1. Chapter 4 1

2. Understand the role of law and government in promoting the health of the public Identify different types of laws Identify functions of governmental agencies Apply this knowledge in solving public health problems 2

3. Values Authority Decisions Enforcement Define the "unacceptable" 3

4. U.S. Constitution (1787) Powers reserved to states and people General welfare Regulate commerce Implied powers 4

5. States have ultimate authority and responsibility for the public's health (mostly) 5

6. 2012: ??? 2010: Affordable Care Act 1990's: Health Security Act failed 1980's: Block Grants 1973: HMO's 1965: Medicare and Medicaid 1946: Hospital Survey & Construction Act; CDC 1935: Great Depression and Social Security 1913: federal income tax = resources 1700's and 1800's: states more independent 6

7. Police Powers Limit the actions of individuals to protect society 7 Jacobsen v. Massachusetts, 1905

8. An athletic event (like the Olympics) is being held in your jurisdiction. The temperature is near 100 degrees. Events include tennis, running, cycling, etc. There are thousands of spectators. There may be heat-related illnesses. Should you as the local health director ask the organizers to postpone the event or issue an order to postpone it or do nothing? 8

9. Support the general welfare Elizabethan Poor Laws Should government provide health care for people who can't afford it? Why or why not? Under what circumstances? 9

10. Federal, state and local agencies evolved States delegate authority to counties, cities, towns, districts "Home rule" gives broad authority to locals Variation in state and local structures 10

11. By legislative or regulatory action, a higher level of government (state or federal) eliminates or reduces the authority of a lower level over a given issue. Under the Supremacy Clause of the U.S. Constitution, Congress and federal regulators have virtually unlimited authority – if they choose to exercise it – to preempt state and local health laws.Supremacy Clause Airline Smoking Ban http://publichealthlawcenter.org/topics/other-public-health-law/preemption-public-health 11

12. Constitutional law Legislative (statutory) law Administrative law Judicial law 12

13. Establishes powers, duties and limits of government Courts interpret the Constitution Does the Constitution protect an individual's right to smoke? 13

14. Congress and state legislatures; city councils, etc. Regulate behavior and distribute resources Consistent with the U.S. Constitution Selects policies Delegates authority Mandates activity Establishes and funds programs 14

15. Executive branch Regulations more detailed than statutes Implement, decide, enforce, and interpret Extensive public process Continuing oversight by legislature Example: asbestos removal in schools 15

16. Interpret constitutionality of laws/regulations Interpret intent of laws/regulations Decide case law 16

17. http://www.hhs.gov/about/orgchart/ 17

18. Variation Centralized v. decentralized Umbrella v. Stand alone 18

19. 3,000+ local health departments Mostly county Mostly small jurisdictions (<50,000) Some consistency and variation in services Public Health Accreditation Websites? 19

20. http://www.pbs.org/wgbh/pages/frontline/te ach/vaccine/ http://www.pbs.org/wgbh/pages/frontline/te ach/vaccine/ Should government prohibit children from entering school without vaccinations? If there are exemptions, on what grounds? What are the underlying legal and other issues? 20