Public Health Law and Ethics: Lecture Note

Lecture Note PUBLIC HEALTH LAW & ETHICS
Public Health Law

and Ethics
Lecture Note
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Specific objectives
.By the end of this unit you should be able to:
● Define and describe the Ethics and law.

● Describe the purpose & function of law.
● Identify core principles of Ethics in health care.
● To explain tort action role in public health.
● Give a definition Public Health Law and Ethics.
● To explain the role of Criminal Law in Public Health.
● To discuss Law and governance for health.
● Outline strategies Public Health Law for preventing and controlling the spread of infectious
diseases.
● Describe International Health Law.
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Course Units
● Unit 1: Ethics and Law definition. ......................................................................Page 4 -10
● Unit 2: Tort Law. ......................................................................Page 11 -15
● Unit 3: Public Health Law and ethics.....................................................................Page 15 -20
● Unit 4 Public Health Law and controlling Disease............................................. Page 21 -29
● Unit 5: Environment and health threats ............... ..............................................Page 30 -33
● Unit 6. Health Policy. .......................................................................Page 5 -10
● Unit 7: Role of the Law and governance for health ............................................Page 5 -10
● Unit 8: The Right of Health. ....................................................................Page 5 -10
● Unit 9: International Health & Travel Medicine ...........................................Page 5 -10
● Unit 10: International Health Regulations. .....................................................Page 5 -10
Introduction
Health has long been and is increasingly a concern of all people as citizens of the world,
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as citizens of sovereign nations, as participants in the endeavours of the field of social

welfare/social development, and as professionals engaged directly or indirectly in
various roles in the human services.
The health extension service is being provided as a package focusing on preventive

health measures targeting households at the National level. A new cadre of health
namely health extension package workers are undergoing training to take
responsibilities in implementing health extension programme.
The delivery of a meaningful health service can only be successful when accompanied by
sound principle of Health Ethics and adequate knowledge of health laws related to
health service delivery system. The issue of human rights-personal, civic and those that
are international in scope has been brought often to the public’s attention in the past
several years.
Routinely in public health, scientific considerations blend with political and ethical
conflicts, and questions of autonomy, individual rights, coercion, justice, community, the
common good, the norms of research, and multi-cultural values are central.
In public health today several different types of political and moral theory overlap,
converge, and contend with one another.
Public health policy and interventions is always the product of controversy, and often
remain surrounded by controversy as they are implemented.
There is a growing interest in the ethical, legal, and social

aspects of public health policy and practice
Unit 1
Ethics and Law definition,
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Characteristics,
Principles and types
Introduction
Ethics have common features in different countries. However, each country adopts certain
modifications according to prevailing local culture, religious beliefs, social norms and standards
of public health practice.
“Ethics is the branch of philosophy that dealing with what is good and bad, with moral duty
and obligation”. Also it’s the science of human duty in terms of what is right and wrong, true or
false.
Ethics can be defined is to:
“The philosophical study of the moral value of human conduct and the rules that govern
it”
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Morality “refers to norms about right and wrong human conduct that are so widely shared that
they form a stable social consensus”
As morals and ethics of society in general are changing, health care ethics merely reflects and
absorbs this change. It is obvious, therefore that this lecture note of Public health Ethics and
laws for health extension package workers will require periodic review based on social, health
and legal progress.
The practical manifestations of ethics relates to codes of normative behaviour for
society and an awareness of issues within society that have moral importance .
Importance of Ethics
❖ To help health professional identify moral and ethical issues,
❖ To know what is right and wrong about what should and should not be done.
❖ To know and respect the issues of human rights, personal and civic.
❖ Greater transparency in decision making.
❖ Enhanced public trust and relationship building.
❖ Strengthened scientific integrity and professional excellence.
The Big Five ethics Principles

These principles are widely used as a starting point for practical decision making in clinical
professions dealing with individual cases (biomedical)
1) Autonomy- free choice
2) Beneficence-doing good
3) Nonmaleficence- do no harm
4) Justice- fairness
5) Truth telling (honesty)
1)The Principle of Autonomy:

This principle means that people, being individuals with individual differences must have a
freedom to choose their own ways and means of being moral with the framework of the other
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four principles.
Respect for autonomy involves respecting another person’s rights and dignity such that a
person reaches a maximum level of fulfillment as a human being. In the context of health care
this means that the relationship between clients is based on a respect for him or her as a
person and with individual rights.
Rights in relation to health care are usually taken to include:
• The right to information
• The right to privacy and confidentiality
• The right to appropriate care and treatment
2) Beneficence (doing well)

Beneficence means doing or promoting good as well as preventing, removing and avoiding evil
or harm. E.g. Giving clients clean needles, condoms and provide information about emergency
first aid to reduce the risks of HIV infection or accident.
3)Non-Malficence (doing no harm)

Non-Malficence holds a central position in the tradition of medical ethics and guards against
avoidable harm to subjects.
4)Justice (fairness)
This principle states that human being should treat other human being fairly and justly in
distribution goodness and badness among them. In other words justice should include:
▪ Fair distribution of scarce resources
▪ Respect for individual and group rights
▪ Following morally acceptable laws
5)The principle of truth telling (honesty)

At the heart of any moral relationship is communication. A necessary component of any
meaningful communication is telling the truth, being honest.
Ethical Character Traits

1. Honesty is being open and truthful with other people.
2. Justice is treating other people fairly and equally.
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3. Compassion is being sympathetic to the difficulties of others.

4. Integrity is doing what is right regardless of personal consequences.
Source of Ethics
• It predates each of us; it is passed along through generations. People grow up with a
basic understanding of universal moral norms, such as truth-telling, promise-keeping, not
killing or harming innocent persons.
• Throughout history, many religious traditions and philosophical theories have offered
perspectives on morality and have contributed to an understanding about what constitutes
right and wrong human conduct and about what moral norms should guide human decision
making.
Fields of Ethics
• Bioethics: The study of ethical issues brought about by
advances in biology and medicine
• Clinical ethics: Analysis of ethical issues and dilemmas in
clinical practice
• Research ethics: Protection of research subjects (in
compliance with the Common Rule)
• Public health ethics: Practical decision making that supports
public health’s mandate
Law
Defined both as "the Science of Justice" and "the Art of Justice“
Law is a social science and grows, develops with the growth and development of society, new
developments in society create new problems and law is required to deal with those problems.
In order to keep pace with society
“Law is a system of rules that are created and enforced through social or government institutions
to regulate behaviour”
Law is the system of rules of conduct established by the government of a society to maintain
stability and justice. It is a rule of personal conduct enforced by Institutions called courts
It is a rule established by authority society or custom based on reason as quoted “Law is
nothing but reason and that what is not reason is not law”.
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
Take Note
Law defines the legal rights and duties of the people and
provides the means of enforcing these rights and duties.
Laws are rules that mandate or prohibit certain societal

behaviour.
Types of law;
On the basis of its source law is divided into three types;
1. Common Law
2. Islamic law
3. Statute Law
1) Common Law
It is any unwritten and generally applied systems of law based on the conduct decisions,
usage and customs.
2) Islamic law or sharia law
“A religious law forming part of the Islamic tradition. It is derived from the religious
precepts of Islam, particularly the Quran and the hadith”.
3) Statute Law
It is enacted by the legislative body of a representative government or decreed by a
ruler.
▪ If assembly passed the law it will become an ACT.
▪ If president passed the law it will become an Ordinance.
It is written and codified law of a country
Law, it is notified in Extra-ordinary Gazette of the Government and later published in a
book or booklet form.
Statute law is two types

