john q. wong, md, msc 28 july 2009. gostin lo. public health law: power, duty, restraint....
TRANSCRIPT
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John Q. Wong, MD, MSc28 July 2009
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Gostin LO. Public Health Law: Power, Duty, Restraint. University of California Press, Canada: 2000.
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Theory and definition of public health law (PHL)
Systematic evaluation of public health regulations
Evaluation of the Philippine Tobacco Regulation Act
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Medical jurisprudenceLegal aspects of the application of
medical and surgical knowledge to individuals
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PHL is the study ofThe legal powers and duties of the state
To assure the conditions for people to be healthy and
The limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for the protection or promotion of community health
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Government Populations Relationships Services Coercion
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GovernmentResponsible for PH
PopulationsFocus of PH
RelationshipsBetween the state and the populationBetween the state and individuals who
place themselves or the community at risk
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ServicesProvision of population-based services
grounded on the scientific methodologies of PH
CoercionPower to coerce individuals and
businesses for the protection of the community rather than relying on an ethic of voluntarism
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Primacy of government in the constitution
Obligations of government Governmental health regulation in
history and practice
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Medicine Why did this patient get this disease at this time? Example
Causes of death are cancer, heart disease, CVD, and pulmonary disease
PH What can we, as a society, do collectively to
assure the conditions for people to be healthy? Example
Causes of death are environmental, social, and behavioral factors
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Benefits and burdens placed by government on legally protected interestsAutonomyLibertyPrivacyProperty
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Mission Core functions Essential services Leading indicators
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Protecting and preserving community health is not possible without constraint of a wide range of private activities
Private actors have incentives to engage in behaviors that are personally profitable or pleasurable but may threaten other individuals or groups
Examples Individuals with STDs Polluting industries Unsafe or unhygienic products
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Paradox To act affirmatively to promote the health of the
people But cannot unduly invade individuals’ rights in the
name of the communal good Overreaching regulation
Minimal health benefit with disproportionate human burdens
Tension Voluntarism and coercion Civil liberties and public health Discrete (or individual) threats and aggregate
health outcomes
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‘That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others…’
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Public health activity Public benefits Private interests/ rights
Prohibition of behavior - smoking in public places
Protect health and safety of person or others by restricting risk behaviors
Personal autonomy and freedom of action
Product design - product (cigarettes) liability under tort law
Prevent injuries by regulation or incentives for safer product design, and compensate injured persons
Freedom of contract (manufacturer-consumer), business interests, property uses, consumer costs
Informational constraints - labeling requirements
Restrict content of commercial messages that encourage harmful behavior, provide consumer information to avoid hazards
Freedom of speech, freedom of press, business and property interests
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Public health activity
Public benefits Private interests/ rights
Youth access restrictions - cigarettes
Reduce health and safety risks among children and adolescents
Autonomy of youth, spill-over effects in denying access to adults
Taxation - cigarettes
Reduce demand for hazardous products by price increases, create disincentives or incentives to promote healthier behavior
Consumer costs, business and property interests, and possible fairness problem with regressive taxation
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Risk to othersthe ‘harm principle’
Protection of incompetent persons ‘best interests’
Risk to selfSelf-regarding behaviorMotorcycle helmets, gambling
prohibitions, fluoridation of drinking water
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Nature of the risk Duration of the risk Probability of harm Severity of harm
Inverse correlation with probability of harm
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Social valuesShould popular judgment trump science?PH should account for traditional values of
Voluntarism Personal benefit Fair distribution of risk
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Risk-risk trade-offsDecreasing one risk increases anotherExamples
Chemical disinfection reduce risks of water-borne infection but increase risks of cancer
Universal precautions in hospitals decrease risks of blood-borne infections but increase costs and reduce access
Nuclear power regulation reduces radiation risk but increases hazards due to coal- or oil-based energy
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Government should demonstrate, through scientific data, that the methods of regulation adopted are reasonably likely to achieve public health objective
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Agency resources to devise and implement the regulation
Costs to individuals and businesses subject to the regulation
Lost opportunities to intervene with a different, potentially more effective, technique (opportunity costs)
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Inordinate costs for small health benefitsLow cost-effectiveness
Regulation carried to illogical extremesGoing the last mile
Arbitrary selection of regulatory topicsRandom agenda selection
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The least restrictive alternative Criteria
Invasiveness To what extent does it intrude on rights
Frequency and scope One person, a group, or an entire population
Duration How long is the infringement
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Just distribution of benefits, burdens, and costs
RuleProvide services to those in need Impose burdens and costs on those who
endanger the PHAvoid under- and over-inclusiveness
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Systematically evaluate the Philippine Tobacco Regulation Act using Gostin’s criteriaDraw a conclusion as to whether or not it is
a ‘fair’ law. Conclusion has to be supported by evidence.
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Mechanics New groups3 pages, 1” margin minimum, Times New
Roman 12”, single spaceDue 5 Aug 2009 by email