Module 4 Law, Government, and Public Health

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Module 4Law, Government,and Public Health
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Module 4 Will Help You To

• identify strategies used by governments to
  influence the health status of their citizens
• describe how various forms of law contribute to
  government's ability to influence health
• describe the basic administrative law processes
  carried out by public health agencies
• identify the various federal health agencies and
  describing their general purpose and major
  activities
• identify different approaches to organizing
  health responsibilities within state government
• describe common features of local health
  departments in the United States
• discuss implications of different approaches
  among states to carrying out public health's
  roles

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American Governmentand Public Health

• All politics is local but is all public health
  local as well?
• Federalism and Public Health
• Health hard to find in US Constitution
• Relative roles of national, state and local
  governments in health matters shift over time
• Social values shift over time as well

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Public Health Law

• Different forms for law
• Constitutionally based law
• Legislatively based law
• Administrative law
• Judicially based law
• Purposes for public health laws
• Protect and promote health (police and general
  welfare powers)
• Ensure rights of individuals

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Administrative Law

• Separation of powers (legislative, executive,
  judicial) not apparent in administrative law
• Reliance on experts and professionals
• Extensive impact on daily life

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Governmental Public Health

• Major levels
• National federal health agencies such as DHHS
  and its components
• Tribal Indian Health Service and others
• State state health agencies such as health
  departments and human service agencies
• Local local public health agencies, often called
  local health departments

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Federal Health Agencies
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Fiscal Year 2007 U.S. Public Health Service
Agency Budget Authority. Source Fiscal Year
2007 Budget, USDHHS, 2006.
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State Health Agencies

• Health roles and duties often scattered among
  dozens of agencies
• Many different configurations for state health
  agency (free-standing, unit or larger health and
  human services agency, etc.)
• Various duties depending on above.

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States with Responsibilities in Emerging Areas of
Public Health Practice United States, 2001.
Source Beitsch et al. AJPH 200696167-172.
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Selected Organizational Responsibilities of State
Health Agencies, 2002. Source ASTHO 2002 Salary
Survey of State and Territorial Health Officials.
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Local Public Health Organizations

• Where the rubber meets the road
• Often relate to 10 or more state and federal
  agencies for funding and direction
• 2 basic arrangements
• Decentralized relate primarily to local
  government although may also report to state
  health agency
• Centralized a unit of the state health agency

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Small, Medium and Large Local Public Health
Agencies (LPHAs) Percentage of All LPHAs and
Percentage of Population Served,United States,
2005.Source NACCHO, 2006.
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Median FTEs in Selected Occupational Categories
Employed by LHDs.Source NACCHO, 2006
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Intergovernmental Relationships

• Prior to 1915, federal government had minimal
  health role and little financial power states
  had authority but local governments were where
  the action was
• After 1915, federal tax resources and social
  shifts pushed federal government to become more
  active states retained primary authority and
  local governments were unable to keep up with
  local needs and expectations

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Federal public health spendingas percent of
adjusted total public health spending US,
1960-2000
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Adjusted total public health spending (in
millions)from federal and state/local
sourcesUS, 1960-2000
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Implications at Centurys End

• Expectations rising
• Federal role diminished
• Health policy investment opportunities
• Tobacco settlement
• BT preparedness
• Emergency public health preparedness now both a
  national security as well as personal safety
  priority

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Discussion

• All learners should be making arrangements to
  attend a meeting of an official board of health
  (these meetings are open to the public). This may
  require some advanced planning since many boards
  of health meet only once a month. If you are
  unsure of what a board of health is, visit the
  National Association of Local Boards of Health
  (NALBOH) web site, especially the article "About
  Local Boards of Health." Another useful resource
  is the Illinois Department of Public Health site
  on local health departments in Illinois (or
  similar information for your state).

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Discussion

• Select a local public health agency from a state
  other than Illinois (also, it must not relate to
  the Board of Health whose meeting you will be
  attending!) and identify the jurisdiction it
  serves and whether or not it relates to a local
  board of health. Also include information as to
  how this local public health agency was
  established (resolution or referendum), who it
  reports to, and how it relates to the state
  health agency (for example Is it a unit of the
  state agency or an independent entity?  Is it
  certified or accredited by the state?).