1) Civil law
2) Criminal Law
1) Civil Law is that law, which deals with the rights of citizens in a particular state or
nation as distinguished from criminal law. It provides remedies for personnel
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grievances of individuals or group of individuals, for example:

● Industrial injury.
● Poisoning.
● Medical negligence.
● Matrimonial and
● Land lord tenant disputes are dealt under civil law.
Damage is compensated in terms of money.
2) Criminal Law Involves crime and its punishment. It is body of law, which exists for
better government of persons within the state. Its contravention is punished with fine,
imprisonment or death.
Terms of Law
1. Courts “places where people bring their grievances against others to seek remedies”
or “Court includes all the judges and magistrates legally authorized to take evidence”
2. Complaint means “an oral or written allegation made to magistrate to take action
against a person who has committed an offence”
3. Offence: “A thing made punishable by National penal code”
4. Warrant: “any written signed and stamped authority to arrest a person, which shall
remain in force till its execution or cancellation”.
5. Judge: “A person who is officially designated or empowered by law to give a definite

judgment in any legal proceeding civil or criminal”.
6. Fault “an unattractive or unsatisfactory feature, especially in a piece of work or in a
person's character”. Fault is a failure to take reasonable steps to prevent causing
harm to the person, that a reasonable man would foresee him to be put at risk.
7. Crime “an unlawful act punishable by a state or other authority”
8. Plaintiff “a person who makes the complaint in the court of law and has to prove his
case is called Plaintiff”
9. Defendant “person who is accused of breach of law and has to defend himself in the
court of law is called defendant”
10.Witness: “Any person who testifies the fact as perceived by him in a proceeding” is
called witness, or a person who presents the evidence before a court.
11.Evidence means “a fact or information in an issue in a case, which a witness is
capable of perceiving through any of his senses” i.e. vision, hearing, smell, taste and
touch.
12.A lawyer (also called an "advocate", "attorney", "barrister", "counsel", "counselor",
or "solicitor") “ someone who practices law. A lawyer has earned a degree in law,
and has a license to practice law in a particular area”.
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The purpose & function of law

1) To enforce morality
2) Maintains social control
3) Protects public order
4) To resolve disputes
5) Brings out justice in society
6) Setting standards of conduct behavior
7) To protect citizens´ from the government (e.g. Bill of Rights)
Causes of unethical and illegal behavior.

Three general causes of unethical and illegal behavior: ignorance, accident, intent
Accident: an unfortunate incident that happens unexpectedly and unintentionally,
typically resulting in damage or injury.
Ignorance: lack of knowledge or information.
Intent: intention or purpose to do something.
Method for preventing an illegal or unethical activity

Deterrence is best method for preventing an illegal or unethical activity; e.g., laws,
policies, technical controls, Laws and policies only deter if two conditions are present:
1) Fear of penalty
2) Probability of penalty being administered
LAW ETHIC
Purpose Rules and regulations that have specific Social guidelines based on mor
penalties and consequences when violated. principles and values
Punishments have punishments, fines or associated Ethics do not have punishment
penalties when people fail to abide by fines or associated penalties whe
them people fail to abide by them
Role Provides authority, limitations on state Provides ongoing analysi

power, incentives and disincentives for deliberation about, and justificatio
behaviour for public health action and policy
Source A system of rules that are created and It is passed along throug
made by a collective legislature or by a generations. People grow up with
single legislator basic understanding of univers
moral norms,
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Difference between Law and Ethics
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Tort law definition

Classification of Tort offences
Objectives of tort law
Elements of tort action
.
Tort law
A tort is a civil wrong in the sense that it is committed against an individual (which
includes legal entities such as companies) rather than the state.
The gist of tort law is that a person has certain interests which are protected by law.
These interests can be protected by a court awarding a sum of money, known as
damages, for infringement of a protected interest.
“A person who commits a tort is known as a tort feaster or a wrongdoer”.
A crime is a public /community wrong that gives rise to sanctions usually designated in a
specified code. A tort is a civil ‘private’ wrong. An action in criminal law is usually
brought by the state or the Crown. Tort actions are usually brought by the victims of the
tort.
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The principal objective in criminal law is punishment. In torts, it is compensation

The law of torts is derived from a combination of law principles and legislative
enactments.
Tort law decides whether a person should be held legally responsible for injury against
another, and what type of compensation the injured party is entitled to.
Classification of Tort offences

Tort offences may be intentional (willful) or unintentional (accidental).
Tort offences
Intentional (Willful) Unintentional

Intentional Torts (Accidental)
When one person intentionally harms another, the law allows the injured party to seek a
remedy in a civil suit. The injured party can be financially compensated for any harm
done by the person guilty of committing the tort. If the conduct is judged to be
malicious, punitive damages may also be awarded includes
● Assault Open threat of bodily harm
● Invasion of privacy Interference with a person’s right to be left alone
● Defamation of character Damaging a person’s reputation by making false and
malicious public statements
● Fraud Depriving or attempting to deprive a person of his or her rights
● False imprisonment Intentional, unlawful restraint or confinement of a person
Unintentional Torts
Acts that are committed with no intent to cause harm but done with a disregard for the
consequences, the term negligence is used to describe such actions when health-care
practitioners fail to exercise ordinary care, resulting in patient injury, Malpractice is the
negligent delivery of professional services.
Main Objectives of tort law
Tort law has two main objectives: deterrence and compensation.

❖ Deterrence
Individual deterrence, the theory behind individual deterrence is that the possibility of a
civil sanction, such as damages, will cause the defendant to alter their behaviour and
avoid inflicting damage.
❖ Compensation
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One of the major aims of tort law is to compensate those who have suffered personal
injury. The present system shifts losses from the claimant to the defendant when the
defendant has been shown to have been at fault.
Objectives of tort law

The law of torts serves four objectives
First: it seeks to compensate victims for injuries suffered by the culpable action or
inaction of others.
Second: it seeks to shift the cost of such injuries to the Person or persons who are legally
responsible for inflicting them.
Third: it seeks to discourage injurious, careless, and risky behavior in the future
Fourth: it seeks to vindicate legal rights and interests that have been compromised,
diminished, or emasculated.
Elements of tort action

Three elements must be established in every tort action
First: - (Plaintiff) the plaintiff must establish that the defendant was under a legal duty
to act in a particular fashion.
Second: - (Defendant) the plaintiff must demonstrate that the defendant breached this
duty by failing to conform his or her behaviour accordingly.
Third: - (Injury or Damage) the plaintiff must prove that he suffered injury or loss as a
direct result of the defendant's breach.
To determine fault, the following may be proved:

