March 09, 2021

There is No Public Health without the Law

By Montrece McNeill Ransom

What is “Public Health Law”?

Teachers are critical partners in expanding society’s understanding of public health, our system of government, and the law. Public health law offers expansive opportunities for diverse students to have meaningful experiences with each of these topic areas, and many more. Public health law governs the authority of Federal, state, tribal, local, and territorial governments to protect the population’s health in the United States. Public health law further protects individuals’ autonomy, privacy, liberties, proprietary information, and other legally protected interests. Therefore, action using public health legal authority, whether in emergency or routine situations, must consider both the needs of the population as whole, and the interests of individuals. This balancing act of individual rights must at times give way to the common good, a process best stated by Justice Harlan in the seminal case of Jacobson v. Massachusetts: “[t]here are manifold restraints to which we are all necessarily subject for the common good.”

Current examples of public health laws include the following:

  • The United States Code gives the United States Department of Health and Human Services the authority to prevent the transmission of communicable disease in the United States.
  • State laws give the Governor the authority to enforce isolation or quarantine order to prevent the spread of COVID-19 or another infectious disease.
  • State laws require vaccinations to ensure “herd immunity” against infectious disease, with limited exceptions.

There is no public health without the law. Law is a tool that has been used to advance public health goals for centuries. Consider the 10 Public Health Achievements of the 20th Century, which include advancements in vaccinations, maternal and newborn health, heart disease and stroke, seatbelt laws, and safer drinking water.

A Sailboat Analogy  

There are three main types of law that govern public health: constitutions, statutes and regulations, and case law. Public health law can be further organized into two major categories or domains: foundational and interventional. Foundational public health law is the legal authority for public health action, sources of law, and constitutional principles. Interventional public health laws include specific laws implemented and enforced by public health practitioners to promote and protect the public’s health.

Public health law can be likened to a sailboat. The hull forms the foundation of the sailboat. Without it, there is no footing, structure, or base. The sails are used to power the sailboat, and the rudder guides it in the right direction, keeping the boat on the right course toward its destination. Similarly, foundational public health laws—which consist of constitutional frameworks and legal authorities for public health practice—form the base of the system in which public health practitioners operate. Interventional public health law can be used to steer society toward better health choices and change the context in which people live, learn, play, worship, work, and age. It has been said that public health law can deliver a public health intervention to hundreds of thousands of individuals with the stroke of a pen. Examples of interventional public health laws include emergency quarantine laws, clean indoor air ordinances, and prescription drug monitoring.

Public Health Law in the Time of COVID-19

On March 9, 2020, Governor Mike DeWine of Ohio signed an Executive Order declaring a State of Emergency, and on March 12, Ohio became the first state in the United States to close schools in effort to stop the spread of SARS-CoV-2 (commonly known as COVID-19). States across the country quickly followed suit as the impact of the virus became dire. DeWine and other governors used public health laws to balance the needs of individuals (e.g., employers, employees, students) against the urgent need to protect the health of the community, particularly the states’ most vulnerable citizens.

The COVID-19 pandemic has raised a host of foundational public health law-related constitutional questions about the distribution of power among Federal, state, and local governments, and how state and local governments can use their police powers to implement and enforce social distancing policies. Legal issues related to the use of quarantine and isolation, civil liberties and human rights, data sharing and privacy, and vaccination requirements, are just a few of the interventional law related issues that public health practitioners are dealing with in response to the worst pandemic in history.

The pandemic has also highlighted significant health inequities in the United States and across the globe.  Minorities and underserved groups (e.g., race, low-income, immigrants) have been disproportionately impacted by the virus. These groups are particularly vulnerable because of our system of existing laws and policies that impact the fundamental drivers of health inequities. The law, our legal systems, and legal structures exert a powerful influence on health through a structure that perpetuates inequities across the social determinants of health: education, food, housing, income, employment, sanitation, and healthcare access.

What can Teachers do?

