Public Health Bill Workshops

PHA February 2008

PHA workshops

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Help PHA make an excellent submission to Parliament

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Inform others about the Bill and encourage them to make submissions supportive of public health

Governments can: -

Fund things Have staff do things Talk up ideas Pass laws

Today

Pass laws

Legal context

Heath Act Mental Health (CAT) TB Burials & Cremation RMA, Biosecurity, Building, HSNO, LGA

Determinants of health

Health laws

Health Act / PH Bill Mental Health (CAT) Health and disability, Medicines HPCAA H&D Commissioner Radiation Protection SOL, SFE GA, …

Bill

Act, Bills and Regulations

a proposed law being considered by Parliament Act Regs a law passed by Parliament further detailed laws under a specific Act,

if that Act permits the making of such regulations

Achieving healthy public policy

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Parliament makes or changes laws MMP environment We have (and have had) minority governments

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Government alone cannot pass laws

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Role for minority parties

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Deals for support

Timing

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Select Committee must report back in 6 months (dec 07 + 6/12 = June 08)

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Election date?

Timing

SC has the options:

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Send to the vote advising yes

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Send to the vote with changes

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Send to the vote advising no

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Delay – needs more work

Purpose of the Bill

to improve, promote, and protect public health in order to help attain optimal and equitable health outcomes for Maori and all other population groups

The Public Health Bill

A law that propose the ways in which normal rights and freedoms can be bypassed to control risks to public health

Fundamental tension

The rights of individuals and businesses to go about their affairs free from interference and The rights of individuals and communities to be free from avoidable risks to health

Or – building community

Valuing the common good Sanctioning those who betray their fellows Enabling joint action for mutual good

Overview – context

1900 plague in Sydney NZ - 1901 Health Act Population and social changes 1956 Health Act TB Act 1948 Social and technological changes Public Health Bill

Social and technological changes • New and emerging health issues, eg non communicable conditions, SARS • New strategies to prevent ill-health, eg immunisation and screening • New technologies • Attention to human rights • RMA, Fair Trading Act, HSNO, LGA etc

International obligations

• International Health Regulations 1951, 1969 (yellow fever, cholera, plague) • Since then, globalisation, air-travel +++, SARS, avian influenza, radiation, chemical risks • Need to improve (world-wide and in NZ): – emergency management – border health control, – communicable disease management • New IHRs ‘all risks’ in scope

Human Rights

The Health Act 1956 shows its age • No attention to privacy issues • No procedural rights eg appeal or review for persons detained • Enhancing human rights can help support public health objectives

Legal context

Every sector should do its work safely Workplaces Health/Hospitals Roads Goods - OSH - H&D Services Safety, - HPCAA - Land transport - Fair Trading Regulation under health should be by exception.

New approaches needed

• ‘risk-based approach’ • human rights and consultation • international law

PH Bill

6 7 8 1 2 3 4 5 Roles Information Non-communicable diseases Conditions posing health risks TAs Regulated activities Emergencies and border health Miscellaneous

Maori references – purpose

(s 3) to improve, promote, and protect public health in order to help attain optimal and equitable health outcomes for Maori and all other population groups …aim to reduce health inequalities by improving health outcomes for Maori and other population groups

Maori references - NCDs

(s 80) … the Director-General must take into account the importance of-- … (d) the well-being and mutual interdependence of families and their communities, including whanau, hapu, and iwi: (g) Working towards social and cultural environments conducing to health and well being

Maori references – consultation re individuals (s 110, 131) If a medical officer of health is considering applying to the Court – the medical officer of health may, at his or her discretion, consult with the individual's family or whanau – Can an order be avoided by assistance on the part of the family or whanau;

Maori references – powers of entry and search Marae treated as private dwellings (s 255, 270, 306, 327) (s353) (1) Every entry and search power authorises the person exercising it-- (b) to request any person to assist with the entry and search (including, without limitation, a member of a hapu or iwi if the place to be entered is of cultural or spiritual significance to that hapu or iwi)

Improving health outcomes for Maori?

• Tiriti references?

• Consultation as in LGA and PHDA?

• Principled action to prioritise health of those most affected • What other things can be put into the law to improve health and increase health equity for Maori?

Equity - purpose

(s3) Statement of purpose –

optimal and equitable health outcomes for Maori and all other population groups

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aiming to reduce health inequalities by improving health outcomes for Maori and other population groups

Equity – principles NCDs

(s80) take into account – the health of communities – broad determinants of health – involving communities – consultation – mutual interdependence of families and communities, – health status of general population and communities: – social and cultural environments

Equity – objectives

(s 47) Cervical screening programme The objectives of the NCSP are to-- inform women and the community of the risks, benefits, and expected population health gains from participation in the NCSP

Equity – definitions

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(s4) public health

…health of all of the people of New Zealand; or a community or section of those people •

(s4) health impact assessment

… assess… health of a population or part of a population and the distribution • (s79)

risk factor

... incidence of non-communicable diseases in the general population or in communities or in sections of the general population or communities

Equity – questions

• Who will be most affected?

• Who will benefit the most?

• What other things can be put into the law to increase health equity?

• What is the evidence (references, please) that changing environments improves equity?