1) Motive and Malice.
Motive means the reason behind the act of the defendant, when motive is colored with
ill will, it becomes malice. Malice means desire or ill will to cause damage to someone.
As a general rule, motive is irrelevant in determining liability in tort.
A good or bad intention is not a defense in tort. This provision regulates against motives
that may be aimed to harm.
The law of tort provides legal remedy inform of compensation and prosecution of
officers proved to have wrongful doings in line of duty with or without ill motive. Any
illness or injury resulting from this might lead to a tort& financial compensation.
2) Trespass
It is unlawful presence in another's closure or land or premises, offence to the body of a
person or even wrongful taking of goods or chattels.
Acts of trespass common in public health practice relate to direct interference with the
person (body) or of another which is actionable in the absence of any lawful justification.
Trespass to person includes assault, battery and false imprisonment.
Assault means conduct or threat to apply violence on the person of the plaintiff in
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circumstances that may create apprehension that the latter is in real danger.
3) Negligence
The plaintiff suing under tort of negligence must prove that:
The defendant owed him a duty of care, the circumstances must be such that the
defendant knew or reasonably ought to have known that acting negligently would injure
the plaintiff. The standard of care expected of the defendant is that of a reasonable
man.
There has been a breach of that legal duty of care. The plaintiff has to prove that there
was a duty imposed by common law, statute or otherwise, upon the defendant and that
the defendant was in breach of this duty. However, at certain times, negligence is
presumed without proof of breach of duty by the plaintiff.
Damage: For the plaintiff to succeed in claim of Negligence, he must prove that he
suffered harm, loss or prejudice, unless this is presumed as in the case of Injuries sine
dumdum. No damage, no negligence.
Negligence cases are sometimes classified using the following three legal terms.
1. Malfeasance refers to an unlawful act or misconduct.
2. Misfeasance refers to a lawful act that is done incorrectly.
3. Nonfeasance refers to failure to perform an act that is one’s required duty or that is
required by law.
The Four Ds of Negligence

The American Medical Association (AMA) lists the following four Ds of negligence:
1. Duty 2. Derelict 3. Direct cause 4. Damages
1. Duty. Patients must show that a physician-patient relationship existed in which the
physician owed the patient a duty.
2. Derelict. Patients must show that the physician failed to comply with the standards of
the profession.
3. Direct cause. Patients must show that any damages were a direct cause of a
physician’s breach of duty.
4. Damages. Patients must prove that they suffered injury.
Following are examples of negligence:

1. Abandonment: A health-care professional who stops care without providing an
equally qualified substitute can be charged with abandonment. For example, a labor
and delivery nurse is helping a woman in labor. the nurse’s shift ends, but all the other
nurses are busy and her replacement is late for work. Leaving the woman would
constitute abandonment.
2. Delayed treatment: A patient shows symptoms of some illness or disorder, but the
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doctor decides, for whatever reason, to delay treatment. If the patient later learns of
the doctor’s decision to wait, the patient may believe he has a negligence case.
4) Vicarious Liability
Means the liability of one person for the torts committed by another person, the general
rule is that every person is liable for his own wrongful act. However, in certain cases a
person may be made liable for wrongful acts committed by another person.
For example: An employer may be held liable for the tort of his employees. Similarly, a
master is liable for any tort, which the servant commits in the course of his employment.
The reason for this rule of common law is that:

As the master has the benefit of his servant's service he should also accept liabilities.
The master should be held liable as he creates circumstances that give rise to liability.
The servant was at mere control and discretion of the master. Since the master engages
the servant, he ought to be held liable when engaging a wrong person.
5) Strict liability
It means liability without proof of any fault on the part of the wrongdoer. Once the
plaintiff is proved to have suffered damage from the defendant's wrongful conduct, the
defendant is liable whether there was fault on his part or not.
Strict liability must be distinguished from absolute liability.
6) Nuisance
This is the lawful interference with a person’s use or enjoyment of land or some other
rights over or in connection with land. It entails the doing or an unjustifiable thing, which
interferes with the use or enjoyment of another’s land.
This tort protects a person’s enjoyment of land or rights vested in the land. Nuisance
may be public or private.
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Public Health definition
Goals of Public Health
Public Health ethics and Law definition.
Public Health Law Function
Principles of Ethical Practice of Public Health
Criminal Law & Public Health
Public Health Law and ethics

Public Health
Definitions of public health vary widely; however, a unifying theme is that public health
is a mutually shared, societal obligation. Collective entities such as governments and
communities must take responsibility for promoting the health of the public.
The Institute of Medicine defines public health as “what we, as a society, do collectively
to assure the conditions for people to be healthy.” (Future of Public Health, 1988)
Public health is focus on health of populations, rather than the health of individuals.
Public health is more concerned with broad strategies to prevent or ameliorate injury
and disease than with clinical interactions between professionals and patients.
Public Health is the science and art of (1) preventing disease, (2) prolonging life, and (3)
promoting health and efficiency through organized community efforts for
●The sanitation of the environment,
●The control of community infections,
●The education of the individual,
●The organization of medical and nursing service for the early diagnosis and preventive
treatment of disease, and
●The development of the social machinery which will ensure to everyone a standard of
living adequate for the maintenance of health.
●So organizing these benefits as to enable every citizen to realize his birthright of health
and longevity. C.E.A. Winslow, 1920
The goal of public health services is first and foremost to protect and promote the
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health of the public, across three essential domains:

❖Health protection
❖Disease prevention and
❖Health promotion.
Before you read any further, If public health is what society does collectively to
assure the conditions for healthy people, then what are public health ethics?
Public health ethics

May be defined “as the principles and values that help guide actions designed to
promote health and prevent injury and disease in the population”
Public health law

Refers to “rules of action prescribed by controlling authority and having binding legal
force. Law is found in constitutions, statutes, regulations, and court cases”
Law creates a mission for public health authorities, assigns their functions, and specifies
the manner in which they may exercise their authority.
Public health law can be defined as “the study of the legal powers and duties of the
state to assure the conditions for people to be healthy (e.g. to identify, prevent and
ameliorate risks to health in the population) and the limitations on the power of the
state to constrain the autonomy, privacy, liberty or other legally protected interests of
individuals for protection or promotion of community health”.
The legal system helps define the roles and responsibilities of different players in the
health care system or about health issues. For example, state and federal laws have
been used to set the minimum standards that affect the provision of health care, the
scope of health coverage, public program policy, consumer protections, as well as the
regulation of pharmaceuticals and medical devices.
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The relationship between health care workers and patients may take the form of a
contract or a duty of care imposed by the law because of the special relationship
between health care workers and patients.
A patient who consults a doctor or other health care practitioner in private practice
enters into a contractual relationship with the practitioner but the latter also owes the
patient a duty of care
Public Health is based on Law To:

1) Protect health of the population
2) Stop the spread of disease
3) Promote optimal conditions for health
4) Protect the environment
5) Provide services in general
6) Provide services to specific groups in the population
7) Financially assist and license development of health manpower, facilities under
national standards
8) Programs to assure quality of care
Principles of the Ethical Practice of Public Health

1. Public health should address principally the fundamental causes of disease and
requirements for health, aiming to prevent adverse health outcomes.
2. Public health should achieve community health in a way that respects the rights of
individuals in the community.
3. Public health policies, programs, and priorities should be developed and evaluated
through processes that ensure an opportunity for input from community members.
4. Public health should advocate and work for the empowerment of disenfranchised
community members, aiming to ensure that the basic resources and conditions
necessary for health are accessible to all.
5. Public health should seek the information needed to implement effective policies and
programs that protect and promote health.
6. Public health institutions should protect the confidentiality of information that can
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bring harm to an individual or community if made public. Exceptions must be justified on

the basis of the high likelihood of significant harm to the individual or others.
Criminal Law & Public Health