To understand the role of teachers in this area, we can return to the sailboat analogy. A sailboat needs a variety of players—a captain, officers, sailors, a deck crew, and maintenance workers—with multiple skillsets to move it forward. Public health and public health law need a similar variety of players. Lawyers, public health practitioners, healthcare providers, community-based organizations, businesses, teachers, and students all play a role, individually and collectively, in ensuring conditions that allow all to live healthy lives.

When students, regardless of grade level, learn principles of public health and public health law, they learn a broad range of 21st century skills that encourage success in any work environment, and in their daily life. These skills include communication, collaboration, innovation, leadership, problem solving, cultural competency, social consciousness, and technology.

Today’s public health challenges are daunting: an increasing aging population, the burden of the social determinants of health leading to increased mortality and morbidity from chronic and other noncommunicable diseases; national disasters; the opioid epidemic; the health impacts of climate change and environmental pollution; and the rapid transfer of infectious pathogens that create the potential for more—and deadlier—global pandemics.

Including elements of public health and public health law in school curricula, specifically in programs for high school students, presents opportunities to promote math, scientific, and health literacy. Studying these topics can empower students to be scientifically literate, engaged participants in the democratic decision-making process concerning public health law and policy, can expose students to epidemiology (the basic science of public health which provides a practical and relevant context for teaching science and mathematics), and can serve to highlight the myriad career opportunities within the field of public health. 

This integration of public health and public health law into high school curriculum may, perhaps, be more important now than ever before. Numerous indicators point to this conclusion: the need for additional trained professionals in the public health workforce; insufficient diversity in the public health workforce; an increasing number of undergraduate and masters programs focused on public health; increasing expectations of public health practitioners as the field grapples with core public health and public health law issues in the wake of the COVID-19 pandemic in the United States and around the world; and an alarming socio-economic disparity in access to healthcare information and services, and health outcomes.

Tools for Teachers

To help build the next generation into one that is healthier, readily available to contribute to the community’s well-being, prepared and interested in becoming part of the future public health workforce, and more civically engaged, it will take an all-hands on deck approach. For teachers who are interested in integrating public health or public health law activities or lessons into their curriculum, here are a few resources:

The Public Health Law Academy (PHL Academy), supported by ChangeLab Solutions and the Public Health Law Program at the Centers for Disease Control and Prevention (CDC), are free and easy to use online trainings that provide an essential understanding of the use of law and policy to improve public health outcomes.

CDC’s Teacher Roadmap is a collection of resources for educators wishing to teach classes, units or entire courses in epidemiology and public health sciences.  

Teaching Tomorrow’s Disease Detectives: Science skills for the problem-based world is a series of various educational activities, collectively designed to help students learn and practice public health and epidemiology skills, like disease detectives, that they can also apply to their daily life.

Public Health 101 is an online training and toolkit from the Rocky Mountain Public Health Training Center that might be a helpful tool for teachers. It introduces public health topics in a micro-learning format which consists of short, animated videos, and offers resource guides, videos, articles, and additional learning resources.

Leadership Training in Public Health Law is an online training developed by the Western Region Public Health Training Center. This training focuses on defining, understanding, and accessing public health law, and reviews tools to navigate and implement public health law, and describes the source and scope of public health legal authorities.

Introduction to Public Health Law for High School Students: Super Duck Flu is a course is designed to introduce high school students to the role of law in public health, the legal authority for public health activity, and key legal issues associated with high-visibility public health functions. The course includes a slide presentation and exercises to engage students actively in thinking about public health law. The Instructor’s Guide provides materials and steps for teachers to successfully deliver “Introduction to Public Health Law” to students.

 

Montrece McNeill Ransom, JD, MPH is a public health lawyer, executive leadership coach, and currently serves as the Director of the National Coordinating Center for Public Health Training. In 2017, Montrece was honored with the Jennifer Robbin’s Award for the Practice of Public Health Law, the 2019 Awardee of the ABA Health Law Section’s Champion of Diversity and Inclusion Award, and is the editor of the forthcoming Springer textbook, Public Health Law: Concepts and Case Studies.