09/07/2022

Lectures on Professional
Ethics
Delivered to Students of the Uniport School of Public Health
Lecture ONE
By
Prof. Best Ordinioha
Definitions and Introductions
Professor of Public Health and Community Medicine
(policy, law, public health)

Brief history of Public Health and law Assumed causes of epidemics

• The industrial revolution of the • The outbreak of the epidemics
19th century in Europe and were blamed on:
America led to the development • foreign imports, or
of cities.
• The filth and housing conditions of
city life.
• The rural-urban migration that
followed led to overcrowding • Reasons given according to the
and creation of slums, economic interest of the person
• resulting in several outbreaks of
epidemic diseases

Port cities
• Traditionally, port cities had dealt with
epidemics by means of quarantine
regulations,
• confining ships suspected of carrying
disease in the harbour for up to forty days.
• These quarantine regulations interfered
with shipping,
• so were energetically opposed by those
whose economic interests were tied to
trade.
Creation of public health agency
• These disputes were however resolved in 1842
with the publication of “the sanitary condition of
the labouring poor”
• by the ubiquitous Victorian civil servant and lawyer,
Edwin Chadwick,
• based on his experience as the Secretary of the Poor
Commission
• In this report, he emphasized the crucial link
between dirt due to unsanitary conditions and
overcrowding and disease;
• and stressed the need for a central administrative
structure to oversee health issues.
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Slums
• Opponents of quarantine argued that
disease was generated by the filthy
conditions that provided an ideal
environment for “putrefactive
fermentation”.
• The causes of disease epidemics were in
dispute throughout much of the 19th
century.
• Health regulations were thus written and
revised more in response to political
pressures than to shifts in medical thinking.
Creation of public health agency 2
• Public health agencies of different nomenclatures
were thus created all over the world
• Buoyed by the fact that the primary purpose of
government everywhere is to work for the
collective good of the citizens.
• This was clearly as follows in the 1999 Nigerian
constitution.
• “The Federal Republic of Nigeria shall be based on the
principles of democracy and social justice…. the security
and welfare of the people shall be the primary purpose
of government”

Medical Officer for Health
• The position of the Medical Officer of Health was
created to head the public health agencies
• Dr. Isaac Ladipo Oluwole became the first African
Medical Officer for Health in Nigeria
• when he was appointed first as Assistant Medical
Officer for Health in 1925 and then Medical Officer for
Health in 1935
Sanitary inspection
• The Medical Officer of Health was
appointed to ensure the health of all
the people in his area of jurisdiction;
• In the era in which he was first
appointed,
• this amounted to the duties of sanitary
inspection and
• the tracing of the foci of infection
during epidemic.
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Medical Officer for Health 2
• The main duties of the Medical Officers
of Health were captured in section 4 of
the Public health law in Nigeria as
follows:
• “…inspect the area to which he is
appointed and to abate nuisances and
otherwise to enforce the powers vested in
him relating to public health”
The Public Health law
• These activities were more like police
function that need to be accomplished by
a strong legal back up.
• This was realized with the passage of the
Public Health Ordinance cap 56 of 1917 in
Nigeria.
• This law still subsists as The Public Health
Act in each of the States in Nigeria

Definitions
• A policy is a set of ideas or plans that is used as a
basis for making decisions
• Policy has also been defined as a deliberate
system of guidelines to guide decisions and
achieve rational outcomes.
• Governments, individuals and groups have
policies
• to serve as guides in the achievement of the desired
objectives on certain issues.
Executive orders
• The ability to make executive orders is based on
expressed or implied Acts of the Assembly that delegate
to the President/ Governor some degree of discretionary
power (delegated legislation).
• Examples of executive orders include:
• Presidential executive orders, issued by President Buhari to
address the issues of corruption and ease of doing business
• Executive orders, issued by State governments to tackle the
corona pandemic, such as the one issued by the Rivers State
Governor
09/07/2022
Government policies
• Governments in Nigeria, over the years have
several policies to achieve the desired health
outcomes
• Government policies include:
• Executive Orders; and
• Policies on specific aspects of governance
• An executive order is a directive by the
President or Governor
• on how certain functions of the executive branch
of government are to be carried out
Government policies
• Health-related government policies include:
• National Policy on Population for Sustainable Development
(NPP),
• issued in 2004 to improve standards of living and quality of life for
Nigeria’s people
• by addressing the complex interrelationships between population and
development.
• The National Policy on Health,
• to address the issue of Universal Health Coverage (UCH) and other
health-related Sustainable Development Goals (SDGs)
• The National Policy on the Environment
• that addresses issues related to the environment.
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Policy differs from law Policy differs from law 2

• Policy differs from law, even though they are both from the • Also, government policies, including the
government,
Executive Order must be grounded in
• Laws must be obeyed,
subsisting laws, and
• no matter how bad the person considers it to be • must not contravene any law, especially rights
granted in the constitution.
• Policies on the other hand are not strong enough to compel
or prohibit a behavior, but are designed to encourage
actions towards the desired outcome. • They can be challenged in the court, and
• For instance, the National Population policy recommends that each ruled as illegal,
couple should have a maximum of four children.
• if found to have contravened existing laws
• The policy however lacks the powers to prosecute any couple that
has more than four children.

Definition of law Types of law

• Law has been variously defined as: • Laws are of different types, and called
“The rule of civil conduct or action, different names.
prescribed or formally recognized by the supreme power of a
State, • Ordinance
to be binding to all, • Bye-law
the violation of which attracts some sanction from an • Decree
enforcement authority”.
• Edict
• Act
• The main features of a law are:
• It must be obeyed, no matter the person’s opinion about
the law • Laws passed by democratic governments,
• with the three arms of government properly
• Refusal to obey the law, and other actions that are constituted are the only true laws.
contrary to the law are penalized by the legal system.
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Ordinances Decrees and edicts

• Laws enacted by the executive arm of the • Laws enacted by military
government,
• without the involvement of the legislature are called
government are called decrees,
ordinances. • if passed at the federal level, and
• edict, if enacted at the State level.
• These laws were mostly passed by Local Government
Councils,
• and were so called because the Local Councils did not have
a proper Legislative Assembly during the colonial era

• Some laws passed by the LGAs are called bye-laws,

• because they are derived from the laws previously passed
by the State or federal government.

Decrees and edicts 2 Classes of law

• Most of the decrees and edicts passed
during the Military regimes in Nigeria
have been converted to laws,
• following the constitutional blessing given
to them by the 1999 Constitution
• In pursuance of this, the decrees and
edicts are therefore presumed to have
been respectively promulgated by the
National Assembly and States’ Houses of
Assembly,
• So they are no longer called ‘Decree’ or
‘Edict’ but ‘Act’ and ‘Law’.
• Laws are classified as:
• Private Law or
• Public Law.
• Private law is concerned with the rights and duties of
individuals as they relate with other individuals as
private individuals or citizens.
• Private laws include:
• Laws that guide the relationship between two persons
• Laws that deals with property, contracts, torts or legal
wrongs, trusts, partnership among others.
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Public law Types of Public law

• Public laws are the laws that: • Public laws that govern the relationship between
individuals and government include:
• guide the relationship between an individual • constitutional law,
and the government, and • administrative law
• tax law

• relationships between individuals that are of

direct concern to society, for example murder • Public laws that guide relationships between individuals
that are of concern to the society are called criminal laws.