To a certain extent public health laws encompass criminal law rules and criminal laws
have a indirect impact on the public’s health
Criminal law and public health have a number of points of contact. Nearly all fields of
public health law define special crimes. In such cases the public health offence becomes
a crime and May in addition to administrative sanctions, lead to punishment of the
violator under criminal law.
Public health practice and criminal law proceed hand in hand. Therefore, investigations
of the cause of public health issues may shift into criminal investigations.
E.g. Prohibition of female genital mutilation
General criminal laws are also for protection of the public from harm. When forbidding
personal injuries, criminal law has a behaviour influencing effect in the interest of the
community’s health. This is an indirect effect of criminal law on public health.eg.
Tobacco Control.
Medical doctors, nurses and other health professionals may be subject to prosecution
because of patient injuries and they need to be aware of criminal law risks and their
deterrent effects of such laws that regulate professional conduct
Public health officers may also be prosecuted if they fail to provide accurate services and
negligently do not prevent a public heath harm, or if they violate personal rights.
Criminal law will apply to employers who fail to provide workers with means of
appropriate workplace safety. E.g.: Occupational Safety and Health Act
Criminal law also applies to individuals or companies causing harm to the public health.
Such cases involve persons with infectious disease who disregard protection measures
and transmit disease to others.eg. HIV/AIDS prevention and control Act
Criminal laws that penalize traffic offences have contributed to the community’s health
and safety.
In the aftermath of the terrorist attack in the US, forensic epidemiology emerged as a
contact point between criminal law and public health. Use of epidemiologic methods as
part of an ongoing criminal investigation of a health problem for which there is
suspicion of acts of criminal behaviour supports connection between criminal law and
public health .
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Criminal laws are used to punish a defendant

States can deter unsafe practices through criminal laws that authorize fines and jail
sentences. Criminal penalties vary significantly between jurisdictions and often depend
on the intent and severity of a crime.
Criminal laws are used to punish a defendant on behalf of the state and the public and
deter future criminal behavior. Because criminal charges do not compensate victims of
preventable harms, those individuals may have to pursue an action in civil court for
damages.
Laws like these may be intended to encourage personal responsibility in the hope that
individuals will modify their behavior in order to avoid criminal penalties. They may also
be motivated by the belief that those who fail to protect others from HIV transmission,
or from the risk of transmission, deserve punishment.
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Public Health Law and controlling Disease

Controlling the spread of infectious diseases
NCD and Public Health Act
NCD risk factors and interventions
Introduction
The importance of public health law in improving population health, a central question
in public health law and policy is what degree of intervention is appropriate to improve
population health?, it is understood governments have a “duty to look after important
needs of people individually and collectively”.
Goals of public health programs in this perspective should encompass reduction of risk,
environmental protections, protections for vulnerable populations, health promotion,
enabling the population to make healthy choices, access to medical services and a
reduction of health inequalities.
The effectiveness of public health service to the community depends on
1. The way the public health laws prevailing in the community.
2. Political support
3. People co-operation
The law can be a powerful tool for the protection and advancement of the population’s
health. Law can become an important part of the ongoing work of creating the
conditions necessary for people to live healthier and safer lives. A public health law that
contributes to health of course be up-to-date in the methods of assessment and
intervention it authorizes.
Legal action as a tool for prevention

The use of law as a tool to address preventable harms and promote health in states
through incentives, disincentives, and deterrence also can support disease prevention.
Public health law also plays a role in preventing negligent practice.
Laws set standards to guide particular activities, a breach of these standards may
implicate lack of necessary due care in causing bodily harm.
Public health law Purpose

CANADA British This act replaces the outdated legislation,
Columbia Public supports improved health and wellness of
Health Act 2008 23
British Columbians and helps to address
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current public health issues including new

challenges in infectious disease control
like SARS or pandemic influenza,
environmental toxin exposures, prevention
of chronic disease, injuries, and
poisonings and bioterrorism threats.
FRANCE Public Health ∙ To improve the health of the population
Act 2004 by establishing a more effective
administrative system in public health and
by reinforcing the implementation of
national and regional programs.
AUSTRALIA New South ∙ To protect and promote public health.
Wales Public Health ∙ To control the risk to public health.
Act 2010 24
∙ To promote the control of infectious
diseases
∙ To prevent the spread of infectious
diseases.
∙ To recognize the role of local
governments in protecting public health.
NORWAY Norwegian ∙ To contribute to societal development
Public Health Act that promotes public health and reduces
201125
social inequalities in health.
∙ Public health work will promote the
population’s health, well-being and good
social and environmental conditions, and
contribute to the prevention of mental and
somatic illnesses, disorders or injuries.
SCOTLAND The Public ∙ To re-state and amend the law on public
Health etc. health;
(Scotland) Act
∙ To make provision about mortuaries and
200827
the disposal of bodies;
∙ To enable the Scottish Ministers to
implement their obligations under the
International Health Regulations;
∙ To make provision relating to the use,
sale or hire of sun beds;
∙ To amend the law on statutory nuisances;
and for connected purposes.
Six Public Health Responsibilities
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• Prevention of epidemics & spread of disease

• Protection of people against environmental Hazards
• Prevention of injuries
• Promotion & encouragement of healthy behavior changes
• Quick response to the disaster & to assist the communities in recovery phase
• To assure quality, accessible, and affordable comprehensive health care services
Controlling the spread of infectious diseases

Minimizing the transmission of infectious diseases is a core function of public health law.
Law enables public and private institutions to promote public health and safety
objectives, legal mechanisms for addressing preventable harms
Communicable Diseases
Defined as “any condition which is transmitted directly or indirectly to a person from an
infected person or animal through the agency of an intermediate animal, host, or vector,
or through the inanimate environment”
Transmission is facilitated by the following
1. more frequent human contact due to
2. Increase in the volume and means of transportation (affordable international air
travel),
3. globalization (increased trade and contact)
4. Microbial adaptation and change
5. Breakdown of public health capacity at various levels
6. Change in human demographics and behaviour
7. Economic development and land use patterns
Communicable Diseases Modes of transmission
1. Direct a) sexual – HIV, Hepatitis B,C
b) Inhalation – Tuberculosis, influenza, anthrax
2. Indirect
a) Vector-borne- malaria, trypanosomiasis
b) Food-borne – E.coli, Salmonella,
c) Contaminated water- Cholera, rotavirus, Hepatitis A
3. Zoonotic diseases – animal handling and feeding practices (Mad cow disease, Avian
Influenza)
Communicable Disease Control

Department can use surveillance, segregation, quarantine or modified quarantine of
contacts of a person or animal with a communicable disease or infection, or any other
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appropriate disease control measure necessary to protect the public from the spread of
infectious agents
Public health Law for control Communicable disease

