This paper summarizes key shifts in judicial decisions relating to public health powers during the pandemic and the implications of those decisions for public health practice. Then, it gives a preview and call for partnership in developing a legal framework for authority that guides public health to better activities, processes, and accountability in service of the public’s health.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health — a partnership of public health law organizations — has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.

In D.A.B.E., Inc., v. Toledo-Lucas County Board of Health, the Supreme Court of Ohio held that the Ohio Revised Code does not grant a local board of health the power to proscribe smoking in all public places as defined by the Lucas County Regional Health District Clean Indoor Air Regulation.On May 24, 2001, the Board of Health of the Lucas County Regional Health District adopted the regulation in question, prohibiting smoking in all public (...) areas in Lucas County, which were defined as “every enclosed, indoor area to which members of the general public are invited or in which members of the general public are normally permitted.” In addition, the regulation prohibited smoking within twenty feet of any entrance or open window of these public areas and in all vehicles of public transportation. (shrink)

In a new era of regulatory oversight, the US Supreme Court upended traditional Chevron deference to agency interpretations of ambiguous Congressional provisions in Loper in June 2024. Federal courts were instructed to make their own assessments of statutory authorities amid an onslaught of public health agency challenges surfacing nationally. Even so, SCOTUS may be eyeing further limits on agency powers despite clear and substantial repercussions for the health of the nation.

Public health nurses (PHN) have had a long history of working with new mothers in the community. Their practice includes collaboration, building therapeutic relationships, mutual goal setting, establishing trust, supporting clients’ strengths, empowerment and social justice. The wealth of information that new mothers receive both solicited and unsolicited may come from many different sources such as medicine, midwifery and those created personally by families. Although much of the information on mothering is presented with the intent of helping, it (...) can also be hegemonic and oppressive depending on different discourses, stereotypes and myths of mothering and therefore may cause confusion, guilt and uncertainty. Public health nurses often address conflicting social, cultural and personal discourses about mothering practices in order to support an empowering mothering experience. The term ‘social mediator’ was purposefully created in an attempt to describe the unique work of PHNs that this author has witnessed through her own research and practice as a PHN. This paper will present a discussion of the author's own work and research findings that will suggest how feminist poststructuralist theory may be used to guide and understand information exchange between PHNs and mothers as they mediate different social, cultural and personal discourses on mothering. (shrink)

Although Jonathan Herington, Angus Dawson, and Heather Draper offer valuable insights on how to conceptualize health hazards and understand their effects on populations, I resist the label “public health emergency” for obesity, and here is why. It is important—politically and pragmatically—to be judicious with words that have legal and real‐world consequences. Once a concept is stretched to encompass a broad swath of events, it loses its power. The broader the application of the term “public health (...) emergency,” the more it loses the core idea of an emergent event. Thus, framing a long‐simmering health hazard such as obesity as an emergency would mute the voices of public health authorities seeking a surge response to a truly emergent event, such as a rapidly spreading novel disease or a natural or man‐made disaster. (shrink)

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal (...) that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors’ overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses’ ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses’ moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice. (shrink)

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to (...) volunteerism, and from cooperation to cooption.” Hence, a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)

Public health authorities (PHAs), including Tribal nations, have the right and responsibility to protect and promote the health of their citizens. Although Tribal nations have the same need and legal authority to access public health data as any other PHA, significant legal challenges continue to impede Tribal data access.

The ethical dimensions of health communicators' interventions and campaigns are brought into question in this thought-provoking book. Examining the efforts to effect behavior change, the author questions how far health communication can and should go in changing people's values. The author broadens the current analysis of interventions and presents conceptual frameworks that help identify values and justifications that are embedded in health communication goals, strategies, and evaluation criteria. This critical approach helps explain how and why choices are (...) made in design and implementation, and provides constructs and frameworks to examine them. It also widens the criteria for program evaluation and policymaking, and provides practitioners, planners, policy-makers, researchers, and students with practice-oriented questions. (shrink)