• Criminal laws are technically private laws,

• because they relate to the relationships between persons,
• but they are concern to the society, because they can disturb
public peace and harmony, if not properly handled. For example,
murder and theft.

Constitutional law Constitutional law

• Constitutional law is the fundamental law of the • Nigeria has had several constitutions since its
country. amalgamation by the British in 1914.

• It is the body of law that defines

• the role, powers, and structure of the three arms of • The constitution that is currently effective is
government - executive, legislature, and the judiciary; the 1999 constitution
• that was enacted at the beginning of the current
• the basic rights of citizens and, democratic dispensation.
• the relationship between the three tiers of the
Nigerian government
• federal government, state and the LGAs
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Administrative law Criminal law

• Administrative law is also called the law of government in
action.
• It is the body of law that governs the activities of
government agencies such as NAFDAC, RIWAMA and
NOSDRA.
• These laws include the Establishment Laws of the agencies
that
• clearly specifies how the agencies would discharge its
responsibilities.
• For example, NAFDAC was established by Decree No. 15 of
1993,now the NAFDAC Act Cap N1 Laws of the Federation
of Nigeria (LFN) 2004
• clearly specified the functions and responsibilities of NAFDAC
• Criminal law is the body of law that relates to
crime.
• Criminal law proscribes conduct perceived as
threatening, harmful, or otherwise
endangering
• to the property, health, safety, and moral welfare
of people inclusive of one's self.
• Crimes against one's self are detrimental
actions against oneself such as attempted
suicide or self mutilation

Criminal law 2 Importance of public health laws

• Most criminal law is established by statute, • The laws used in the practice of public health
laws passed by the legislature, are mostly:
• such as the laws against child marriage, and • The administrative laws of public health agencies,
• female genital mutilation and

• Although criminal laws often prescribe
punishment for violation,
• they are make provisions for the rehabilitation of
certain offenders,
• especially if the crime was committed due to
certain circumstances, such as drug addiction,
mental illness
• The Public Health Act that guides the actions of the
Medical Officer of Health.
• The Public Health Act was used by the Medical
Officer of Health as schoolmaster
• to compel people to maintain a clean
environment

Law as a schoolmaster
• The use of law as a schoolmaster was condemned as
shown in the words of Dr. Charles V. Chapin, one of the
foremost practitioners of public health of the 19th
century when he wrote:
“Thus far the promotion of public health has been largely a
matter of compulsion. The state took away men's property
and men’s liberty . . . The rigorous enforcement of isolation
took away man's most cherished right, his personal liberty.
Police work is not pleasant work. It is slow work, and he who
does it finds it difficult to obtain the good will of those whom
he coerces”
Lecture Two
The drafting and review of public
health legislations
09/07/2022
New diseases
• The use of legislations has waned with the
increasing prevalence of life-style related
diseases such as HIV/AIDs, cancer and
diabetes
• caused by lifestyles such as unsafe sex and
unhealthy foods that are difficult to legislate
against;
• These new diseases are better controlled
with the use of
• biomedical and engineering technologies like
immunization and drugs; and
• health education.
Introduction
• Public health legislation in Nigeria has
stagnated since after the colonial era,
• and the revision of subsisting ones to keep pace
with the trend in public health practice has been
painfully slow.
• Most of the subsisting Public Health Acts in
Nigeria are just revised copies of the public
health ordinance Cap 56 of 1917,
• which was based on the miasmic theory, seriously
out of date,
• making their implementation and enforcement very
difficult.
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Introduction 2
• The only recognizable activities in
public health legislation in Nigeria
are the comprehensive legislations
establishing government agencies
like NAFDAC.
• These organizations are able to use
the powers conferred on them by
their Establishment Acts
• to make regulations that are consistent
with international standards.
Introduction 3
• Unfortunately, not all aspects of public
health have so benefited from new or
revised laws
• Formulating or revising health legislations
require inputs from health and legal experts,
• with knowledge of the social context in which
the laws would be enforced

Law making Law, the responsibility of the executive

• Legislation is law that is written down. • When a law has been passed,
• Legislation created by the legislature is called Act of
Parliament or statute.
• it is the duty of the executive branch of
• The word Act merely refers to the fact that the
government to enforce it
legislature has acted in its capacity as the law-making
arm of government

• In exercising its mandate as the law-making arm of

government, it is the responsibility of the legislature
• to ascertain, by means of thorough investigation and
discussion,
• what laws are needed, and then to promulgate them.

Law, the responsibility of the Judiciary
• Once a law is passed by the legislature,
• it is the responsibility of the judiciary to
• first determine the constitutionality of the law; and
• then to interpret the law in cases brought to it, when
the law is adjudged to be constitutional
• The constitution is the supreme law of the
country,
• therefore no law passed by the legislature is tenable,
if it is shown to be contrary to the dictates of the
constitution
Delegation of the powers to make law
• Sometimes the legislature delegates its powers to
make law to the other arm of government,
• to aid the discharge of the responsibilities of that arm of
government
• For example, a legislature can enact a law for the
control of communicable diseases in the State, but
delegate to the State Ministry of Health, the power to
make rules and regulations that would aid the control
of the communicable diseases, such as
• the designation of the diseases to be reported and the
manner of reporting,
• the nature and extent of quarantine for each of the
notifiable diseases, and all other necessary procedures.
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The law
• The legislature may decide as a matter of fact
that:
• vaccination is a necessary intervention to control
epidemic of diseases; and
• Conclude that compulsory vaccination is in the
interest of public health, to control the deadly
epidemic; and
• accordingly pass a law to that effect.
• If such legislation does not infringe on any
constitutional right of citizens,
• it will be upheld by the courts,
Delegated powers
• The power to make rules and regulations
are usually delegated to a public health
agency through the Establishment Act of
the agency.
• For example, the public health law gave
public health officials the power to make
rules necessary for the control of epidemic
diseases,
• while NAFDAC through its Establishment law
is given the power to make rules guiding the
safety of food and drug.

Delegated powers 2
• The rules and regulations made by agencies have
the force and effect of a law, and
• are obeyed by all persons affected by them.
• They are called subordinate legislation;
because:
• they are subordinate to the primary legislation passed
by the legislature, and
• Because they were made with delegated powers.
• It is important to note that subordinate
legislations cannot be contrary to the primary
legislation.
Problems created by delegated powers
• The power to make subordinate legislations
has led to multiplicity of rules and regulations,
• that are sometimes contradictory,
• making it difficult for an average citizen to
comprehend and comply with
• For example, in Rivers State, the decisions on
Sanitation Day are taken by both the Ministry
of Environment and the Rivers State Wastes
Management Agency (RIWAMA),
• the directives issued are sometimes contradictory
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Advantages of delegated powers
• It makes the revision of the details of the
legislation easier,
• since it frees the busy legislators from the
responsibility.
• The work of a parliament is limited by the
times of its sittings, and the task of passing
new laws can take considerable time
• It ensures that rules that require technical
details are properly handled by the
professionals in the government agency.
Problems created by delegated powers
• Citizens are entitled to be adequately and precisely
informed of what is expected of them,
• It is now a common requirement that subordinate
legislations must be made known to the general public,
• particularly to those who are most directly affected,
• before they are legally binding
• Such regulations are required to be published in:
• official state gazette,
• Radio announcements
• Bulletins or magazines issued regularly by the health
department,
• Newspapers and
• in pamphlet form, for general distribution.

