Law, Government, and Public Health

1. Law, Government, and Public Health Chapter 4

2. Learning Objectives • 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

3. Why does public health need the law? • Values • Authority • Decisions • Enforcement • Define the "unacceptable"

4. U.S.:Responsibility for Public’s Health • U.S. Constitution (1787) • Powers reserved to states and people • General welfare • Regulate commerce • Implied powers

5. States have ultimate authority and responsibility for the public's health (mostly)

6. National v. State Governments:Key Events

7. Legal Concepts • Police Powers • Limit the actions of individuals to protect society Jacobsen v. Massachusetts, 1905

8. Your turn • 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?

9. Legal concepts • 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?

10. 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

11. Preemption • 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

12. Types of Law • Constitutional law • Legislative (statutory) law • Administrative law • Judicial law

13. Constitutional Law • Establishes powers, duties and limits of government • Courts interpret the Constitution • Does the Constitution protect an individual's right to smoke?

14. Legislative (statutory)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

15. Administrative 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

16. Judicial Law • Interpret constitutionality of laws/regulations • Interpret intent of laws/regulations • Decide “case law”

17. Structure: Federal Agencies • http://www.hhs.gov/about/orgchart/

18. Structures: State, Tribal and TerritorialAgencies • Variation • Centralized v. decentralized • Umbrella v. Stand alone

19. Structure: Local Health Departments • 3,000+ local health departments • Mostly county • Mostly small jurisdictions (<50,000) • Some consistency and variation in services • Public Health Accreditation • Websites?

20. The Vaccine War • 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?