Making Good Public Health
Policy
Jessica Berg, JD, MPH
Professor of Law, Bioethics &
Public Health
Case Western Reserve University
March 27, 2012
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
What is policy?
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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
What counts as Public Health?
BP Oil Spill
Gun Control
Infant Morality
National Drug
Control Strategy &
Drug Shortages
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)
Importance of Studying Law
• 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
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
Examples
• 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?
Law and PH Professionals
• Licensing
• Confidentiality and Reporting Obligations
• Authority (police power)
▫ Permits
▫ Nuisance Orders
 Orders to Cease & Desist, Liens, Prosecutions
▫ Subpoena records
▫ Isolation, quarantine, detention
Examples
• 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?
Legal Issues in Evaluation of Policy
• 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
Soda Taxes
Phys Ed Mandates
NSLP Rules
Trans Fat Bans
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
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
Types of Ethics
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Regulatory and Policy
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Moral weight of community health
Public Accountability
Social Justice and Human Rights
Professional and Organizational Ethics
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APHA Code of Ethics
Importance and Limits of Advocacy
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Theoretical
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Applied
Ethical Theories = Tools
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Consequentialist (Utilitarianism)
Deontological (Kant, Rawls)
Principlism (Beauchamp & Childress)
Liberal Individualism
Communitarianism
Natural law/ Religion
Virtue Ethics (Aristotle)
Casuistry
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.
Ethics Summary
• Need to understand:
▫ Professional ethical obligations
▫ Types of ethical theories and their limitations
▫ How to identify ethical issues
• Interplay with law
Bernard Schoenbaum ID: 29443,The New Yorker 11/30/1992
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)
Step 2: Practice
• Policy Brief
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Statement
Background
Landscape
Options
Analysis
Recommendation
• Format, Length, Feedback, Goal
Step 3: Provide Additional Background
on Implementation
• Health Management Background
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Management Theories
Organizational Behavior
Conflict Resolution
Human Resources
Financial Principles
 Accounting and Budgeting
Step 4: Apply What You’ve Learned
• Team Project
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Choose an option to implement
Identify steps necessary for implementation
Identify potential barriers
Basic cost analysis/budget
Work together to present/teach/advocate
Bernard Schoenbaum, ID: 2859, The New Yorker