The making of public health
legislations
The formulation stage
• The formulation stage of a health
legislation takes place in the Ministry
of Health or public health agency,
• It follows a decision to use legislation
as part of the methods for the control
of an emerging public health problem.
• This decision is reached when officials
of the ministry or public health agency
are convinced that legislation is
seriously needed for the control of the
problem.
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Introduction
• In a democracy, the process and procedure of making a public health
legislation, and indeed all legislations follows three stages:
• The formulation stage;
• The enactment stage; and
• The operation stage
The formulation stage 2
• With this conviction, the Minister or
Commissioner in charge of the ministry
must seek the approval of the Executive
Council before continuing with the
legislative process.
• This would involve the presentation of a
policy document to the Cabinet,
• justifying the introduction of such a law
and outlining the scope of legislative
changes required to implement the policy.

The formulation stage 3
• Specifically, the policy document
prepared by the Ministry of
Health or its agency should
address:
• Why regulation of that particular
area of activity by legislation is
necessary;
• The purpose of the legislation; and
• Any matters of decided policy.
The formulation stage 5
• Not every new health problem would require a
new legislation.
• A new legislation is only necessary when there is
no existing law that can be used to solve the
emerging public health problem.
• This process is carried out by a comprehensive
review of existing statute laws on the subject by
officials of the Ministry of Health
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The formulation stage 4
• Legislation is now an option of last
resort in public health.
• Therefore, there must be a strong
convincing reason why legislation is
chosen ahead of health education in
tackling the health problem,
• Considering the limitation of individual
rights that come with legislations.
The formulation stage 6
• Old legislations can be re-purposed to deal with new
public health problem by any of the following two
processes:
• To approach the court to provide clarification on the
applicability of old legislations in solving the new problem;
or
• Proposing to the legislature, for an amendment of the
existing legislation
• For example, the House of Representative attempted
to repel the Quarantine Act and replace it with a new
law,
• to give the NCDC more powers to control epidemics like the
current corona pandemic

The formulation stage 7
• A comprehensive review would help
decide whether what is needed is to:
• Repeal the existing law
• Amend the law; or
• Write a new law
• As a general rule,
• At present, no new health problem would
require an entirely new legislation for its
control.
• It is often best to amend related legislations
Drafting the legislation 2
• The wordings of legislation are often short, direct and
precise.
• Obscurity, vagueness, ambiguity and equivocation are avoided,
• for it was once said that there is a useless lawsuit in every
useless word of a statute.
• Nowadays, legal precedents (examples of legislation that
are in place elsewhere) are used to assist legal drafting;
• The WHO quarterly journal – the International Digest of Health
Legislation provides a wealth of such health statutes.
• Legal precedents are however only a guide,
• as the conditions and resources in countries are not the same.
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Drafting the legislation
• With the approval of the Executive council, the real process of
drafting the legislation commences.
• This is often handled by lawyers in the Attorney-General’s office,
• assisted by the originators of the law in the Ministry of Health.
• Because public health legislations are regulatory, and impose
drastic restraints upon persons and property,
• they need to be carefully and properly drafted to withstand the test of
court analysis.
• Valid, adequate, practical and enforceable public health
legislation requires the input of experts
• who are not only familiar with public health policies,
• but also with the technique of bill drafting.
The enactment stage
• After the legislation has been properly drafted, it is
sent to the legislature for consideration and possible
passage.
• At this stage, the legislation is called a "bill";
• it becomes an “act” when it has been passed and
enacted.
• Every bill must go through a certain routine
procedure before becoming a law.
• There are slight differences in the procedure in the
State and National Assembly,
• due to the bicameral nature of the national assembly.

The enactment stage 2
• Nigeria has a bicameral national assembly
• The Senate represent the States, while the House of
Representatives the people,
• Both of them have equal powers of legislation, and no
bill can become a law without the assent of both the
House and the Senate.
• The Senate consists of 109 members,
• three from each State, and one from the Federal
Capital Territory, Abuja;
• while the House of Representatives consists of
three hundred and sixty members,
• representing constituencies of nearly equal population
The enactment stage 4
• Any member of the national assembly who
desires to introduce a bill must rise,
• be recognized by the Presiding Officer of the
assembly, who is often the Senate President in the
Senate and Speaker in the House of Representative,
and
• announce that he wishes to introduce a bill.
• It is then deposited beside the Presiding Officer's
desk,
• later read by a clerk and referred to the proper
committee.
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The enactment stage 3
• Bills may originate in either branch.
• Frequently, identical bills are introduced
simultaneously in both houses, especially if they
are executive bills proposed by the executive arm
of government.
• Sometimes a bill is suggested or drafted by a citizen
and given to a member of legislature to present.
• Any member of the national Assembly may
introduce a bill in his own name, which is called
private member bill.
• Both houses have legislative drafting services which
prepare bills in accepted legislative phraseology.
The enactment stage 5
• The bill is considered by the
committee, which may hold public
hearings on it.
• The committee may then do one of
four things:
• Report the bill favorably as it stands,
• Report it favorably with amendments,
• Report it unfavorably, or
• Take no action at all.

The enactment stage 6
• The number of bills introduced in national
assembly during the 181-day legislative year is
legion.
• But, many of these bills never get out of the committee
stage.
• Usually this means that the bill has no chance of
passage,
• However, in a few instances, often to deal with an
emergency,
• a motion is made that a committee be discharged from
consideration of the bill,
• with the result that the bill is brought directly before
the legislative house.
The enactment stage 8
• Information about the bill is given to the legislators before
the open debate of the bill on the floor of the assembly
• This is to ensure that legislators are properly informed
about the need of the bill, to enable them make informed
contribution
• This information is provided in the form of an explanatory
statement or explanatory notes that contains the
following information:
• the intention of the legislation,
• Draw attention to matters of policy and
• Give a brief description of significant provisions.
• Sometimes, the services of lobbyists are employed for the same
purpose.
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The enactment stage 7
• When a bill is favorably considered by the relevant committee,
• it then goes upon the calendar.
• The consideration of a bill can however be called up out of order, and brought
forward for discussion, to deal with an emergency
• When the bill comes up, it is read on the floor of the legislative house for
open debate.
• Every time draft legislation is introduced in a legislative house, it is referred to
as a reading of the bill.
• The total number of times a bill must be read before passage is specified in
the rules of the national assembly, and
• it is unacceptable for a bill to be read more than once at any one sitting of national
assembly,
• unless there is proven urgency for the adoption of the law.
The enactment stage 9
• After debate, the required amendments
are made, before the bill is voted for with a
voice vote
• If the bill passes, it is sent to the other
legislative house for concurrence.
• When a bill which has already been passed
in one arm of national assembly is laid
before the other,
• it may be passed as it is,
• amended and passed,
• left in committee, or
• rejected

The enactment stage 10
• If a bill is passed in both houses of the National Assembly,
• it goes to the President for assent.
• If amended,
• it goes back to the original arm for concurrence to the
amendments, which may be done at once.
• If there is disagreement,
• each chamber appoints a specific number of members to form
a conference committee to meet and settle the differences.
• The report of this committee is laid before each house, which
may adopt it or disagree.
• Conferences are again held and this process is continued until
both Senate and House have agreed on the measure.
• It then goes to the President, as an enrolled bill.
The operation Stage 2
• When the President vetoes the bill by refusing to
give his assent,
• he sends back the bill to National Assembly with a
written statement of his objections.
• National Assembly may make the amendments
as suggested by the President,
• or may decide to stick with their original version
of the bill.
• In this case, they need a two-thirds majority in each
house of the National Assembly to override the
President’s veto.
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The operation Stage
• According to the 1999 Nigerian constitution,
• the President has 30 days, within which to signify that he
assents or
• that he withholds assent to the bill sent from the National
Assembly.
• If he signs the bill, or fails to sign it within that period,
• the bill becomes a law and is known as an act.
• The act is sent to the Secretary of Government of the
Federation
• to be numbered and filed as the original copy of the law; and
• then forwarded to the Public Printer to be printed for public
use.
The operation Stage 3
• Sometimes an effective date is inserted into the law itself;
• in other cases, the coming into force is stated to be ‘on a date
to be proclaimed’.
• This provision is often used in cases where more detailed
provisions for effective implementation, such as regulations,
are required to be put in place before the legislation takes
effect,
• as is the case with the Petroleum Industry Bill
• The disadvantage of this is that the secondary processes may
be delayed or deferred so much that, the legislation may not
be proclaimed.

