2

The Law and Public Health
Infrastructure

This chapter first describes the basic components of the public health infrastructure1 and the organization of governmental public health in the United States. Next, the committee discusses the laws that establish the mission, mandate, structure, capacity, governance, powers, and limits of public health agencies at the national, state, tribal, and local levels. The committee then reviews the recent history of public health law reform, and discusses the changes needed to equip the governmental public health sector to lead and support efforts to improve population health. Finally, the committee discusses the critical question of public health federalism—that is, the optimal locus of responsibility and authority among the levels of government with regard to health-relevant public policy.

THE ORGANIZATION OF GOVERNMENTAL PUBLIC HEALTH IN THE UNITED STATES

The primary reason for the existence of government is to provide for the health, safety, and welfare of the people (Gostin, 2010; Lopez and Frieden, 2007). In the United States, governmental public health responsibilities and roles exist at three different levels: federal, state/tribal, and local/municipal. The fundamental division of responsibility among these levels is defined by

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1 The 2003 report The Future of the Public’s Health in the 21st Century used the term public health infrastructure in reference to the array of public entities charged with keeping the public healthy (e.g., agencies, laboratories, and partners) and to their operational capacity. CDC has also defined three components of the basic public health infrastructure: workforce capacity and competency, information and data systems, and organizational capacity (CDC, 2008).



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2 The Law and Public Health Infrastructure This chapter first describes the basic components of the public health infrastructure1 and the organization of governmental public health in the United States. Next, the committee discusses the laws that establish the mis- sion, mandate, structure, capacity, governance, powers, and limits of public health agencies at the national, state, tribal, and local levels. The committee then reviews the recent history of public health law reform, and discusses the changes needed to equip the governmental public health sector to lead and support efforts to improve population health. Finally, the committee discusses the critical question of public health federalism—that is, the op- timal locus of responsibility and authority among the levels of government with regard to health-relevant public policy. THE ORGANIZATION OF GOVERNMENTAL PUBLIC HEALTH IN THE UNITED STATES The primary reason for the existence of government is to provide for the health, safety, and welfare of the people (Gostin, 2010; Lopez and Frieden, 2007). In the United States, governmental public health responsibilities and roles exist at three different levels: federal, state/tribal, and local/municipal. The fundamental division of responsibility among these levels is defined by 1 The 2003 report The Future of the Public’s Health in the 21st Century used the term public health infrastructure in reference to the array of public entities charged with keeping the public healthy (e.g., agencies, laboratories, and partners) and to their operational capacity. CDC has also defined three components of the basic public health infrastructure: workforce capacity and competency, information and data systems, and organizational capacity (CDC, 2008). 27

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28 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY the fact that the Constitution leaves untouched the states’ sovereign power (sometimes called “police powers,” discussed below) over most health issues and limits the role of the federal government primarily to (1) regulation of foreign and interstate commerce issues—and by extension, health issues and threats that could affect commerce, and (2) the power to tax and spend for the public welfare (Gostin, 2010; Grad, 2005). The organization of public health at the federal level consists of the De- partment of Health and Human Services (HHS), which includes the Centers for Disease Control and Prevention (CDC) that function as the nation’s lead public health agency, the Food and Drug Administration (FDA), and several other pertinent agencies each of which has multiple functions relevant to health. Other federal departments and agencies have health-related duties. These include the Department of Agriculture, whose functions include set- ting dietary guidelines, ensuring food safety, and administering the national program that sets and enforces organic standards; the Environmental Pro- tection Agency, which is charged with protecting Americans from risks to health and to their environment; and the Occupational Health and Safety Administration, in the Department of Labor, which is given oversight of workplace safety and health issues. The federal public health agencies were created by administrative statute, and their actions are authorized by the Public Health Service Act first passed by Congress in 1944 and by a host of other laws (Goodman et al., 2006). Below the federal level, the organization of public health is similarly complex, and the existing classification system for how public health is structured has had numerous iterations over several decades (see for ex- ample the earliest descriptions in DeFriese et al., 1981 and Miller et al., 1977). Each structural arrangement may have advantages and disadvantages in terms of the agencies’ ability to function and shape public policy, cultivate legislative champions, and secure needed funding, but given the heterogene- ity among agencies and locales, there is little research on the topic and very limited resources to support it. First, there are four primary organizational models for state public health agencies, depending on whether the public health component is stand-alone or combined with other functions, such as mental health, substance abuse and human services programs, although this typology is often abridged to stand-alone agencies and umbrella agen- cies (ASTHO, 2007) (see Box 2-1). The statutes or laws that authorize state public health agencies are grounded in the US Constitution which both constrains their actions and allows them significant powers. Second, three models describe the administrative relationship between state and local public health organizations (or how states deliver services). These include a decentralized or home rule arrangement, under which local public health agencies operate independently of the state and report to local government; a centralized model in which there are no local public health agencies,

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29 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE BOX 2-1 Four Models of State Public Health Agency Traditional Public Health Agency—an agency that oversees public health and primary care only. While it may also administer one other health-related program (i.e., environmental health, alcohol and drug abuse), its responsibilities are usually limited to improving or protecting the overall health status of the public Super Public Health Agency—an agency that oversees both public health and primary care and substance abuse and mental health. This usually includes ad- ministering services supported by the federal Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant programs Super Health Agency—an agency that oversees public health and primary care as well as the state Medicaid program Umbrella Agency—an agency that oversees public health and primary care, substance abuse and mental health, the Medicaid program, and other human services programs SOURCE: ASTHO, 2007. though the state agency may have regional offices; and shared and mixed authority models where the local agencies are responsible to both the state public health agency and to local government, or where some local agencies in a state report to the state agency while others operate solely under local government control (NACCHO, 1998; Novick and Mays, 2005). Local public health agencies in 29 states have decentralized (also called “home rule,” or local) governance; local agencies in 6 states and the District of Columbia have centralized (or state) governance, and 13 have shared or mixed (state and local) governance (NACCHO, 2008). Local public health agencies may also be categorized by geographic distribution as county, city, city/county, township, and multi-county/district/regional—60 percent are classified as county-type (NACCHO, 2001, 2008).2 Public health responsibilities at both the state and local levels generally reside in multiple agencies, in addition to the public health agency. Each state has its own legal framework for public health. All state public health agencies have one or more foundational (or enabling) statutes (laws) that provide the agencies with authority to conduct public health activities and 2A similar typology, but one that describes five types of local public health agencies, may be found in NACCHO’s Local Public Health Agency Infrastructure: A Chart Book (2001).