Recent advances in our understanding of the human genome have raised high hopes for the creation of personalized medicine able to predict diseases well before they occur, or that will lead to individualized and therefore more effective treatments. This possibility of a more accurate science of the prevention and surveillance of disease also illuminates the field of public health, where the translation of genomic knowledge could provide tools enhancing the capacity of public health authorities to promote (...) health and prevent diseases. But beyond scientific considerations, the use of genomics in public health research and interventions gives rise to several ethical and social issues of great importance. Considering the impact that PHG could have on the future of public health while still paying attention to the uncertainty surrounding the use of genomic databases for the benefit of populations, this article seeks to explore the promise of genomics in public health and the ethical issues that emerge from its application. (shrink)

This paper provides an overview of recent US Department of Health and Human Services initiatives and efforts — under the leadership of the General Counsel, the Secretary, and the President — regarding legal preparedness for public health emergencies. In addressing this topic, the paper focuses on four core elements comprising public health legal preparedness:effective legal authorities to support necessary public health activities;competencies of public health professionals to know and then to apply (...) those laws;coordination of the application of laws across jurisdictions and across multiple sectors; andinformation and best practices in public health law. (shrink)

Although empirical evidence may provide a much desired sense of certainty amidst a pandemic characterised by uncertainty, the vast gamut of available COVID-19 data, including misinformation, has instead increased confusion and distrust in authorities’ decisions. One key lesson we have been gradually learning from the COVID-19 pandemic is that the availability of empirical data and scientific evidence alone do not automatically lead to good decisions. Good decision-making in public health policy, this paper argues, does depend on the availability (...) of reliable data and rigorous analyses, but depends above all on sound ethical reasoning that ascribes value and normative judgement to empirical facts. (shrink)

Public-health measures are very effective and efficient means of improving health, yet public health is either neglected by the literature or fraught with unease, mainly due to the combination of the aggregate-distributive tension with the element of compulsion.The author argues that this unease can be decreased by 1) a pluralist-holistic view of health, situating the normative value of health in its effect on well-being, incorporating both the objective and subjective source of the value (...) of health; and 2) by a rich concept of reciprocity.This article supports Martha Nussbaum’s critique of social-contract thinking for placing too much weight on the scale of normal functioning and productive reciprocity, as well as Sen’s distinction between well-being and agency freedom.To reach an adequate understanding of the value and goal of public health within the general setting of health care, a pluralist conception of health, well-being and reciprocity is necessary. (shrink)

It has now been 10 years since the framework for public health legal preparedness was put forth as a model to meet new public health challenges in the 21st century. Public health legal preparedness is defined as the “attainment by a public health system of specified legal of standards essential to the preparedness of the public health system.” The framework has continued to develop over time and four core elements have (...) emerged to make up the basis for public health legal preparedness. The four core elements are: laws and legal authorities; competency in using laws effectively and wisely; coordination of legally based interventions across jurisdictions and sectors; and information on public health laws and best practices. (shrink)

Human rights constitute a universal concern in different countries’ responses to COVID-19. Vietnam is internationally praised for its success in containing the pandemic; nevertheless, human rights issues are a key area that needs to be assessed and improved. Little legal and ethical research is available on human rights in Vietnam, particularly in its response to COVID-19, however. In Vietnam, decentralization took place during the pandemic: higher authorities delegated power to lower ones to make and implement public health measures. (...) Unfortunately, many measures made and implemented decentrally caused human rights concerns or breaches. This article aims to study what makes such measures cause human rights concerns or breaches. It argues that several social, legal, and political factors, including an inadequate understanding of human rights, the undefined breadth of discretion, and lack of supervision, are underlying factors for such problematic decentralized measures. Accordingly, this paper proposes two solutions (i) improving the supervision of the decentralization process, and (ii) improving the understanding of human rights. While Vietnam should learn from the international community to improve its measures, lessons and experience from Vietnam can also contribute to a richer dialogue and better protection of human rights globally. (shrink)

Should public health authorities have access to your personal medical information without your permission? The usual justifications for requiring informed consent do not necessarily apply. That is not to say that consent may be avoided in all situations, just that the reasons for requiring consent in public health are different than for traditional medical treatment.

