Public Health Program Challenges in Municipalities

Introduction: Community and Government Collaboration in Public Health

For public health challenges to be effectively solved, the entire community — along with political, legal, and governmental processes — must be synergized. This collaborative effort is essential to improving public health. A one-sided approach would be detrimental, because the policies that govern the public health system require the input of the local community, the political class, and public health administrators (Gostin, 2001). The devolved nature of public health law has limited the scope that state and federal governments have over the operation of public health. As a result, local entities such as boards of health, city councils, and county councils have had considerable influence over how public health issues are managed within their areas of jurisdiction.

Most of the available literature on public health law largely addresses matters pertaining to firearms, housing, or smoking regulations. There are more than 18,000 local authorities within the United States that are mandated by law to address public health concerns (Gostin, 2001). Due to the unique character of each of these local authorities, they normally legislate laws that address pressing health concerns within their respective localities. Public health concerns such as food handling are common across many local governments but are managed differently depending on whether the setting is urban or rural, as well as on factors such as population size and local governance structure. Other public health issues — including physical activity, outdoor burning, and smoking — are addressed at the local level in ways that differ significantly from federal or state approaches (Gostin, 2001).

Local authorities exercise powers granted to them by the state in addressing public health issues. Forty-eight states have constitutional or statutory home-rule laws that allow 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 tobacco use and firearm control. In other jurisdictions, state laws preempt local ordinances. Local governments 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 in public health programs and the impact of those 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 the relationship between local and state public health laws. In order to understand the functions of municipal government in public health programs, the study focused on the scope and breadth of local ordinances. Ordinances from approximately 50 municipalities of various sizes and locations were examined using online research tools such as LexisNexis and city government websites (McCarthy, Nelson, Hodge, & Gebbie, 2009). Based on this review, common public health topics and themes were extrapolated.

From the initial review, 37 geographically dispersed jurisdictions with populations ranging from 51,000 to 9.5 million were selected in order to study public health themes in their ordinances (McCarthy & Nelson et al., 2009). In order to understand the challenges in the realm of public health, questionnaires were dispatched to officials in these 37 local authorities. Completed questionnaires were then collected for data analysis.

Results: Common Public Health Topics Across Municipalities

After reviewing the 37 selected municipalities, 22 public health topics that recurred to varying degrees in many municipal codes were identified. These 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, among others. The most predominant public health topics regulated by local authorities were garbage collection and disposal, animals, and sewer systems.

The diversity in the scope of municipal ordinances is illustrated through their communicable disease control provisions. Twenty-four percent of municipalities addressed this issue in their codes. Billings, Montana, featured provisions on quarantine, reporting, and cost related to communicable disease. Wichita, Kansas, and Dallas, Texas, each had 26 ordinances touching on communicable and infectious diseases, which underscores that state laws primarily govern such diseases (McCarthy & Nelson et al., 2009).

Local public health laws governing food tended to be more complex. Some municipalities had laws that regulated food handling and distribution, mobile food units, restaurant licensing, inspection and sanitation, and meat and milk. Providence, Rhode Island, had ordinances that touched on four of those categories, while Albuquerque, New Mexico, had ordinances covering three of the five categories. Reno, Nevada, however, had only one ordinance addressing food handling and distribution.

References

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 Reports, 124(3), 458–462.

Moskowitz, J. M., Lin, Z., & Hudes, E. S. (2000). The effect of workplace smoking ordinances in California on smoking cessation. American Journal of Public Health, 90, 757–761.