PH functions of DHBs

• Employ MOsH and HPOs • Monitor risks to public health • Assess (and report to the DG) those risks • Take steps to contain and manage those risks (where appropriate) (can arrange for another to do)

PH functions of DHBs

Lost opportunity to use WHO approach to the essential functions of public health

Essential PH functions according to WHO WPRO

Health situation monitoring and analysis Epidemiological surveillance/disease prevention and control Regulation and enforcement to protect public health

Essential PH functions according to WHO WPRO – ctd

Health promotion, social participation and empowerment Development of policies and planning in public health Human resources development and planning in public health

Essential PH functions according to WHO WPRO- ctd

Research, development and implementation of innovative public health solutions Ensuring the quality of personal and population-based health services Strategic management of health systems and services for population health gain

Information Part 2 Grab-bag of Subsidy compliance verification Cervical screening programme Notification Anonymous hospital data collection (now includes private hospitals) Disclosure to authorised authorities Blood collection(????) Retention of records

No principles Information Part 2 DG annual report on the state of the public health elsewhere DHBs may require a report on risks to health from TAs – but can be charged for it

Information Part 2 This is a lost opportunity to align • DHB obligation to do 3 yearly health needs assessment • TA obligation to survey the district for serious risks to health • TA obligation to 3 yearly report community outcomes

Conditions posing health risks

Privacy and individual rights vs Community right to protection Individual responsibility vs Political correctness

Notification (part 2)

a more flexible framework

• Case, condition, cluster or contaminant (s31) • Medical practitioner + labs+ others +/- vets (s 33-36) • Option for “temporary” status (s38) • “quarantinable “ becomes “epidemic”

Conditions posing health risks

Protects public health more • Allows examination on suspicion (s97) • Can have urgent orders (s106) • Offense to recklessly spread (s126)

Conditions posing health risks

New provisions for contact tracing – Authorises contact tracing where it doesn’t happen voluntarily (s138-149) – Medical practitioner / MOH may approach employers etc for contact details (s145) – Medical practitioner / MOH may disclose information on risks posed to them to sexual partners / household members (s 150-152)

Conditions posing health risks

Respects individual more (s92-93) • Gives a wide range of disease containment options (s95) • Requires use of least restrictive option (s91) • Strengthened safeguards – eg appeals (s112-123), time restrictions (s 96)

Your views

How should the balance between individual rights and community protection be reflected in law? How do we defend the rights of communities to be safe when there are those who trivialise the risks by saying that we are too politically correct?

What else should be included?

Balancing individual choice with supportive environments

- the dreaded Nanny State or sensible controls? Non-communicable diseases

Non-communicable diseases Commercial pressures vs Supportive environments Individual choice vs The nanny state

Non-communicable diseases

As proposed by Health Select Committee report on the inquiry into Obesity and Type II Diabetes

Non-communicable diseases

Non-binding codes and guidelines (s81-87) Incentive = awards Parliamentary report back – within 3 years, can be extended Can make regulations (s 374 x)

Your views

How should the balance between individual choice and supportive environments be reflected in law?

How do we defend the rights of communities to be free from health-harming commercial exploitation when there are those who say that the Nanny Sate has gone too far?

What else should be included?

Environments and Activities Commercial pressures vs Supportive environments Individual choice vs The nanny state

Environments and Activities •

an enabling regulatory framework

• Activity specific regulations (eg, camping grounds, funeral directors or needle and syringe exchange) • Regulations may set mandatory objectives and performance measures • Licensing by “Activity Consents” • Option for public health risk management plans

Environments and Activities • Restrictions proportionate to risks • Duties of operators to identify risks, take all practicable steps

P5 Role of Territorial Authorities

continuing their existing functions

• Duties to protect public health • Duties to abate nuisances • Duties to provide for Environmental Health Officers • Discretion re bylaws • Role with activities (consent authority & Assessors, subject to regulations) • Role with sanitary works

Territorial Authorities • Clarifies that Building Act, HSNO, LGA RMA take precedence unless “less appropriate” (s192) • “Nuisance” re-defined to be “injurious to public health”

Nuisances Gay’s interpretation Health law should only be used to control issues that have clear health risks to others Future proofing by allowing “nuisance” to cover unforeseen affairs likely to be injurious to public health

P7 Border health protection

Public health security

• Give effect to existing and future WHO obligations as specified in the International Health Regulations • Public health inspection of, and clearance for, travellers and craft • Health measures at the border, eg, screening, examination, quarantine etc

P7 ctd Public health emergencies • Provisions for public health action to protect the community • Builds on and dovetails with other key statutes, eg CDEM Act, Epidemic Preparedness Act • Flexible provisions for Minister declarations and for emergency regulations.

P8 Miscellaneous • HIA – non mandatory • Entry and inspection • Examination of children • Compliance orders • Incorporation by reference • Search warrants • etc

HIA (s 324-325) • HIA defined broadly • ..if undertaken …have regard to any criteria specified by the Director-General • copy … must be supplied to the DG

Examination of children now (HA s 125) Person authorised…may at all reasonable times enter any public school or child care centre and examine the children attending the school or centre, and may notify the parent or guardian of any such child … of any condition which in his opinion is affecting the health or normal development of the child or of any disease or defect from which in his opinion the child may be suffering.

Examination of children proposed (PHB s 328) A person aged under 16 years may not be examined, tested, or screened unless the parent …has given …consent.

If consent not obtainable or refused… and child may have a significant health condition that requires further investigation … may advise the parent and refer the child for further investigation

Examination of children Now (HA s 125) Enables population screening Proposed (PHB s 328) Restricts to “significant health condition” -? Hunting for abuse and neglect?

? Follow option of cervical screening and have “opt out”?