Scope of public health act in protecting the health of the

community

By DR.I.SELVARAJ, I.R.M.S

B.SC., M.B.B.S., D.P.H (MADRAS MEDICAL COLLEGE).,D.I.H.,PGCH&FW (NIHFW, New Delhi)

Sr.D.M.O (SELECTION GRADE OFFICER)

ON STUDY LEAVE

Post Graduate student in M.D Community Medicine

SREE RAMACHANDRA MEDICAL COLLEGE & RESEARCH INSTITUTE,CHENNAI,TAMILNADU

Dr.I.Selvaraj

1.The effectiveness of public health service to the community depends on the way the public health laws prevailing in the community.

2. Political support 3. People co-operation 4.Public health laws includes very many acts (MTP Act, Prenatal

Diagnostic sex determination act, Indian medical council Act ,Indian nursing council Act, Indian Pharmacy act, PFA Act, Public health Act etc.,)

5. In this presentation the importance public health act and its role in the health of the community will be discussed.

6. The public health managers and community medicine experts have to play a key role in this field

7. This presentation which I made it as a gift to public health personnel and community medicine experts in my country. This will enrich their knowledge while teaching undergraduates and post graduates in community medicine, and post graduate diploma in public health.

8. This presentation will be able to disseminate various sections and other provisions of Tamil Nadu public health act to the public health specialists and make them to understand their importance in the community.

PUBLIC HEALTH

Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.”

TEN ESSENTIAL PUBLIC HEALTH SERVICES• Develop policies, and plans that support individual and

community health efforts• Diagnose & Investigate the health problems & Health

hazards in the community• Mobilize community partnerships • Inform, educate,& empower people about health issues• Link people to needed personnel health services and

assure the provision of comprehensive health care when otherwise unavailable

• Assure a competent public health & personnel health care workforce

• Monitor health status to identify the community health problems

• Monitoring & evaluation of population based health care services

• Operational research to find out new innovative solution to the health problems

• Enforce laws and regulations that protect health and ensure safety

Courtesy- Super Course

SIX PUBLIC HEALTH RESPONSIBILITIES

• Prevention of epidemics & spread of disease• Protection of people against environmental

Hazards• Prevention of injuries• Promotion & encouragement of healthy

behavior changes• Quick response to the disaster & to assist

the communities in recovery phase• To assure quality, accessible, and affordable

comprehensive health care services

Courtesy- Super Course

THE TAMIL NADU PUBLIC HEALTH ACT (1939)

• A Pioneering Act – 1939• Steered by Great Scholar and Minister for

Health Dr.T.S.S.Rajan• The Death Relief Act• To improve the Health of the people of

Madras province

Tamil Nadu is the first state in the country to enact a law for public healthTamil Nadu Public Heath Act 1939 remains as a model till today for the entire country.Amendments in 1941, 1944 and 1958The Act was modified in 1970The Act was translated in Tamil in the year 1986.Tamil Nadu to its credit had the first Act in the country for Food Adulteration alsoTamil Nadu Prevention of Food Adulteration Act 1918.The Act was repealed by the Central Act, 1954.Constitution of the Public Health Board.

Regulations for construction of new buildings.Powers of the Police Officers to arrest offendersPowers of the Executive Officers and Public Health Staff to arrest Offenders.Act to over right other Enactments “Public Health Act” is supreme Power to the Government to remove difficulties in implementation of the Act as and when they appear.Powers of the Government and of the Director of Public Health and his Staff to advise local authoritiesThere is a provision in this act for Fairs and Festivals

Highlights of Tamilnadu public health act

• Vision Healthy people in healthy community• Mission• To promote physical and mental health• To prevent disease, injury, and disability• Goal• Prevention of disease• Prolongation of life• Improvement of quality of life• Elimination of health disparity• Organizing community efforts to achieve

above

THE TAMIL NADU PUBLIC HEALTH ACT (1939)

• Chapters – 15

• Sections – 145

• Schedules – 2

Chapter section Outline of Public Health Matters

From To

I 1 3 Short Title and Extent, Commencement and Definitions

II 4 7 Public Health Board-Constitution and Functions Powers of Govt & DPH

8 16 Public Health Establishments of Local Authorities

III 17 26 Water Supply

IV 27 36 Drainage

V 37 40 Sanitary Conveniences

VI 41 51 Abatement of Nuisances

VII 52 61 Prevention, Notification and Treatment of Diseases - Part - I: Infectious Diseases in general

