and law enforcement agencies.
Role of Public Health Law in AIDressing High Priorities in Public Health
The indispensable role of law is evident across the entire history of U.S. public health—from early colonialists’ needs to defend against infectious threats to today’s innovative law-based approaches to preventing chronic diseases, injuries, and other problems (Table 2). The U.S. experience with smallpox illustrates how, at some points in history, law-based interventions were implemented even before science elucidated the nature of the public health threat and the basis of the intervention. The legal-epidemiologic strategy of quarantine to prevent the spread of smallpox was employed on Long Island as early as 1662 (10). Smallpox prevention also was at the root of the 1905 landmark decision in Jacobson v. Massachusetts in which the U.S. Supreme Court upheld the Massachusetts statutory requirement for smallpox vaccination (11).
Public health is examining law-based countermeasures to the use of smallpox virus and other infectious pathogens as biologic weapons. In its program of grants supporting states’ development of capacity to aIDress public health emergencies, CDC expects states to attain legal preparedness for such emergencies in the wake of the 2001 anthrax attacks, the severe acute respiratory syndrome epidemic in 2003, the 2005 hurricane disasters, and the specter of an A(H5N1) influenza pandemic. Response to these threats has spawned new and innovative resources, such as the draft Model State Emergency Health Powers Act, the CDC forensic epidemiology course for joint training of public health and law enforcement officials, community public health legal preparedness workshops for hospital and public health attorneys, public health law “bench books” for the judiciary, and the CDC Public Health Emergency Legal Preparedness Clearinghouse (8).
Public health law also helps aIDress high priorities other than infectious diseases and emergencies, as illustrated by the roles of law and legal strategies in tobacco control (12). CDC and others are exploring the role of law in preventing chronic diseases (13), including development of legal frameworks for aIDressing cardiovascular disease (14) and obesity (15), and for fostering healthy built environments (16). Injury prevention has benefited from litigation, laws requiring preventive measures, and other legal interventions (17,18).
In 2002, a rich multidisciplinary public health law community began taking shape at the first national public health law conference, which CDC convened. This community comprises practitioners trained in the classical disciplines of public health, attorneys in the public and private sectors, increasing numbers of professionals trained and experienced in both public health and law, elected officials, emergency management and law enforcement professionals, judges, educators, researchers, and others. The more than 7,000 current subscribers to the weekly CDC Public Health Law News (8) attest to the size of the community.
Requirements for Achieving Full Public Health Legal Preparedness to Support the Mission of Public Health
Effective responses to emerging threats and attainment of public health goals require CDC, partner organizations, and communities to achieve full public health legal preparedness (13,19). Public health legal preparedness, a subset of public health preparedness, is the attainment by a public health system of specified legal benchmarks or standards essential to preparedness of the public health system (19). The elements of public health legal preparedness (Table 3) include requirements to
Ensure the presence of effective legal authorities to carry out essential public health services. U.S. communities, states, and the nation as a whole should have public health legal authorities consistent with modern jurisprudence.
Establish and sustain the competencies of public health professionals to apply those laws. Public health officials, their staff and legal counsel, judges, and others should have access to training to achieve competencies in public health law and be skilled in applying essential legal authorities.
Provide for coordination of law-based efforts across jurisdictions and sectors. Law-based measures to protect communities and promote health must be coordinated effectively across the local-state-federal-international dimension and among multiple public and private sector entities (i.e., disciplines, officials, and organizations having diverse missions and enabling legal authorities).
Develop and make accessible information about public health law best practices. Public health agencies, policymakers and lawmakers, and others must have access to science-based knowledge about effective public health laws.
CDC increasingly envisions public health law as an integral element in the armamentarium of each of its programs and in the competencies of its professionals. CDC and its partners are working vigorously toward full legal preparedness throughout the public health system, developing and deploying new legal tools that policymakers and front-line practitioners will apply to the entire spectrum of 21st-century public health challenges and opportunities.
Public Health Law, Ethics, and Human Rights:
Mapping the Issues http://www.publichealthlaw.net/Reader/ch1/ch1.htm
[Editor’s Note: The tables and figures have been removed from this full-text web version of Chapter One. A PDF version of this chapter is available from theUniversity of California Press.]
