Public Health Program Challenges

Public Health Program Challenges in Municipalities
For public health challenges to be amicably solved, the entire community, political, legal, and government processes have to be synergized. This collaborative effort is quintessential in improving public health. A one man show would be detrimental because we have to appreciate that policies that help in running public health system require the input of the local community, the political class, and public health administrators (Gostin, 2001). The devolved nature of the public health law has seen limited scope the state and the federal government has had on the operation of public health. To that effect, local entities like boards of health, city councils, and county council have had a lot of say on how public health issues are managed within their areas of jurisdiction. Most of the available literature on public health law largely captures matters pertaining to firearms, housing, or smoking regulations. There are more than 18,000 local authorities within the United States which are mandated by law to address public health concerns (Gostin, 2001). Due to the uniqueness of each of these local authorities, they normally legislate laws that address pressing health concerns within their respective localities. Public health concerns like the handling of food are common across many local governments but are handled differently depending on whether it is an urban or a rural setting, population size, local governance, to mention but a few factors. Other public health issues like physical activity, outside burning, and smoking are uniquely addressed at the local level different from federal or state approaches (Gostin, 2001). Local authorities exercise powers bestowed upon them by the state in addressing public health issues. Forty-eight states have constitutional or statutory home-rule law that allows them to address specific local public health concerns (Diller, 2007). In cases where there is a gap in federal or state public health laws, local ordinances can be instituted to address critical public health issues (Barron, 2003). This has been witnessed in ordinances that regulate use of tobacco and control of firearms. In other jurisdictions, state laws preempt local ordinances. Local government must therefore, in such instances, carry out state health regulations while adapting them to address local needs and priorities (Gostin, 2001).
Findings and implications for Local Public Health Policy
This research seeks to establish the functions of municipal government on public health programs and the impact of public health programs on local services. It also endeavors to assess the major themes, legal approaches, and effectiveness of local law in improving public health with a view to facilitating an understanding of relationship between local and state public health laws. In order to know the functions of the municipal government on public health programs I focused on understanding the scope and the breadth of local ordinances. I researched the ordinances of approximately 50 municipalities of various sizes and locations using online research engines like LexisNexus and city government websites (McCarthy, Nelson, Hodge. & Gebbie, 2009). Based on my review of these municipalities’ laws, I did an extrapolation of common public health topics and themes. From the initial review, I selected 37 geographically dispersed locally dispersed jurisdictions with populations ranging from 51,000 to 9.5 million in order to study public health themes in their ordinances (McCarthy & Nelson, et al., 2009).
In order to know the challenges in the realm of the public health, questionnaires were dispatched to officials in this 37 local authorities. Duly filled questionnaires were then taken back for purposes of data analysis.
Results
After reviewing the 37 selected municipalities 22 public health topics that recurred in a varying degree in many municipal codes were identified. Some of the public health topics included air quality, alcoholic beverages, animals, child care centers, communicable diseases, food, garbage collection and disposal, housing and building codes, noise, and mass gatherings, to mention but a few. The most predominant public health topics regulated by local authorities included garbage collection and disposal, animals, and sewer systems.
Diversity of the scope of municipalities’ ordinances is illustrated through their communicable disease control provisions. Twenty four per cent of municipalities addressed this issue in their codes. Billings, Montana feature quarantine, reporting, and cost which pertain to communicable disease. Wichita and Kansas, within Dallas, Texas, has 26 ordinances touching on communicable and infectious diseases which points out that state laws mainly govern communicable and infectious diseases (McCarthy & Nelson, et al., 2009).
Local public health laws that govern food seemed to be more complex. Some municipalities had laws that regulated handling and distribution of food, mobile food units, restaurant licensing, inspection , and sanitation, and meat and milk. A municipality, like Providence, in Rhode Island, had ordinances that touched on four of the above mentioned categories while Albuquerque, in New Mexico had ordinances touching on the three of the five mentioned categories. However, Reno, Nevada, had only one topic that touched on food handling and distribution.
To ascertain if population correlated with municipalities’ regulations on on specific health topic, on ordinance, jurisdictions were grouped according to size within three categories:
Small=22 municipalities within populations ? 500,000; medium= 8 municipalities with populations between 500,001 and 999,999; large= 10 municipalities with populations ? 1 million.