Public health laws can support the control of infectious diseases in two important ways.
Firstly, law has a proactive or preventive role: Improving access to vaccinations and
contraceptives, together with screening, education, counselling and other strategies
that aim to minimize exposure to disease.
Secondly, law has a reactive role: Supporting access to treatment, and authorizing
health departments and health care providers to limit contact with infectious individuals
and to exercise emergency powers in response to disease outbreaks.
1)Proactive or preventive role
Law can contribute to the prevention of infectious diseases by improving access to
vaccinations and contraceptives, and by facilitating screening, counselling and education
of those at risk of infection. Immunization is a successful and cost-effective public health
strategy that saves millions of lives each year. Governments can support vaccination
coverage by ensuring that vaccination is free or affordable, by ensuring that all children
are vaccinated, and that vaccinations are documented.
National requirements for child vaccination
Public Health Act Child to be vaccinated within three months
(1) Every parent of a child shall, within three months after the birth of the child, or within three
months after receiving into custody the child, take or cause the child to be taken to a public
vaccinator of the district in which such child is then resident, to be vaccinated according to this Act,
unless the child has been previously vaccinated by a [medical practitioner].
Inspection after vaccination
(1) On the eighth day after the vaccination, the parent shall again take or cause the child to be taken
to the public vaccinator for inspection at such time and place as may have been appointed by him at
the time of vaccination.
(2) If on inspection it is ascertained that the vaccination has been unsuccessful, the parent shall, if the
vaccinator so directs, cause the child to be forthwith again vaccinated and afterwards inspected as on
the previous occasion.
(3) If the vaccination has been successful the public vaccinator or surgeon forthwith shall give to the
parent a certificate ... and within seven days shall transmit a certified copy of the certificate to the
Registrar of the district within which the child’s birth was registered ... or if the birth of the child has
Screening
not been registered, then he shall give it to the Registrar of the district where the child resides.
Screening individuals to determine if they have been infected with or exposed to an
infectious disease is a core public health strategy. Screening enables health care
providers to begin treatment in a timely manner, to manage co-morbidities more
effectively, to encourage patients to reduce high-risk behaviour and, in certain cases, to
identify the need for compulsory treatment. In addition to reducing the severity of
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illness, early treatment may also reduce transmission rates. For example, early
treatment with antiretroviral drugs lowers the viral load of people with HIV and
significantly.
Reduces the risk of sexual transmission, WHO supports the expansion of HIV testing and
counselling in order to identify people with HIV early on in their infection and to “link
them successfully to prevention, care, and treatment services”.
HIV and AIDS education and information as a health care service.
(1) The provision of HIV and AIDS education and information shall form part of the
delivery and health care services by all health care providers at public and private
health care facilities.
Prevention of mother-to-child transmission. In order to prevent or reduce the risk of

mother to- child transmission of HIV, the Minister shall ensure that –
(b) HIV counseling and testing is made available and offered to all pregnant women
and their partners, as part of ante-natal care services.
Contents of post-test counselling.

(3) Where the result of a test is HIV positive, a counselor shall –
(a) Provide post-test counseling which shall include at a minimum –
(i) The medical consequences of living with HIV;
(ii) The modes of prevention and transmission of HIV and other opportunistic
infections;
(iii) The importance of disclosure of the person’s status to the person’s spouse or
spouses or sexual partner or partners;
(iv) The medical treatment and other social facilities available;
(v) The need to continuously seek professional services relating to HIV; and
(b) Refer the tested person to an appropriate health service provider for follow up
testing or treatment.
Reactive role
Early treatment has important public health benefits; for example, people receiving
treatment for tuberculosis and HIV infection are less likely to transmit the infection to
others. Public health laws may authorize the isolation of individuals and groups who
may have been exposed to an infectious disease, as well as the closure of businesses and
premises and the confiscation of property.
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The exercise of these powers must be based on public health considerations, without
discrimination on grounds of race, gender, tribal background, or other inappropriate
criteria. Clearly defined legal powers are needed to respond to outbreaks of contagious
and serious diseases at national level. The appropriate exercise of legal powers will vary
according to the seriousness of the disease, the means of transmission, and how easily
the disease is transmitted.
Isolation separates sick people with a contagious disease from people who are not
sick.
Quarantine separates and restricts the movement of people who were exposed to a
contagious disease to see if they become sick.
Quarantine of persons exposed to communicable disease

When a person known to have been exposed to a communicable disease is declared
quarantinable, the board will restrict this person to his place of residence or other
suitable place, prohibit entrance to or exit from such place without the board’s written
permission in order to prevent contact with others not exposed, and enforce restrictive
measures prescribed by the department.
Mandatory reporting of infection or exposure

(1)This section applies to a health professional, a person responsible for administering a
hospital or laboratory, and a prescribed person who, in carrying out his or her duties,
becomes aware that a person or thing
(A) Is an infected person or infected thing, or
(b) Has died or may have died as a result of being an infected person or infected thing.
(2) The nature of the infectious agent or hazardous agent, including
(A) Any signs or symptoms,
(B) Any diagnostic examination or other examination that was done or preventive
measures that were taken, and
(C) The results of any diagnostic examination or other examination that was done or
preventive measures that were taken.
Public health laws should authorize compulsory treatment only in circumstances where
an individual is unable or unwilling to consent to treatment, and where their behaviour
creates a significant risk of transmission of a serious disease. Compulsory treatment
orders should restrict individual liberty only to the extent necessary to most effectively
reduce risks to public health.
Appropriate exercise of legal powers

The appropriate exercise of legal powers will vary according to the seriousness of the
disease, the means of transmission, and how easily the disease is transmitted. Some
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diseases are entirely preventable by vaccination (e.g. measles and polio), or by access to
improved sanitation and clean drinking water (e.g. diarrheal and parasitic diseases).
Others are treatable when detected in a timely manner (e.g. tuberculosis and malaria).
The epidemic of HIV can be substantially reduced through laws supporting access to
treatment, combined with measures to educate and support individuals and
communities to implement proven strategies for preventing transmission.
Infection and injury due to unsafe injection practices

Infection and injury due to unsafe injection practices in healthcare settings are
considered preventable harms, and as such, may provide grounds for legal disputes. The
law can be a deterrent and thereby a tool for prevention, providing options to
prosecutors and the public under existing legal sources.
Limiting contact with infectious persons

Isolating persons who have or may have been exposed to a serious contagious disease,
in order to prevent transmission, is a long-established public health strategy that may be
applied to both individuals and groups
Public health laws should authorize public health officials to make orders for the
isolation of infected individuals, and the quarantine of those who have been exposed to
a serious contagious disease
Non-communicable diseases and Public Health Act
Non-communicable diseases (NCDs) create a serious health and financial burden for
local and national governments. NCDs can be defined as diseases that are not infectious.
These diseases may result from genetic or behavioural factors and include coronary
heart disease, stroke, hypertension (high blood pressure), type 2 diabetes, kidney
disease, certain forms of cancer, respiratory and liver diseases, and overweight and
obesity, as well as certain mental health conditions
Most NCDs can be linked to the modifiable determinants of tobacco use, harmful use of
alcohol, poor diet and lack of physical activity. Legislation is one key tool to address
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these risk factors and determinants. While traditionally public health law has addressed
issues of communicable diseases, the changing global burden of disease means that in
recent decades it has also been used to address non-communicable disease.
NCD risk factors and interventions
As stated above, the proximate causes of NCDs across all countries include tobacco use,
harmful use of alcohol, the over-consumption of saturated fat, sugar and salt, and lack
of physical activity. While many interventions may be cost-effective, WHO has classified
some as ‘best buys’ – meaning “actions that should be undertaken immediately to
produce accelerated results in terms of lives saved, diseases prevented and heavy costs
avoided.” These are listed in Table 1.
Table 1: The World Health Organization’s for NCD interventions
• Protecting people from tobacco smoke and banning smoking in public places
• Warning about the dangers of tobacco use
• Enforcing bans on tobacco advertising, promotion and sponsorship
• Raising taxes on tobacco
• Restricting access to retailed alcohol
• Enforcing bans on alcohol advertising
• Raising taxes on alcohol
• Reducing salt intake and salt content of food
• Replacing Trans fats in food with polyunsaturated fat
• Promoting public awareness about diet and physical activity, including through mass
media.
Categories of health legislations