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30 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY permit them to promulgate regulations and take action. Some state statutes are detailed in outlining duties and powers, while others are broadly worded and permit the agency to promulgate regulations as needed (ASTHO, 2007). State public health statutes have been reviewed and well-characterized by model Act efforts such as the Turning Point Model State Public Health Act and the Model State Emergency Health Powers Act, both of which provide templates for updating the statutory foundations of public health practice. The rights, powers, and authorities of local governments have no special standing under the U.S. Constitution, and are instead “either delegated by the state legislature or derived directly as a grant of authority from the state constitution” (Goodman et al., 2007, p. 57). Public health statutes of local governments are less well characterized, in part because there are 2,794 local public health agencies (NACCHO, 2008) and “18,000 local jurisdic- tions (e.g., counties, cities, boroughs, and special districts)” (McCarty et al., 2009, p. 458). McCarty et al. (2009) have begun a process of identifying the major categories of local ordinances that pertain to public health for a range of local jurisdictions. Boards of health are a historical mechanism for public health gover- nance at the state and local level, but their roles have evolved over time, and some have been dismantled entirely (Nicola, 2005). Eighty percent of local public health agencies have an associated local board of health (NACCHO, 2008), and 23 states have a state board of health (Hughes et al., 2011). Some local boards are advisory, and others play a role in governance and policymaking. Their functions may include adopting public health regula- tions, setting and imposing fees, approving the agency budget, hiring or firing the top agency administrator, and requesting a public health levy (Beitsch et al., 2010; Leahy and Fallon, 2005). State boards play varying roles as well, including agency oversight, appointing the health officer, and a quasi-legislative function (i.e., adopting/rejecting rules) and a quasi-judicial function (i.e., enforcing rules) (Hughes et al., 2011). State Police Powers Police powers, which the states possess as sovereign governments pre- ceding the U.S. Constitution, are the powers to safeguard the health, safety, welfare, and morals of the population and may be exercised by public health agencies (also called health departments), along with police, fire, and sanitation departments (Lopez and Frieden, 2007) (see Box 2-2). States may delegate this power to local governments and for health purposes to public health and related agencies. Surveillance and required disease reporting are exercises of state police powers. In some states, disease reporting is man- dated in decades-old statutes, while in others, the statutes may be general, and simply empower the state health commissioner or board of health to

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31 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE BOX 2-2 State Police Powers Refers to authority of state to enact laws, promulgate regulations, and adjudicate to (1) Protect, preserve, and promote • Health • Safety • Morals • General welfare (2) Restrict private interests (within limits set by federal and state Constitutions): • Personal interests—Autonomy, privacy, association, expression, liberty • conomic interests—Contractual freedom, property uses, pursue trades E and occupations SOURCE: Gostin, 2010. “create, monitor, and revise the list of reportable diseases and conditions” (Neslund et al., 2007, p. 224). In other states, this may be done either by statute or by regulations promulgated by the health department. The First, Fourth, Fifth, and Fourteenth Amendments provide procedural and substan- tive safeguards that constrain the exercise of police powers, such as due process and equal protection of the laws (see for example, Gostin, 2008). The 3 Core Functions and 10 Essential Public Health Services The fundamentals of government public health work have been distilled in three Core Public Health Functions outlined in the Institute of Medicine (IOM) report The Future of Public Health (1988). The functions are assess- ment, policy development, and assurance. In 1994, the Core Public Health Functions Steering Committee, which included federal government agencies and major public health organizations, developed the 10 Essential Public Health Services (10 EPHS) framework (see Box 2-3).3 The 10 EPHS have been used as a tool for planning, implementation, and evaluation in public health. Given their purpose to illustrate the range of public health practice, 3 The American Public Health Association, the Association of Schools of Public Health, the Association of State and Territorial Health Officials, the Environmental Council of the States, the National Association of County and City Health Officials, the National Association of State Alcohol and Drug Abuse Directors, the National Association of State Mental Health Program Directors, and the Public Health Foundation.

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32 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY BOX 2-3 The 10 Essential Public Health Services 1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population- based health services. 10. Research for new insights and innovative solutions to health problems. SOURCE: Public Health Functions Steering Committee, 1994. they are extremely broad and somewhat vague. Also, the 10 EPHS are not simply the province of governmental public health agencies. Other organiza- tions deliver services and conduct activities that may be categorized under one or more of the EPHS. However, the 10 EPHS do necessarily spell out the roles of non-health or non-governmental public health actors, or provide a map for implementing health in all policies approaches (intersectoral efforts to consider the health implications of non-health policies). Essential Service 7 warrants attention in the context of implementing the Affordable Care Act. For decades, the public health practitioner com- munity has expressed ambivalence about its role in the provision of limited, generally primary clinical care services as part of a safety net for uninsured and vulnerable populations. This role—providing, not just assuring the delivery of care—has channeled some additional resources to public health agencies, but has both perpetuated the misperception of public health as primarily publicly-funded medical care for the indigent and has been seen by many public health leaders as a programmatic distraction from dis- charging population-oriented responsibilities (Brooks et al., 2009; IOM, 2003a). Work by Honoré in Missouri (Honoré and Schlechte, 2007) and Brooks and colleagues in Florida (Brooks et al., 2009) has showed that a large, disproportionate percentage of public health funds are dedicated to Essential Service 7 to the detriment of agency ability to adequately attend

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33 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE to the other nine essential services. As discussed in and since the IOM re- port The Future of the Public’s Health in the 21st Century (IOM, 2003b), many public health commentators believe that a well-functioning medical care system and expanded access to all or most of the population will free the public health agencies to focus on the “assurance” aspect of Essential Service 7 (e.g., ensuring access to care, linking people to needed care, as- sessing the quality of the care delivered in the community, and assessing and strengthening community supports for good health), rather than engage in the direct provision of clinical services (IOM, 2003b). MODERNIZING PUBLIC HEALTH STATUTES Many public health statutes have not been systematically updated in decades or more. They do not reflect current circumstances, provide insuf- ficient mandates and powers, and guarantee human rights protections that might be interpreted judicially as overbroad (Meier et al., 2009b; National Association of Attorneys General, 2003). Antiquated laws can be confus- ing, fragmented, and duplicative. Older public health laws were, of course, informed by the scientific standards of the day and by the statutory context and constitutional jurisprudence of their time, including conceptions of individual rights. In addition, some laws were enacted in piecemeal fashion in reaction to a specific health problem (e.g., a disease outbreak), leading to layers of statutory accretion rather than holistic or comprehensive legisla- tion (Gostin et al., 2008, p. 676). Public health laws need to be sufficiently broad to deal with unforeseen threats, while still giving public officials clearly specified powers and limits. Many of the antiquated laws currently on the books focus on infectious dis- eases, but lack specific powers and responsibilities for chronic diseases and injuries. They also lack specific authority to exercise modern functions such as managing immunization registries and syndromic surveillance systems, and conducting interventions, in collaboration with other sectors, to alter the built environment. At the same time, antiquated statutes predate the vast expansion of knowledge about the socioeconomic determinants of health and their role in the complex pathways to chronic disease and other poor health outcomes. Extant statutes also frequently fail to protect individual rights such as privacy, nondiscrimination, and due process. Consequently, policymakers must systematically and comprehensively review public health statutes to ensure that sufficient and clear authority is in place, together with safeguards of individual rights. The challenges presented by outdated laws are most starkly apparent in the context of preparedness for public health emergencies (see Box 2-4). The preparedness component of public health agency activities developed significantly in the last decade of the 20th century because of federal and

