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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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.
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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
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
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 . . .
Public Health Law Reform in the 21st Century
Public health law in the United States is ripe for reform
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 Public health statutes are outdated and may fail to reflect modern constitutional norms, public health and biological sciences, individual and population ethics, and public health practices,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
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
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
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?
“…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
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.
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
ScopeParametersState Legislative UpdateCase Studies in Specific States
The Turning Point Act - Scope
The Turning Point Act is the most comprehensive model state public health act ever produced in the United States.
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
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.
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.
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.
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
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
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
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
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
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
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.