Enactment of laws in the States
• The passage of laws in the States of
the Federation as shown in Section
100 of the 1999 constitution also
follows this pattern.
• The only difference being that the
legislative house in the States is
unicameral,
• which eliminates the need to get a
concurrence from the other legislative
house before a bill is passed.
Law making in the Local Government Areas 2
• The administrative structure of the LGAs is
determined by the relevant legislations in the
various States of the Federation.
• However, most States of Nigeria still retain the
Presidential system of government at the Local
Government level,
• with an elected Chairman wending executive power,
and
• elected Councilors forming the legislative arm.
• Thus, the process of legislations basically follows
the process outlined in the constitution for the
State and National Assembly.
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Law making in the Local Government Areas
• The fourth schedule of the 1999 constitution
listed the functions of the Local Government
Areas as:
• The provision and maintenance of primary, adult
and vocational education;
• The development of agriculture and natural
resources, other than the exploitation of materials
• The provision and maintenance of health services;
and
• Such other functions as may be conferred on a
local government council by the House of
Assembly of the State.
Law making in the Local Government Areas 2
• The local Government Councils make only Bye-laws,
• because they are only capable of making regulations within
an already existing law.
• While the LGAs have wide authority, they may not, as a
general rule,
• pass any regulation contrary to one passed by the State, or
• one that is inconsistent with a state law, or a regulation
adopted by the state health department, as authorized by
law.
• It is however within the powers of the Local
Government Bye-law to make the terms of a state law
stricter,
• but not to the extent that it violates constitutional rights

Lecture Three
The statutory powers of public
health agencies and their staff
(The power to tax and spend)
Introduction 2
• According to Lawrence Gostin of the Georgetown/
John Hopkins Program on Law and Public Health,
• this power granted public health agencies to make
rules are used in five different ways:
• The power to tax and spend
• The power to alter the informational environment
• Direct regulation of individuals, professionals and
businesses (police power)
• The use of the tort system; and
• Deregulation
09/07/2022
Introduction
• Public health officials derive their mandate and powers from
the administrative laws that established their various
agencies.
• For example, the public health law created the position of a
Medical Officer of Health; and Section 4 of the law gave the
duties of a Medical Officer of Health as:
“…inspect the area to which he is appointed and to abate nuisances
and otherwise to enforce the powers vested in him relating to public
health”
• Also, the Establishment Act of the National Agency for Food
and Drug Control (NAFDAC) empowers the agency to take any
necessary measure to ensure the quality and safety of foods
and drugs in Nigeria,
• including the powers to make rules.
The power to tax and spend
• The power to tax and spend is one of the
powers granted to a public health agency
• by virtue of the administrative law that
establishes it.
• It provides the agency with an important
regulatory technique,
• which is often used to encourage healthy
behavior, and penalize unhealthy ones.

The power to tax and spend
• The power to tax and spend is used to encourage healthy behavior,
and penalize unhealthy ones mainly in three different ways:
• Tax reliefs are used to encourage private health-promoting activities which
are seen as advantageous to community health.
• Tax burdens or fines are applied to exert economic pressure on people that
engage in activities which the public health agency considers to be unhealthy
or dangerous, especially if the activity negatively affects the health of other
people
• Conditional benefits are used to force people to patronize a service as a
requirement for certain other services
Tax reliefs 2
• Tax reliefs are used in the health sector to
encourage the patronage of health services
and products that protect not only the
individual, but also protect others.
• These products and services include:
• The national policy on health that makes
preventive services like immunization free, to
encourage people to get immunized.
• Products such as ITNs enjoy tax reliefs because
they are effective against a common endemic
disease, and protects not just those that sleep
under the ITN, but also persons sleeping in the
same room, and even in the whole community.
09/07/2022
Tax reliefs
• Tax relief is an incentive that reduces the amount
of tax paid by an individual or business entity.
• Examples of tax relief include:
• Import duty waiver, that exempts the beneficiary from
paying the tax levied on imported goods, to make the
price of the imported goods more affordable.
• Tax exemption, that exempts the beneficiary from
paying certain taxes, such as tax exemptions granted for
pension contributions, children and contributions in
health insurance
Public Health Goods
• The products and services are called Public Health
Goods.
• A Public Health Good is defined as things used by an
individual that benefits not only the individual, but also
other members of the community, country and the world.
• The concept of Public Health Good explains:
• Why communicable diseases such as HIV/AIDS, Ebola and
Polio receive donor funding and their treatment provided
free of charge to patients, whereas patients with such non-
communicable diseases such as cancer and sickle cell
disease are made to pay for their diagnosis and treatment.
• Why the EPI vaccines are provided free of charge to children
and the Human Papilloma Virus (HPV) vaccine that protects
against cancer of the cervix has to be paid for by the patient

Tax burdens
• Tax burdens include taxes, excise duty and import duty.
• Taxes are levied on individuals,
• while duties are levied on goods.
• Excise duty is duty paid on manufactured goods,
• at the time of their manufacture, rather than at point of their
sale,
• Sales tax are levies paid at the point of sale of the
product or service.
• Import duty is levy paid on imported goods
Conditional benefits
• Public health agencies exercise their power to
spend by giving conditions in which certain benefits
are enjoyed.
• These are called Conditional Benefits.
• Conditional benefits are benefits enjoyed upon
meeting certain conditions.
• The most popular example in Nigeria is the
Conditional Cash Transfer (CCT) program
• that pays a certain amount of money to a poor person
• once he/she is able to show evidence of having enrolled
his/her children in school, or patronized a government
health service.
09/07/2022
Tax burdens 2
• Tax burdens are used by public health agencies to exert
economic pressure and discourage unhealthy behavior.
• This is especially if the unhealthy behavior also has an adverse
effect on other people.
• Examples include:
• The taxes and duties on unhealthy products such as cigarettes
and alcohol, to make them more expensive, to discourage
their excessive use.
• The heavy taxes paid by prostitutes in countries where
prostitution is legal, to make their services expensive
• The sugar tax levied by some countries on sugary foods and
beverages, to make them more expensive and reduce their
consumption
Conditional benefits 2
• Conditional benefits are used to reward healthy
behavior and penalize certain behaviours.
• Other examples include:
• A child being required to show an evidence of having
received full childhood immunization before being
registered into a government free primary education.
• The benefits of the National Health Insurance Scheme
extended to a maximum of four children, to discourage
people from having more than four children, as
recommended by the National Population Policy.