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34 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY BOX 2-4 Preparedness Laws: Still in Need of Reform “Existing state laws may thwart effective surveillance activities. Many states do not require timely reporting for the most dangerous agents of bioterrorism. Most states do not require immediate reporting for all the critical agents identified by the CDC [Centers for Disease Control and Prevention]. At the same time, states do not require, and may actually prohibit, public health agencies from monitoring data collected through the health care system. Private information held by hospitals, managed care organizations, and pharmacies that might lead to early detection of a public health threat, such as unusual clusters of fevers or gastrointestinal symptoms, may be unavailable to public health officials because of insufficient reporting mechanisms or privacy concerns” (The Centers for Law and the Public’s Health, 2010). Although the Model State Emergency Health Powers Act was implemented to vary- ing degree by a number of jurisdictions around the country, the general state of legal preparedness of public health emergencies such as epidemics and bioterrorist attacks remains deficient. The CDC, the nation’s top public health agency, has powers “to quarantine, inspect, disinfect and even destroy animals that are sources of dangerous infection to humans” that have “limited applicability to a few diseases. If the CDC did try to exercise power in response to swine flu, its legal authority would surely be challenged, causing needless delays and uncertainty—and its actions might be ruled unconstitutional. To its credit, the CDC has tried for more than a decade to modernize its legal authority. But its proposed congressional interest in public health readiness for deliberately introduced biological, chemical and other threats to the public’s health. These efforts, which received legislative attention in the late 1990s, intensified after the events of September and October 2001, including a major focus on the legal aspects of preparing for bioterrorism and other types of disasters. Goodman and colleagues have described the core elements of public health legal preparedness: essential legal authorities, competencies to apply laws, coordination across jurisdictions and sectors, and information about public health law best practices (Goodman et al., 2006). Preparedness cuts across many of the 10 EPHS. In addition to the factors described above, other major shifts have occurred in the backdrop to public health laws, including demographics, health challenges, and in aspects of public health practice. For example, the population lives much longer and the age distribution of the popula- tion ranges across a much wider lifespan than was the case when some early public health laws were framed. Americans live very different lives than they did even 30 years ago. Examples are changes in how they com- municate, grow food, and transport themselves. The infectious diseases common a century ago pose far less of a threat in contemporary life in

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35 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE fundamental revision was submitted more than three years ago, and regulations have yet to be finalized” (Gostin, 2009). In addition, based on reports from Association of State and Territorial Health Officials (2010) and the National Association of County and City Health Officials (2010) that were prepared for the CDC following the H1NI epidemic, O’Connor and colleagues (2011) identified several areas where laws and policies at all levels of government were not adequate to meet the needs of the public. They stated that “although progress in public health legal preparedness has been made since 2001, it is apparent from the law and policy challenges encountered during H1N1 that no single U.S. jurisdiction—state, local, tribal, or federal—is yet fully legally prepared to respond to a major public health threat.” Key issues they identified include vaccine allocation, distribution, and dispensing issues; coordination among levels of government about the use of stockpiled material; and the need for sustainable public health response funding. The authors noted that the laws and policies related to the vaccine campaign “presented significant challenges, espe- cially for state and local public health responders,” including decisions on vaccine avail- ability, formulation, allocation, prioritization, and guidance as well as tracking, recalls, and adverse event reporting. “Use and accounting for stockpiled materiel raised many policy and legal questions during 2009 H1N1.” Funding from Public Health Emergency Response was also restricted. The allowable methods for distributing the funds limited state and local flexibility for their use which ultimately slowed their ability to implement public health measures (O’Connor et al., 2011, pp. 53, 54). the United States compared to chronic disease and the potential of longer life in diminished health (Kominski et al., 2002; Vaca et al., 2011; Woolf et al., 2010). Approximately two thirds of the adult population (Calle and Kaaks, 2004) and a growing proportion of children are overweight or obese (Center for Health Improvement, 2009), changing the profile of chronic disease patterns in the U.S. population. The empirical evidence about what creates and impairs health on the population level has con- tinued to evolve, clarifying that medical care contributes far less to health outcomes than do the broader societal, environmental, and economic conditions that strongly influence human behavior (see Braveman et al., 2011; Cutler et al., 2006; McGinnis et al., 2002). Given the enhanced and evolving understanding of the causes of poor health and death in the popu- lation, public health tools and approaches are also changing. Furthermore, fundamental transformations are taking place in public health practice and in the health system in general. These changes offer opportunities for legal reforms to ensure modern laws and regulations meet contemporary needs, in addition to conforming to evolving science and evidence to address the major health hazards facing the population. Public health statutes at the state level do not generally reflect the con-

