Public Health Law

The World Health Organization (WHO), founded in 1948, is a specialized agency of the United Nations with a broad mandate to act as a coordinating authority on international health issues. Headquartered in Geneva, Switzerland, and composed of 194 member states, WHO works worldwide to promote health, keep the world safe, and serve the vulnerable. Its overarching mission is “attainment by all peoples of the highest possible level of health,” and its current goals are to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and to provide an additional billion people with better health and well-being.

The World Health Assembly (WHA), composed of representatives from WHO’s 194 member states, is the supreme decision-making body for WHO. It is convened annually and is responsible for selecting the director-general, setting priorities, and approving WHO’s budget and activities. Every 6 years, WHA negotiates and approves a work plan for WHO, and every 2 years it approves a biennial budget for the work plan. The annual WHA meeting in May also serves as a key forum for nations to debate important health policy issues.

Finally, WHO administers the International Health Regulations, or IHR (2005), helping countries work together to save lives and livelihoods threatened by the international transmission of diseases and other health risks. They entered into force on June 15, 2007, and are binding on 194 countries across the globe, including all WHO member states. The IHR (2005) aim to prevent, protect against, control, and respond to the international transmission of disease while avoiding unnecessary interference with international traffic and trade. The IHR (2005) are also designed to reduce the risk of disease transmission at international airports, ports, and ground crossings. Born of an extraordinary global consensus, the IHR (2005) strengthen the collective defenses against the multiple and varied public health risks that today’s globalized world is facing and that have the potential to be rapidly transmitted through expanding travel and trade. The IHR (2005) establish a set of rules to support the global-outbreak alert and response system and to require countries to improve international surveillance and reporting mechanisms for public health events and to strengthen their national surveillance and response capacities.

Some diseases always require reporting under the IHR (2005), no matter when or where they occur; others become notifiable when they represent an unusual risk or situation.

Always Notifiable:

• Smallpox

• Poliomyelitis due to wild-type poliovirus

• Human influenza (flu) caused by a new subtype

• Severe acute respiratory syndrome (SARS)

Potentially Notifiable:

• Other diseases that might be transmitted quickly through a nation or region (eg, cholera, plague, or a viral hemorrhagic fever like Ebola)

• Other biological, radiologic, or chemical events that meet IHR criteria

• Serious illnesses of unknown origin

See also WHO's Frequently Asked Questions About the International Health Regulations (IHR).

The World Trade Organization (WTO), recognizing that there is much common ground between trade and health, also addresses international health issues through its agreements on public health with WHO. These agreements address key issues for those who develop, communicate, or debate policy issues related to trade and health. They also recognize that countries have the right to take measures to restrict imports or exports of products when this is necessary to protect the health of humans, animals, or plants. Eight specific health issues are covered:

• infectious disease control

• food safety

• tobacco

• environment

• access to drugs

• health services

• food security

• some emerging issues, such as biotechnology

In each case, examples of challenges and opportunities in implementing coherent trade and health policies are provided.

Specifically, WTO and WHO have main agreements on the following issue areas (see WTO Agreements & Public Health):

• Technical barriers to trade (TBT)

• Sanitary and phytosanitary (SPS) measures

• Trade-related intellectual property rights (TRIPS)

• Trade in services (GATS)

Within the US, the public health system is a complex network of people and organizations in both public and private sectors that collaborate in various ways at national, state, and local levels to promote and protect public health. The governmental public health system is made up of public health agencies from the federal government, 51 states (including the District of Columbia), 2,794 local governments, and 565 federally recognized tribal agencies. Because of the broad flexibility that states have in defining their public health role, the governmental public health infrastructure throughout the US is extremely varied.

The US Constitution makes no specific provision for health or public health. Therefore, in accordance with the Tenth Amendment, these powers are reserved by the states. This power is generally understood to include the essential role of protecting and promoting health through population-wide actions. To fulfill this public health role, state health departments have a wide range of responsibilities, including the following six governance functions:

• Policy development: Lead and contribute to the development of policies that protect, promote, and improve public health while ensuring that the agency and its components remain consistent with the laws and rules (local, state, and federal) to which it is subject.

• Resource stewardship: Ensure the availability of adequate resources (legal, financial, human, technological, and material) to perform essential public health services.

• Legal compliance: Exercise legal authority as applicable and understand the roles, responsibilities, obligations, and functions of the governing body, health officer, and agency staff.

• Partner engagement: Build and strengthen community partnerships through education and engagement to ensure the collaboration of all relevant stakeholders in promoting and protecting the community’s health.

• Continuous improvement: Routinely evaluate, monitor, and set measurable outcomes for improving community health status and the ability of the public health agency’s governing body to meet its responsibilities.

• Oversight: Assume ultimate responsibility for public health performance in the community by providing necessary leadership and guidance in order to support the public health agency in achieving measurable outcomes.

"Structure" refers to a state health department’s placement within the state government’s larger organizational infrastructure. In 55% of all states, the state health department is freestanding or independent. Some of these independent departments focus exclusively on public health, while others include such health care–related functions as the administration of Medicaid. In 45% of all states, the health department is one unit in a larger umbrella agency (or "superagency") that includes a variety of functions, such as mental health services, public assistance, longterm care, or human services, in addition to traditional public health functions.

State health departments serve multiple public health functions, some of which are shared or assumed by sister agencies in state government (eg, licensure of health professionals, regulation of indoor air quality, or regulation and inspection of health care facilities). Despite a wide range of governance structures, each state’s health department is generally the primary public health authority within the state and plays a key role in supporting the delivery of public health services.

Police power: Authority of “police power” usually is invoked to protect the common good. Not synonymous with criminal enforcement, this authority establishes means by which a community promulgates and enforces self-protective measures. Examples include regulation of health care professionals and facilities; establishment of health and safety standards; quarantine, health, and inspection laws to limit the transmission of infectious diseases; mandatory vaccination programs; age restrictions for drinking alcohol and purchasing tobacco products; and requirements for speed limits, seatbelts, and helmets.

Parens patriae power: This is the power of the state to serve as guardian of persons under legal disability. Examples include juveniles and the legally insane.

State constitutional power: These authorities are granted under each individual state constitution (varies by state).

States typically have at least two levels of local governments: counties and municipalities (which can include cities, townships, towns, boroughs, villages, and hamlets). The role and regulatory structure of local health departments can vary as widely as the types and sizes of jurisdictions served. For example, local health departments in large metropolitan areas may have a broad range of functional capacities similar to, and in some cases more developed than, those of state health departments. In contrast, small local health departments often provide a narrow set of public health services. Local health departments can be structured as a locally governed health department, a branch of the state health department, a state-created district or region, a department governed by and serving a multicounty area, or any other arrangement that has governmental authority and is responsible for public health functions at the local level. In addition, the public health community in each jurisdiction includes individuals and public and private entities engaged in activities that affect the public’s health.

The following standards, developed by the National Association of County and City Health Officials (NACCHO), are public health services that a typical local health department provides:

• Monitor health status and understand health issues facing the community.

• Protect people from health problems and health hazards.

• Give people information they need to make healthy choices.

• Engage the community to identify and solve health problems.

• Develop public health policies and plans.

• Enforce public health laws and regulations.

• Help people receive health services.

• Maintain a competent public health workforce.

• Evaluate and improve programs and interventions.

• Contribute to and apply the evidence base of public health.