Anthony D. Moulton

What Is Public Health Legal Preparedness

Legal preparedness has gained recognition as a critical component of comprehensive public health preparedness for public health emergencies triggered by infectious disease outbreaks, natural disasters, chemical and radiologic disasters, terrorism and other causes. Public health practitioners and their colleagues in other disciplines can prepare for and respond to such an event effectively only if law is used along with other tools. The same is true for more conventional health threats. At first glance, public health legal preparedness may appear to be only a matter of having the right laws on the books. On closer examination, however, it is as complex as the field of public health practice itself. Public health legal preparedness has at least four core elements: laws (statutes, ordinances, regulations, and implementing measures); the competencies of those who make, implement, and interpret the laws; information critical to those multidisciplinary practitioners; and coordination across sectors and jurisdictions. The process of improving public health legal preparedness has begun in earnest with respect to potentially massive public health emergencies. Elected officials, public health, legal, and law enforcement practitioners, and national security organizations have contributed to initial benchmarks for the core elements. A few gaps in legal preparedness have been identified in the context of exercises, actual public health emergencies, and through more general assessments of public health preparedness conducted by CDC and the Department of Justice. While a strong beginning has been made, this work is incomplete. Redoubled effort is needed to define practical, measurable benchmarks or standards of legal preparedness, to identify and correct shortcomings, and to review findings from regular exercises and actual public health emergencies. There is great value in having this work move forward on two converging tracks, one defined by states and localities acting on their own initiative and the other shaped by the federal government as informed by state and local experience. The TOPOFF and Dark Winter exercises exemplify the grounded, case-based approach that teaches practical lessons about benchmarks, gaps, and steps to improve public healths legal preparedness. It goes without saying that action on both tracks should be taken by collaboratives whose membership includes representatives of the many different communities integral to the design and application of laws that affect the health of the public and the effectiveness of the public health system itself. Consistent with the concept of a public health or population health system with which we began this paper, participants in both tracks should include representatives of non-governmental bodies--community-based organizations, non-profit organizations active in disaster preparedness and response, and others. This paper presents a conceptual and analytic framework those groups may apply, one that is sufficiently broad to serve as an integrating schema across sectors and jurisdictions but also sufficiently flexible to accommodate the unique features of the many community and state public health systems which, together with federal partners, comprise the U.S. public health system, in sum, a framework responsive to the exigencies of our times, faithful to the guiding principles of American federalism, and conductive to a new standard of health protection for all our citizens.

CDC's Information Network for Public Health Officials (INPHO): a framework for integrated public health information and practice.

To strengthen the public health infrastructure, the Centers for Disease Control and Prevention (CDC) initiated the Information Network for Public Health Officials (INPHO). CDC INPHO has three goals: (1) to make communication among public health practitioners throughout the United States easy, (2) to make information accessible, and (3) to make secure data exchange as swift and smooth as contemporary technology will allow. Based on a systems approach to supporting the core functions of public health, CDC INPHO achieves its goals by creating a flexible and user-responsive infrastructure of open communications and information exchange.

Addressing gaps in health care sector legal preparedness for public health emergencies.

Health care providers and their legal counsel play pivotal roles in preparing for and responding to public health emergencies. Lawyers representing hospitals, health systems, and other health care provider components are being called upon to answer complex legal questions regarding public health preparedness issues that most providers have not previously faced. Many of these issues are legal issues with which public health officials should be familiar, and that can serve as a starting point for cross-sector legal preparedness planning involving both the public health and health care communities. This article examines legal issues that health care providers face in preparing for public health emergencies, and steps that providers, their legal counsel, and others can take to address those issues and to strengthen community preparedness.

Public Health Legal Preparedness: A Framework for Action:

13 A. Introduction Public health emergencies have occurred throughout history, encompassing such events as plagues and famines arising from natural causes, disease pandemics interrelated with wars (such as the influenza pandemic of 1918-1919), and industrial accidents such as the 1986 Chernobyl disaster, among others. Law and legal tools have played an important role in addressing such emergencies. Three prime U.S. examples are Congressional authorization of quarantine as early as 1796,1 legally mandated smallpox vaccination upheld in a landmark 1905 U.S. Supreme Court ruling,2 and the President’s 2003 executive order adding SARS to the federal government’s list of “quarantinable communicable diseases.”3 The public health emergencies of the present – both actual and potential – pose equally serious threats but do so in the context of greatly magnified expectations that stem directly from the attacks of September 11, 2001, and the immediately following anthrax attacks. These events transformed the environment in which government agencies – public health, emergency management, law enforcement, and others – work to address public health emergencies in the U.S. As a result, public health emergencies now are seen under the intense spotlight of national security concerns. The agencies charged to prepare for, and respond to, public health emergencies at all levels face extraordinary expectations for safeguarding the nation from potentially catastrophic health threats. Other trends have further transformed the operating environment for public health emergency preparedness, including, for example: the rapid emergence of new threats to the public’s health, such as SARS and influenza A (H5N1); the expectations of elected officials and the public for effective emergency response on an accelerated timeline and on a 24/7 “always on” basis; and, certainly not least, expansion in the origins and scope of public health threats from the local and regional levels to the national and global levels. The public health emergencies the nation faces today require urgent and highly complex responses that involve multiple governments, agencies, jurisdictions, and social sectors. They also may require the use of many public health tools rooted in legal authority, such as disease surveillance; control of movement through quarantine and isolation; government use of private property; allocation of vaccines, medicine and medical supplies; and evacuation of populations. The nation needs modern legal tools to enable rapid, effective responses to such highly complex challenges. Many states and communities, like the federal government and partners at every level, have worked hard to strengthen legal preparedness beginning even before the attacks of September and October 2001. Most, if not all, states have updated their public health emergency laws since then. Many have conducted training in legal preparedness and have incorporated legal issues into preparedness exercises. Further, beginning in 2002, legal preparedness has been an explicit focus of CDC’s program of preparedness grants to the states.4 In spite of this progress, continually emerging events – such as the case of a U.S. citizen who traveled internationally in 2007 while infected with a dangerous form of tuberculosis – underscore that much remains to be done. The driving impetus for the 2007 Georges C. Benjamin, M.D., F.A.C.P., is the Executive Director of the American Public Health Association. Anthony D. Moulton, Ph.D., is the Co-Director of the Public Health Law Program at the Office of the Chief of Public Health Practice, Centers for Disease Control and Prevention. Public Health Legal Preparedness: A Framework for Action