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36 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY temporary causes of poor health. State laws often feature specific references to communicable disease duties of public health agencies, while making no explicit reference to chronic diseases and injuries. Meier et al. (2009a) conducted a 50-state comparison of enabling public statutes against the standards of the 10 Essential Public Health Services and the 6-part mis- sion of public health (like the EPHS, the mission4 was defined in the 1994 HHS document Public Health in America). The study’s findings aside, it is important to note that the mission statements refer to injuries and infec- tious disease, and the 10 EPHS refer very broadly to “health problems.” However, the lack of explicit reference to, for example, the leading causes of death (i.e., chronic disease), may lead to a limited understanding among policymakers and the public about the role of public health agencies. Such narrow understanding leads to inadequate funding for the full breadth of public health services necessary to safeguard the health of the public. When considering the need for change in contemporary public health law, there are several contextual factors and fundamental transformations that must be considered, including • n ational health legislation that holds the promise of expanding ac- cess to medical care, thus partially releasing public health agencies from the need to provide safety net clinical services; • a renewed emphasis on and commitment to quality performance and accountability of public health agencies (e.g., the national Public Health Accreditation effort, the 2008 HHS Consensus State- ment on Quality in the Public Health System 2009), and the 2007 Pandemic and All Hazards Preparedness Act provision requiring development of performance standards and measures by (Nelson et al., 2007); and • m ultiple recent developments—legislative, technologic, and practi- cal or operational—in the health information arena that have pro- found implications for public health practice and for its relationship to clinical care (e.g., the American Recovery and Reinvestment Act of 2009 provisions for health information technology, including payments to spur adoption of electronic medical records; the estab- lishment of Regional Health Information Organizations to facilitate health information exchange across institutions in a community or region; and the development of the Meaningful Use concepts which 4 The mission of public health: (1) Prevents epidemics and the spread of disease; (2) Protects against environmental hazards; (3) Prevents injuries; (4) Promotes and encourages healthy behaviors; (5) Responds to disasters and assists communities in recovery; and (6) Ensures the quality and accessibility of health services (Public Health Functions Steering Committee, 1994).

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37 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE include some consideration of public or population health needs as part of health information networks). The changes outlined above are likely to have implications for the legal and policy aspects of public health practice. The growing understanding of the multiple determinants of health also requires attention to the adequacy of existing public health statutes. It also will require public health agencies to have greater public policy expertise and capacity in interactions with the heads of the Executive Branch to whom they report (e.g. mayors, gover- nors), the Legislative Branch, and other sectors of government. Prior Efforts to Update Public Health Law Two major efforts to review and update public health law took place around the turn of the 21st century: the Turning Point Model State Public Health Act (1997–2003) and Model State Emergency Health Powers Act (MSEHPA, 2001–2002) (Gostin et al., 2002). The Turning Point Model State Public Health Act was a broad (though not comprehensive) sample law composed of nine articles and incorporated two other model acts—a revised version of the MSEHPA in the article pertaining to emergency powers, and the Model State Privacy Act (Gostin et al., 2001). The Turning Point Act presents the broad mission of state and local public health agencies to be conducted in collaboration with other stakeholders, and provides language for updating laws pertinent to the traditional powers of public health agen- cies (e.g., communicable disease control nuisance abatement, inspections) (Public Health Statute Modernization National Excellence Collaborative, 2003). As of August 2007, “subject matter or specific language from the Turning Point Act” was featured or introduced in whole or part through 133 bills or resolutions in 33 states, and 48 of these bills or resolutions have passed (The Centers for Law and the Public’s Health, 2007). Box 2-5 provides some lessons from the experience of four states that participated in the Turning Point Collaborative. These illustrate how widely circumstances may vary from one state to another: the level of interest of public health attorneys in the public health agency; the array and relationships among champions and advocates of public health law reform; the nature of the political establishment; and the level of interest in the administration and legislature currently in power. Despite the development and dissemination of the model Acts and their generally partial adoption, by some state governments, much of public health law in jurisdictions around the country was crafted in the late 19th and early 20th centuries and remains largely unchanged. Also, Meier et al. (2009a) have demonstrated on the basis of an analysis of state codes in comparison to the public health mission and essential services described in

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46 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY cedural requirements of a given course of action; and undertakes research and provides legal opinions 2. Protector of confidentiality: Exercise vigilance to protect infor- mation in the custody of a health department from Freedom of Information Law8 (FOIL) requests and subpoenas, but also role as educator on the public health exception to Health Insurance Portability and Accessibility Act (HIPAA) (disclosures required by law, e.g., in the case of public health surveillance or epidemiologic investigations) 3. Legislative and regulatory counsel: Ensure that changes to the health code or regulations enacted comply with the law (will ana- lyze the statutory basis and legal viability of health officer’s propos- als, will prepare language for the basis and purpose of the rule, and the actual language of the resolution) 4. Enforcement: Agency exercises police powers by issuing valid and enforceable orders (compelling directly observed tuberculosis treat- ment, or ordering lead abatement in a rental residence with peeling lead paint and children ages 10 or younger). 5. Miscellaneous duties: Public health counsel may be called on to carry out additional duties, including preparing contracts with out- side organizations and vendors; advise in cases of employee-related conflicts of interest; handle disciplinary matters (other than criminal or corrupt behavior requiring the inspector general); investigate when human rights cases, such as involving discrimination or sexual harassment are brought against the department; and act as litigation liaison in cases of litigation against the health agency or by the local government (Lopez and Frieden, 2007). Public health agencies access legal counsel in different ways, and their choices may in part be influenced by their size, governance structure, or both (IOM, 2010b; Pestronk, 2010). Some agencies have internal counsel that is part of the agency staff. Other agencies have external counsel that is drawn from the state attorney general’s office, state health department, county or city counsel, or simply private counsel. Some agencies may have both types. The type of legal counsel available to a public health officer may present challenges for the work of agencies. For example, legal counsel that serves another client (e.g., local government or the mayor) may be influenced by potentially conflicting agendas, political influences, timelines, and various priorities. This may also mean that counsel has expertise in public policy, but not necessarily specific public health knowledge or any appreciable un- derstanding of public health law. Respondents to an Association of State and 8 In some states, this is known as the Open Records Act.

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47 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE Territorial Health Officials survey reported that many local public health agencies have counsel that is only part-time and frequently lacks public health knowledge (ASTHO, 2008). Although it is preferable for the public health counsel to report to the health officer, sometimes it may be necessary for the attorney to organiza- tionally report to an outside entity such as an attorney general. Because the vast majority of attorneys general are independently elected, such arrange- ments raise the potential for the public health legal advisor to report to someone other than the person to whom the health officer reports, typically the chief executive. Adequate legal counsel needs to be readily accessible to be present at all high-level policy discussions in the department to facilitate clear understanding of the legal rationale underlying public health initia- tives or interventions before issues become crises. Hiring attorneys with grant funds and embedding them within particular grant-funded programs to work in an isolated manner may also not be optimal.9 Moreover, the increasing availability of legal assistance from several existing national academic or not-for profit sources such as the Public Health Law Network, while beneficial, cannot take the place of an official legal advisor that is recognized by, and part of the same team as the health officer and the juris- diction’s chief executive. Public health agency legal counsel would require training in public health and in public health law, and should have knowledge and experience in the following areas: • L aws that establish the public health agency and set forth its juris- diction and authorities • P rogrammatic aspects of the agency’s work • P rocedures and processes consistent with applicable laws and policies Such experience can be obtained through adequate career ladders within a health department, through education or, ideally, a combination of both. One of the prerequisites for strengthening public health law capacity in health departments is the availability of legal training in schools of public health (e.g., for individuals wishing to pursue a J.D./M.P.H. degree and for other public health students) and in schools of law for individuals interested in public policy and especially health policy. Schools of law offer little on public health law, and the professional education resources available to train public health personnel and legal professionals on public 9 Personal communication with Wilfredo Lopez, Former General Counsel for Health to the New York City Department of Health and Mental Hygiene Current Counsel Emeritus to the New York City Health Department and Board of Health , May 19, 2011; and Steve M. Teutsch, Chief Science Officer Los Angeles County Public Health, May 19, 2011.