Public health is currently evolving, expanding, and reinforcing itself as a governance project in which health authorities’ concerns meet and blend with epidemiology and civil engineering. Rarely, however, are those concerns found worthy of examination, at least not to account for the multiplying involvements of public health, its ability to find political life in things, and its many translations. The shape of public health is dictated as much by its matters of concern as (...) it is by biopolitical and brute matters of fact. This article presents a genealogy of public health in Victorian England between 1834 and 1848 in order to glimpse the matters of concern around which it stabilized. The political medicine that preceded public health holds the clue in its assertion of life as a form of worth, as prominent a criterion for the assessment of sociomaterial arrangements as profitability or efficiency. This article describes public health as an ensemble presence, a unique gathering, in which political will follows medical diagnosis, and life is worth at least as much as money. (shrink)

Public-health measures are very effective and efficient means of improving health, yet public health is either neglected by the literature or fraught with unease, mainly due to the combination of the aggregate-distributive tension with the element of compulsion.The author argues that this unease can be decreased by 1) a pluralist-holistic view of health, situating the normative value of health in its effect on well-being, incorporating both the objective and subjective source of the value (...) of health; and 2) by a rich concept of reciprocity.This article supports Martha Nussbaum’s critique of social-contract thinking for placing too much weight on the scale of normal functioning and productive reciprocity, as well as Sen’s distinction between well-being and agency freedom.To reach an adequate understanding of the value and goal of public health within the general setting of health care, a pluralist conception of health, well-being and reciprocity is necessary. (shrink)

The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary (...) purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory. (shrink)

Quality of democratic arrangements does matter. This kind of conceptual breakthrough has been made through painfully engagement with the nonphilosophical area of inquiry arisen by the COVID-19 pandemic. The pandemic has dramatically emphasized that health is a highly political domain. No surprise then that it made possible to challenge common thought about democratic procedures in political theory that considers procedure-independent standards suspicious. Therefore it is fair to state that the COVID-19 pandemic has taken the quality of democratic outcomes back (...) on center stage in the debate in political theory, which has been dominated by fair proceduralism’s claim not to refer to any procedure-independent standards of good political decisions. Procedural values have traditionally been seen as a defining element of fair deliberation and essential for democracy. They have been extolled in social choice theory that claims that democracy does not exhibit any particular disposition to lead to good or just political arrangements. They are the focus of attention in Jürgen Habermas’ procedural rationality, though philosophers are now more skeptical about the divorce between procedures and substantive standards. Overall, issues surrounding the topic of ensuring citizens’ health make the topic politically central and philosophically interesting for epistemic theories and impartial proceduralism theories of democracy alike. The aim of this paper is to justify the legitimacy and authority of public health policies on the basis of arguments that do not simply are a matter of their being democratic. In the first part, I want to display and criticize the idea that proceduralism’s not getting one’s hands dirty with the substance of decisions and remaining neutrally adherent only to procedures is untenable in the present case. Having criticized democratic theories that want to restrict themselves to purely procedural values, in the second part I will focus on the idea of knowledge and make explicit its characters of being practical and shared. Eventually, it will help to have one example. M-Health will show that many valuable insights would be incompatible with the restrictions of the proceduralism. Philosophical consideration of health will combine epistemic issues with political ones triggered by technology and sharpened by the COVID-19 pandemic. (shrink)

These teaching materials explore the specific powers of governments to implement control measures in response to communicable disease, in two different contexts:The first context concerns global pandemic diseases. Relevant legal authority includes international law, World Health Organization governance and the International Health Regulations, and regulatory authority of nations.The second context is centered on U.S. law and concerns control measures for drug-resistant disease, using tuberculosis as an example. In both contexts, international and domestic, the point is to (...) understand legal authority to address public health emergencies. (shrink)

Public health legal preparedness begins with effective legal authorities, and law provides a key foundation for public health practice in the United States. Laws not only create public health agencies and fund them, but also authorize and impose duties upon government to protect the public's health while preserving individual liberties. As a result, law is an essential tool in public health practice and is one element of public health (...) infrastructure, as it defines the systems and relationships within which public health practitioners operate.For purposes of this paper, law can be defined as a rule of conduct derived from federal or state constitutions, statutes, local laws, judicial opinions, administrative rules and regulations, international codes, or other pronouncements by entities authorized to prescribe conduct in a legally binding manner. Public health legal preparedness, a subset of public health preparedness, is defined as attainment of legal benchmarks within a public health system. (shrink)