The Georgia Information Network for Public Health Officials (INPHO): a demonstration of the CDC INPHO concept.

The Georgia Division of Public Health is serving as the first demonstration model of a statewide implementation of the Centers for Disease Control and Prevention Information Network for Public Health Officials. The goals of the project are to make communication easy, to make information accessible, and to make data exchange as swift and as smooth as technology will allow. By having a state-of-the-art telecommunications network, public health officials will be able to rapidly collect health data and transform them into meaningful health status information that can be used to inform health policy decisions. The Georgia Information Network for Public Health Officials is a unique consortium of private and public sector partners funded with a grant from the Robert W. Woodruff Foundation. The project will install the telecommunications infrastructure and the supporting software to position Georgia public health as the health information leader of the state.

Law, public health, and the diabetes epidemic.

The prevalence of new cases of diabetes continues to increase, and the health burden for those with diabetes remains high. This is attributable, in part, to low adoption of evidence-based interventions for diabetes prevention and control. Law is a critical tool for health improvement, yet assessments reported in this paper indicate that federal, state, and local laws give only partial support to guidelines and evidence-based interventions relevant to diabetes prevention and control. Public health practitioners and policymakers who are concerned with the human, fiscal, and economic costs of the epidemic can explore new ways to translate the evidence base for diabetes prevention and control into effective laws and policies.

Legal Preparedness for Obesity Prevention and Control: A Framework for Action

15 Introduction Purpose The Proceedings of the National Summit on Legal Preparedness for Obesity Prevention and Control is based on a two-part conceptual framework composed of public health and legal perspectives. The public health perspective comprises the six target areas and intervention settings that are the focus of the obesity prevention and control efforts of the Centers for Disease Control and Prevention (CDC).1 This paper presents the legal perspective. Legal preparedness in public health is the underpinning of the framework for the four “assessment” papers and the four “action” papers that are integral to the application of public health law to any particular health issue. In addition, this paper gives real-world grounding to the legal framework through examples that illustrate the four core elements of legal preparedness in public health that are at work in obesity prevention and control. Law in Public Health Law, a traditional and indispensable public health tool, made important contributions to all 10 “great public health achievements” in the United States during the 20th century. These achievements include control of infectious diseases, motor vehicle safety, and a decline in deaths attributed to coronary heart disease and stroke.2 At a fundamental level, law operates as a public health tool by establishing public health agencies and programs focused on preventing disease and promoting health. The Public Health Service Act, for example, authorizes many federal public health agencies and programs.3 States and many tribes and localities have enacted similar authorities. Laws also can support public health interventions directly, such as through tobacco excise taxes, rules requiring restaurants to label menu items with calorie information, and school immunization requirements.

Strengthening the legal foundation for public health practice: A framework for action

Growing concern that public health laws may be inadequate to the challenges that confront public health practitioners has led to adoption of a Healthy People 2010 objective for improved laws and policies. It has also led to concerted efforts to strengthen the legal foundation for public health practice. In this editorial, the authors present a framework for collaborative research, analysis, and development to strengthen public health laws, skill in applying laws, and law-related information resources.

Toward a National Climate Change Health Coalition

The author argues that the U.S. public health community should develop comprehensive climate change adaptation strategies in 2016 that will embed population health as a main issue in the domestic and global response to climate change. The Paris Agreement international pact to limit global climate warming and greenhouse gas emissions is examined, along with the 1997 Kyoto Protocol environmental protection accord. A right to health, the U.S. government, and global responsibilities are assessed.

Legal Authority and State Public Health Response to Climate Change

The article discusses legal aspects of U.S. state public health responses to climate change impacts. Topics include the draft legislation Comprehensive Climate Change Health Protection Act, the role of U.S. federal public health agencies in addressing health impacts of climate change, and U.S. state policies addressing greenhouse gas mitigation and climate change adaptation.