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48 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY health law are generally limited (Goodman et al., 2002; IOM, 2003c; PHLA, 2004). Recommendation 4: The committee recommends that every public health agency in the country have adequate access to dedicated governmental legal counsel with public health expertise. The committee emphasizes “access to” to make it clear that it is not recom- mending a one-size-fits-all approach (e.g., a full-time public health attorney for every public health agency, no matter how small), but rather, that dif- ferent strategies are needed to ensure that public health agencies can obtain quality legal advice from attorneys with pertinent expertise. For example, approaches such as regionalization will be needed to ensure that every public health agency possesses the needed capabilities, either on its own, or through collaborative linkages. Even in today’s constrained fiscal environment, solutions to a shortage of adequate legal counsel could potentially be addressed by placing a law- yer from the attorney general’s office who is currently assigned to advise the health department within the health department thus facilitating close working relationships between counsel and practitioners. THE LOCUS OF GOVERNMENT RESPONSIBILITY FOR THE PUBLIC’S HEALTH In this section, the committee addresses central issues that emerge from the preceding discussion of the ways in which laws define and constrain the roles and authorities of the federal, state, and local levels of government. These include the duty and responsibility of each level of government per- taining to population health and the optimal level of government to act to create the most beneficial conditions for the population’s health. Gostin has written that “[t]he level of government best situated for deal- ing with public health threats depends on the evidence identifying the nature and origin of the specific threat, the resources available to each unit for ad- dressing the problem, and the probability of strategic success” (Gostin and Powers, 2006, p. 1056). Following logically from this is that national-level crises such as pandemics and bioterrorism threats require the substantial resources of the federal government, while a localized environmental threat may only require the involvement of the local public health agency. Preemption is an area of considerable contention among the three levels of government because it involves a higher level of government restricting or eliminating a lower level of government’s regulatory ability on an issue (NPLAN and Public Health Law Center, 2010). The Constitution grants Congress and federal regulators broad authority to preempt, and states

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49 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE have similarly broad powers to preempt municipalities (this may depend somewhat on how municipal powers are granted or revoked by the state) (Public Health Law Center, 2010). “Floor” preemption refers to federal or state laws or regulations that set and enforce a minimum standard, and permit lower levels of government to not enact statutes or promulgate regulations that go above that minimal standard. For example, the Health Insurance Portability and Accessibility Act, HIPAA, sets a protective floor for privacy protection, but allows the states to enact stricter privacy standards. Ceiling preemption refers to feder- al or state laws or regulations that set a maximum standard that lower-level governments may not exceed. The recently passed federal Affordable Care Act effectively preempts state and local authorities from requiring menu labeling that differs from the federal standards in restaurants and vending machines covered by the federal law. Many public health advocates express concern with ceiling preemption because it does not allow ample scope for states and localities to innovate in the field of public health (NPLAN, 2009). Federal or state (ceiling) preemption of state and local authority can often be harmful from a public health standpoint because it can compromise the ability of public health practitioners to implement more stringent standards that may be important and well accepted in a local setting. Ceiling preemp- tion also interferes with local control over local needs and with local-level accountability, and it could limit the ability of jurisdictions to meet the needs of constituents. In a few areas of public health, federal preemption seems highly appro- priate. For example, federal oversight of food manufacturing and process- ing may be appropriate because of its close nexus to interstate commerce. (However, localities regulate sanitary standards for and grant permits to food establishments.) Another example may be found in the federal ban on smoking on airplanes—the interstate nature of airline flight makes this area ideally suited to federal preemption. Ceiling preemption is appropri- ate in situations where national uniformity is absolutely necessary and only after the impact on public health and enforceability has been thoroughly assessed and mitigated. A good example of preemption with strong public health benefit is found in the 2011 U.S. Supreme Court case of Bruesewitz v. Wyeth LLC. In that case, the Court held that the National Childhood Vac- cine Injury Act of 1986 preempts all claims against vaccine manufacturers for injuries or death purported to be related to a vaccine (NEDSS, 2001). The Court’s decision upheld the law that established the Vaccine Injury Compensation Program that requires vaccine safety and effectiveness while removing the threat of litigation from vaccine manufacturers. A recent White House document cautioned against excessive agency preemption because “[t]hroughout our history, state and local govern- ments have frequently protected health, safety, and the environment more

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50 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY aggressively than has the national government.”10 Furthermore, the federal government does not have the police powers granted to states in the area of health and safety. Another example where federal ceiling preemption is relevant is the content, packaging, or labeling of packaged foods that are manufactured or processed in one state and shipped across many states in packaged form for distribution and consumption. However, in an area such as public health that is primarily the province of a state’s police power, the need for preemption and the kind of preemption that may be warranted should be closely examined on a case-by-case basis, and the presumption should be that “floor” preemption is the more appropriate option in the area of public health. For example, one can argue that the preemption provisions put into the 1969 amendments to the Federal Cigarette Labeling and Advertising Act should not prohibit a local health department from requiring local ciga- rette retailers to post warning signs about the dangers of smoking. Such a requirement would not affect the manufacturing, packaging, or labeling of cigarettes produced in one state and transported in interstate commerce. Yet, a recent federal court decision struck down such a requirement in New York City on the grounds that it was preempted by the language of the federal statute.11 Here, the need for preemption would seem to be outweighed by the detrimental impact on public health and local control. Preemption in the field of public health may also lead to non-enforce- ment of a preemptive federal standard. As discussed below, when a federal agency is given preemptive authority to regulate in an area that local public health agencies have a greater capacity and infrastructure to regulate, the result will likely be that the public health measure will not be enforced. In such instances preemption, and certainly “ceiling” preemption, needs to be avoided or arrangements for local enforcement should be put in place. The use of law as a tool often requires an integrated strategic approach. When considering the appropriateness of preemption the impact on public health and enforceability must be assessed. As the federal government em- barks on a regulatory review to ascertain if federal regulations unnecessarily hamper business activity, the committee urges that this principle be upheld and efforts be made to avoid creating new or interpreting existing preemp- tive laws in ways that may have unintended and unhealthful consequences. Recommendation 5: The committee recommends that when the federal government regulates state authority, and the states regulate 10 See Memorandum for the Heads of Executive Departments and Agencies, Office of the Press Secretary, The White House, 2009 WL 1398319 (May 20, 2009). 11 See Grocery Corps v. New York City Health Department Case 1:10-cv-04392-JSR Docu- ment 63 (12-29-10).

