1. Making Good Public Health Policy Jessica Berg, JD, MPH Professor of Law, Bioethics & Public Health Case Western Reserve University March 27, 2012

2. Goals Identify what counts as “policy” Discuss the skills and background needed to develop good public health policy Describe an approach to teaching these skills

3. What is policy? Guiding principle A way of doing things Guidance toward attainment of goals Stated position on a matter Course of action adopted or pursued Measures adopted to achieve ends Authoritative guidelines or decisions Oxford English Dictionary

4. What counts as Public Health? BP Oil Spill National Drug Control Strategy & Drug Shortages Infant Morality Gun Control

5. Public Health Policy includes: Health-related decisions made by legislators that are codified into law Rules/regulations to implement legislation or operate government and health-related programs Judicial decisions related to health Some private organization policies Longest (1998)

7. Central to organization of PH agencies Central to understanding what PH agencies and professionals are authorized to do Crucial for proposing and evaluating health policy *Need to have general understanding of legal system and public health laws to know when to get more information Importance of Studying Law

8. PH Organization and Structure Federal Structure ▫Federal Legislation ▫Federal Agencies State Structure ▫State Legislation (Health Code) ▫State Department of Health Local structure ▫Centralized, decentralized or hybrid ▫Local Health Board (volunteer, appointed, elected) ▫Ordinances

9. Do you report to the mayor, a local board of health, or a state health department official? Where can you get legal advice? If you need to enforce a law do you go to the sheriff's department, the city police department, the state police department? What powers are authorized at what level? Examples

10. Licensing Confidentiality and Reporting Obligations Authority (police power) ▫Permits ▫Nuisance Orders  Orders to Cease & Desist, Liens, Prosecutions ▫Subpoena records ▫Isolation, quarantine, detention Law and PH Professionals

11. May you reveal HIV status of a county employee? Do you have the authority to quarantine a building in an infectious disease case? Can you issue a permit for a temporary food service for a charitable event? Under what circumstances can you issue an isolation order for a noncompliant homeless MDR-TB patient? Examples

12. What do we expect to accomplish? Is the policy appropriate? ▫Does it reduce aggregate health risks? ▫Are there less intrusive means? Range of legal interventions available Implications of our choice: ▫Individual rights ▫Allocation of public resources ▫Unanticipated effects Legal Issues in Evaluation of Policy

13. Soda Taxes Trans Fat Bans NSLP Rules Phys Ed Mandates

14. Law Summary Need to know: ▫Basics of legal system, implications for PH organization, professional responsibility, and authority ▫Circumstances that require accessing legal expertise ▫Range of legal tools  Educate, create incentives, deter behavior, punish individuals or companies  Require safer product design  Alter the informational, physical, social or economic environment Interplay with Ethics

15. Importance of Studying Ethics in Developing Good PH Policy Increase your ability to recognize ethical issues Develop analytical skills in ethics Minimize potential ethical distress when you face difficult cases Enhance your ability to practice public health

16. Types of Ethics Regulatory and Policy ▫Moral weight of community health ▫Public Accountability ▫Social Justice and Human Rights Professional and Organizational Ethics ▫APHA Code of Ethics ▫Importance and Limits of Advocacy Theoretical Applied

17. Ethical Theories = Tools Consequentialist (Utilitarianism) Deontological (Kant, Rawls) Principlism (Beauchamp & Childress) Liberal Individualism Communitarianism Natural law/ Religion Virtue Ethics (Aristotle) Casuistry

18. Examples Vaccine distribution in shortage Restrictions on travel due to infectious disease Determining whether to withdraw an efficacious drug from the market because of safety concerns Limited funds for research vs. surveillance, and determining which populations should be studied.

19. Need to understand: ▫Professional ethical obligations ▫Types of ethical theories and their limitations ▫How to identify ethical issues Interplay with law Ethics Summary

20. Bernard Schoenbaum ID: 29443,The New Yorker 11/30/1992

22. Step 1: Lay the Groundwork Basics of Political System Basics of Legal System Basics of Health Economics Basics of Public Health System (including Health Delivery System)

23. Step 2: Practice Policy Brief ▫Statement ▫Background ▫Landscape ▫Options ▫Analysis ▫Recommendation Format, Length, Feedback, Goal

24. Step 3: Provide Additional Background on Implementation Health Management Background ▫Management Theories ▫Organizational Behavior ▫Conflict Resolution ▫Human Resources ▫Financial Principles  Accounting and Budgeting

25. Step 4: Apply What You’ve Learned Team Project ▫Choose an option to implement ▫Identify steps necessary for implementation ▫Identify potential barriers ▫Basic cost analysis/budget ▫Work together to present/teach/advocate

26. Bernard Schoenbaum, ID: 2859, The New Yorker