Transcript Turning Point Public Health Statute Modernization National

Modernizing Public Health Laws in the
21st Century: The Impact of the
Turning Point Model State Public Health
Act on State Legislative Reforms
James G. Hodge, Jr. J.D., LL.M.
Center for Law and the Public’s Health, Georgetown & Johns Hopkins
Universities
Benjamin Mason Meier, J.D., LL.M., M.Phil. &
Kristine M. Gebbie, Dr.PH, R.N.
Center for Health Policy, Columbia University School of Nursing
A Brief Overview
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Public Health Law Reform in the 21st Century
The Turning Point Statute Modernization
Project
The Turning Point Model State Public Health
Act
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Scope
Parameters
State Legislative Update
Assessing the Turning Point Act – Analyses
from Key Jurisdictions
Public Health Law Reform in the
21st Century
The Institute of Medicine,
The Department of Health and Human Services,
The Trust for America’s Health,
Dozens of State Legislators and Health
Departments,
The Turning Point Statute Collaborative,
and others agree . . .
Public Health Law Reform in the
21st Century
Public health law in the United
States is ripe for reform
Assessment of State Public Health Law
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Antiquated. Public health statutes are outdated and may fail to
reflect modern constitutional norms, public health and biological
sciences, individual and population ethics, and public health practices,
policies, and relationships
Unfocused. Public health law does not always articulate a clear
mission for public health, nor reflect core or essential public health
services.
Inconsistent and Complicated. Public health law is varied and
complicated, difficult for the public to comprehend, and challenging
at times for health officials to implement
Benefits of Public Health Law Reform
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Modernize and amend antiquated laws to keep pace
with scientific developments
Reflect modern constitutional, legal, and ethical
norms
Clarify public health legal powers and duties
Stimulate public health dialogue with policy makers
and communities
Improve communication and working relationships
within the public health system
Improve public health programs/outcomes
Risks of Public Health Law Reform
Statutory editions may change the landscape
of public health practice
 Changes in public health laws may add costs
without matching resources
 Statutory reform in state legislatures is
fraught with potential complications and
compromises
 Modernizing public health laws does not
assure improved public health practices
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State Public Health Law Reform
Despite the risks, the essential question
concerning public health law reform
among state law- and policy-makers is
not why, but how?
State Public Health Law Reform
“…the Nation’s public health infrastructure
would be strengthened if jurisdictions had
a model law and could use it regularly for
improvements.”
DHHS, Healthy People 2010
(similarly stated in IOM, Future of Public Health . . ., 2003)
Turning Point Mission
To transform and strengthen the
legal framework for the state public
health system through a
collaborative process to develop a
model state public health law.
Turning Point Timeframe
Phase I: State Public Health Law Assessment completed May 31, 2001
Phase II: Development of a Model Law completed August 31, 2003
Turning Point Model State Public Health Act released September 16, 2003
Phase III: Dissemination & Education ongoing
Core Collaborative Partners
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Alaska
Wisconsin
Colorado
Nebraska
Oregon
CDC
HRSA
APHA
ASTHO
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NACCHO
National Governors’
Association
National Conference of
State Legislatures
National Indian Health
Board
National Association of
Local Boards of Health
Institute of Medicine
The Turning Point Model State
Public Health Act
 Scope
 Parameters
 State
Legislative Update
 Case Studies in Specific States
The Turning Point Act - Scope
The Turning Point Act is the most
comprehensive model state public
health act ever produced in the
United States.
The Turning Point Act - Topics
Topics addressed within the Act’s 9 substantive
Articles include:
 Mission and Functions
 Public Health Infrastructure
 Collaboration and Relationships
 Public Health Authorities and Powers
 Public Health Emergencies (re: MSEHPA)
 Public Health Information Privacy (re: the
MSPHPA)
 Administrative Procedures, Criminal/Civil
Enforcement
The Turning Point Act –
What It Is
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Legislative provisions for states to use as a tool to
compare to their existing public health laws
Balance of community and individual interests to
protect the public’s health while respecting civil
liberties
Incorporation of an intersectoral public health
infrastructure
Essential public health services and functions that can
be used in a wide array of public health responses.
Attempt to incorporate modern scientific methods of
public health practice consistent with key policy
choices.
The Turning Point Act –
What It Is Not
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A mandate to states to improve their public health laws.
Design for a model state and local public health system.
An attempt to cover all areas of public health relevance
(e.g., mental health, substance abuse, environmental
health).
Specification of public health powers based on certain
diseases (e.g., HIV/AIDS, tuberculosis) or conditions (e.g.,
obesity, injuries).
