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Modernizing Public Health Laws in the 21 st 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

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Page 1: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

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

Page 2: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

A Brief Overview

Public Health Law Reform in the 21st Century The Turning Point Statute Modernization

Project The Turning Point Model State Public Health

Act Scope Parameters State Legislative Update

Assessing the Turning Point Act – Analyses from Key Jurisdictions

Page 3: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

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 . . .

Page 4: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Public Health Law Reform in the 21st Century

Public health law in the United States is ripe for reform

Page 5: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Assessment of State Public Health Law

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 Public health statutes are outdated and may fail to reflect modern constitutional norms, public health and biological sciences, individual and population ethics, and public health practices,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

Page 6: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Benefits of Public Health Law Reform 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

Page 7: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

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

Page 8: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

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?

Page 9: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

“…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)

State Public Health Law Reform

Page 10: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Turning Point MissionTurning 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.

Page 11: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Turning Point TimeframeTurning Point TimeframePhase 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

Page 12: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Core Collaborative Partners

Alaska Wisconsin Colorado Nebraska Oregon CDC HRSA APHA ASTHO

NACCHO National Governors’

Association National Conference

of State Legislatures National Indian

Health Board National Association

of Local Boards of Health

Institute of Medicine

Page 13: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

The Turning Point Model State Public Health Act

ScopeParametersState Legislative UpdateCase Studies in Specific States

Page 14: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

The Turning Point Act - Scope

The Turning Point Act is the most comprehensive model state public health act ever produced in the United States.

Page 15: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

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

Page 16: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

The Turning Point Act – What It Is 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.

Page 17: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

The Turning Point Act –What It Is Not

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.

Page 18: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

The Turning Point Act – Legislative Update

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.

Page 19: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

CACA

OROR

WAWA

IDID

MTMT

TXTX

SDSDWYWY

NVNV

OKOK

KSKS

NENE

COCO

NMNMAZAZ

UTUT

NDND

SCSC

MNMN

WIWI

IAIA

MOMO

ARAR

LALA

VAVA

NCNC

GAGA

FLFL

ALALMSMS

ILILWVWV

KYKY

TNTN

NYNY

PAPA

ININ OHOH

MIMI

DEDENJNJ

CTCT

MEME

DCDC

MDMD

NHNHVTVT

PR - PR - (Puerto Rico)(Puerto Rico)

HIHIAKAK

The Turning Point Act - States that have Introduced Bills or Resolutions

RI

MA

MSEHPAIntroduced BillsTotal: 33 States

Data Current as of October 24, 2006

Page 20: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

CACA

OROR

WAWA

IDID

MTMT

TXTX

SDSDWYWY

NVNV

OKOK

KSKS

NENE

COCO

NMNMAZAZ

UTUT

NDND

SCSC

MNMN

WIWI

IAIA

MOMO

ARAR

LALA

VAVA

NCNC

GAGA

FLFL

ALALMSMS

ILILWVWV

KYKY

TNTN

NYNY

PAPA

ININ OHOH

MIMI

DEDENJNJ

CTCT

MEME

DCDC

MDMD

NHNHVTVT

PR - PR - (Puerto Rico)(Puerto Rico)

HIHIAKAK

The Turning Point Act - States that have Passed Bills or Resolutions

RI

MA

MSEHPAPassed BillsTotal: 25 States

Data Current as of October 24, 2006

Page 21: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Transforming National Collaboration into State Legislation—A Comparative Case Study JustificationJustification – Assess how the Turning Point Act is

currently being used by state and local law- and policy-makers in legislative and regulatory reform initiatives

ScopeScope – Describe the effectiveness of the Turning Point Act as a means to promote public health through legal reforms at the state and local levels

ImplicationsImplications – Apply lessons learned from the Turning Point Act experience to future state legislative reform efforts

Page 22: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Public Health Law Reform Pursuant to the Turning Point Act

METHODSMETHODS Case Study MethodCase Study Method – Successes and Failures Legislators, Bureaucrats, AdvocatesLegislators, Bureaucrats, Advocates Semi-Structured InterviewsSemi-Structured Interviews

Role of the informant 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

Page 23: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Preliminary Conclusions—State Political and Policy Efforts Matter

ALASKA

The Turning Point Experience

Politicization of Public Health

Top-Down Reform

WISCONSIN

The Turning Point Experience

Stakeholder Collaboration

Bottom-Up Reform

Strong Legislative Champion

* Preliminary Results

SOUTH CAROLINA

Lack of an External Galvanizing Force

Bureaucratic Expansiveness and the Risk of Backsliding

Page 24: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Example—A Process Model of Successful State Public Health Law Reform: Alaska

Stage I:Stage I: The Emergence and

Utilization of the Turning

Point Act Dominant Actors

Turning Point Collaboration

Division of Public Health

Key Forces Agenda

Setting Result

Model Developed for Discussion of Issue

Stage III:Stage III: Legislative Action

Dominant Actors Legislators Division of Public

Health Executive Branch Advocacy Groups

Key Forces The Turning Point

Experience Politicization of

Public Health Executive

Prerogative Result

Reform of State Public Health Law

Stage II:Stage II: The Development of

Draft Law Dominant Actors

Division of Public Health

Office of the Attorney General

Key Forces Public Health

Necessities Political Efforts

Result State Law

Developed to Pursuant to Turning Point Act

Page 25: Modernizing Public Health Laws in the 21 st Century: The Impact of the Turning Point Model State Public Health Act on State Legislative Reforms James G

Conclusions

The Turning Point Act is a comprehensive model for state public health authorities to assess their existing laws.

The objective is to use law as a tool for targeted reform initiatives that collectively seek to improve public health infrastructure and outcomes.

Different states have incorporated various parts of the Turning Point Act into their law based upon individual, political, and institutional factors.

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.

Thank you!