In a recent article in this journal, Parker Crutchfield argues that if moral bioenhancement ought to be compulsory, as some authors claim, then it ought to be covert, i.e., performed without the knowledge of the population that is being morally enhanced. Crutchfield argues that since the aim of compulsory moral bioenhancement is to prevent ultimate harm to the population, compulsory moral bioenhancement is best categorized as a public health issue, and should therefore be governed by the norms and (...) values that apply in public health settings. In this article, I argue for two related claims. First, I question the extent to which compulsory moral enhancement should be considered a public health issue that ought to be governed by the norms and values that apply in public health settings. Second, I argue that Crutchfield's argument that covert moral bioenhancement would better respect people's autonomy than an overt program overlooks two important autonomy‐based reasons that, in fact, favor an overt moral enhancement program over a covert one. (shrink)

This paper uses six policy problems in public health to illustrate the complexity of value considerations in decision-making, and derives an ethic for health protection policies based on the primacy of non-harming. In the first part, health policy is shown to require value considerations beyond simple utilitarianism. In the second, the author posits that much of health impairment can be traced to erosions of health outside the immediate control and consent of the individual. Accordingly, (...) he argues that health impairing actions on the part of others warrant strict regulations in spite of the paternalistic nature of such interventions. The priority for these interventions should be set along a gradient of vulnerability and autonomy, with the greatest hazards to non-consent giving persons warranting the greatest controls. Special attention to fetuses and developing infants is thereby justified, and actions which prevent harms are shown to have priority over those which mitigate harms, ameliorate their effects or promote good. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for (...) consideration by policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

This article explores the tension between the fundamental perception that the provision of privatized services such as health and social care remain inherently public and the absence of any clearly developed juridical concept of ‘public services’ as the basis of judicial control in accordance with public law standards. In a series of recent cases, courts have had the opportunity to determine whether private contractors engaged in the provision of local authority residential and social care services (...) are amenable to judicial review or susceptible to direct vertical proceedings under the Human Rights Act, on grounds that they are performing functions which are by their very nature quintessentially public. However, conflating questions of amenability to review and susceptibility to the Human Rights Act (hereafter HRA), courts have refused to adopt a test based on the public character of a body's functions, irrespective of the source of power. This article acknowledges the constitutional propriety and rationality of a broad based functional test of review. Nevertheless, it is argued that if courts continue to resist such a test, Parliament must legislate to ensure judicial regulation of decisions by independent contractors of health and social care services, in accordance with public law principles and HRA obligations, which transcend the boundaries of their strict contractual undertakings. (shrink)

Encouraged by the success of smoking denormalization strategies as a tobacco-control measure, public health institutions are adopting a similar approach to other health behaviors. For example, a recent controversial ad campaign in New York explicitly aimed to denormalize HIV/AIDS amongst gay men. Authors such as Scott Burris have argued that efforts like this are tantamount to stigmatization and that such stigmatization is unethical because it is dehumanizing. Others have offered a limited endorsement of denormalization/stigmatization campaigns as being (...) justified on consequentialist grounds; namely, that the potential public health benefits outweigh any stigmatizing side effects. In this paper, I examine and reject the blanket condemnation of stigmatization efforts in public health. I argue that the moral status of such efforts are best evaluated within a contractualist, as opposed to a consequentialist, framework. Contractualism in public health ethics asks whether a particular stigmatizing policy could be justified to reasonable individuals who do not know whether they will be affected by that policy. Using this approach, I argue that it is sometimes permissible for public health institutions to engage in health-related stigmatization. (shrink)

Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds. Privacy advocates consistently seek to limit the acquisition, use, and disclosure of identifiable health information in governmental and private sector settings. Their concerns relate to misuses or wrongful disclosures of sensitive health data that can lead to discrimination and stigmatization against individuals. Public health practitioners, on the other hand, seek regular, ongoing access to and use of identifiable (...) health information to accomplish important public health objectives. The collection and use of identifiable health data by federal, tribal, state, and local health authorities support nearly all public health functions and goals.Identifiable health data are the lifeblood of public health practice. When aggregated, these data help authorities monitor the incidence, patterns, and trends of injury and disease in populations. Health data are acquired by public health authorities through testing, screening, and treatment programs. (shrink)

Vaccines are responsible for many global public health successes, such as the eradication of smallpox and significant reductions in other serious infections like diphtheria, pertussis, tetanus, polio and measles. However, mass vaccination has also been the subject of various ethical controversies for decades. Several factors need to be considered before any vaccine is deployed at national programme like the potential burden of disease in the country or region, the duration of the protection conferred, herd immunity in addition to (...) individual protection, vaccine-related risks, financing and the logistical feasibility of the large-scale vaccination. Moreover, several ethical dilemmas revolve around authority and mandates for vaccination, informed consent, benefits vs. risks, and disparities in access to vaccination. This review paper aims to elaborate the ethical issues involved in mass vaccination programme and present some additional challenges in the context of a resource-poor settings of public health in Bangladesh. (shrink)

This chapter explores the tension between public health protection and the freedom of commercial expression from a Commonwealth Caribbean perspective, using Barbados and Jamaica as case studies. First, it assesses the scope of the right to freedom of expression. Second, it discusses the extent to which public health protection may be invoked to restrict the right. The authors conclude that Commonwealth Caribbean states can justifiably restrict commercial speech about tobacco products and unhealthy food and beverages.

What happens when the scientific tradition of openness clashes with potential societal risks? The work of American toxic-exposure epidemiologists can attract media coverage and lead the public to change health practices, initiate lawsuits, or take other steps a study’s authors might consider unwarranted. This paper, reporting data from 61 semi-structured interviews with U.S. toxic-exposure epidemiologists, examines whether such possibilities shaped epidemiologists’ selection of journals for potentially sensitive papers. Respondents manifested strong support for the norm of scientific openness, but (...) a significant minority had or would/might, given the right circumstances, publish sensitive data in less visible journals, so as to prevent unwanted media or public attention. Often, even those advocating such limited “burial” upheld openness, claiming that less visible publication allowed them to avoid totally withholding the data from publication. However, 15% of the sample had or would, for the most sensitive types of data, withhold publication altogether. Rather than respondents explaining their actions in terms of an expected split between “pure science” and “social advocacy” models, even those publishing in the more visible journals often described their actions in terms of their “responsibility”. Several practical limitations (particularly involving broader access to scientific literature via the Internet) of the strategy of burial are discussed, and some recommendations are offered for scientists, the media, and the public. (shrink)

In this response to Jonny Anomaly’s ‘Is Obesity a Public Health Problem?’ I argue, contra the author that public health actually increases individuals’ abilities to choose actions that further their health goals, specifically in the case of obesity. The intractability of obesity as an individual medical problem combined with the health benefits of modest (5–10 per cent of body weight) weight loss suggest that public health measures helping people make small changes in (...) eating habits improve population health. I argue that such measures are available to public health via behavioral economic research and policy proposals from libertarian paternalists. I respond to author’s claim that obesity does not constitute a public health problem because: (i) it is not an epidemic and (ii) obesity reduction is not a public good. I argue that epidemic status is not required for classification as a public health problem, but that obesity does have the status of an epidemic. I also point out flaws in author’s reasoning about obesity, public health and social costs. I conclude by suggesting that public health, in partnership with stakeholders and other areas of government, is poised to help create conditions for modest weight loss and increased population health overall. (shrink)

The knowledge and information systems (KIS) perspective arose from reflections on agricultural development. In the health sector, it is not quite as common to think in terms of KIS. Yet in this complex field, in which health education and promotion play increasingly important roles, the KIS perspective might be very useful. In this article, the authors attempt to apply ideas about KIS and knowledge management to health, by paying attention to the historical development, especially of public (...) health, and by exploring the contribution these ideas could make to the field. Some of the observations made in this attempt are: upstream information flows often are developed poorly, interaction and exchange among the different KIS parties require ongoing stimulation, in special projects and complex communication situations, a system-integrator is needed. (shrink)

