QUESTION ONE

This Paper will discuss public administration and it affects health in relation with Parliament, Legal
System and the Judiciary.

Parliamentarians have the power to collaborate and build partnerships with relevant stakeholders to
achieve the health-related MDGs, working closely with governments, civil society, local
communities, health care professionals, academics and research institutions, multilateral
organizations, global funds and foundations, the media and the private sector. The Inter
Parliamentary Union also recommended to all parliamentarians to closely monitor the domestic
implementation of international, regional and national human rights instruments so as to ensure that
all health-related obligations and recommendations, including those under the Universal
Declaration of Human Rights, CEDAW, the CRC and the Convention on the Rights of Persons with
Disabilities, are fully implemented and respected by all levels of government, and calls upon
parliaments to participate in the deliberations of the UN Committee on the Elimination of
Discrimination against Women and the Committee on the Rights of the Child, and to seek the
support of the IPU Coordinating Committee of Women Parliamentarians.

Parliaments can request annual updates on the steps taken by their governments to implement
international human rights instruments and programmes related to health and gender equality;
parliaments to see to it that national health policies and strategies incorporate a gender perspective,
and that education of health care workers and research take full account of the existing gender
differences in health

Parliaments have the power to introduce or amend legislation to guarantee equal access to health
services for all women and children without discrimination, and to provide essential health services
that are free at the point of use for all pregnant women and children; parliaments to use the
oversight and accountability tools at their disposal throughout the budgetary process, as well as
innovative financing approaches, to ensure that adequate domestic financial resources are allocated
for sexual, reproductive, maternal, newborn and child health, which should include funding
commensurate with the gap between existing resources and those necessary. parliaments to further
enhance support for education in order to improve long-term health outcomes and to promote social
participation. parliaments to advocate for lines in the health budget to be earmarked for the
provision of essential sexual, reproductive, maternal, newborn and child health services to
vulnerable women and children, including those in the poorest households, those living in rural
areas, those who are members of indigenous communities or minority groups, those with
disabilities, those living with HIV/AIDS, and adolescent girls; parliaments to ensure that
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parliamentary committees entrusted with monitoring issues pertaining to health and gender equality
are adequately resourced and operational.

Calls upon Member Parliaments, in particular those of the G8 countries, to use the oversight and
accountability mechanisms at their disposal to monitor the fulfilment of financial commitments
made towards health initiatives in the least developed countries; Calls upon parliamentarians to
scrutinize all government health interventions to ensure they are, as far as possible, evidence-based,
conform to international human rights standards, and are responsive to regular and transparent
performance reviews. parliaments to explore innovative approaches to health service design and
delivery, including the use of information and communications technologies such as tele-medicine
and mobile phones, in order to reach women, children and adolescents in remote areas, to facilitate
emergency responses to births, and to collect and disseminate health information as widely as
possible in accessible formats to women with disabilities, and to ensure sex education.

Although not always perceptible, law is all around us. The most common definition of law is a body
of norms (or rules of conduct) of binding force and effect, specified and enforced by a recognised
authority. Law is used to create rights and duties, which should be applied fairly and consistently
throughout society. Once implemented, people experience the effects of law every day, as it shapes
their lives through the enforcement of legal standards and accompanying policies. This
understanding of law is best illustrated at the domestic level, where the recognised authority is the
sovereign state—the supreme authority within that territory. Because nation states have

sovereign authority, they can enact and enforce laws. However, no sovereign authority exists at the
international level, and the law requires states to agree to the terms of the legal instrument. Even
when governments do assent to international agreements, these can be hard to enforce.

Nevertheless, international legal norms remain essential for advancing health rights.

Domestic and international law are interrelated and bidirectional in their impact on health and
justice. Innovations in domestic law and policy can offer a model for other cities, countries, or
regions to follow, or have a global effect; high-impact litigation in one jurisdiction can empower
advocates in other jurisdictions to undertake similar action. International law, in turn, influences
domestic law and policy by creating widely accepted standards. Domestic legal norms diffuse to
other jurisdictions and up to international institutions, while international norms diffuse down to
influence local and national laws, regulations, and policies.

Public Policy. This term refers to the broad arena of positions, principles, and priorities that inform
high-level decision making in all branches of government, but is often used to refer collectively to
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laws, regulations and rules, executive agency strategic plans, executive agency guidance
documents, executive orders, judicial decisions and precedents. Many public policies are not laws,
but may have help change norms and behaviors in health. Each branch of government—executive,
legislative, and judicial—makes contributions to public policy.

Laws: Statutes and Ordinances. These are usually originated by the legislative branch of
government (e.g., Congress, state senate or assembly, city council). Under the federal and most state
constitutions, laws are not finalized until signed by the chief executive officer (e.g., president,
governor, mayor). Laws require conformance to certain standards, norms, or procedures.

Regulations. These are rules, procedures, and administrative codes often promulgated by the
executive branch of government, such as federal or state agencies, to achieve specific objectives or
discharge specific duties. These are applicable only within the jurisdiction or toward the purpose for
which they are made. Laws authorize administrative agencies to promulgate regulations.

