State Public Health Law Reform Assessing the Policy Impact of the Turning Point Model State Public Health Act Benjamin Mason Meier, JD, LLM, MPhil Columbia.
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State Public Health Law Reform Assessing the Policy Impact of the Turning Point Model State Public Health Act Benjamin Mason Meier, JD, LLM, MPhil Columbia University March 30, 2009 CENTER FOR HEALTH POLICY COLUMBIA UNIVERSITY Outline Background Framework Methods Results Analysis Implications/Limitatio ns Future Research Public Health Law Reform Law as a Determinant of Health Future of Public Health Public Health Law Reform Assessment of State Public Health Enabling Laws Healthy People 2010 “Public health “State lawNation’s inpublic thepublic “…the health laws are, health infrastructure United States would be strengthened in many cases, is ripe for if seriously jurisdictions had a model law and could reform” outdated…” use it regularly for improvements.” Turning Point Statute Modernization Collaborative 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.” The Turning Point Model State Public Health Act Phase I: State Public Health Law Assessment Phase II: Development of a Model Law Turning Point Model State Public Health Act released September 2003 Phase III: Dissemination & Education Turning Point Act - Topics Topics addressed within the Act’s 9 substantive Articles include: Mission and Essential Services Public Health Infrastructure Collaboration and Relationships Public Health Authorities and Powers Public Health Emergencies Public Health Information Privacy Administrative Procedures, Criminal/Civil Enforcement Turning Point Act - States That Have Introduced and Passed Bills or Resolutions Legislative Tracking States have used the Act as the basis for state public health law reforms Wisconsin Act 198, “An Act Related to Public Health,” is based on multiple articles /provisions of the Act Passed Bills: 26 Transforming National Collaboration into State Legislation—Study Design Natural Experiment Objectives - Assess the Impact of the Turning Point Act Compare how the Turning Point Act is used by policymakers in public health law reforms Describe the effectiveness of the Turning Point Act as a model for state law Apply lessons from the Turning Point experience to future reform efforts and empirical research Conceptual Framework Why Reasons for Reform (Grad 1990, Gostin 2000) Antiquated Unfocused Inconsistent How Process of Reform (Gebbie 1998, 2000) Stages Actors Forces Working Assumption Policy consideration of the Turning Point Act will differ in form, substance, and process according to: state political institutions, individual actors, and perceived imperatives in public health Methods - Comparative Case Study Comparative Method Individual Case Varied Responses to Studies the Same Model Informant Sample Case Selection – Wisconsin Congruence with the Alaska Turning Point Act Semi-Structured Interviews Nebraska Legal Analysis of Reforms in South Carolina Comparison with Model Act Legislators Bureaucrats Advocates Public health problems addressed by reforms Obstacles to reform Subsequent changes in public health programs Content Analysis Comparative Results – State Political and Policy Efforts Matter WISCONSIN ALASKA NEBRASKA ALASKA WISCONSIN NEBRASKA SOUTH CAROLINA SOUTH CAROLINA The Turning Stakeholder Lack of an The Turning Point Collaboration External Point Experience Lack of Galvanizing Experience Lack Stakeholder Legislative Force of an External Galvanizing Force Top-Down Collaboration Support Lack Stakeholder of Legislative Collaboration Support Bureaucratic Reform Top-Down Reform Bottom-Up Risk of Expansiveness Bureaucratic Expansiveness and the Republican Reform Backsliding and the Risk of Support for a Strong Selective Backsliding “Democratic Legislative Incorporation by Bill” Selective Strong Legislative Incorporation Champion byRegulation Regulation Champion Politicization of Public Health Politicization of NonPublic Health Politicization Non-Politicization Stakeholder The Point The Turning Turning Collaboration Point Experience Experience Risk Bottom-Up Backsliding Reform Risk ofofBacksliding Republican Support for a “Democratic Bill” Alaska—A Process Model of Successful State Public Health Law Reform Stage I: Emergence and Utilization of the Act Dominant Actors Turning Point Collaborative Division of Public Health Key Forces Agenda Setting Result Model Developed for Discussion of Issue Stage II: Development of Draft Law Dominant Actors Division of Public Health Office of the Attorney General Key Forces Public Health Imperatives Result State Law Developed Pursuant to Turning Point Act Stage III: Legislative Action Dominant Actors Legislators Division of Public Health Advocacy Groups Key Forces Politicization of Public Health Result Reform of State Public Health Law Analysis – Correlates of Reform Facilitators Gap Analysis Agenda Setting Key Partnerships Legislative Champions Public Health Ass’n Health Commissioner Inhibitors DOH Unaltered Model Language Lack of Impetus for Reform Turning Point Fear of Backsliding Act Completed Assembly Lack of Legal Chair Leadership Activist South Carolina Contributing Governor Department of Health Partner and Environmental Control Meetings Begin Assembly Bill 881 Introduced Analysis – Common Correlates Comparative Process Model – Stages of Reform, Principal Actors and Decisive Forces Actors Forces I. Utilization of the II. Development Turning Point Act of Draft Law Public Health Legal Counsel Partners III. Regulatory Action Legislative Champions Agenda Setting Advocacy Gap Analysis Leadership Implications / Limitations Resources to support future reforms Little understanding of current state of law Need for additional research on: State of Public Health Legislation Effect of Law on Performance Meier, Hodge & Gebbie (2007-2009) Transitions in State Public Health Law: Comparative Analysis of State Public Health Law Reform Journal of Health Politics, Policy and Law Report from the Field Alaska Public Health Law Reform Future Studies Competencies for Applying Law Gap Analyses for Public Health Law Reforms Relationship between Public Health Law Reform and Health System Performance Essential Services in Law (Meier, Merrill & Gebbie 2009) Law & Performance (Merrill, Meier, Keening & Gebbie 2009) Link between Public Health Law, Individual Health Behaviors, and Public Health Outcomes Conclusions States selectively codify provisions of the Turning Point Act based upon individual, political, and institutional factors. Additional research is necessary to determine the effect of these reformed laws. For more information on legislative tracking and comparative case studies, see: www.publichealthlaw.net/Resources.htm. Benjamin Mason Meier, JD, LLM, MPhil Columbia University [email protected] Case Selection – Congruence with the Turning Point Act Legislative Tracking SOUTH WISCONSIN NEBRASKA ALASKA CAROLINA 173 NAC 6 – Directed Alaska HB 95 – An Act Health Measures to of AB Norelating 881 Proposed – An Act Legislation or to to the Related duties Regulation Prevent orofLimit the& Public Health (March the Dept Health Spread Communicable SocialofServices (June 2006) Disease, Illness, or 2005) Poisoning (Feb. 2007) Passed Bills: 26 Legislative Tracking Little understanding of current state of law Passed Bills: 26