Lecture Three
The statutory powers of public health agencies
and their staff
(The power to alter informational
environment)
Introduction 2
• The power of public health agencies to alter
the informational environment is often
exercised through the following:
• Consumer product information through labeling
requirements
• Regulations in the advertisement of unhealthy
products
• Standards in the advertisement of foods and drugs
• Ban on the self-advertisement of medical and
dental practitioners
09/07/2022
Introduction
• Information is vital for health and health care delivery:
• It can be used for good,
• to encourage health behavior,
• It can also be used for bad,
• to entice a person into an unhealthy behavior, such as the
cigarette adverts that glamourize cigarette smoking.
• This is one of the reasons why public health agencies all over
the world take steps to control the type of information that is
available to the public,
• to at least protect the health of vulnerable members of the
community.
Labeling requirements of consumer products
• Product label performs several functions.
• It helps to identify and promote the product.
• It also provides essential information about the
product and its use.
• Studies indicate that the labeling of a product is
responsible for about 70% of the sales of the
product,
• hence the tendency of some unscrupulous
manufacturers to mislabel their products to promote
sales.

Labeling of consumer products
• This explains why public health agencies like NAFDAC
and Standards Organization of Nigeria insist that
products be labeled in ways that do not mislead the
customer.
• They require that the labelling should be
informative, accurate and non-promotional in tone,
and must not contain any false or misleading
information.
• Products such as herbal medicines are required to
show adequate evidence of safety, and substantial
evidence of effectiveness.
NAFDAC labeling requirements 2
• NAFDAC also requires that the following
information should be provided:
• The production ‘batch’ number, date of manufacture
and “best use before” date.
• Net content, specifying essential ingredients in
metric weight for solids, semisolids and aerosols,
and metric volume for liquids.
• Food additives and colours must be declared on the
label.
09/07/2022
NAFDAC labeling requirements
• NAFDAC also requires that the
following information should be
provided:
• The product’s brand name must be
written in bold colour.
• A complete “location” address of the
manufacturers.
• The country of origin of the product must
be clearly stated on the product label, if
the product is imported
Health warnings
• Public health agencies sometimes insist on
the inclusion of health warnings on the
packaging of unhealthy products,
• to warn consumers of the dangers of consuming
such products.
• These warnings have been used for cigarette
and alcohol
• Alcoholic beverages are required to have on their
labels that they should not be sold to persons
below the age of 18 years.
• They are also required to have a statement that
admonishes drinkers to drink responsively.

Health warnings on cigarettes
• The Nigerian law requires that cigarette packs
sold in Nigeria should contain warning messages
and/or pictograms that cover at least 50% of the
pack.
• The common health warnings on these packs
include:
• “The Federal Ministry of Health warns that Smokers
die young”
• Cigarette smoking kills
Nutritional Information 2
• Nutritional Information is especially needed
to guide diabetic patients on the choice of
food.
09/07/2022
Nutritional Information
• Processed foods are also required to include
Nutritional Information on their packaging,
• to inform buyers of their nutritional contents,
especially as they affect the Recommended Daily
Allowance of important nutrients.
• Nutritional Information is especially needed
to guide diabetic patients on the choice of
food.
Certification mark
• Sometimes, a certification mark is placed on
the label of a product,
• to indicate that the product had been
manufactured in a certain way.
• One of the most common certifications is
the Halal certification
• that certifies that the product had been
processed strictly according to Islamic
injunctions

Regulations in the advertisement of unhealthy
products
• Public health agencies also regulate the
advertisement of unhealthy products such as alcohol
and cigarette,
• to protect vulnerable persons.
• Nigerian broadcasting laws ban the advertisement of
alcoholic beverages during the prime time of the
mass media – 6
• am to 8pm for radio, and
• 6am and 10pm for television stations.
• The laws also ban the advertisement of alcoholic
beverages in children and sporting programmes.
Standards in the advertisement of foods and
drugs
• Public health agencies also set standards for
the advertisement of foods and drugs,
• to protect vulnerable persons, and
• reduce the patronage of unhealthy foods and
drugs.
• Nigerian broadcasting laws require that no
food, drink or drug will be advertised in the
mass media, except they have been registered
by NAFDAC.
09/07/2022
Ban on the advertisement of tobacco
products
• The Nigerian broadcasting laws however
bans all cigarette advert in the mass
media.
• Studies however show that cigarette
companies in Nigeria still find ways to
make their product visible to the public,
• for example through inscriptions on gift
items such as umbrella and plastic bags.
Standards in the advertisement of foods and
drugs 2
• The laws also require that the adverts
must not use superstition or fear,
• to promote the patronage of the product,
and
• That the drug must not be advertised to
have no side effects, or
• To be more effective than other drugs of
the same kind.

Ban of advertisement
• Sometimes, public health agencies place
restriction on the advertisement of certain
foods and drugs
• in certain places,
• in certain media, and
• to certain persons,
• to achieve some desired public health objectives
• Breast milk substitutes, commonly called
infant formula are not to be advertised or
sold in hospitals,
• as part of the Baby Friendly Hospital Initiative,
• to promote the exclusive breast feeding of babies
Ban of advertisement 3
• Breast milk substitutes and alcohol
can not be advertised in ways that
target pregnant women,
• because the use of the products is
dangerous to the health of their babies.
09/07/2022
Ban of advertisement 2
• Only Over-the-Counter drugs that can be
bought without the prescription of a
doctor can be advertised in the mass
media.
• Drugs that require doctor’s prescription
can only be advertised in medical journals,
and the other publications read only by
health professionals.
Ban on the self-advertisement of medical and
dental practitioners
• The Nigerian law, through the code of
ethics issued by the Medical and Dental
Council of Nigeria (MDCN) banned all
forms of self-advertisement.
• This ban is designed to protect the
patient from unscrupulous practitioners,
and reduce professional rivalry.

Lecture Four
The statutory powers of public health
agencies and their staff
(Police powers)
Introduction 2
• Police powers include:
• The powers to arrest, detain and generally
restrict the movement and association of a
person, within constitutional limits, and
• The powers to restrict the use of private
properties
• The power to restrict the use of private
properties is embodied in the common
law maxim,
• “use your own property in such a manner as
not to injure that of another”.
09/07/2022
Introduction
• Public health agency being a government agency has the
responsibilities to protect the health, safety, morals, and
general welfare of the population.
• It is therefore vested with the necessary powers to
deliver on these responsibilities.
• The power to deliver on these responsibilities are called
police powers.
• Police power has been defined as:
“the inherent power of a government to exercise reasonable
control over persons and property within its jurisdiction in the
interest of the general security, health, safety, morals, and
welfare except where legally prohibited”.
Use of police powers
• Public health agencies have used their
police powers in so many ways,
including:
• Direct regulation of persons for the
control of communicable diseases
• Regulation of health professionals; and
• Regulation of businesses

Direct regulation of persons
• The police powers of a public health
agency to restrict the movement and
association of an individual are usually
applied in efforts to control epidemics of
infectious diseases such as COVID-19
• These powers are usually applied in the
following ways:
• Medical examination and testing
• Compulsory vaccination and;
• Isolation and quarantine
Medical examination and testing 2
• Persons who are engaged in certain
occupations such as food handlers, nurses,
and teachers are also compulsorily
subjected to testing and medical
examinations before they are permitted to
practice their occupation,
• because they can easily spread infections to
their clients.
• The importance of this was illustrated by a
housemaid nicknamed Typhoid Mary,
• who was able to infect hundreds of persons
with typhoid, working as a maid or in a
restaurant
09/07/2022
Medical examination and testing
• The public health law provides the public
health official with the power to compel
individuals to submit to testing or medical
examination,
• especially when these procedures are helpful
in limiting the spread of disease.
• For example, all those who were exposed
to confirmed corona patients are
compulsorily tested and retested to
ascertain if they have been infected
Medical examination and testing 3
• Compulsory testing and medical
examination are invasions of a
person’s autonomy and privacy
• They must therefore be carried out
with clear justification,
• failing which it becomes an illegal
violation.