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51 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE local authority in the area of public health, their actions, wherever appropriate, should set minimum standards (floor preemption) al- lowing states and localities to further protect the health and safety of their inhabitants. Preemption should avoid language that hinders public health action. The IOM recently recommended that the FDA modify its GRAS (Gen- erally Regarded as Safe) standard relative to the amount of sodium in packaged food and in food prepared in restaurants (IOM, 2010a). Such an initiative would extend helpful public health protections nationally, but they would vest the FDA with regulatory authority over facilities that it has not regulated in the past. Food service establishments such as restaurants have historically been regulated and inspected by state and local health depart- ments, and these agencies have well-established, albeit strained, inspection workforces in place. There is also an adjudicatory infrastructure, such as state courts or administrative tribunals, to enforce the sanitary laws and regulations under the auspices of public health agencies. Whether a state or local health department can enforce a federal health standard in a res- taurant, for example, can be a legally complex matter potentially subject to interpretation. One example of such complexity can be found in Section 337(a) of the Food, Drug, and Cosmetics Act (FDCA), which in part reads, “Except as provided in subsection (b) of this section, all such proceedings for the enforcement, or to restrain violations, of the chapter shall be by and in the name of the United States.” That is, only the federal government can en- force that chapter. However, subdivision (1) of subsection (b) specifies that, “A State may bring in its own name and within its jurisdiction proceedings for the civil enforcement, or to restrain violations of” eight listed sections of the FDCA. This provision would seem to authorize at least states, if not their municipal subdivisions, to enforce those listed sections in state courts and possibly state tribunals. The intended point is that in times of increasing fiscal distress at all levels of government, protective federal health measures that are vested within the jurisdiction of a federal agency to enforce should not be allowed to go unheeded, unimplemented, and unenforced if there are cost-effective means to implement them. For example, if a state or local health depart- ment has a workforce that regularly inspects restaurants, and a judicial or administrative body to adjudicate violations, it would appear obvious that it would be more efficient for such an agency to enforce a federal standard than it would for the federal agency to create a new infrastructure to directly enforce a federal standard in a domain entirely new to it. Federal agencies must make every effort to leverage resources, and work cooperatively with the states to facilitate enforcement of federal standards by states or locali- ties where the statutory or regulatory structure would allow. However, it

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52 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY would not be helpful to mandate that states and localities assume this federal responsibility without adequate funding to do so. Recommendation 6: The committee recommends that federal agen- cies, in collaboration with states, facilitate state and local enforce- ment of federal public health and safety standards, including the ability to use state or local courts or administrative bodies where appropriate. Federal, state, and local agencies should combine their resources, especially in areas where regulatory authority is vested in one level of government but enforcement capacity exists in another level. REFERENCES ASTHO (Association of State and Territorial Health Officials). 2007. Understanding State Public Health. Arlington, VA: ASTHO. ASTHO. 2008. Exploring the Future of Public Health Law: A Dialogue on Past Accomplish- ments and Future Directions. Arlington, VA: ASTHO. ASTHO. 2010. Assessing Policy Barriers to Effective Public Health Response in the H1N1 Influenza Pandemic: Project Report to the Centers for Disease Control and Prevention. Arlington, VA: ASTHO. Baker, E. L., and J. P. Koplan. 2002. Strengthening the nation’s public health infrastructure: Historic challenge, unprecedented opportunity. Health Affairs 21(6):15-27. Bates, L., B. Lafrancois, and R. Santerre. 2010. An empirical study of the consolidation of local public health services in Connecticut. Public Choice 147(1-2):1-15. Beitsch, L. M., L. B. Landrum, C. Chang, and K. Wojciehowski. 2007. Public health laws and implications for a national accreditation program: Parallel roadways without intersection? Journal of Public Health Management and Practice 13(4):383-387. Beitsch, L. M., C. Leep, G. Shah, R. G. Brooks, and R. M. Pestronk. 2010. Quality improve- ment in local health departments: Results of the NACCHO 2008 survey. Journal of Public Health Management & Practice 16(1):49-54. Braveman, P. A., S. A. Egerter, and R. E. Mockenhaupt. 2011. Broadening the focus: The need to address the social determinants of health. American Journal of Preventive Medicine 40(1 Suppl 1):S4-S18. Brooks, R. G., L. M. Beitsch, P. Street, and A. Chukmaitov. 2009. Aligning public health financ- ing with essential public health service functions and national public health performance standards. Journal of Public Health Management and Practice 15(4):299-306. Calle, E. E., and R. Kaaks. 2004. Overweight, obesity and cancer: Epidemiological evidence and proposed mechanisms. National Reviews Cancer 4(8):579-591. CDC (Centers for Disease Control and Prevention). 2008. Public Health’s Infrastructure: A Status Report Prepared for the Appropriations Committee of the United States Senate. Atlanta, GA: CDC. Center for Health Improvement. 2009. Tackling Obesity by Building Healthy Communities: Changing Policies Through Innovative Collaborations. California Health Policy Forum Brief. Sacramento, CA: Center for Health Improvement. The Centers for Law and the Public’s Health. 2007. The Turning Point Model State Public Health Act-State Legislative Update Table. Baltimore, MD: CDC Collaborating Center Promoting Health Through Law and WHO/PAHO Collaborating Center on Public Health Law and Human Rights.

