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Health Law
SUNY Buffalo Law School
Szczygiel, Anthony H.

Chapter 2
I.                   The Public Health System: Law and the Population’s Health
a.      Foundations of PH:
                                                               i.      History
1.      1798 – Marine Hospital
2.      1862- Bureau of Chemistry – FDA
3.      USPHS – Emerged in the early 20th century
a.       Cities
                                                                                                                                       i.      Sanitation
                                                                                                                                     ii.      Slums
                                                                                                                                    iii.      violence
b.      Industry
                                                                                                                                       i.      Working conditions
4.      New Deal expansion of federal public health
5.      1946 – CDC
6.      salus populi est suprema lax – the welfare of the people is supreme law
7.      Why do states have power?
a.       Democracy
b.      Collective action more effective
c.       Community has a stake
                                                             ii.      Health of Populations
1.      longevity and functionality of populations
2.      STIs, TB, HIV/AIDS
3.      PH seeks to ensure a favorable environment
                                                            iii.      Communities and Civic Responsibility
1.      Community – shares language, history and values
2.      what health risks exist in communities
a.       why do differences in health risks exist in different communities?
                                                                                                                                       i.      Socioeconomic status
                                                                                                                                     ii.      Race
                                                                                                                                    iii.      Behavior
                                                                                                                                   iv.      Sex
3.      attachment encouraged
                                                           iv.      Prevention
1.      interventions designed to avert the occurrence of injury or disease
a.       vaccination
b.      education
c.       fluoridation
d.      seatbelts, helmets
                                                             v.      Core functions of agencies
1.      prevent epidemics
2.      protect from environmental hazards
3.      promote healthy behaviors
4.      respond to disasters, help communities in recovery
5.      assure the quality and accessibility of health services
                                                           vi.      Essential Services of PH
1.      monitoring community health status
2.      informing and educating people about health
3.      enforcing health and safety legislation
4.      mobilizing community partnerships
5.      researching new insights/innovations
                                                          vii.      Sciences
1.      Epidemiology
2.      Biostatistics
b.      The Public Health System
                                                              i.      Institute of Medicine, The Future of the Public’s Health in the 21st Century
1.      Rise and Fall
a.       decreased awareness
2.      Issues that shape the nation’s health status
a.       Societal influences
                                                                                                                                       i.      Ascension of infections disease, chronic disease
b.      Systemic Issues
                                                                                                                                       i.      Government’s part in disarray
                                                                                                                                     ii.      Lack of funding, political backing
                                                                                                                                    iii.      Example: TB resurgence
3.      Changes Necessary
a.       population health approach
b.      backbone
c.       partnership
d.      accountability
e.       evidence
f.        communication
c.      The Population Focus

    Behaviorally appropriate
                                                                                                                                     ii.      Disadvantages
1.      Small benefit to each individual
2.      Small expectations
II.                The Legitimate Scope of Public Health
a.      Generally
                                                               i.      Politically contested terrain
                                                             ii.      Broad: focuses on underlying socio-economic determinates of health (poverty, homelessness, racism, violence, far).
                                                            iii.      Narrow: discrete government interventions to prevent the immediate causes of morbidity and premature mortality.
b.      Angus Deaton, Policy Implications of the Gradient of Health and Wealth
                                                               i.      The gradient of health and wealth is a relationship between socioeconomic status and health outcomes. It is deep, persistent, and cross cultural.
                                                             ii.      Recognizes that solely redistributing wealth will not solve any problems, that there are many factors that contribute to this gradient.
c.      John Lynch et al, Is Income Inequality a Determinant of Population Health? Part 1: A Systematic Review.
                                                               i.      Income is not a major determinant of public health. It may influence some health directly – homicide. But, giving the poor more money will improve their health and reduce inequalities – which is better for population health in the long run.
Richard Jackson & Chris Kochtitzky, Centers for Disease Control and Prevention, Creating a Healthy Environment: The Impact of the Built Environment on Public Health.