Law, Government, and Public Health

Chapter 4

1

Understand the role of law and government in promoting the health of the public

Identify different types of laws Identify functions of governmental agencies Apply this knowledge in solving public

health problems

2

Learning Objectives

Values Authority Decisions Enforcement Define the "unacceptable"

3

Why does public health need the law?

U.S. Constitution (1787)

Powers reserved to states and people

General welfareRegulate

commerceImplied powers

4

U.S.: Responsibility for Public’s Health

States have ultimate authority and responsibility for the public's

health (mostly)

5

2012: ???

2010: Affordable Care Act

1990's: Health Security Act failed

1980's: Block Grants

1973: HMO's

1965: Medicare and Medicaid

1946: Hospital Survey & Construction Act; CDC

1935: Great Depression and Social Security

1913: federal income tax = resources

1700's and 1800's: states more independent

6

National v. State Governments: Key Events

Police Powers Limit the actions of

individuals to protect society

7

Legal Concepts

Jacobsen v. Massachusetts, 1905

An athletic event (like the Olympics) is being held in your jurisdiction. The temperature is near 100 degrees. Events include tennis, running, cycling, etc. There are thousands of spectators. There may be heat-related illnesses.

Should you as the local health director ask the organizers to postpone the event or issue an order to postpone it or do nothing?

8

Your turn

Support the general welfare

Elizabethan Poor Laws

Should government provide health care for people who can't afford it? Why or why not?

Under what circumstances?

9

Legal concepts

Structures and Organization to Support Governmental Public

Health Federal, state and

local agencies evolved States delegate

authority to counties, cities, towns, districts

"Home rule" gives broad authority to locals

Variation in state and local structures

10

By legislative or regulatory action, a “higher” level of government (state or federal) eliminates or reduces the authority of a “lower” level over a given issue.

Under the Supremacy Clause of the U.S. Constitution, Congress and federal regulators have virtually unlimited authority – if they choose to exercise it – to preempt state and local health laws.

Airline Smoking Ban http://publichealthlawcenter.org/topics/other-public-health-law/preemption-public-health

11

Preemption

Constitutional law Legislative (statutory) law Administrative law Judicial law

12

Types of Law

Establishes powers, duties and limits of government

Courts interpret the Constitution Does the Constitution protect an individual's

right to smoke?

13

Constitutional Law

Congress and state legislatures; city councils, etc.

Regulate behavior and distribute resources Consistent with the U.S. Constitution Selects policies Delegates authority Mandates activity Establishes and funds programs

14

Legislative (statutory)law

Executive branch Regulations more detailed than statutes Implement, decide, enforce, and interpret Extensive public process Continuing oversight by legislature Example: asbestos removal in schools

15

Administrative Law

Interpret constitutionality of laws/regulations

Interpret intent of laws/regulations Decide “case law”

16

Judicial Law

http://www.hhs.gov/about/orgchart/

17

Structure: Federal Agencies

Variation Centralized v. decentralized Umbrella v. Stand alone

18

Structures: State, Tribal and Territorial Agencies

3,000+ local health departments Mostly county Mostly small jurisdictions (<50,000) Some consistency and variation in services Public Health Accreditation Websites?

19

Structure: Local Health Departments

http://www.pbs.org/wgbh/pages/frontline/teach/vaccine/

Should government prohibit children from entering school without vaccinations?

If there are exemptions, on what grounds? What are the underlying legal and other

issues?

20

The Vaccine War