OCR for page 27
53 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE The Centers for Law and the Public’s Health. 2010. The Model State Emergency Health Pow- ers Act (MSEHPA). http://www.publichealthlaw.net/ModelLaws/MSEHPA.php (March 18, 2010). Chuang, S., and K. Inder. 2009. An effectiveness analysis of healthcare systems using a systems theoretic approach. BioMed CentralHealth Services Research 9(1):195. Cutler, D. M., A. B. Rosen, and S. Vijan. 2006. The value of medical spending in the United States, 1960–2000. New England Journal of Medicine 355(9):920-927. DeFriese, G. H., J. S. Hetherington, E. F. Brooks, C. A. Miller, S. C. Jain, F. Kavaler, and J. S. Stein. 1981. The program implications of administrative relationships between local health departments and state and local government. American Journal of Public Health 71(10):1109-1115. Fielding, J. E., S. M. Teutch, and L. Breslow. 2010. A framework for public health in the United States. Public Health Reviews 32(1):174-189. Goodman, R. A., Z. Lazzarini, A. D. Moulton, S. Burris, N. R. Elster, P. A. Locke, and L. O. Gostin. 2002. Other branches of science are necessary to form a lawyer: Teaching public health law in law school. Journal of Law, Medicine & Ethics 30(2):298-301. Goodman, R. A., A. Moulton, G. Matthews, F. Shaw, P. Kocher, G. Mensah, S. Zaza, and R. Besser. 2006. Law and public health at CDC. Morbidity and Mortality Weekly Report 55:29-33. Goodman, R. A., P. L. Kocher, D. J. O’Brien, and F. S. Alexander. 2007. The structure of law in public health systems and practice. In Law in the Public Health Practice, edited by R. A. Goodman, R. E. Hoffman, W. Lopez, G. W. Matthews, M. A. Rothstein, and K. L. Foster. New York, NY: Oxford University Press. Pp. 45-68. Gostin, L. 2009. A shot in the arm for the WHO and CDC. The Washington Post. http:// www.washingtonpost.com/wp-dyn/content/article/2009/04/30/AR2009043003517.html (July 4, 2011). Gostin, L. O. 2008. Public Health Law: Power, Duty, Restraint. Second ed. Berkley and Los Angeles, California: University of California Press. Gostin, L. O. 2010. Healthy people, healthy places: How to have a healthy life, commmunity, and country. Insights on Law and Society 11(1):12-30. Gostin, L. O., and M. Powers. 2006. What does social justice require for the public’s health? Public health ethics and policy imperatives. Health Affairs 25(4):1053-1060. Gostin, L. O., J. G. Hodge, and R. O. Valdiserri. 2001. Informational privacy and the public’s health: The Model State Public Health Privacy Act. American Journal of Public Health 91:1388-1392. Gostin, L. O., J. W. Sapsin, S. P. Teret, S. Burris, J. S. Mair, J. G. Hodge, Jr., and J. S. Vernick. 2002. The Model State Emergency Health Powers Act: Planning for and response to bio- terrorism and naturally occurring infectious diseases. Journal of the American Medical Association 288(5):622-628. Gostin, L. O., B. E. Berkerman, and J. Kraimer. 2008. Foundations in Public Health Law. Edited by International Encyclopedia of Public Health. Vol. 2. San Diego: Academic Press. Grad, F. P. 2005. Public Health Law Manual. Third ed. Washington, DC: American Public Health Association. Greenfield, D., and J. Braithwaite. 2008. Health sector accreditation research: A systematic review. International Journal for Quality in Health Care 20(3):172-183. Hamm, M., and Associates. 2007 (February 7). Quality Improvement Initiatives in Accredi- tation: Private Sector Examples and Key Lessons for Public Health. Paper presented at Adapting Quality Improvement (QI) to Public Health. Cincinnati, Ohio: Robert Wood Johnson Foundation.

OCR for page 27
54 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY HHS (Department of Health and Human Services). 2006 (September 13). Committee on Consolidation and Shared Government Services. David Gruber: Testimony Before the Assembly Joint Legislative Committee on Consolidation and Shared Government Ser- vices. Washington, DC. Honoré, P. A., and T. Schlechte. 2007. State public health agency expenditures: Categorizing and comparing to performance levels. Journal of Public Health Management and Practice 13(2):156-162. Hughes, R., K. Ramdhanie, T. Wassermann, and C. Moscette. 2011. State boards of health: Governance and politics. Journal of Law, Medicine & Ethics 39 (Suppl 1):37-41. IOM (Institute of Medicine). 1988. The Future of Public Health. Washington, DC: National Academy Press. IOM. 2003a. Assuring America’s health. In The Future of the Public’s Health in the 21st Cen- tury. Washington, DC: The National Academies Press. Pp. 19-45. IOM. 2003b. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. IOM. 2003c. The governmental public health infrastructure. In The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. Pp. 96-177. IOM. 2010a. Strategies to Reduce Sodium Intake. Washington, DC: The National Academies Press. IOM. 2010b. (May 18). Transcript, Fourth meeting of the IOM Committee on Public Health Strategies to Improve Health. Washington, DC: IOM. Jesperson, K. 2004. Regionalization: Forced, Voluntary and Somewhere in Between. Morgan- town, West Virginia: National Evironmental Services Center. Koh, H. K., L. J. Elqura, C. M. Judge, and M. A. Stoto. 2008. Regionalization of local public health systems in the era of preparedness. Annual Review of Public Health 29:205-218. Kominski, G. F., P. A. Simon, A. Ho, J. Luck, Y. W. Lim, and J. E. Fielding. 2002. Assessing the burden of disease and injury in Los Angeles County using disability-adjusted life years. Public Health Reports 117(2):185-191. Konkle, K. M. 2009. Exploring Shared Services Collaboration in Wisconsin Local Public Health Agencies: A Review of the Literature. Madison, WI: Institute for Wisconsin’s Health Inc. Leahy, E., and M. Fallon. 2005. Boards of health: Extinction or evolution? Transformations in Public Health 6(3):1-4. Lewis, S. 2007. Accreditation in Health Care and Cducation: The Promise, the Performance and the Leasons Learned. Toronto, ON, CA: Social Housing Services Corporation. Libbey, P., and B. Miyahara. 2011. Cross-Jurisdictional Relationship in Local Public Health: Preliminary Summary of an Environmental Scan. Princeton, NJ: Robert Wood Johnson Foundation. Lopez, W., and T. R. Frieden. 2007. Legal counsel to public health practitioners. In Law in Pub- lic Health Practice, edited by R. A. Goodman, R. E. Hoffman, W. Lopez, G. W. Matthews, M. A. Rothstein, and K. L. Foster. New York, NY: Oxford University Press. Pp. 199-221. Mays, G. P. 2004. Can Acreditation Work in Public Health? Lessons From Other Service In- dustries. Working Paper Prepared for the Robert Wood Johnson Foundation: Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences. Princeton, NY: Robert Wood Johnson Foundation. Mays, G. P., M. C. McHugh, K. Shim, N. Perry, D. Lenaway, P. K. Halverson, and R. Moo- nesinghe. 2006. Institutional and economic determinants of public health system perfor- mance. American Journal of Public Health 96(3):523-531. McCarty, K. L., G. D. Nelson, J. G. Hodge, and K. M. Gebbie. 2009. Major components and themes of local public health laws in select U.S. jurisdictions. Public Health Reports 124(3):458-462.