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, a major piece of health care reform legislation. This comprehensive legislation includes provisions that focus on prevention, wellness, and public health. Some, including authors in this symposium, question whether Congress considered public health, prevention, and wellness issues as mere afterthoughts in the creation of PPACA. As this article amply demonstrates, they did not.This article documents the extent of congressional consideration on (...) class='Hi'>public health issues based on personal experience working on the framework for health care reform — specifically, my experience as a Fellow for a member of the Health Subcommittee of the Senate Finance Committee from 2008-2009. I also include a review of congressional activity in the United States House of Representatives. Analysis of the congressional meetings and hearings reveals that Congress had a deep understanding about the critical need to reform the U.S. public health and prevention system. (shrink)

Law plays a critical role in all stages of a public health emergency, including planning, response, and recovery. Public health emergencies introduce health concerns at the population level through, for example, the emergence of a novel infectious disease. In the United States, at the federal, state, and local levels, laws provide an infrastructure for public health emergency preparedness and response efforts: they grant the government the ability to officially declare an emergency, authorize responders (...) to act, and facilitate interjurisdictional coordination. Law is perhaps most visible during an emergency when the president or a state's governor issues a disaster declaration establishing the temporal and geographic parameters for the response and making financial and other resources available. This legal authority has increasingly been used during the last decade. (shrink)

This article outlines the author's experience designing and implementing an asynchronous online course. Designed as a complement to public health law externships at any location, the course addresses professionalism and strategic lawyering. The article further describes the author's fellowship journey, which emboldened her view that faculty must attempt to live the expectations we have for our students, and also declare our professional values, especially when teaching about policymaking which is fraught with values conflicts. It concludes with a call (...) for others to pilot innovative teaching approaches to address both the crisis in legal education and pressing societal issues, thereby contributing to the health of our legal community. (shrink)

A compelling argument of how human health is adversely affected by our poor treatment of non-human animals. The author contents that in order to successfully confront the 21st Century's health challenges, we need to broaden the definition of the word 'public' in public health to include non-human animals.

In lieu of an abstract, here is a brief excerpt of the content:Public Health Ethics: Health by the NumbersMartina Darragh (bio) and Pat Milmoe McCarrick (bio)Hippocrates had nothing to say about public health. Rather, the idea that a government should protect its citizens from disease by maintaining sanitary conditions has its origin in Renaissance humanities texts, and the notion that physicians have public health responsibilities emerged in the works of such Enlightenment authors as (...) Johann Peter Frank, Benjamin Rush, and John Gregory (II, Coughlin and Beauchamp 1996). When the spread of infectious diseases such as typhoid and cholera accompanied the growth of the Industrial Revolution, England was the first to respond by passing the Public Health Act of 1848. The motivation for this reform was not based in humanitarian concerns but in the realization that unsanitary conditions were costly to industry. “... [The] founders of the public health movement were guided by nineteenth century utilitarian moral theories... the greatest good for the greatest number... accompanied by a growing appreciation for the innate value and dignity of mankind... however, the rights and autonomy of individuals have not always been respected in pursuing these important objectives” (I, Coughlin 1995, p. 1).Public health projects have dramatically improved global health status. One measure of their success is that “... most poor people now live longer, on average, than the wealthiest people a century ago” (I, Beaglehole and Bonita 1997, p. 13) These projects are not limited to such activities as disinfecting sewers. “Public health is what we, as a society, do to collectively assure the conditions in which people can be healthy. This requires that continuing and emerging threats to the health of the public be successfully countered. These threats include immediate crises, such as the AIDS epidemic; enduring problems, such as injuries and chronic illness; and impending crises foreshadowed by such developments as the toxic by-products of a modern economy” (I, Institute of Medicine (IOM) 1988, p. 1) The practice of public health has embraced this IOM challenge and includes the subspecialties of epidemiology, health promotion and education, public health administration, international health, maternal and child health, biostatistics, environmental health, and nutrition. This annotated bibliography focuses on epidemiology, [End Page 339] health promotion and education, and public health administration, and includes a wide variety of opinions on each topic.EpidemiologyAt first glance, it is hard to see what ethical issues could arise in population studies of the causes and control of illness. Disclosure of risk information in the clinical encounter is complicated by issues of uncertainty with regard to the data itself. Causation and causal inference may be affected by “wish bias,” leading to studies that use the same data but reach widely varying conclusions (II, Weed 1997). Given the complexity of the statistical calculations used to validate public health recommendations, and mass media’s portrayal of them, the public may be unintentionally deceived by population-based recommendations (V, Seedhouse 1997; II, Lupton 1995). With the addition of genetic screening, another layer of statistical complexity is added to this mix (VI, Stone and Steward 1996).Health Promotion and EducationIncreased life expectancy brought about by advances in public health has raised a new set of problems. With the realization that illness can be promoted in part by individual life-style choices, population-based recommendations about risk factors become important in the clinical encounter. This shift is not without difficulties; one author notes that he has yet to receive any risk information from his physicians, even when he asks “the experts” (V, Dugdale 1998). This may be due in part to the fact that “... public health lacks a vocabulary with which to speak about and identify commonalities among health problems experienced by very different populations” (IV, Mann 1997, p. 8). Furthermore, the mix of disciplines informing health promotion activities (sociology, psychology, recreation medicine, and the like) creates an illusion of shared ethics where none exists, which in turn leads to programs based on value systems that may not be meaningful for the populations they serve (V, Seedhouse 1997).Given these factors, a number of authors are skeptical of introducing public health measures into the clinical encounter. “We might do well to encourage people to live lives of modified hedonism so that they might... (shrink)