Compulsory vaccination
• Compulsory vaccination is also commonly
used by public health agencies in the
control of serious epidemics,
• especially when it is established that the
vaccination is very safe and effective.
• Compulsory vaccination has been
established to be the most cost-effective
tool in the control of highly infectious
epidemic diseases like measles, Ebola Viral
Disease and COVID-19
Compulsory vaccination 3
• Sometimes, individuals object to vaccination citing
religious reasons.
• Some religious groups like Faith Tabernacle do not
use modern medicine, including vaccination,
• Several other religious groups reject certain
vaccines, based on how the vaccines were
produced.
• For example, some Muslim and Judaism sect reject
vaccines produced using pig,
• because their religion consider pig as unclean, and thus
should not be “eaten” in any guise.
09/07/2022
Compulsory vaccination 2
• Compulsory vaccination was commonly used by
the colonial administration in Nigeria and Ghana
• A nurse in Ibadan gave the following description
of the compulsory vaccination carried out by the
colonial Mobile Field Unit during the 1957
smallpox epidemic in Ibadan:
“We set up vaccination stalls in the market …..and along
every road into Ibadan and manned them whenever we
were off duty for 24 hours a day, for a fortnight. Nobody
was allowed into or out of the city without being
vaccinated and the mammie wagons were emptied at
the side of the road to ensure this”.
Compulsory vaccination 4
• Health professionals consider any objection to
vaccination as dangerous to the health of the
individual and to the society, and seriously kick
against it.
• For example,
• some religious groups rejected measles vaccination
in the US, but that resulted in an outbreak of the
disease among members of the group
• Polio vaccine was also rejected by some Islamic
groups in Kano leading to similar result
 09/07/2022

Compulsory vaccination 5 Isolation and quarantine

• Following several litigations in
countries all over the world, it has
now been largely established that
objection to vaccination should only
stand in the court of law,
• if the belief against compulsory
vaccination is genuine, sincere, and
• an integral part of the religious
doctrine.
• Public health agencies have the police powers to
isolate or quarantine persons who are infected with, or
exposed to an infectious disease,
• to ensure that they do not constitute a threat to public
health.
• Persons infected with an infectious epidemic disease
were isolated in specially established Infectious
Disease Hospitals during the colonial period in Nigeria.
• Most of these Infectious Disease Hospitals are no
longer in operation,
• hence the establishment of new Isolation Centers and the
isolation of patients in regular hospitals at the height of the
COVID-19 pandemic

Isolation and quarantine 2

• Similarly, persons exposed to a patient
with an infectious epidemic disease are no
longer placed on ‘house arrest’ until after
the incubation period of the infection, as is
the case in the colonial period,

• But only have their movement restricted Regulation of health professionals

to certain areas, and
• banned from going to public places like
schools, market, workplaces and worship
centers.

Regulation of health professionals
• Government uses its police power to regulate
the entry and practice of business or profession
that have the potential to harm public health or
general welfare,
• This is done by:
• The imposition of reasonable and uniform standards
and specifications for the conduct of the business of
practitioners
• The issuance of appropriate licenses or permit that
may be withheld or revoked at the discretion of the
issuing government agency.
Regulatory agencies
• The practice of the major health professions in
Nigeria are regulated by their own regulatory
agencies:
• The practice of medicine in Nigeria is regulated by
the Medical and Dental Council of Nigeria
• The practice of nursing is regulated by the Nursing
and Midwifery Council of Nigeria
• Pharmacists in Nigeria are regulated by the
Pharmacists’ Council of Nigeria
09/07/2022
Regulation of health professionals 2
• In accordance with this power,
• government regulates all aspects of the health care practice
• This regulation is to safeguard the health and safety of
the public, and
• to ensure that the professionals act in reasonably competent
and safe ways.
• Most of the regulations are carried out through
licensure,
• with the licensing agency given special legislative powers to
promulgate rules and set standards that meet the changing
needs of the public for protection.
Regulatory agencies 2
• The practice of Community Health Workers in Nigeria is
regulated by the Community Health Practitioners
Registration Board of Nigeria
• The practice of Environmental Health Officers in Nigeria
is regulated by the Environmental Health Officers’
Registration Council of Nigeria
• The practice of Health Information Managers in Nigeria
is regulated by the Health Records Registration Board
of Nigeria

Regulatory agencies 3
• These regulatory agencies set the minimum
qualification required for the practice of the
various professions in Nigeria,
• a type of qualification that bestows certain skills on
the professional that makes his/her services safe
for the general public.
• Once an individual receives a license from a
regulatory agency,
• it cannot be revoked or suspended without proper
notice and hearing.
Regulation of businesses
09/07/2022
Demerits of licensure
• Licensure on itself is a restriction of the person’s
freedom to carry on an activity, profession,
occupation, or business of choice.
• It creates a monopoly for a group of persons, and
• stifles competition by restricting the number of people
who can legitimately practice the profession.
• The only reason it is being used in public health is
for the protection of the health, safety and
welfare of the public.
Regulation of businesses
• Businesses with a strong potential of affecting
public health and safety are regulated to ensure
that they do not pose much danger.
• These businesses include:
• Businesses that are directly involved in health care
delivery such as hospitals, nursing homes,
ambulatory-care center, medical laboratories and
pharmacies; and
• Businesses with the potential to affect public health
such as food industry and waste management
companies.

Regulation of businesses 2
• Businesses with a strong potential
to affect public health are usually
regulated using:
• Licensure
• Inspections; and
• Nuisance abatement drives
Licensing of private hospitals
• According to the Private Hospital Act,
private health institution must satisfy the
following conditions:
• 1. The medical practitioners in the private
hospital are qualified to provide the type of
services delivered in the hospital
• 2. The registered nursing staff is adequate,
and
• that the person in charge of the nursing staff
holds a diploma or certificate of training from an
institution recognized by the Nursing and
Midwifery Council of Nigeria.
09/07/2022
Licensing of businesses of public health interest
• Licensure ensures that licensed businesses
have the manpower and other resources
that guarantee the safety of clients.
• The registration is often handled by a
regulatory agency.
• For example, the Private Hospital Act CAP 537,
Laws of the Federation of Nigeria, vested the
power to register private clinics on the Private
Hospitals’ Registration Authority of each State of
the federation.
• Although each State of the federation has its
own version of this statute, the conditions for
registration are virtually the same.
Licensing of private hospitals 2
• 3. The housing of the facility is satisfactory
and conforms to the requirement
approved by the regulatory authority.
• 4. The equipment are suitable and
sufficiently adequate to meet the
requirements of such private hospitals
• 5. The provisions of the law or regulations
guiding private hospitals with in-patient
and out-patient only facilities are met
according to the status of the hospital.