Public registration to assess mortality and enumeration of population
i. The Census Act 1948
ii. The Registration of Births and Deaths Act 1969
iii. Legislation related to control of epidemics
iv. The Epidemic Diseases Act 1897
To improve and maintain high standards in the medical education and

services
v. The national Medical Council Act 1956 and Regulation 2002
vi. The national Nursing Council Act 1947
vii. The Dentists Act, 1948
viii. The Pharmacy Act, 1948
ix. The Consumer Protection Act (COPRA) 1986
To prevent drug addiction and substance abuse and safe manufacturing
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of drugs, distribution and storage

x. The Narcotic Drugs and Psychotropic Substances Act 1985
xi. The Cigarettes and Other Tobacco Products Act (COTPA) 2003
xii. The Drugs and Cosmetics Act 1940
xiii. The Drugs & Magic Remedies Act 1948
For child protection and Health

xiv. The Infant Milk Substitutes, Feeding Bottles and Infant Foods
(Regulation of Production,
Supply and Distribution) Act 1992

xv. The Child Labour (Prohibition and Regulation) Act 1986
xvi. The Child Marriage Restraint Act 1929
xvii. The Juvenile Justice (Care and Protection of children) Act 2000
For welfare of Older Persons

xviii. Maintenance and Welfare of Parents and Senior Citizens Act 2007
For welfare rehabilitation of disadvantaged

xix. The Persons with Disabilities (Equal Opportunity, Protection of
Rights and Full Participation) Act 1995
xx. The National Trust for Welfare of Persons with Autism, Cerebral
Palsy, Mental Retardation And Multiple Disabilities Act 1999 And
Rules 2000
xxi. The Mental Health Act 1987
Occupational Health and legislation

xxii. The Factories Act 1948
xxiii. The Employees State Insurance (ESI) Act 1948
xxiv. The Workmen’s Compensation Act 1923
xxv. The Minimum Wages Act 1948
xxvi. The Dangerous machine (Regulation) Act 1983
xxvii. The unorganized Sectors Worker’s Social Security Act
xxviii. The plantation Labor act 1951
Environmental Health legislations

xxix. The Environment (Protection) Act 1986
xxx. The Biomedical Waste (Management and Handling) Rules 1998
xxxi. The Municipal Solid Waste (Management and Handling) Rules 2000
xxxii. The Hazardous Waste (Management and Handling) Rules 1989
xxxiii. The Motor Vehicle Act 1988
xxxiv. The national environment Tribunal Act 1995
Legislation related to other public health problems

xxxv. The Transplantation of Human Organ Act 1994
xxxvi. Food safety and standard Act 2006
xxxvii. The Protection of Human Rights Act 1993
xxxviii. The Disaster Management Act 2005
The Epidemic Disease Act,1897
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Unit 5
Public Health for Protection of Environment
Clean Water Act
Clean Air Act
Food control
Occupational Safety and Health Act
Introduction
Health is affected to a great measure by environmental conditions.
Environment can defined “the aggregate of surrounding things, conditions, or
influences; surroundings”
Ecology the air, water, minerals, organisms, and all other external factors surrounding
and affecting a given organism at any time
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The social and cultural forces that shape the life of a person or a population
The WHO defines environment and health as including both the direct pathological
effects of chemicals, radiation and some biological agents, and the effects on health and
well-being of the broad physical, psychological, social and aesthetic environment, which
includes housing, urban development, land use and transport.
Environment-related diseases continue to afflict many people, particularly the world's
poorer people.
Environmental health is “the branch of public health concerned with all aspects of the
natural and built environment affecting human health. Environmental health is focused
on the natural and built environments for the benefit of human health”
The relationship between mankind and the environment is a close knit one, as mankind
strives to protect the environment and natural resources. Yet, human activities have
created adverse environmental consequences that have led to ill health.
Diseases related to the environment are increasing at an alarming proportion. Health,
environment, and natural resources are interdependent and are a key aspect of
sustainable development today.
Therefore, health coupled with a positive attitude towards environmental protection can
promote sustainable economic development. For example, diarrheal diseases, largely
preventable through access to safe drinking water, sanitation and food hygiene.
Finally, climate change has had a negative effect on public health. Climate change causes
variants in the "geographical range of disease organisms and vectors; the quantity of air,
food, and water; and the stability of the ecosystems on which we depend.
Environmental Health:-
⚫ Water
⚫ Clean Air
⚫ Food Control
⚫ Housing
⚫ Sanitation
⚫ Occupational Safety and Health
⚫ Rats, Mice and Mosquito control
Clean Water Act

What is the purpose?
The stated objective of the Clean Water Act is to restore and maintain the chemical,
physical, and biological integrity of the Nation’s waters.
What is the scope?
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All point sources that discharge any pollutants into the waters of the United States must
first obtain a permit under the Act.
Clean Water regulation

⚫ Establishment of Technical Assistance for maintenance of Water works.
⚫ Surveillance of Water sources
⚫ Control over bottled water supply
⚫ Periodical Examination of Water
⚫ Action over the unsanitary sources
⚫ Prevention of Pollution of Water
⚫ Control over Private Water Sources
Clean Air Act

• What is the purpose?
– To control air pollution by instituting point source controls and establishing maximum
pollutant levels for the ambient air.
• What is the scope?
– The main focus is stationary sources of air pollution but the Act also provides some
regulation for mobile sources.
Air pollution is also associated with a variety of health risks. Acute respiratory infections
such as pneumonia are the leading killers of young children, and also associated with
such factors as indoor air pollution.
Housing:-
A poor house is that which does not meet the basic physiological and psychological
requirement for human life and comfort has no protection against infectious or
contagious disease and accidents
Prohibition of Occupation of House
⚫ If it is without water supply
⚫ If it is without Drain
⚫ If there is nuisance
⚫ If there is notified disease
⚫ Prohibition of Over crowding
⚫ Not to be occupied on certain places
⚫ New house should be provided with sanitary conveniences
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Food control
"food" includes water, ice or any substance manufactured, prepared, sold or
represented for use as food or drink, or flavoring or condiments used in or with the
preparation of food;
"food-handling establishment' means a place where food is prepared or sold for human
consumption and includes the categories of retail and food service premises set out in
Part I of the second Schedule; Second Schedule.
"high risk food" means non-acidic, moist, and protein based food which, in order to
ensure product safety, requires the application and maintenance of specified
temperatures at various stages of its preparation, and includes meat and meat
products, milk and milk products, eggs, poultry, fish and shellfish, gravies, puddings,
custards, cream-filled baked goods, potato and other mayonnaise based salads, cream
based soups and sauces;
Regulation of Public Health act to Control of Food

1) No person shall manufacture, store or prepare for sale or have in his possession for
sale or sell or offer for sale, any food which is unfit for human consumption or which
has been condemned as being unfit for human consumption.
2) No Person shall package any food—
(a) In any container which is not clean and sanitary;
(b) With any equipment which is not clean and sanitary;
(c) With any packaging material which is not approved for such use by the M.O.H
(D) Which is toxic
(E) In any container which is not sealed so as to prevent contamination of the food by
dirt, dust or any other such matter.
3) No person shall-
(a) Use any disposable food container more than once;
4) prohibition of sale of food without license in certain places (Hotel, Tea shop, Coffee
house, Café, Refreshment room, Mobile canteen, or catering establishment)
5) No person shall keep store or prepare for sale any animal intended for human
consumption which is diseased
6) Periodic Inspection of the Places, Premises or Institutions etc.
7) Investigation of Complaints related to Public Health matters
8) Taking note of Violations, omissions, Nuisances, failure to adopt conditions or
precautions etc.
Sanitation
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• Responsibility of Local authority and private in construction of Drains and Cesspool