This book offers a novel critique of public-private partnerships in public health. The author argues these relationships create webs of influence that undermine the integrity of public health agencies, and imperil public health. He makes a compelling case that the paradigm interaction between governments and corporations should be at arm's length: separation, not collaboration.

Incest taboos are universal, but it is questionable whether consensual incest should continue to be illegal. The most common argument in favor of the illegalization of consensual incest appeals to genetic risks and the harm to potential offspring. In this article, we examine whether public health concern is a sufficient reason to illegalize consensual incest. We posit that indeed, incest represents a risk, but this is not reason enough to illegalize incest. For, other circumstances of sexual intercourse may (...) lead to similar risks, and yet, such practices are not illegal. While those practices may represent an added risk to public health, to forbid them as a way to improve the genetic pool would be akin to eugenic program, and that is morally objectionable. This does not imply that consensual incest ought to be legal, for there may be other good reasons to illegalize it. But they do not relate to public health and genetic risks, and consequently, medical practitioners and public health officials ought to avoid using their medical authority as a platform to make moral pronouncements. (shrink)

The author created a new course, called “Seminar in Public Health Law and Policy in an Interprofessional Setting” to address the need for interprofessional education to equip graduate and professional students for collaborative practice at the systemic and policy levels in the health care and public health fields. Despite important work being done at the clinical practice level, limited existing IPE models examine larger systemic issues. The course is designed specifically to enable students in social (...) work, law, and public health to recognize the reciprocal relationships between policy and interprofessional collaborative practice, including the need for understanding of the impact of team-practice work at the system and policy levels. (shrink)

In this editorial we introduce the special Public Health Ethics symposium on social justice in public health. We present here a select set of papers arising from an international workshop, organized on 4–5 June 2012 by the Institute of Biomedical Ethics, in collaboration with the University Research Priority Program for Ethics at the University of Zurich. Meeting the Author is a series of international workshops organized by the Ethics Center of the University of Zurich. In this (...) workshop format, a selected group of junior and senior researchers discusses a seminal work in ethics together with the authors. (shrink)

*The views represented are the author's alone and should not be construed as representing policies of the American Medical Association.