Within small jurisdictions, garbage collection and disposal were the most frequently regulated public health topics. In fact, 86% of these municipalities regulated garbage and waste collection. Seventy seven of small jurisdictions regulated alcoholic beverages, animals, and sewer systems. Most predominant topics regulated within medium jurisdictions were nuisances, garbage collection and disposal, followed by noise, swimming pools and spas. A hundred per cent of large municipalities regulated public health topics like animals (McCarthy & Nelson, et al., 2009). This was closely followed by garbage collection and disposal, noise, and tobacco at 85%.
The most commonly regulated public health topic within the three categories of municipalities was garbage collection and disposal(90%), animals (81%). By size categories, 86% of small municipalities regulated garbage collection and disposal, 88% of medium municipalities, and 85% of large municipalities. With regard to animals, 77% small municipalities, 75% medium municipalities, and 100% large municipalities regulated this health topic through their local ordinances (McCarthy & Nelson, et al., 2009).
Governmental entity with delegated legislative power and authority normally drive the public health agenda by setting and enforcing standards. Local health departments or boards of health are in this regard charged with the responsibility of enforcing municipal public health ordinances. Twenty municipalities under review had have local health departments while 21 municipalities have separate local sanitation, environmental health, and environmental services departments. Cities without municipal health departments fall under the authority of county or state health agencies (McCarthy & Nelson, et al., 2009).
Some of the challenges that municipal council without health departments have to grapple with is the bureaucracy involved in the quest for delivery of services. Basic public health functions are provided by state health agencies which slow down the speed of delivery of services. Other challenges include lack of laws that are suppose to govern certain public health concerns because of under-representation (McCarthy & Nelson, et al., 2009).
It is worth noting that research does not highlight the degree to which degree the public health functions are to additional agencies and departments. It does not also measure variation in approaches in delegating and exercising governmental powers. Its scope does not also encompass potential advantages and and disadvantages of specific organizational structures. This is a fertile ground for further research.
Summary, conclusion, and recommendations
The relationship between state and local public health laws with regard to enforcing public health issues is blurry. Somebody without attention to details might think that local ordinances take up public health issues that state governments hitherto address with a view to supplementing state public health powers (McCarthy & Nelson, et al., 2009). Some would be taken to believe that local ordinances are independent of state influence.
In reality, local ordinances are supplementary to public health laws by the virtue of the fact that they fill the gaps in state public health law by addressing critical public health issues not stipulated in the state public health laws. For example, in Columbus, Ohio, a court upheld an ordinance banning indoor smoking in restaurants, bars, and places of employment, because Ohio’s no smoking ban did not regulate smoking in those locations (Maskowitz, Lin, & Hudes, 2007). A Ohio Supreme Court also upheld a Cincinnati, Ohio, ordinance limiting possession of firearm. These instances are an indication that municipal ordinances fill gaps in existing state regulatory schemes.
There are cases where where state laws preempt local ordinances. This requires local governments to adhere to state mandates. For example, the Texas Supreme Court struck down a Dallas zoning ordinance that targeted business selling alcohol simply because that particular ordinance was preempted by the state law (Diller, 2007).
It is a common occurrence to find municipal regulations mirroring state statutes. However, there are instances when municipal regulations adapt state statutes with a view to addressing local needs and priorities. For example municipalities may institute an ordinance that regulate noise that was more restrictive than state law abatement law.
Local ordinances massively impact public health issues and the general lives of residents within those local jurisdictions. To understand the effects of and development of local policies and the legal landscape underlying those ordinances, this research examined public health ordinances in a wide spectrum of municipalities. Subsequent studies should focus on analyzing the relationship between state and local and state laws. State courts have played massive role in filling the gaps that exist between state and local ordinances and developing responses to state specific concerns, there is an urgent need for developing a base for strengthening quality of public health laws and utility of public health ordinances.



References List
Barron, D.J. (2003). Reclaiming Home Rule. Harvard Law Review, 116, 2255-2386.
Diller, P. (2007). Intrastate Preemption. Boston University Law Review,87, 1113-1176.
Gostin, L.O. (2001). Public Health Law Reform. American Journal of Public Health, 91, 1365-1368.
McCarthy, K.L., Nelson, G.D, Hodge, J.G. & Gebbie, K.M. (2009). Major Components and Themes of Public Health Laws in Select U.S. Jurisdictions. Public Health Report, 124(3), 458-462.
Moskowitz, J.M., Lin, Z., & Hudes, E.S. (2000). The Effect of Working Place Smoking Ordinance in California on Smoking Cessation. American Journal of Public Health, 90, 757-761.