• Prevention of Let out of refuse in the Streets
• Prevention of Disposal of injurious refuse into the Drain
• Responsibility of Local authority to provide Sanitary conveniences
• Provision Sanitary arrangements during Fairs and Festival
• Provision of Sanitary conveniences in Houses)
Occupational Safety and Health Act
What is the purpose?
– To ensure that “no employee will suffer material impairment of health or functional
capacity” from a lifetime of occupational exposure.
What is the scope of the Act?
– The Act extends to all employers and their employees in all fifty states, except
workplaces with fewer than ten workers and federal or state employees.
Who implements the Act?
The Occupational Safety and Health Administration (OSHA)
Unit 6
Healthy Policy
Healthy Policy
The Health Policy is a vital guide towards health development of any country. It is
particularly, important in a country like ours where're sources and technology are more
limited than in other countries, which emphasized on the need for increasing
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community involvement in health development and improved access and equity in

health and health services.
Health policy refers to decisions, plans, and actions that are undertaken to achieve
specific health care goals within a society. An explicit health policy can achieve several
things: it defines a vision for the future which in turn helps to establish targets and
points of reference for the short and medium term. It outlines priorities and the
expected roles of different groups; and it builds consensus and informs people.
The National Health Policy is aimed at providing direction towards improvement and
sustainability of the health status of all the people, by reducing disability, morbidity and
mortality, improving nutritional status and raising life expectancy, the policy recognizes
that, good health is a major resource essential for poverty eradication and economic
development.
Law and governance for health

Law and governance for health concerns the legal mechanisms, processes and
institutions that determine the allocation of power, and the accountability for its
exercise, in the health system. It’s about how decisions are made, how governments,
citizens and providers articulate their views and interests, exercise their legal rights,
meet their legal obligations and mediate their differences.
Health laws Health law is the area of law concerned with the health of individuals and
populations, the provision of health care and the operation of the health care system.
Examples of how health laws are used include laws that:

● Advance important health policy goals such as Universal health coverage;
● Establish the basis for organizing, governing and financing a country’s health
system;
● Protect the public and social nature of healthcare;
● Protect public health from communicable diseases or other public health risks;
● Regulate the operation of hospitals, clinics or other health services;
● Control the training and practice standards of health workers;
● Regulate the safety and efficacy of medicines and medical devices;
● Protect patient rights; address non-communicable disease risk factors (e.g.
smoking); and Regulate the collection and use of health information.
Role of the Government for Health

The Ministry of Health as a technical Ministry is responsible for all matters pertaining to
health in the country.
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The Ministry of Health is responsible for: -

● Policy formulation, health legislation, regulation and control;
● Resource mobilization and allocation, coordination and inter sectoral linkages;
● Public health related interventions;
● Supervision and Monitoring of special and Referral Hospitals owned by NGOs;
● Training of key professional health cadres and monitoring quality of training;
● Monitoring and evaluation of health services countrywide;
● Supervision and inspection of provision of health services;
● Health research;
The Government Development Vision and the Health Policy

● Access to quality primary health care for all;
● Access to quality reproductive health service for all individuals of appropriate
ages;
● Reduction in infant and maternal mortality rates by three quarters of current
levels;
● Universal access to clean and safe water;
● Life expectancy comparable to the level attained by typical middle-income
countries.
● Food self sufficiency and food security
Before you read any further, Why does government has the power and duty to safeguard the
public’s health?
Government Power and Duty:

Public health activities are the primary responsibility of government. The importance of
government in assuring the conditions for the population’s health is demonstrated by its
constitutional powers public health law is principally about government’s assurance of
the conditions for the population’s health,
WHAT MUST GOVERNMENT DO TO SAFEGUARD HUMAN HEALTH?
The law can be a powerful tool for the protection and advancement of the population’s
health. Law can become an important part of the ongoing work of creating the conditions
necessary for people to live healthier and safer lives. A public health law that contributes
to health will, of course, be up-to-date in the methods of assessment and intervention it
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authorizes. Governments should carefully consider the appropriate role of criminal law
when amending laws to prevent the transmission of infectious and communicable
diseases. For example, criminal penalties for transmission of HIV may create disincentives
to individuals to come forward for HIV testing and treatment, or may provide the pretext
for harassment and violence against vulnerable groups. Encouraging personal
responsibility and self-protection is critical, especially in countries where rates of HIV
infection are high.
The Ministry of Health as a technical Ministry is responsible for all matters pertaining to
health in the country.
The Ministry of Health is responsible for: -

1. Policy formulation, health legislation, regulation and control.
2. Resource mobilization and allocation, coordination and inter sectoral linkages;
3. Public health related interventions;
4. Supervision and Monitoring of special and Referral Hospitals owned by NGOs;
5. Training of key professional health cadres and monitoring quality of training;
6. Monitoring and evaluation of health services countrywide;
7. Supervision and inspection of provision of health services;
8. Health research;
The Health Development Vision and the Health Policy
❖ Access to quality primary health care for all;
❖ Access to quality reproductive health service for all individuals of appropriate
ages;
❖ Reduction in infant and maternal mortality rates by three quarters of current
levels;
❖ Universal access to clean and safe water;
❖ Life expectancy comparable to the level attained by typical middle-income
countries.
❖ Food self sufficiency and food security
Why does government have the power and duty to safeguard the public’s health?
The word public in public health has two overlapping meanings—
1. One that refers to the entity that takes primary responsibility for the public’s
health, and
2. Another that indicates who has a legitimate expectation of receiving the benefits.
Public health overlapping meanings

1. The government has primary responsibility for the public’s health. A government
exercises powers or duties to protect or promote the population’s health
2. The population as a whole has a legitimate expectation of benefiting from public
health services.
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INTERNATIONAL HEALTH
International public health law is that branch of law or body of rules which regulates
the relation of states and other entities recognized as possessing international
personality as well as how states treat and recognizes the rights of their citizens
The International health law works for disease notification and quarantine service law.
This is law prescribes that government at levels including the international community
should notify the general public of the occurrence of certain diseases which are
referred to as the International modifiable diseases.
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The World Health Organization International Health Regulations 1969 requires the
reporting of some diseases to the organization in order to help with its global
surveillance and advisory role.
The current (1969) regulations are rather limited with a focus on reporting of three
main diseases: cholera, yellow fever and plague.
The revised International Health Regulations 2005 (which to entered into force in June
2007) has broaden the scope to include other emerging diseases such as Avian
Influenza, SARS, Ebola virus, Mad cow disease among others and is no longer limited
to the notification of specific diseases.
It also defines a limited set of criteria to assist in deciding whether an event is
modifiable to WHO
The international environmental law shall be examining is the air pollution law which
prohibit the emission into the atmosphere chemical substances that are injurious to
human health and limit the emission of carbon dioxide and green house gases, these
substances do not only have harmful effect on human health but also deplete the
ozone layer which has led to acid rains in the United Kingdom, global warming, and
deforestation also water pollution law which prohibit the dumping into water any
hazardous waste that is capable of causing harm to human and marine life.
Migration health
A specialized field of health sciences, characterized by its focus on the well-being of

migrants and communities in countries and regions of origin, transit, destination, and
return, It has a dual focus, addressing individual migrants' needs as well as the public
health of host communities, Migrants are affected by social inequalities and are likely
to go through several experiences during the migration process which put their
physical, mental and social well-being at risk.
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Migrants often face poverty and social exclusion, which has negative influences on
health, especially in countries of destination and transit. Migrants’ health is also to a
large extent determined by the availability, accessibility, acceptability and quality of
services in the host environment.
Migrant population’s health