Preemption is a powerful strategy used by special interest groups to undermine strong, local public health standards. Currently, 20 states in the U.S. have preemption ordinances in place related to clean indoor air initiatives. These preemption laws are the direct result of an ongoing and aggressive campaign of tobacco companies to thwart clean indoor air initiatives, which ultimately, according to tobacco industry internal documents, cause significant reductions in their annual revenues. Clean indoor air policies have arisen from a (...) greater understanding of the documented health risks associated with exposure to secondhand smoke and action by local government to protect the public from these hazards. The efforts of the tobacco industry undermine local authority and seek to shift policy action to the state and federal levels, where the industry has greater political influence. (shrink)

Even though health care provider reporting of diseases to public health authorities is common, often there is under-reporting by providers, including for notifiable diseases; frequently, under-reporting occurs by wide margins. Two causal factors for this under-reporting by providers have been that: disclosing data may violate their patients’ privacy, and disclosed data may be used to evaluate their performance. A reluctance to disclose information due to privacy concerns exists despite the U.S. Health Insurance Portability and Accountability Act (...) Privacy Rule permitting disclosures of personal health information for public health purposes without patient authorization. On the other hand, such patient privacy concerns are somewhat justified: there have been documented breaches of patient information from public health data custodians.A common way to address this privacy issue is to de-identify patient data before it is disclosed to public health. (shrink)

Nuffield Council on Bioethics, London * Corresponding author: Nuffield Council on Bioethics, 28 Bedford Square, London WC1B 3JS, UK. Email: hschmidt{at}nuffieldbioethics.org ' + u + '@' + d + ' '//--> Abstract In November 2007, the Nuffield Council on Bioethics published the report Public Health: Ethical Issues . While the report has been welcomed by a wide range of stakeholders, there has also been some criticism. First, it has been suggested that it is not clear why, in developing (...) its ‘stewardship model’, the Council felt the need to go beyond the liberal position developed by John Stuart Mill—what is it that the stewardship model adds? Second, it is suggested that the Report is confused about the concept of paternalism. Third, it is argued that the discussion of the concept of stewardship is lacking in detail and substance. We clarify the Working Party's thinking regarding these three areas, which demonstrates the robustness of the framework set out in the report. CiteULike Connotea Del.icio.us What's this? (shrink)

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and (...) substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention, and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; and coordination of law-based public health actions; and information.This action agenda offers options for consideration (...) by those responsible for or interested in ensuring that public health professionals, their legal counsels, and relevant partners understand the legal framework in which they operate and are competent in applying legal authorities to public health emergency preparedness.Competencies are critical to an individual's ability to make effective legal response to all-hazards public emergencies. (shrink)

One of the great challenges for students of any discipline is to be able to put into practice the knowledge learned in theory. Public health does not escape this challenge. Research Methods for Public Health is a book that seeks to help students understand in a simple way how to enter into the practice of public health research. This book stands out for its easy reading, but especially because it emphasizes the existence of quantitative (...) and qualitative methods, as well as the combination of both methods. On the other hand, the authors show between the lines, and sometimes more clearly, the importance of teamwork in research groups, a key element to avoid errors, validate procedures or instruments and increase the reliability of the results, as well as the importance of criteria of validity, reliability, precision, relevance, transparency and credibility, among others. -/- Uno de los grandes retos para los estudiantes de cualquier disciplina es poder poner en práctica los conocimientos aprendidos en la teoría. La salud pública no se escapa de este desafío. Research Methods for Public Health es un libro que busca ayudar a comprender de manera sencilla cómo introducirse en la práctica de la investigación en salud pública. Este libro se destaca por su fácil lectura, pero especialmente porque pone el énfasis en la existencia de los métodos cuantitativos y cualitativos, así como en la combinación de ambos métodos. Por otro lado, los autores dejan ver entrelíneas, y a veces más claramente, la importancia del trabajo en equipo en los grupos de investigación, elemento clave para evitar errores, validar procedimientos o instrumentos y aumentar la confiabilidad de los resultados, así como la importancia de criterios de validez, confiabilidad, precisión, relevancia, transparencia y credibilidad, entre otros. -/- Reseña del libro: Stuart McClean, Isabelle Bray, Nick de Viggiani, Emma Bird and Paul Pilkington. Research Methods for Public Health. London: SAGE, 2020. 273 p. (shrink)