Module 4 Law, Government, and Public Health

1. Module 4Law, Government,and Public Health

2. 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

3. 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

4. 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

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

6. 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

7. Federal Health Agencies

8. Fiscal Year 2007 U.S. Public Health Service Agency Budget Authority. Source: Fiscal Year 2007 Budget, USDHHS, 2006.

9. 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.

10. States with Responsibilities in Emerging Areas of Public Health Practice: United States, 2001.Source: Beitsch et al. AJPH 2006;96:167-172.

11. Selected Organizational Responsibilities of State Health Agencies, 2002. Source: ASTHO 2002 Salary Survey of State and Territorial Health Officials.

12. 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

13. Small, Medium and Large Local Public Health Agencies (LPHAs): Percentage of All LPHAs and Percentage of Population Served,United States, 2005.Source: NACCHO, 2006.

14. Median FTEs in Selected Occupational Categories Employed by LHDs.Source: NACCHO, 2006

15. 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

16. Federal public health spendingas percent of adjusted total public health spending US, 1960-2000

17. Adjusted total public health spending (in millions)from federal and state/local sourcesUS, 1960-2000

18. Implications at Century’s 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

19. 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).

20. 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?).