chapter 4 1. understand the role of law and government in promoting the health of the public...
TRANSCRIPT
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Law, Government, and Public Health
Chapter 4
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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
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Learning Objectives
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Values Authority Decisions Enforcement Define the "unacceptable"
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Why does public health need the law?
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U.S. Constitution (1787)
Powers reserved to states and people
General welfareRegulate
commerceImplied powers
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U.S.: Responsibility for Public’s Health
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States have ultimate authority and responsibility for the public's
health (mostly)
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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
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National v. State Governments: Key Events
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Police Powers Limit the actions of
individuals to protect society
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Legal Concepts
Jacobsen v. Massachusetts, 1905
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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?
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Your turn
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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?
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Legal concepts
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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
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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
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Preemption
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Constitutional law Legislative (statutory) law Administrative law Judicial law
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Types of Law
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Establishes powers, duties and limits of government
Courts interpret the Constitution Does the Constitution protect an individual's
right to smoke?
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Constitutional Law
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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
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Legislative (statutory)law
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Executive branch Regulations more detailed than statutes Implement, decide, enforce, and interpret Extensive public process Continuing oversight by legislature Example: asbestos removal in schools
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Administrative Law
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Interpret constitutionality of laws/regulations
Interpret intent of laws/regulations Decide “case law”
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Judicial Law
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http://www.hhs.gov/about/orgchart/
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Structure: Federal Agencies
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Variation Centralized v. decentralized Umbrella v. Stand alone
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Structures: State, Tribal and Territorial Agencies
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3,000+ local health departments Mostly county Mostly small jurisdictions (<50,000) Some consistency and variation in services Public Health Accreditation Websites?
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Structure: Local Health Departments
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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?
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The Vaccine War