Escolar Documentos
Profissional Documentos
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Public Health Law:
A Tool to Address Emerging Health Concerns
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CDC Public Health Law Program Founded in 2000
cdc.gov/phlp/index.html
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September 11, 2001
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Public Health Law Program’s Mission
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Legal history reveals both the
POWER and LIMITATIONS of
government authority to
protect the public’s health
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Early Example of a Legal Public Health Intervention
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New York City After Sanitation Reform
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Legal Support for Government to Intervene through
Law and Regulation to Protect the Public’s Health
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Key Holdings in Jacobsen vs. Massachusetts
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The Role of Law in Selected Public Health
Achievements of the Last Century
Health Achievement Laws Associated with Public Health Achievement
Vaccination School vaccination laws
Childhood vaccination programs
Vaccine Adverse Event Reporting System
Control of Sanitary codes, drinking water standards, food inspection
infectious diseases Quarantine and isolation laws
Mosquito and rodent control
Decline in heart Education and information programs
disease and stroke Food labeling
Bike and walking paths
Recognition of Sales tax and restrictions on sale to minors
tobacco as a Smoke-free laws
health hazard Lawsuits leading to settlement agreements
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Modified from: CDC. MMWR Morb Mortal Wkly Rep. 1999 Apr 2;48(12):241-3.
Who has the power to shape public
policy to improve public health?
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Federal Government Has Limited Public Health Authority
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Legal Concept of Police Power
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Balancing State and Local Public Health Authority In California
“A county or city
may make and
enforce within its
limits all local,
police, sanitary, and
other ordinances
and regulations not
in conflict with
general laws.”
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ssf.net/DocumentCenter/View/9920
Public Health Law on Tribal Lands
Utah Colorado
New
Arizona
Mexico
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How can law be used
as a tool
to improve public health?
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Federal Authority Can Be Used to Shape Public Health
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South Dakota v. Dole, 483 U.S. 203.
Federal or State Authorities Can Also Prohibit Action
by Lower Levels of Government
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State and local governments can …
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Investigate Disease Outbreaks (Common)
Isolate or Quarantine (Rare)
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Ban Smoking in Multi-unit Housing, But Not Single-Occupancy Homes
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Create Zoning for Farmer’s Markets
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Require Kids to Wear Helmets
22 state-wide laws
201 local ordinances
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helmets.org/mandator.htm
Prevent Drug Overdose Deaths
Examples:
Emergency declarations
Emergency Use Authorizations
Social distancing laws
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Public Health Law Past and Present
Over the past century and a half, laws and rules have been increasingly
used as tools to promote and protect the public’s health
In the United States, legal authority for public health resides primarily
at the state, local, and tribal level
Governments can provide incentives and disincentives for actions at
lower levels of government
Legal interventions can promote prevention of infectious, chronic, and
injury-related diseases
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Using Law to Improve Public Health Practice
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Social Determinants of Health
Life Span
for Given
Location
rwjf.org/en/library/articles-and-news/2015/09/city-maps.html
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Maintaining healthy
housing
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Creating transportation infrastructure
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Promoting social
and cognitive
development
through
educational laws
and policies
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Law As a Social Determinant of Health
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Legal Epidemiology
cdc.gov/phlp/docs/php-radioactive.pdf
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Legal Mapping Legal Evaluation
What do laws say How do laws Do trends in law What impact does
across jurisdictions across jurisdictions relate to trends the law have on health,
on a topic? change over time? in health? cost, and
the health system?
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Legal Mapping
Comparing provisions in law and policy across jurisdictions or
over time
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Legal Assessments in Practice: School Vaccine Exemptions Laws
Midwest
This polar graph shows a cross-
Northeast
sectional analysis of vaccination
exemption laws by state
West
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cdc.gov/phlp/publications/topic/vaccinations.html
Policy Surveillance Compares Changes in Laws Over Time
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Ebola Screening and Monitoring Policies for Asymptomatic Individuals
WA
OR MN VT
PA CT
IA
guidance:
UT IN
MD
CO WV
VA DC
CA KS MO KY
TN
NC More restrictive
Equivalent
AZ OK
NM AR SC
MS AL GA
Less restrictive
TX
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Sunshine G, Pepin D, Cetron M, et al. MMWR Morb Mortal Wkly Rep. 2015 Oct 16;64(40):1145-6.
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Ebola Screening and Monitoring Policies for Asymptomatic Individuals
WA
OR MN VT
IA PA
guidance:
UT IN
MD
CO WV
VA DC
CA KS MO KY
TN
NC More restrictive
Equivalent
AZ OK
NM AR SC
MS AL GA
Less restrictive
TX
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Sunshine G, Pepin D, Cetron M, et al. MMWR Morb Mortal Wkly Rep. 2015 Oct 16;64(40):1145-6.