62 77 Part - II: Notified Infectious Diseases

78 80 Part - III: Venereal Diseases

81 Part - IV: Powers to Make Rules

VIII 82 Maternity and Child Welfare

IX 83 88 Mosquito Control

X 89 93 Sanitation and Buildings Part - I : Residential Areas

94 96 Part - II : Control over In Sanitary Buildings

98 100 Part - III : Abatement of Overcrowding (Sce.97 omitted)

XI 101 107 Lodging House

XII 107A 115 Food Control

XIII 116 125A Fairs and Festivals

XIV 126 127 Finance

XV 128 135 Rules, By-Laws, Penalties Etc.,

136 145 Miscellaneous: Appeals, Method of Serving Notice, Compounding, Punishment for malicious abuse of powers, Overriding etc

Schedule - I Ordinary Penalties

Schedule – II Penalties for continuing breaches

Public health board

• The Minister of public health• The Minister of local administration• Three members of the Tamil Nadu

legislatures nominated by the Government • The Director of Public Health• Surgeon General• The sanitary engineer• One more state Government officer

nominated by the Government

The Main Focus on:-

• Environmental Health

• Communicable Disease Control

• Food Hygiene

• Maternity & Child Health measures

Environmental Health:-

• Water

• Drainage

• Housing

• Rats, Mice and Mosquito control

• Nuisance

• Sanitation

Water• Establishment of Technical Assistance for

maintenance of Water works.• Surveillance of Water sources• Control over bottled water supply• Govt. ensure local authority to provide adequate

continuous, wholesome water (Sec. 17, 18, 19)• Role of Govt. and other authorities in Water supply

(Sec. 20, 21)• Role of Railway Administration (Sec.22)• Periodical Examination of Water (23)• Action over the unsanitary sources (24)• Prevention of Pollution of Water (36, 57)• Supply of Water during Fair or Festival (120)• Control over Private Water Sources (124)

Drainage:-

• Responsibility of Local authority and private in construction of Drains and Cesspool (27, 28, 29, 30, 31, 32)

• Prevention of Let out of Sullage in the Streets (34)

• Prevention of Disposal of injurious refuse into the Drain (35)

H o u s i n g :-Prohibition of Occupation of House

– If it is without water supply (26)– If it is without Drain (33)– If there is nuisance (46)– If there is notified disease (63, 70)– If it is unfit for Habituation (96)– Prohibition of Over crowding (98, 99, 100)– Not to be erected on certain places (94)– Registration, Renewal and Maintenance of

Lodging House (101, 102, 103, 104, 105, 106)– New house should be provided with sanitary

conveniences (38)

Communicable Diseases:List of infectious diseases - Section- (52)

1. Acute influenza pneumonia 2. Anthrax3. Cerebrospinal fever4. Chickenpox5. Cholera6. Diphtheria7. Enteric fever 8.Leprosy

9.Measles10. Plague 11. Rabies12. Relapsing fever13. Scarlet fever14. Small pox15. Tuberculosis16. Typhus fever

List of Notified DiseasesSECTION- (62)

Cerebrospinal feverChickenpoxCholeraDiphtheriaLeprosyMeaslesPlagueRabiesScarlet feverSmall poxTuberculosis

Infectious HepatitisEpidemic InfluenzaWhooping cough

Viral EncephalitisHemorrhagic feverMalariaTetanusPoliomyelitisAIDS

• Information by Medical practitioners (56)• Persons responsible for giving information (64)• Appointment of Health staff, medicines appliances

(53)• Isolation wards, ambulance (54, 155)• Disposal of bodies of person died from notified

diseases (74)• Venereal diseases control (78,79)• a) Provision of Diagnosis and Treatment (78)• b) Education of Patients (79)• Destruction of Rats and Mice (77)• Prevention of spread of disease (57, 58, 59, 60, 61)• To prevent spread of disease in public places (63,

65, 66, 67, 68, 69, 70, 71, 72, 75)• Control of other Diseases during Epidemic and Endemic (81)