Licensing of private hospitals 3
• 6. The private hospital with in-patient
facilities must have up to the minimum
stipulated number of beds.
• 7. Where the hospital would engage in the
compounding and dispensing of drugs,
• must retain the services of a qualified
pharmacist registered with the Pharmacists’
Council of Nigeria.
• 8. The private hospital must also comply
with the provisions of the Public Health
Law.
Inspections of businesses 2
• Inspections of businesses of public
health significance are different from
criminal law searches, because:
• They are advisory, and designed to
assist the establishment to better
safeguard the health of the patronizing
public
• they are not primarily intended to
uncover evidence to be used in the
prosecution of a crime,
09/07/2022
Inspections of businesses
• The inspection of businesses for
public health purposes is:
• to determine whether conditions
exist that are deleterious to health, or
• if there are violations in the public
health standards, set up to protect
the public from possible harm from
the business.
Inspections of businesses 3
• Although the inspections are
mainly for educational
purposes,
• it is however not to say that
gross violations cannot be
prosecuted and penalties
imposed.

Demerits of the inspections of businesses
• Inspections violate the individual’s right
to privacy and security, but public
health inspections are often tolerated
by businesses
• because the inspections are stipulated in
the registration document of the business.
• So they were forewarned, before they
were registered to operate
Nuisance abatement drives 2
• A nuisance is a condition that threatens the public’s right to health,
comfort, and repose.
• According to the Public Health Law, the public health official has the
right to enter any premises in search of nuisance.
• Section 9 (1) of the Public Health Law (Rivers State) states as follows:
“ It shall be lawful for the health officer to enter any premises at any time
between the hours of six in the morning and six in the evening for the purpose
of examining as to the existence thereon of any nuisance, until a nuisance found
to exist has been abated or the works ordered to be done are completed or the
closing order is cancelled”
09/07/2022
Nuisance abatement drives
• The abatement of nuisance is an old
preoccupation of the public health official,
• applied to ensure that conditions do not exist in the
community that are capable of jeopardizing the
health of the public.
• The duty was so important in the practice of
public health that the duty of the Medical
Officer of Health as contained in the Public
Health Law was simply
“to inspect the areas to which he is appointed and to
abate nuisances”.
Nuisance abatement drives 3
• The nuisance abatement drives involve the
invasion of private property, and therefore must
be clearly justified.
• If a health officer abates a non-dangerous
condition, or acts excessively in the light of the
danger posed,
• then the purported abatement may constitute a
“taking” or damaging of private property without due
process of law.
• In such cases, the owner of the property can be
entitled to compensations for the loss suffered.

Lecture Five
The statutory powers of public
health agencies and their staff
(The use of the tort system)
Introduction 2
• Whenever a person’s right is violated,
• the resulting wrong to the individual is known as a tort.
• Torts are of numerous kinds and classes, and
• include many that involve hazards to human life and injuries
to personal health.
• Thus providers of products and services found to be
injurious to health may be sued
• It therefore offers an opportunity for the indirect regulation of
individuals and businesses involved in health care delivery,
• as it provides strong incentives for them to engage in less risky
activities.
09/07/2022
Introduction
• Everyone is entitled by law to the reasonable
enjoyment of life, liberty, and property, and
• to the security of his person, his family, and his possessions.
• Government recognizes these rights and protects
them,
• although the sovereign power may properly impose certain
desirable restraints upon individual rights for the benefit of
the common good.
• The State always regulate life, liberty, and property in
the interests of the public health and the general
welfare.
Duty to provide quality service
• Any person who offers his services in a
professional capacity, whether as a physician
or other health worker contracts with his
employer – the patient that:
• he possesses the reasonable degree of learning,
skill, and experience usually possessed by
members of his profession;
• that he will employ reasonable and ordinary care
and diligence in the exercise of that skill and
knowledge, according to his best judgment.

Liability for negligence
• Injuries resulting from failure to do the
things expected from an average health
worker makes the practitioner liable.
• The tort system provides compensation
for persons who are injured through
• the negligent or intentional actions of
others
• who have a legal duty to avoid such
injuries.
Malpractice suits 2
• Because of the huge amount
usually paid out to the
aggrieved patients,
• medical practitioners routinely
buy a malpractice insurance, to
enable them cope with the
payout.
• This is called medical indemnity
Insurance
09/07/2022
Malpractice suits
• This compensation is usually achieved through
a Malpractice law suit,
• which is often first heard in the tribunal set up by
the registration council of the professional group.
• This tribunal has members with the requisite
professional qualification and experience,
• and is thus in the best position to determine that
the act allegedly committed is unprofessional
and/or below the acceptable standard.
Malpractice suits 3
• The huge indemnity fee has pushed medical
practitioners to become very cautious in their
practice,
• with a tendency towards defensive medicine, which is
one of the reasons why medical bills are very expensive in
the United States.
• Defensive medicine is the ordering of diagnostic
tests and the hospitalization of patients,
• not necessarily because they are needed in the
management of the patient,
• but to protect the doctor in the event of any litigation, for
failing to do everything necessary.

Litigations against unhealthy
products
Litigations against unhealthy products 2
• Despite the legal rule known as caveat emptor,
• under which the buyer purchases at his own risk, in the
absence of a warranty or of fraud,
• There is always an implied warranty that food and
drugs sold for human consumption is wholesome
and safe.
• This implied warranty.
• Thus, a drug manufacturer who sells his drug to a
patient can be liable for illness caused by the toxic
properties in the drug.
09/07/2022
Litigations against unhealthy products
• Litigations have also been used to influence
manufacturers to make their products safer,
• especially as they can be sued for the harm
caused by their products.
• Remarkably, litigations have been used by
public health agencies to facilitate:
• the building of safer cars,
• reduced advertising and promotion of cigarette
to young people, and
• to ensure the safety of food and drugs.
Litigations against unhealthy products 3
• However, the mere fact that an injury or death
results from the application or use of a health
product does not constitute proof that the
preparation was at fault.
• It must be shown by competent evidence:
• That the injury or death was due to the product of
the manufacturer,
• That the product of the manufacturer was
inherently dangerous and/or poisonous, and
• That the manufacturer was negligent in putting
upon the market such a product

Litigations against unhealthy products 4
• Landmark litigations of public health
interest include:
• The litigation against the cigarette companies
• The litigation against the manufacturers of
talcum power
• The litigation against asbestos companies
• The litigation against Monsanto, the
manufacturer of the weed killer Glyphosate
Litigation against tobacco companies 2
• This suit led to the Tobacco Master Settlement
Agreement in 1998, in which the tobacco companies
agreed:
• To pay the state governments in perpetuity, to
compensate them for some of the medical costs of caring
for persons with smoking-related illnesses.
• The tobacco companies in this agreement accepted to pay
a minimum of $206 billion over the first 25 years of the
agreement.
09/07/2022
Litigation against tobacco companies
• One of the most important suits against the tobacco companies
is
• the litigation against the four major cigarette companies in the United
States by the government of 46 states of the country.
• Philip Morris USA has cigarette brands like Marlboro, Virginia
Slims and Benson & Hedges
• R. J. Reynolds Tobacco Company has cigarette brands like Camel
and Pall Mall.
• Brown & Williamson Tobacco Corp, American subsidiary of
British American Tobacco, producers of brands include Dunhill
and Rothmans
• Lorillard Tobacco Company has brands like Kool, Maverick and
Salem
The litigation against the manufacturers of
talcum power
• For decades, talcum powder was feared to have
contributed to the development of ovarian cancer
in thousands of women.
• In recent years, thousands of women who used
talcum powder and have developed ovarian
cancer have filed lawsuits against Johnson and
Johnson, and other manufacturers of talcum
powder.
• Some of these women have been awarded damages
totalling over $5 billion