OCR for page 27
55 THE LAW AND PUBLIC HEALTH INFRASTRUCTURE McGinnis, J. M., P. Williams-Russo, and J. R. Knickman. 2002. The case for more active policy attention to health promotion. Health Affairs 21(2):78-93. Meier, B. M., K. M. Gebbie, and J. G. Hodge. 2007. Contrasting experiences of state public health law reform pursuant to The Turning Point Model State Public Health Act. Public Health Reports 122(4):559-563. Meier, B. M., J. G. Hodge, Jr., and K. M. Gebbie. 2009a. Transitions in state public health law: Comparative analysis of state public health law reform following The Turning Point Model State Public Health Act. American Journal of Public Health 99(3):423-430. Meier, B. M., J. Merrill, and K. Gebbie. 2009b. Modernizing state public health enabling statutes to reflect the mission and essential services of public health. Journal of Health Management Practice 15(2):112-119. Miller, C. A., E. F. Brooks, G. H. DeFriese, B. Gilbert, S. C. Jain, and F. Kavaler. 1977. A survey of local public health departments and their directors. American Journal of Public Health 67(10):931-939. Minnesota Department of Health. 2010. National Public Health Standards and Voluntary Accreditation: Implications and Opportunities for Public Health Performance Improve- ment in Minnesota. A Report from the Performance Improvement and Accreditation Work Group of the State Community Health Services Advisory Committee. St. Paul, MN: Minnesota Deparment of Health. Monroe, J. 2010. (May 18). Authorities, Organization, and Key Issues in (and Between) Federal, State, and Local Public Health Agencies. Presentation fo the IOM committee on Public Health Stategies to Improve Health.Washington, DC: IOM. NACCHO (National Association of County and City Health Officials). 1998. Research Brief: NACCHO Survey Examines State/Local Health Department Relationships. Vol. 2. Washington, DC: NACCHO. NACCHO. 2001. Local Public Health Agency Infrastructure: A Chartbook. Washington, DC: NACCHO. NACCHO. 2008. National Profile of Local Health Departments. Washington, DC: NACCHO. NACCHO. 2010. NACCHO H1N1 Policy Workshop Report. Washington, DC: NACCHO. National Association of Attorneys General (NAAG). 2003 (December 2-6). Resolution Urging States to Review Their Public Health Laws. Resolution Adopted, NAAG Winter Meeting. Williamsburg, VA. NEDSS (National Electronic Disease Surveillance System). 2001. A standards-based approach to connect public health and clinical medicine. Journal of Public Health Management & Practice 7(6):43-50. Nelson, C., N. Lurie, and J. Wasserman. 2007. Assessing public health emergency prepared- ness: Concepts, tools, and challenges. Annual Review of Public Health 28:1-18. Neslund, V. S., R. A. Goodman, and J. L. Hadler. 2007. Frontline public health: Surveilance and field epidemiology. In Law in Public Health Practice, edited by R. A. Goodman, R. E. Hoffman, W. Lopez, G. W. Matthews, M. A. Rothstein, and K. L. Foster. New York: Oxford University Press. Pp. 222-235. New Jersey Health Officers Association. 2008 (October 22). Peter N. Tabbot: Testimony before the local unit alignment reorganization and consolidation commission. Nicola, R. M. 2005. Boards of health give citizens a voice. Transformations in Public Health 6(3):2-4. Novick, L. F., and G. P. Mays, eds. 2005. Public Health Administration: Principles for Popu- lation-Based Management. Sudbury, MA: Jones and Bartlett Publishers. NPLAN (National Policy & Legal Analysis Network to Prevent Childhood Obesity). 2009. Model Menue Labeling Ordinance. Okland, CA: NPLAN. NPLAN and Public Health Law Center. 2010. Negotiating Preemption: Strategies and Ques- tions to Consider. Oakland, CA: Public Health Law & Policy.

OCR for page 27
56 FOR THE PUBLIC’S HEALTH: REVITALIZING LAW AND POLICY O’Connor, J., P. Jarris, R. Vogt, and H. Horton. 2011. Public health preparedness laws and policies: Where do we go after pandemic 2009 H1N1 influenza? Journal of Law, Medicine & Ethics 39:51-55. Pestronk, R. M. 2010. (May 18). Public Health Law at the Local Level. Presentation to the IOM Commmittee on Public Health Strategies to Improve Health. Washington, DC: IOM. PHLA (Public Health Law Association). 2004. Public Health Law Awareness Among American Bar Association Members. Atlanta, GA: PHLA. Public Health Functions Steering Committee. 1994. The Public Health Workforce: An Agenda for the 21st Century. Full Report of the Public Health Functions Project. Washington, DC: HHS. Public Health Law Center. 2010. P reemption in Public Health: Overview. h ttp:// publichealthlawcenter.org/topics/other-public-health-law/preemption-public-health (April 4, 2011). Public Health Law Network. 2010. Public Health Agency Accreditation and Shared Service Delivery: Fact Sheet. St. Paul, MN: Public Health Law Network. Public Health Statute Modernization National Excellence Collaborative. 2003. Model State Public Health Act: A Tool for Assessing Public Health Laws. Seattle, WA: Turning Point National Program Office at the University of Washington. RWJF (Robert Wood Johnson Foundation). 2009. Public Health Practice-Based Research Networks. A Call for Proposals. Princeton, NJ: RWJF. Salinsky, E. 2010. Governmental Public Health: An Overview of State and Local Public Health Agencies. Washington, DC: National Health Policy Forum. Stier, D. 2010. (May 18). Authorities, Organization, and Key Issues in (and Between) Federal, State, and Local Public Health Agencies. Presentation fo the IOM committee on Public Health Stategies to Improve Health. Washington, DC: IOM. Stoto, M. A., and L. Morse. 2008. Regionalization in local public health systems: Pub- lic health preparedness in the Washington metropolitan area. Public Health Reports 123(4):461-473. Vaca, F. E., C. L. Anderson, and D. E. Hayes-Bautista. 2011. The Latino adolescent male mortality peak revisited: Attribution of homicide and motor vehicle crash death. Injury Prevention 17(2):102-107. Woolf, S. H., R. M. Jones, R. E. Johnson, R. L. Phillips, Jr., M. N. Oliver, A. Bazemore, and A. Vichare. 2010. Avertable deaths associated with household income in Virginia. American Journal of Public Health 100(4):750-755.