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Ebola Screening and Monitoring Policies for Asymptomatic Individuals
WA
OR MN VT
as of February 2, 2015
NH
ID WI NY MA
SD
WY MI CT RI
IA PA
guidance:
UT IN
MD
CO WV
VA DC
CA KS MO KY
TN
NC More restrictive
Equivalent
AZ OK
NM AR SC
MS AL GA
Less restrictive
TX
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Sunshine G, Pepin D, Cetron M, et al. MMWR Morb Mortal Wkly Rep. 2015 Oct 16;64(40):1145-6.
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Ebola Screening and Monitoring Policies for Asymptomatic Individuals
WA
OR MN VT
IA PA
guidance:
UT IN
MD
CO WV
VA DC
CA KS MO KY
TN
NC More restrictive
Equivalent
AZ OK
NM AR SC
MS AL GA
Less restrictive
TX
American Samoa
Guam
Northern Mariana Islands
Puerto Rico
U.S. Virgin Islands
Sunshine G, Pepin D, Cetron M, et al. MMWR Morb Mortal Wkly Rep. 2015 Oct 16;64(40):1145-6.
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Legal Evaluations
Measuring the impacts of law and policy on health, and vice versa
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2012 Fungal Meningitis Outbreak Due to
Contaminated Injectable Steroids
PROBLEM: Contaminated steroid given to many patients in
hospitals and pain clinics across the United States
20 States
751 Infections
64 Deaths
FDA Recall
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cdc.gov/HAI/outbreaks/meningitis.html
Evaluated Public Health Access to Electronic Health Records
● List of barriers
● Suggestions to
overcome barriers Electronic
Health
● Highlight best practices Record
and policies
● Practical tools
Healthcare Facilities
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Perceived Legal Barriers vs. Actual Legal Prohibitions
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Developed Toolkit on Accessing Electronic Health Records
Life Span
for Given
Location
rwjf.org/en/library/articles-and-news/2015/09/city-maps.html
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Developing and Implementing Local Laws that Enhance Community
Health: A Case Study and Model for Public Health 3.0
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A major health
challenge for New
Orleans: 25 year gap
in life expectancy
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Health Issues not caused by Hurricane Katrina
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Delivery System Successfully Reformed
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Better Care: Necessary But Not Sufficient
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A major health
challenge for New
Orleans: 25 year gap
in life expectancy
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Three Buckets of Prevention
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Social Determinants Obvious
The Hurricane Katrina Writing Group, JGIM, 2007; Grumbach, JAMA, 2002; Gelberg, Am J Public Health, 1997; Kim, et al, HSR 2006; DeSalvo, et al, J Urban
Health, 2007 61
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What we do together as a
PUBLIC society to ensure the
conditions in which
HEALTH everyone can be healthy.
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PUBLIC HEALTH 3.0 SYSTEMS
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Public Health Pressures
Governmental Public Health Expenditures 2003–2013
$300 10%
8%
$250
6%
$200 4%
2%
$150
0%
$100 -2%
-4%
$50
-6%
$0 -8%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
publichealtheconomics.org/2015/01/06/national-public-health-spending-still-waiting-for-recovery/
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Public Health Pressures
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Local Public Health: Statutory
Responsibility & Opportunity
Build strong infrastructure – capable in disaster and everyday
● Accreditation as the roadmap
First advice – look to statutory roles and responsibilities
● Identify gaps where new legislation may impact health
● CDC OSTLTS and Public Health Law group
Review
● Framework: required; allowed; not authorized
● Antiquated? Pigs and Fowl regulation in the French Quarter
● Allowed and also not authorized: Smoking
Economic
Opportunity Housing Environment Education
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KEY
PUBLIC HEALTH 3.0 COMPONENTS
ESSENTIAL DATA,
INFRASTRUCTURE ANALYTICS &
METRICS
FLEXIBLE &
LEADERSHIP & STRATEGIC SUSTAINABLE
WORKFORCE PARTNERSHIPS FUNDING
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PUBLIC HEALTH 3.0 RECOMMENDATIONS
www.healthypeople2020.gov/ph3
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PH 3.0: Community Health and the Law in
New Orleans
Public Health Law is a major non-medical determinant of health
Powerful tool to affect change at the system level
Affordable Care Act ensured ongoing access to value focused care
HITECH Act supports health IT efforts for care and for public health
Leading causes of morbidity and mortality
● Complete streets
● City-wide smoking ban
www.healthypeople.gov/ph3
#PH3
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