Health issues, conditions and risks related to migrant populations, and the way in
which it also affects:
-Population of origin,
-Communities in the places of transit and destination.
Migration helps to Cross-border transmission of disease
And these camps and settlements are not manage adequately and many problems
may arise for example
1) Overcrowding
2) Inadequate availability of shelter, food, safe water and sanitation
3) Social problems such as alcoholism, sexual promiscuity psychological and
emotional disorder and social conflict
All of these problems can helps to transmission of communicable infectious

The World Health Organization (WHO) states, “In the 21st century, health is a shared
responsibility, involving equitable access to essential care and collective defence
against transnational threats.”
Health problems, issues, and concerns that go above national boundaries, which may
be influenced by circumstances or experiences in other countries, and which are best
addressed by cooperative actions and solutions (Institute Of Medicine, USA- 1997)
Global Health Issues
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Refers to any health issue that concerns many countries or is affected by transnational
determinants such as:
• Climate change
• Urbanization
• Malnutrition – under or over nutrition or solutions
• Polio eradication
• Containment of avian influenza
• Approaches to tobacco control
Travel vaccines are divided into 3 categories:

1. Mandatory (M): International Certificate of Vaccination is required Yellow Fever
vaccine
2. Recommended (R) for all travellers to certain countries Meningitis vaccine ACYW135
(Saudi Arabia) for Hajj travellers Polio to North and South America
3. Recommended (r) for travellers to certain areas Influenza and Pneumococcal
vaccines for at risk subjects: travellers to USA do have antibodies rabies in Latin
America
International Health Regulations

The International Health Regulations adopted by the Twenty-second World
Health Assembly on 25 July 1969
The International Health Regulations (IHR) are an international legal instrument that is
binding on 194 countries across the globel, including all member states of the World
Health Organization (WHO).
The purpose of the International Health Regulations is to ensure the maximum
IHR- 1969 IHR- 2005
implement a control of Organize the containment of the

travellers and goods when risk at the source, so that risks
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crossing borders and do not escape control and spread

entering countries (e.g., out of the country.
need for appropriate
vaccinations such as YF)
A list of epidemic-prone Report any event constituting a
diseases to be specially threat for the international
controlled (smallpox, yellow community, whether caused by a
fever, and cholera) disease or other sources such as
chemical spill, or even a nuclear
event.
preset measures, which have replaced by a more flexible set
to be adopted by all of adapted responses according to
countries the nature of the event, that
will be implemented by countries
with WHO
security against the international spread of diseases with a minimum interference
with world traffic.
Following the increasing emphasis on epidemiological surveillance for communicable

disease recognition and control, the new Regulations are intended to strengthen the
use of epidemiological principles as applied internationally, to detect, reduce or
eliminate the sources from which infection spreads, to improve sanitation in and
around ports and airports, to prevent the dissemination of vectors and, in general,
In May 2005, The 58th World Health Assembly adopted the revised International
Health Regulations, “IHR”
Why have IHR?

✔ Serious and unusual disease events are increasing and inevitable
✔ Globalization– public health event in one location can be a threat to others
✔ Need for collective effort and agreed rules
✔ strong national public health system
✔ international alert & response system
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Purpose and scope of IHR 2005

⚫ To prevent, protect against, control and provide a public health response to the
international spread of diseases. (help prevent the spread of disease across borders)
⚫ Outline the minimum requirements for functional public health system that
allows countries to quickly detect and respond to disease outbreaks in their
communities
Countries are required to quickly notify WHO of severe disease events that could
spread internationally, also referred to as public health emergencies of international
concern.
“Disease” under IHR (2005): – “an illness or medical condition, irrespective of origin or
source that presents or could present significant harm to humans”
_ Notification: All events that may constitute a public health emergency of
international concern (PHEIC)
This rapid notification allows WHO to quickly guide a coordinated global response to
such an event and minimize unnecessary interference on travel or trade.
They are an international agreement that gives rise to international obligations.

They focus on serious public health threats with potential to spread beyond a
country's border to other parts of the world.
Such events are defined as public health emergencies of international concern(PHEIC.)
The revised International Health Regulations outline the assessment, the management
and the information sharing for PHEICs.
What is a potential public health emergency of international concern?

A public health emergency of international concern is defined as an extraordinary
event that may constitute a public health risk to other countries through international
spread of disease and may require an international coordinated response.
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Four decision criteria are used to assess public health events:

1. Is the public health impact of this event potentially serious?
2. Is this event unusual or unexpected?
3. Is there the potential for international spread?
4. Is there the potential for travel and trade restrictions?
If 2 of the 4 criteria are met, countries are required to notify WHO within 24 hours.
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END
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Public Health Law and Ethics: Lecture Note

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Public Health Law and Ethics: Lecture Note

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Lecture Note PUBLIC HEALTH LAW & ETHICS

Public Health Law

.By the end of this unit you should be able to:

● Define and describe the Ethics and law.

as citizens of sovereign nations, as participants in the endeavours of the field of social

The health extension service is being provided as a package focusing on preventive

There is a growing interest in the ethical, legal, and social

Principles and types

The Big Five ethics Principles

1)The Principle of Autonomy:

2) Beneficence (doing well)

3)Non-Malficence (doing no harm)

5)The principle of truth telling (honesty)

Ethical Character Traits

3. Compassion is being sympathetic to the difficulties of others.

Laws are rules that mandate or prohibit certain societal

Statute law is two types

grievances of individuals or group of individuals, for example:

5. Judge: “A person who is officially designated or empowered by law to give a definite

The purpose & function of law

Causes of unethical and illegal behavior.

Method for preventing an illegal or unethical activity

Role Provides authority, limitations on state Provides ongoing analysi

Difference between Law and Ethics

Tort law definition

The principal objective in criminal law is punishment. In torts, it is compensation

Classification of Tort offences

Intentional (Willful) Unintentional

Main Objectives of tort law

Tort law has two main objectives: deterrence and compensation.

Objectives of tort law

Elements of tort action

To determine fault, the following may be proved:

The Four Ds of Negligence

Following are examples of negligence:

The reason for this rule of common law is that:

Public Health Law and ethics

health of the public, across three essential domains:

Public health ethics

Public health law

Public Health is based on Law To:

Principles of the Ethical Practice of Public Health

bring harm to an individual or community if made public. Exceptions must be justified on

Criminal Law & Public Health

Criminal laws are used to punish a defendant

Public Health Law and controlling Disease

Legal action as a tool for prevention

Public health law Purpose

current public health issues including new

Six Public Health Responsibilities

• Prevention of epidemics & spread of disease

Controlling the spread of infectious diseases

Communicable Disease Control

Public health Law for control Communicable disease

Prevention of mother-to-child transmission. In order to prevent or reduce the risk of

Contents of post-test counselling.

Quarantine of persons exposed to communicable disease

Mandatory reporting of infection or exposure

Appropriate exercise of legal powers

Infection and injury due to unsafe injection practices

Limiting contact with infectious persons

Non-communicable diseases and Public Health Act

Categories of health legislations