This Reader offers an organized selection of government reports, scholarly articles, and court cases on public health law, ethics, and human rights. The publication of a Readeron these subjects may suggest that a coherent, systematic understanding of the relationships between public health law, ethics, and human rights exists. Despite the deep traditions in these separate fields, they have rarely cross-fertilized. For the most part, each of these fields has adopted its own terminologies and forms of reasoning. To the extent that scholars in law, ethics, or human rights have engaged in sustained examinations of issues in health, they have written principally about medical care. This introductory chapter maps the important features of, and issues in, these respective fields as they pertain to the theory and practice of public health. Part I of the Reader explores public health, ethics, and human rights in more detail. Part II examines major issues in public health law, including constitutional, administrative, and tort law. Part III focuses on some of the major controversies and tradeoffs involved in public health theory and practice. And Part IV conceptualizes a vision for public health in a new century.
I. Public Health
In thinking about the application of ethical or human rights to problems in public health, it is important first to understand what we mean by public health. How is the field defined and what is its content—its mission, functions, and services? Who engages in the practice of public health—government, the private sector, charities, community-based organizations? What are the principal methods or techniques of public health practitioners? In truth, finding answers to these fundamental questions is not easy because the field of public health is highly eclectic and conflicted (Beaglehole and Bonita 1997)..
Definitions of public health vary widely, ranging from the utopian conception of the World Health Organization of an ideal state of physical and mental health to a more concrete listing of public health practices. Charles-Edward A. Winslow (1920, 30), for example, defined public health as “the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, [and] the organization of medical and nursing service for the early diagnosis and preventive treatment of disease.” More recent definitions focus on “positive health,” emphasizing a person’s complete well-being (Lancet Editorial 1997, 229). Definitions of positive health include at least four constructs: a healthy body, high-quality personal relationships, a sense of purpose in life, and self-regard and resilience (Rowe and Kahn 1998).
The Institute of Medicine (IOM) (1988, 19), in its seminal report on the Future of Public Health, proposed one of the most influential contemporary definitions: “Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.”
The IOM’s definition can be appreciated by examining its constituent parts. The emphasis on cooperative and mutually shared obligation (“we, as a society”) reinforces that collective entities (e.g., governments and communities) take responsibility for healthy populations. Individuals can do a great deal to safeguard their health, particularly if they have the economic means to do so. They can purchase housing, clothing, food, and medical care. Each person can also behave in ways that promote health and safety by eating healthy foods, exercising, using safety equipment (e.g., seatbelts and motorcycle helmets), or refraining from smoking, using illicit drugs, or drinking alcoholic beverages excessively. Yet, there is a great deal that individuals cannot do to secure their health and, therefore, these individuals need to organize, build together, and share resources. Acting alone, people cannot achieve environmental protection, hygiene and sanitation, clean air and surface water, uncontaminated food and drinking water, safe roads and products, and control of infectious disease. Each of these collective goods, and many more, are achievable only by organized and sustained community activities (Gostin 2000a).
The IOM definition also makes clear that even the most organized and socially conscious society cannot guarantee complete physical and mental well-being. There will always be a certain amount of injury and disease in the population that is beyond the reach of individuals or government. The role of public health, therefore, is to “assure theconditions for people to be healthy.” These conditions include a variety of educational, economic, social, and environmental factors that are necessary for good health.
Most definitions share the premise that the subject of public health is the health of populations—rather than the health of individuals—and that this goal is reached by a generally high level of health throughout society, rather than the best possible health for a few. The field of public health is concerned with health promotion and disease prevention throughout society. Consequently, public health is less interested in clinical interactions between health care professionals and patients, and more interested in devising broad strategies to prevent, or ameliorate, injury, and disease.
Scholars and practitioners are conflicted about the “reach” or domain of public health. Some prefer a narrow focus on the proximal risk factors for injury and disease. The role of public health agencies, according to this perspective, is to identify risks or harms and intervene to prevent or ameliorate them. This has been the traditional role of public health, exercising discrete powers such as surveillance (e.g., screening and reporting), injury prevention (e.g., safe consumer products), and infectious disease control (e.g., vaccination, partner notification, and quarantine).
Others prefer a broad focus on the sociocultural foundations of health. Those favoring this position see public health as an all-embracing enterprise bonded by the common value of societal wellbeing. They claim that the jurisdiction of public health reaches “social ills rooted in distal social structures.” (Meyer and Schwartz 2000). Ultimately, the field is interested in the equitable distribution of social and economic resources because social status, race, and wealth are important influences on the health of populations (Marmot and Wilkinson 1999). This inclusive direction for public health is gaining popularity; many of the government’s health objectives for 2010 seek reductions in health disparities. Figure 1.1 illustrates the determinants of health according to Department of Health and Human Services (2000), physical environment, behavior and biology, and social environment. Using this vision, public health researchers and practitioners have ventured into areas of general social policy including violence, war, homelessness, and discrimination (Breakey 1997).
