Legislation and enforcement of public health practice in America

Settings for Public Health Practice

Public Health

Private health issues centre on the medical care and cost for individuals who have a choice both in the source of the service and the type. Even then there is always a need to control the activities of health providers by laws to create a framework of just use of the relation between the patient, or individual and the health care system. Thus even in the private health care sector, legislation was found necessary in case of privacy of data, insurance and many other aspects like negligence and torts. Public health concerns lie in the realm of no man's land, and the state has to step in first to provide the framework, dealing with the issues in public health, and secondly making it mandatory. Laws thus seek to enforce the public health needs perceived from time to time and also of regulating the service provided. The recent study shows that today seventy percent of U.S. workers have insurance related to health or get relief from an organization. It was only thirty percent some ten years ago. The aim is to include all Americans in national health care programs in the near future. The federal government is on the move to draft the policy for the Medicare and Medicaid beneficiaries such that the whole population comes under its protection. (Billi; Agrawal, 2001) This is due to the power of the legislature and the directives and laws that have been passed to govern and enforce public health.

Legislation and its need

The legislature while dealing with public health issues had to consider the legal validity of the legislation, ethical and sometimes the political issues involved. Human rights, laws regarding restraint and individual freedom all are part of the principles that ought to direct the framing of the issues in the law. Public health became a point of concern and the public health authorities had to be given more powers delegated to them on account of the spread of communicable diseases and terrorist action, especially biological warfare. There is a need, to collect data, and share it with the law enforcement agencies, and the need to enter private property for inspection, and control property as a means of regulating health care. This would not be possible unless they were empowered by legislation. Individuals may also need be detained, investigated and controlled with compulsory physical examination, vaccination and the like and such infringement on the civil liberties also requires authorization in the form of law. Public health providers thus have to be armed with sufficient authority derived by legal and statutory provisions to perform their duties without hindrance in today's society where many activities of companies in biotechnology, pharmacy are sought to be controlled and inspected. The terrorist angle also makes it imperative that the public health personnel have sufficient power to carry out preemptive action, and also borrow on the state resources to carry out the necessary operations. The legislations passed with regard to the public health and its enforcement is derived by the interpretation of the constitution in a bid to protect civil liberties. (Gostin, 2002)

Fundamental rights have been redefined to include the legislations that enabled public health activities and policies. For example the law relating to immunization which was challenged on the ground that immunization was against the religious belief of the Plaintiff and mandatory immunization was held to be valid and within the constitution. The reason was held to be that the law is a valid exercise of police power and the fundamental purpose of the legislation was "protecting school children against deadly diseases." Thus individual concerns were played down by the courts in promoting public health. (Gostin, 2002) Criminal laws have also been amended, and thus a new realm of jurisprudence which makes public health the focus of law is with relation to infectious diseases. There have been defined public health offences in many states and the law and punishment varies from state to state. Culpability of the person who is himself or herself ailing will be determined when the person violates the medical mandates that are required and precautions needed before public interaction. The person who has knowledge of his or her body being infected with a communicable disease, like AIDS or HIV, behaves with that knowledge in such a manner that the disease is transmitted to others commits an offense. (Gostin, 2002)

The courts have upheld the constitutional validity of this rule. The prosecution of these types of offence is relatively easy and the methods of adducing evidence simple. Thus the public health concern is vast in scope and application and has the three elements of administrative, mandatory regulation, and criminal law interwoven in such a way that health officials are at par with the other law enforcing agencies and civil authorities. The power and legal methods of execution vary from state to state and from province to province. The question we are thus faced is which set of laws will apply in any situation? Will it be the local, state, or federal laws? What if one conflicts with another? (Gostin, 2002) Laws passed by the hierarchies of government preempt one another. When a local law or state law would be conflicting with the federal law, it could be seen that the federal law would preempt the state laws in certain circumstances. In other words the federal law will apply nullifying the provisions of the state laws. Where the subject of legislation is reserved by the federal legislature applying it uniformly over the country, it is called explicit preemption. Where by conflict with the state law provisions the federal law overrides the state law, it is an implicit preemption. Some times where the federal law is silent on aspects of operations, the state law will be enforced. (Richards; Rathbun, 1999)

Conclusion

It is to be concluded that the federal laws must be made universally applicable and state laws abrogated so far as health issues are concerned. It is evident that public health questions affect the very security of the country and must be treated on par with the defense of the country. Just as it is legal for the federal defense laws alone to be implemented all over the country, the public health and health enforcement must be a sole federal subject so that much of the confusion and the various state legislations that create anomalies and interstate and inter-department rivalry can be avoided.