Constitutional history and judicial precedents. These refer to the judiciary’s interpretation of the
Constitution, laws, and regulations, including case law from prior judicial opinions.

The primary reason for the existence of government is to provide for the health, safety, and welfare
of the people (Gostin, 2010; Lopez and Frieden, 2007). In the United States, governmental public
health responsibilities and roles exist at three different levels: federal, state/tribal, and
local/municipal.

The fundamental division of responsibility among these levels is defined by the fact that the
Constitution leaves untouched the states’ sovereign power (sometimes called “police powers,”
discussed below) over most health issues and limits the role of the federal government primarily to
(1) regulation of foreign and interstate commerce issues—and by extension, health issues and
threats that could affect commerce, and (2) the power to tax and spend for the public welfare
(Gostin, 2010; Grad, 2005). Refers to authority of state to enact laws, promulgate regulations, and
adjudicate to

(1) Protect, preserve, and promote

• Health

• Safety

• Morals

• General welfare
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(2) Restrict private interests (within limits set by federal and state Constitutions):

• Personal interests—Autonomy, privacy, association, expression, liberty

• Economic interests—Contractual freedom, property uses, pursue trades and occupations

The 10 Essential Public Health Services

1. Monitor health status to identify and solve community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships and action to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the provision of health care when
otherwise unavailable.

8. Assure a competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population based health
services.

10. Research for new insights and innovative solutions to health problems

The considerations brought forth in this chapter regarding critical needs in public health, such as
updating or modernization of statutes and modification of public health infrastructure, clarify the
need for dedicated legal counsel to serve as advisor to the agency and its leadership. Having
dedicated in-house legal counsel is the gold standard in legal and policy capability, and ideally,
counsel would serve the entire department, and preferably report to the health officer as opposed to
the mayor or other executive (Monroe, 2010; Stier, 2010). However, the committee recognizes that
an agency’s ability to retain and make the most use of in-house counsel depends on an agency’s
size, resources, and agenda (e.g., does it have a policy orientation, or is it more intensely involved
in service provision?).

Legal counsel to a public health agency helps the agency carry out the core functions of
“assessment, policy development, and assurance” as set forth in the agency’s enabling statutes,

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which typically focus on the agency’s role of mitigating morbidity and mortality (Lopez and
Frieden, 2007).

Forty years ago, if anyone had asked what the impact of the judicial system was on public
administration, many lawyers probably would have been a little puzzled, but soon would have
responded that at least they were not aware of any real impact. Until ten or fifteen years ago, about
the only public administrators regularly troubled with court review were regulatory agencies
functioning in a structured system of advocacy considering primarily economic matters such as rate
making. Nonetheless, the absence of court involvement in the day-to-day activities of public
administrators for years does not necessarily indicate that agency processes ran so well that no
review or restraints were necessary. The absence of a phenomenon does not tell you why that
phenomenon is absent.

In conclusion even where courts have intervened in the administrative process over the last forty
years, the impact was not universally viewed as constructive or positive. Those who were subject to
the delays and burdens of court review would have been quite pleased to have eliminated the
requirements of hearings, written opinions, evidence in the record and procedural due process - not
to mention the second-guessing on the merits that sometimes occurred. However, until recently,
many areas, such as prisons, were regarded by the courts as involving "mere housekeeping" matters
and remained largely untouched by judicial review. Even in criminal law - clearly a field of law that
contemplates an active role for the judiciary - only a small part of the administrative process ever
saw the light of a courtroom. Eighty-five percent of all federal defendants are still sentenced after
plea bargaining without "judicial" determination of their allegedly criminal activities.Scholars in the
1960's rediscovered this wide discretion of the police, prosecution and prison officials, which had
always affected the freedom of individuals.

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REFERENCES

Gostin, L. O., B. E. Berkerman, and J. Kraimer. 2008. Foundations in Public Health Law.

Edited by International Encyclopedia of Public Health. Vol. 2. San Diego: Academic Press.

Grad, F. P. 2005. Public Health Law Manual. Third ed. Washington, DC: American Public

Health Association.
K. DAvis, DIscRETIONARY JUSTICE (1969); Goldstein, Police Discretion Not to Invoke the
Criminal Process: Low-Visibility Decisions in the Administration of Justice, 69 YALE L.J. 543
(1960).
Lopez, W., and T. R. Frieden. 2007. Legal counsel to public health practitioners. In Law in Public
Health Practice, edited by R. A. Goodman, R. E. Hoffman, W. Lopez, G. W. Matthews, M. A.
Rothstein, and K. L. Foster. New York, NY: Oxford University Press. Pp. 199-221.

Monroe, J. 2010. (May 18). Authorities, Organization, and Key Issues in (and Between) Federal,
State, and Local Public Health Agencies. Presentation fo the IOM committee on Public Health
Stategies to Improve Health.Washington, DC: IOM.

Stier, D. 2010. (May 18). Authorities, Organization, and Key Issues in (and Between) Federal,
State, and Local Public Health Agencies. Presentation fo the IOM committee on Public Health
Stategies to Improve Health. Washington, DC: IOM.