The expansive view of public health may well be justified by the importance of culture, poverty, and powerlessness on the health of populations. Yet, to many, this all-embracing notion is troublesome. First, there is the problem of excessive breadth. Almost everything human beings undertake impacts the population’s health, but that does not justify an overly-inclusive definition of public health. The field of public health appears less credible if it appears to overreach.
Second, there is the problem of expertise. Admittedly, the public health professions incorporate a wide variety of disciplines (e.g., occupational health, health education, epidemiology, and nursing) with different skills and functions. But public health professionals do not possess all the skills necessary to intervene on behavioral, social, physical, and environmental levels (e.g., competence in behavior sciences, economics, and engineering).
Finally, there is the problem of political and public support. By espousing controversial issues of economic redistribution and social restructuring, the field risks losing its legitimacy. Public health gains credibility from its adherence to science, and if the field strays too far into political advocacy, it may lose the appearance of objectivity.
If public health has such a broad meaning, then who engages in the work of public health—government, the private sector, academia, charities, community-based organizations? At the governmental level, public health has a significant jurisdictional problem. Even the most powerful public health agency cannot exercise direct authority over the full range of activities that affect health. Many of the determinants of health are normally the province of other agencies (e.g., agencies concerned with education, agriculture, transportation, housing, child welfare, and criminal justice). Furthermore, much of the behavior that public health authorities try to change (e.g., exercise and diet) is not subject to direct legal regulation at all. At the same time, many of the institutions that affect the public’s health are not within government, such as managed care organizations, business and labor, community-based groups, and academic institutions (Gostin, Burris, and Lazzarini 1999; Bowser and Gostin 1999). Thus, scholars need to consider the actors who carry out the work of public health. It matters a great deal in law and ethics to understand who is acting, with what authority, and with what resources. For example, society is prepared to allow government to wield powers to coerce (e.g., tax, inspect, license, and quarantine) that would be unacceptable in the private sector.
What are the principal methodologies of public health practitioners? Because of the field’s broad sweep, the techniques of public health are highly diverse (Sommer and Akhter 2000). For example, public health practitioners monitor health status, calling for skills in epidemiology and biostatistics; inform and educate the public, calling for skills in education and communication; and create health policy and enforce law, calling for skills in leadership and politics. This description does not account for the many subjects in the field of public health requiring expertise in domains such as infectious diseases (e.g., virology and bacteriology), the environment (e.g., toxicology), and injuries (e.g., behavioral and social sciences). As the IOM (1988) observed: “public health’s subject matter . . . necessitate[s] the involvement of a broad spectrum of professional disciplines. In fact, public health is a coalition of professions united by their shared mission.”
As illustrated in Figure 1.2, the field of public health is caught in a dilemma. If it conceives itself too narrowly then public health will be accused of lacking vision. It will fail to see the root causes of ill health and fail to utilize a broad range of social, economic, and behavioral tools necessary to achieve healthier populations (McGinnis and Foege 1993). At the same time, if it conceives itself too expansively then public health will be accused of overreaching and invading a sphere reserved for politics, not science. It will lose the ability to explain its mission and functions in comprehensible terms and, consequently, to sell public health in the marketplace of politics and priorities (Burris 1997b).
II. Public Health Law
As we have just seen, the question “What is Public Health?” is much more difficult than it first appears. Despite the lack of conceptual clarity, it is important to study carefully the legal foundations of public health, its ethical dimensions, and its relationship to human rights.
The preservation of the public health is among the most important goals of government. The enactment and enforcement of law, moreover, is a primary means with which government creates the conditions for people to lead healthier and safer lives. Law creates a mission for public health authorities, assigns their functions, and specifies the manner in which they may exercise their authority (Gostin, Burris, and Lazzarini 1999).The law is a tool in public health work which is used to influence norms for healthy behavior, identify and respond to health threats, and set and enforce health and safety standards. The most important social debates about public health take place in legal fora—legislatures, courts, and administrative agencies—and in the law’s language of rights, duties, and justice. It is no exaggeration to say that “the field of public health . . . could not long exist in the manner in which we know it today except for its sound legal basis” (Grad 1990, 4).
Despite its importance, there is a scarcity of legal scholarship relating to public health. In the companion text I define public health law as “The study of the legal powers and duties of the state to assure the conditions for people to be healthy and the limits on that power to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for protection or promotion of community health.” Five characteristics help distinguish public health law from the vast literature on law and medicine (Figure 1.3): (1) the role of government in advancing the public’s health; (2) the population-based perspective; (3) the relationship between the people and the state; (4) the services and scientific methodologies; and (5) the role of coercion.