The only acceptable policy choices for public health
practice.
The Turning Point Act –
Legislative Update
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The subject matter of the Act has been featured in over
110 different state legislative bills or resolutions
introduced in 33 states since January 1, 2003. Of
these bills, 44 have passed in 25 different states.
Many states have used or are using the Act (in whole or
part) to assess their existing state public health laws
(e.g., AK, AZ, CO, DE, MT, NE, MI, NM, OR, TN, WI)
Alaska HB 95, “An Act relating to the duties of the Dept
of Health & Social Services,” passed in June 2005, is
directly based on multiple provisions of the Act.
The Turning Point Act - States that have
Introduced Bills or Resolutions
WA
HI
VT NH
AK
MT
ME
ND
MN
OR
ID
SD
WI
WY
NE
NV
CA
UT
AZ
NM
KS
OK
TX
PA
NJ
DE
WV VA
MD
OH
IN
MO
KY
MA
RI
CT
DC
NC
TN
AR
SC
MS
MSEHPA
Introduced Bills
Total: 33 States
MI
IA
IL
CO
NY
AL
GA
LA
FL
PR - (Puerto Rico)
Data Current as of October 24, 2006
The Turning Point Act - States that have
Passed Bills or Resolutions
WA
VT NH
AK
MT
ME
ND
MN
OR
ID
SD
WI
WY
NE
NV
CA
UT
AZ
NM
KS
OK
TX
PA
NJ
DE
MD
OH
IN
WV
MO
KY
MA
RI
CT
DC
NC
TN
AR
SC
MS
MSEHPA
Passed Bills
Total: 25 States
MI
IA
IL
CO
NY
VA
HI
AL
GA
LA
FL
PR - (Puerto Rico)
Data Current as of October 24, 2006
Transforming National Collaboration into
State Legislation—A Comparative Case Study
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Justification – Assess how the Turning Point Act is
currently being used by state and local law- and policymakers in legislative and regulatory reform initiatives
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Scope – Describe the effectiveness of the Turning Point
Act as a means to promote public health through legal
reforms at the state and local levels
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Implications – Apply lessons learned from the Turning
Point Act experience to future state legislative reform
efforts
Public Health Law Reform Pursuant
to the Turning Point Act
METHODS
Case Study Method – Successes and Failures
Legislators, Bureaucrats, Advocates
Semi-Structured Interviews
Role in the legal/regulatory changes
Public health problems addressed by the changes
Obstacles to changes in state law and the strategies used to
overcome these obstacles
Subsequent changes in public health regulation, organization
or programs based on legal reforms
Expected changes in public health outcomes
Preliminary Conclusions—State
Political and Policy Efforts Matter
SOUTH
CAROLINA
ALASKA
WISCONSIN
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The Turning
Point
Experience
 Politicization
of Public
Health
 Top-Down
Reform
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Lack of an
External
Galvanizing
Force
Bureaucratic
Expansiveness
and the Risk
of Backsliding
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The Turning
Point
Experience
Stakeholder
Collaboration
Bottom-Up
Reform
Strong
Legislative
Champion
* Preliminary Results
Example—A Process Model of Successful
State Public Health Law Reform: Alaska
Stage I: The
Emergence and
Utilization of the
Turning Point Act
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Dominant Actors
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Key Forces
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Turning Point
Collaboration
Division of Public
Health
Stage II: The
Development of
Draft Law
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Agenda Setting
Model Developed
for Discussion of
Issue
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Public Health
Necessities
Political
State Law
Developed to
Pursuant to
Turning Point Act
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Legislators
Division of Public
Health
Executive Branch
Advocacy Groups
Key Forces
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Result
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Dominant Actors
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Division of Public
Health
Office of the
Attorney General
Key Forces
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Result
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Dominant Actors
Stage III: Legislative
Action
The Turning Point
Experience
Politicization of
Public Health
Executive
Prerogative
Result
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Reformed State
Public Health Law
Conclusions
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The Turning Point Act is a comprehensive model for state public health
authorities to assess their existing laws.
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The objective is to use law as a tool for targeted reform initiatives that
collectively seek to improve public health infrastructure and outcomes
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Different states have incorporated various parts of the Turning Point
Act into their law based upon individual, political, and institutional
factors.
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For more information, please see the Center for Law and the Public’s
Health website at: www.publichealthlaw.net/Resources/Modellaws.htm
or the Center for Health Policy website at:
http://www.nursing.hs.columbia.edu/research/ResCenters/chphsr/law_pubHealth.html.
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Thank you!