Mosquito control -• Prevention of Mosquito breeding (83)• Protection of Anti Mosquito works (86)• Power to entry and inspect (85,86)S a n i t a t i o n :-• Responsibility of Local authority to provide

Sanitary conveniences (37, 40)• Provision Sanitary arrangements during

Fairs and Festival (120)• Provision of Sanitary conveniences in

Houses (28, 39)Maternity & child health• Local authority is responsible in providing

these services (82)

Food control• Section 107-A – prohibition of sale of food without license in certain

places (Hotel, Tea shop, Coffee house, Café, Refreshment room, Mobile canteen, or catering establishment)

• Section-108 – No person shall keep store or prepare for sale any animal intended for human consumption which is diseased

• If any child < 7 years of age commits offence u/s 108 (1), the employer or the parent of the child are punishable as if the offence was committed by him (Sec.109)

• Section -112 deals with the power of the health officer to enter premises used for food trade

• Section-113 deals with power of the health officer to deal with infected vendors

• Meat Hygiene (110, 111)• Milk and Dairy products (114, 115)• There is provision for prohibition of sale of unsound foods, power

of the Health Officer to enter premises used for food and power of the Health Officer or a person duly authorized by him to destroy such food article and to incorporate expenses for such destruction from the owner himself.

FAIRS & FESTIVALS• Notification of Fairs & Festivals (116)• Levy of pilgrim tax and vehicle toll (117 & 118))• Authority i/c of Festival to notify HO not less than 60 days in

advance to the commencement (119.1)• Sanitary arrangements (120. 1 - 12)

– Demarcation & Preparation of site / Roads– Cleaning & Draining– Drinking (&Cooking) Water Supply– Accommodation for pilgrims– Lighting – Supply of wholesome food at reasonable price– Collection, removal & disposal of refuse– Provision & maintenance of latrines– Detection and segregation of cases of Infectious diseases.– Medical Relief– Others as may be specified

SECTION-(121) - Supervision & Control of arrangements by HO or Authorized Persons

SECTION (122) HO or Authorized Persons to Seize & destroy any food believed to be unwholesome(& perishable or value does not exceed Rs3/-)

• If not destroyed by HO, to be produced to prescribed authority for destruction if unwholesome or for analysis to ascertain the fitness for human consumption

In any case, the expenditure to be paid by the person concerned • SECTION 123• The local authority may, in case of emergency with the

sanction of the District Collector, depute any person to enter upon, occupy and use, without resorting to Land Acquisition Act, 1894 any land or any building not being a Dwelling house in the notified Fair or Festival Centre which in the opinion of the Health Officer, is required and suitable for any purposes connected with the Fair or Festival, such as the construction of Pilgrim sheds, Water sheds, Hospitals, Segregation sheds, Latrines and the like……….. This provision is unique for Public Health Act.

• HO can direct to disinfect / close any Private Water Source (124)• In default, HO can take necessary action and the expenditure to be

recovered from the person (124)• En route Arrangements, Where large number of persons halt on

their way to or return from a festival site (125)

N u i s a n c e:-• Nuisances and the powers of Health Officer for abatement of

Nuisances (41 to 49)• Any premises in such a state as to be prejudicial to health or a

nuisance (41.1)• Any pond, pool, latrine, watercourse which is so foul or in such a

state as to be prejudicial to health or nuisance (41.2)• Any accumulation or deposit of refuse which is prejudicial to health

or a nuisance (41.4)• Any factory or work place is not provided with adequate ventilation

or not clean or not free from noxious effluence or over crowded while work is carried as to be prejudicial to health of those employed therein (41.5)

• Any fire place or furnace which does not as far as predictable consume the smoke arising from the combustible used therein (41.6)

• Any chimney sending forth smoke in such quantity as to be a nuisance (41.7)

• Any noise, vibration, dust, irritating smell or offensive odour produced by a factory or work place which is nuisance to the neighborhood(41.8)

• It deals with inspection from time to time to detect nuisance(42)• Section-45 deals with power of the health officer to abate nuisance

by serving notice to defaulter or the premises owner• Section – 47 deals with the powers of the health officer for disposal

of articles removed it while abating nuisance• Section-48 deals with the power of entry of any executive or any

officer from the public health department • Deposition of Rubbish in streets (51)

Power of Entry 48. a: If the entry is related to Abatement of Nuisance:

Any premises not to enter between sunset and sunrise except when the nuisance is committed between sunset and sun rise

48. b: In cases of dwelling houses – Consent of the occupier is obtained– 24 hrs. Prior notice has been issued

If the entry is related to Notifiable diseasesSection 65.1: Any premises

• Without any notice in cases of factories, workshops, work places, business houses

• After issuing a reasonable notice in other cases and in case of dwelling house

Entry relating to Mosquito Control:

Section 88: Entry at reasonable time after issuing notice

Entry relating to Lodging Houses: Section 106.2: Entry at all times – Manager to allowEntry relating to Food Control: Section 112.1: Anytime – Day or Night – without notice

Any person who prevents lawful entry shall be punishable with simple imprisonment (up to 1 month) or fine (Rs. Five Hundred) or both” (section 135)

General Guidelines for Enforcement of the Act• Periodic Inspection of the Places, Premises

or Institutions etc.,• Investigation of Complaints related to Public

Health matters• Taking note of Violations, omissions,

Nuisances, failure to adopt conditions or precautions etc., - if any

• Advising to rectify the above• Taking action – if required (64 penalties)

described in this schedule• Penalty ranges from 10 rupees to 1000

rupees)

Method of Taking Action• Taking note of Violations, omissions, Nuisances,

failure to adopt conditions or precautions etc., - if any

• Issue of Notice: a) The time limit prescribed b) Method of writing and serving • Power of Entry and Inspection • If replied – Inspection and Acceptance of reply If not

replied– to remind if desirable• compounding as may be permissible• In default / not compounded – Prosecution

Procedure for prosecution

Make a reportEnclose Inspection report Enclose Served copy of notice Enclose Reply received and the opinion thereupon (or the fact of non-receipt of reply) Prepare and enclose Charge Sheets induplicate / triplicate Consult public prosecutor

Submit for sanction of Prosecution Filing of the charge sheet in the courtConducting prosecutionObtaining a copy of the judgmentReviewing the judgmentRenewed action if necessaryFurther prosecutions for continuing breach if any

Miscellaneous– Power to compound Offences (138.A)– Power of Police Officer to arrest offenders

(139)– Power of Health officers, Public health

Staff to arrest Offenders (140) – Punishment for malicious abuse of powers

(143)

Penalties

• Breach of rules (129)

• Breach o by-laws (132)

• Offences under the Act (134.1)

&Schedule I &II

• Preventing entry (135)

STRENGTHENING OF PUBLIC HEALTH ACT

•Emerging and re-emerging diseases•Increasing industries in food production• Emerging social issues like Gender issues, adolescents, geriatric issuesIncreasing environmental hazards – Ozone layer, weaning greenery, radiation, bio-degradation, environmental pollution due to changing life styles.Public Health Service – Made as an essential serviceControl of Health Officer over Public Health staff need to be strengthenedEducation and Training of Public Health StaffThe Penalty provisions has to be increasedStringent action should be taken against those violating the actMedical institutions to maintain register of communicable diseases.Control over disposal from Hospitals•Prohibition of Tobacco and Related items Establishment of Health Education units

Provision of Public Health Laboratory for diagnosis of communicable diseases

•Establishment of Sentinel surveillance•Special provision for treatment of other diseases like Tuberculosis, Leprosy, Hepatitis, Leptospirosis etc.

•Licensing of hospitals, all type of laboratories, blood bank.•Control over the burial ground and burning ghat

•Places of swimming pools, Holiday resorts, Holiday camps to be monitored•Fixing standards of pollution (use of Plastics, Air, Noise and Radiation hazards•Schools, Hostels, Colleges and Factories to be inspected periodically

•Prevention of “Quack” practitioners.•Prevention of sale of Medicines across the counter

CONCLUSION: The developing countries have to develop a model

Public Health Act and modifications and amendments if and when necessary could be made at the appropriate time and appropriate level. Public Health Act if it has any weak areas, It has to be identified and modified by suitable amendment to suit the present needs.

Acknowledgement: 1.Supercourse 2.2.Dr .P. Krishnamurthy Rtd. Director of Public Health and Preventive Medicine, Government of Tamil Nadu - Chennai 600 0063. Tamil Nadu Public health Act, 1939 4. Dr G. Palani, Professor, Department of community medicine, SRMC&RI