Public health law scholars, therefore, are interested in government authority to prevent injury and disease and to promote the public’s health, as well as in the constraints on state action to protect individual freedom (see chapters 6 and 7). Government has ample authority to act for the common good but also must exercise that power within the constraints of the Constitution.
Law can be an effective tool to achieve the goal of improved health for the population. Law, regulation, and litigation, like other public health prevention strategies, intervene at a variety of levels, each designed to secure safer and healthier populations. First, government interventions are aimed at individual behavior through education (e.g., health communication campaigns), incentives (e.g., taxing and spending powers), or deterrence (e.g., civil and criminal penalties for risky behaviors). Second, the law regulates the agents of behavior change by requiring safer product design (e.g., safety standards and indirect regulation through the tort system). Finally, the law alters the informational (e.g., advertising restraints), physical (e.g., city planning and housing codes), or business (e.g., inspections and licenses) environments.
Government engages in the work of public health through three separate branches— legislative, executive, and judicial. The Constitution provides a system of checks and balances where no single branch of government can act without some degree of oversight and control by another. Separation of powers is essential to public health, for each branch of government possesses a unique constitutional authority: (1) legislatures create health policy and allocate the resources necessary to effectuate it; (2) executive agencies implement health policy, promulgate health regulations, and enforce regulatory standards; and (3) courts interpret law and resolve legal disputes. As a society, we forego the possibility of bold public health governance by any given branch in exchange for constitutional checks and balances that prevent government overreaching and assure political accountability.
Public health law is concerned with the tradeoffs entailed in the exercise of government power. Under what circumstances should government be permitted to act to achieve a public good when the consequence of that act is to invade a sphere of individual liberty? This is the kind of question that intrigues scholars interested in law and the public’s health. Rather than using ethical discourse to resolve these conflicts, the law uses the language of duties, powers, and rights.
It is clear from the foregoing description that public health law is a vast field incorporating thinking in a variety of legal subspecialties—constitutional, civil, administrative, and tort law. The Constitution affords the federal government certain powers and limits the authority of all governments to protect a sphere of freedom. Civil and administrative law is concerned with the body of statutes and regulations that set health and safety standards, together with agency powers to interpret and enforce those standards. Tort law provides a method of indirect regulation through the courts. By levying damages for certain kinds of harm, tort law can provide powerful disincentives to risk behaviors (e.g., litigation against cigarette and firearm manufacturers). As the chapters in this Reader unfold, these legal dimensions are explored (see Part II).
III. Public Health Ethics
The field of bioethics has richly informed the practice of medicine and decisions about the allocation of health care resources. Bioethicists, at least until recently, have not devoted the same sustained attention to problems in public health (Steinbock and Beauchamp 1999; Bradely and Burls 2000; Coughlin and Beauchamp 1996). A critical unanswered question is whether public health ethics have features which are distinct from conventional bioethics. Are ethical principles, or the methods of ethical analysis, materially different when applied to populations than when applied to individual patients? In thinking about this question it will be helpful to consider public health ethics from at least two perspectives: the ethics of public health professionals (professional ethics) and ethics in public health theory and practice (applied ethics). See Table 1.2.
The ethics of public health are concerned with the ethical dimensions of professionalism and the moral trust that society bestows on public health professionals to act for the common welfare (Callahan 2000). This form of ethical discourse stresses the distinct history and traditions of the profession, seeking to create a culture of professionalism among public health students and practitioners. It instills in professionals a sense of public duty and trust. Professional ethics are role oriented, helping practitioners to act in virtuous ways as they undertake their functions.
Many professional groups such as physicians and attorneys hold themselves accountable through a set of ethical guidelines, but public health professionals have no code of ethics. Perhaps the explanation is that no single public health profession exists, but rather a variety of different disciplines. Indeed, some public health disciplines have their own ethical codes—e.g., epidemiologists and public health educators. Nevertheless, a code of ethics, or at least a well-articulated values statement, could increase the status of the field and help clarify the distinctive ethical dilemmas faced by public health professionals. Public health professionals work in a field of considerable moral ambiguity where guidance could be instructive.
A public health code of ethics would have to confront the salient issue of fiduciary responsibility. To whom do public health professionals owe a duty of loyalty and how can these professionals know what actions are morally acceptable? Physicians, attorneys, and accountants have a fiduciary duty to their clients that informs their moral world. For example, client-centered professions usually adhere to the principle that the professional s