Public Health Policy

Issues, Theories, and Advocacy

Dhrubajyoti Bhattacharya

• Publisher: Jossey-Bass
• Year: 2013
• ISBN:
  9781118239520
• Edition: 1
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

Public Health Policy: Issues, Theories, and Advocacy offers students an engaging and innovative introduction to public health policy: its purpose, how it is originated, and how it is implemented. The book describes the underlying theories and frameworks as well as practical analytical tools needed for effective advocacy and communication. Drawing on the multidisciplinary nature of public health, the book uses concepts and examples from epidemiology, law, economics, political science, and ethics to examine the policymaking process, explain positions pro or con, and develop materials for various audiences to further a public health policy intervention. In addition, Public Health Policy shows how policymaking is a complex and integrated top-down and bottoms-up process that embraces a myriad of public and private stakeholders.

Written by a highly experienced health policy researcher and teacher, the book is rich in resources that will enhance teaching and learning. Each chapter begins with an overview of the chapter, including core terms and concepts, and includes illustrative examples of how the highlighted component (law, ethics, economics, politics, epidemiology, and medicine) intersects with public health. Discussion questions at the end of every chapter, along with an interview from an expert from each of the component fields, give real-world perspectives on how that particular subject relates to the overall topic. The book also contains 13 case studies that illustrate the framework discussed in the first part of the book, and show how the different components link to create, sustain, evaluate, or obstruct the development of public health policy. Also included are primers on two essential policy tools: how to write research policy briefs, and how to craft effective letters to an editor, including examples of both drawn from the author's publications in journals and newspapers.

Part 1
Building a Framework for Conducting a Multidisciplinary Analysis

Chapter 1
The Role of Law: Agencies, Legislatures, Courts, and the Constitution

Learning Objectives

• Define core legal terms and principles.
• Understand the structure of the US legal system.
• Articulate major legal powers and principles that are relevant to public health.
• Discuss major theories of public health law.
• Provide an introduction to statutory interpretation.

Law affects, and is affected by, public health in ways that are at once restrictive and accommodating. This seemingly perplexing contradiction is by and large a product of a broader activity that underlies our legal system: interpretation. This process is the work of legislatures, agencies, and courts that shape the creation, application, and development of law through statutory enactment (the making of laws), administrative rule making, and adjudication. All of these actors must operate within specific parameters of the law while being aware of its substantive and procedural elements. Individual rights, the reach of governmental authority, and general accountability pervade the discussion of all things legal, and interpretation is the means by which each of these elements is understood for purposes of decision making.

This chapter takes the law out of the shadows of esoteric definitions and concepts into the light of core terms and principles that will allow you to identify and analyze many of the legal issues that may arise in the course of your policy research and advocacy.

The law affects public health by setting boundaries of authority among decision makers and, to the extent possible, ensuring transparency and accountability in the process. Legislatures, agencies, and courts are empowered by law to operate within distinct domains. State and national legislatures create the law through the enactment of statutes that are often broadly worded yet provide a framework and objectives as guidance for addressing a specific issue. Agencies are often delegated the task of implementing a particular statute by issuing regulations that may entail defining core terms, adopting standards for the affected industry, interpreting ambiguous or broadly worded phrases or terms, and outlining the attendant costs and benefits.

Defining Public Health Law

Is there a distinct body of law that governs the practice of public health? Yes and no. State and federal laws are replete with health-related rights, duties, and privileges accorded the institutions and individuals responsible for securing the public's health. Numerous laws regulate the training of health professionals and attempt to standardize their practices. They also regulate the collection and dissemination of data and the provision of resources, services, and information to promote population health.

Table 1.1 Defining Public Health Law, 1947 and 2008

Source	Definition
James A. Tobey (1947)	“Public health law may be defined as that branch of jurisprudence which treats of the relation and application of the common and statutory law to the principles, and procedures of hygiene, sanitary science, and public health administration.”^5
Lawrence Gostin (2008)	“Public health law [is] the study of the legal powers and duties of the state, in collaboration with its partners (e.g., health care, business, the community, the media, and academe), to ensure the conditions for people to be healthy (to identify, prevent, and ameliorate risks to health in the population), and of the limitations on the power of the state to constrain for the common good the autonomy, privacy, liberty, proprietary, and other legally protected interests of individuals.”^6
Oregon Revised Statutes (2008)	“‘Public health law’ means any statute, rule, or local ordinance that has the purpose of promoting or protecting the public health and that establishes the authority of the Oregon Health Authority, the Public Health Director, the Public Health Officer, a local public health authority or local public health administrator to enforce the statute, rule, or local ordinance.”^7

But is there a singular perspective on public health law, and to what extent would it help us in our study of public health policy? Definitions have been suggested by scholars and practitioners for years and have even appeared in state statutes (table 1.1). One of the earliest definitions was proffered in 1947 by James A. Tobey, a public health practitioner and lawyer, who described the intersection of law and public health as applied to matters of personal hygiene, sanitary science, and public health administration. Sixty years later, Lawrence Gostin expanded the scope of public health law, describing it as

… the study of the legal powers and duties of the state, in collaboration with its partners (e.g., health care, business, the community, the media, and academe), to ensure the conditions for people to be healthy (to identify, prevent, and ameliorate risks to health in the population), and of the limitations on the power of the state to constrain for the common good the autonomy, privacy, liberty, proprietary, and other legally protected interests of individuals. The prime objective of public health law is to pursue the highest possible level of physical and mental health in the population, consistent with the values of social justice.¹

At the outset of this definition, Gostin explains the legal context of public health as encompassing governmental authority and duty to protect public health. His definition adopts language from the Institute of Medicine's 1988 definition of public health as what “we as a society do collectively to assure the conditions in which people can be healthy.”² (The Institute of Medicine later elaborated on this definition, stating that the term public health should encompass the “efforts, science, art, and approaches used by all sectors of society (public, private, and civil society) to assure, maintain, protect, promote, and improve the health of the people.”³) The second half of Gostin's definition describes the check on the exercise of government power constituted by the fundamental rights and interests of affected citizens. Thus the definition posits a mixture of positive and negative rights: that is, the government's duty to confer certain benefits upon the people and the people's freedom from arbitrary interference in their personal affairs. But what about activities that take place in the private sector? As Wendy Parmet notes, “not all public health interventions require explicit legal authorization or initiation.”⁴ Indeed, the law may shape the creation, development, and expression of private institutions and organizations that conduct public health activities and affect population health.

Definitions may help to outline the proper scope of governmental action, but in practice they can distort the field of actors and their range of influence. At times, interpretation of concepts and terminology can become an iterative process among governmental branches at federal, state, and municipal levels. In New York City, for example, health officials struggled with judicial review of the constitutionality of proposed regulations to require disclosure of the nutrient content of food served in chain restaurants (discussed further later in this chapter). It is crucial for those involved in public health to become familiar with the breadth of l...

Table of contents

• Cover
• Table of Contents
• Title
• Copyright
• Introduction
• The Author
• Part 1: Building a Framework for Conducting a Multidisciplinary Analysis
• Part 2: Case Studies
• Part 3: Advocacy
• Index
• End User License Agreement