The litigation against asbestos companies
• Asbestos is a product that had several
domestic and industrial uses,
• but exposures to asbestos dust have
been associated with several respiratory
problems.
• This has resulted in several
compensation suits from workers of
asbestos companies and
• persons who feel their ill health was
caused by exposure to asbestos.
Lecture Six
The professional responsibility of
a public health official
09/07/2022
The litigation against Monsanto
• There are several law suits against
Monsanto, an agro-chemical manufacturing
company,
• for failing to warn the public about the cancer
risk associated with the use of its weed killer,
glyphosate.
• In August, 2018, Dewayne Johnson became
the first person to win the case against
Monsanto,
• for his non-Hodgkin lymphoma and was
awarded $289 million in actual and punitive
damages against Monsanto.
Introduction
• Public health can simply be defined as the health
care given to the general public
• Community is commonly defined as a group of
persons with common interest, and residing within
a defined geographical location.
• Thus, the “general public” of an LGA, State or
country consists of several communities:
• rural, urban,
• riverine, upland,
• waterside, old township etc.

Introduction 2
• Public health practitioners are employed
by the government to provide health
care for all the communities that make
up the general public
• Community Health practitioners are
given the responsibility to provide care
usually for a single community,
Introduction 4
• The Medical Officers of Health is the most prominent public
health officer at the LGA,
• There are several public health officials of various background,
skills and training at the State and Federal levels.
• The most prominent Community Health practitioners in Nigeria
are:
• The Environmental Health Officers, and
• The Community Health Officers and the various cadres of Community
Health Extension Workers.
09/07/2022
Introduction 3
• Public health practitioners often work at the LGA,
State and the Federal levels
• where they plan for the several communities that make up
the level of government they work in;
• Community Health practitioners are posted to
specific communities
• where they are responsible for the health and longevity of
everybody in the community they are posted to serve.
Public health officials as civil servants
• Public and community health officials are civil
servants,
• There is therefore a tendency to work according
to the desires of the government of the day.
• This is acceptable only when the policies of the
government, according to the professional
knowledge of the public health official
• are in the best interest of the public,
• and not for the interest of the political party in
power, or other pecuniary interests
 09/07/2022

Responsibility is to the community The battle would be tough

• The public health official must always act

knowing that they owe a duty of loyalty,
• not to the government of the day,
• but to the community which they are appointed
to serve.

• Public health officials derive their powers from

the establishment legislation of the public
health agency,
• and can therefore seek protection from the
Establishment Act.

• This is sometimes not protective enough,

• but justice is often secured in the long run

Public and community as clients Public and community as clients 2

• Public and Community Health practitioners have the
public and community they serve as their clients
• They are therefore like other client-based professionals
such as physicians, accountants and lawyers
• They owe a fiduciary duty to their clients,
• to serve the clients,
• advise the client fully and honestly,
• take instructions from the client, and
• avoid acting against the client’s best interests;
• Although what is best for the community is
often not easy to ascertain,
• the public health skills of epidemiology,
biostatistics and cost-effectiveness analysis
however make the choice easier for the public
health official.
• For example, targeted lockdown instead of the
total lockdown

• Fiduciary is a person who holds a legal or ethical

relationship of trust with another person.

Public and community as clients 3
• The training and appointment as a
public health official presupposes
that the official has the basic skills,
• hence can be liable to a breach of
the duty of care and negligence,
• if he/she fails to make use of these
skills to the advantage of the
community.
Nonfeasance
• Nonfeasance is the failure to act
where an action is required
• For example:
• failure of the government and
security agencies to take decisive
action against illegal refining of crude
oil
• This is not only an economic waste,
but very polluting the environment
09/07/2022
The tort of negligence
• A public health official who fails to effectively
use the skill sets expected from a person of
his/her training, as shown by his/her
certificate, in the discharge of his/her duties
can be held liable for:
• a nonfeasance, failure to act where an action is
required
• a misfeasance, wilful inappropriate action; or
• a malfeasance, wilful and intentional action that
injuries the client
Misfeasance
• Misfeasance is willful inappropriate
action
• At the peak of the COVID-19
pandemic, the Cross Rivers State
government was accused of:
• not testing the right people
• Avoiding the use of NCDC-approved
laboratories
• To ensure that no corona case is
reported in the State
 09/07/2022

Malfeasance Professional ethics

• Malfeasance is a wilful and intentional action that • Public health officials are expected to be professional
injuries the client in their conduct,

• These actions are uncommon, • Professionalism is defined as an ability to

• except the practitioner has a grudge against the clients demonstrate ethical choices, values and practices in
decision making

• Example: • This translates to performing one’s responsibilities

• A religious fundamentalist performing an abortion to according to the ethics of the profession.
harm a woman and teach her a lesson

• A medical doctor prescribing a drug to cause pain and • Professional ethics has been defined as personal and
settle score with a verbally abusive patient corporate standards of behaviour expected from
practitioners of a particular profession.

Code of ethics for public health Code of ethics for public health 2
• To facilitate this, the Public Health Leadership Society (PHLS) of the United • 4. Public health should advocate for, or
States of America developed a code of ethics for public health, to guide work for the empowerment of
practitioners in their practice. disenfranchised community members,
• The 12 principles of the code are as follows: ensuring that the basic resources and
• 1. Public health should address principally the fundamental causes of disease and conditions necessary for health are
requirements for health, aiming to prevent adverse health outcomes. accessible to all people in the community.

• 2. Public health should achieve community health in a way that respects the rights of
individuals in the community. • 5. Public health should seek the
information needed to implement
• 3. Public health policies, programs, and priorities should be developed and evaluated
effective policies and programs that
through processes that ensure an opportunity for input from community members. protect and promote health.

Code of ethics for public health 3
• 6. Public health institutions should
provide communities with the
information they have that is needed
for decisions on policies or programs,
and should obtain the community’s
consent for their implementation.
• 7. Public health institutions should act
in a timely manner on the information
they have within the resources and the
mandate given to them by the public.
Code of ethics for public health 5
• 11. Public health institutions should
ensure the professional competence
of their employees.
• 12. Public health institutions and
their employees should engage in
collaborations and affiliations in ways
that build the public’s trust and the
institution’s effectiveness.
09/07/2022
Code of ethics for public health 4
• 8. Public health programs and policies should
incorporate a variety of approaches that anticipate
and respect diverse values, beliefs, and cultures in
the community.
• 9. Public health programs and policies should be
implemented in a manner that most enhances the
physical and social environment.
• 10. Public health institutions should protect the
confidentiality of information that can 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.
Lecture Seven
Equity and social justice – the moral
underpinnings of public health

Introduction
• Nigeria’s health indices are bad, and about
the worst in Africa,
• in spite of having the largest economy in Africa,
and
• the highest number of health care workers.
• The health indices do not tell the whole
story, as several disparities have been
noticed:
• between states,
• between the north and the south,
• between urban centers and rural areas, and
• even between religious groups.
Social inequities
• Social inequities refer to the
differences in health status between
different socio-economic groups
that are
• produced by social processes,
• rather than biologically determined,
and
• therefore potentially avoidable and
unacceptable, from a human rights
perspective.
09/07/2022
Introduction
• The causes of these disparities are often
preventable and avoidable, because they
are not genetic.
• The causes are therefore called inequities.
• Inequity has been defined as lack of
fairness or justice.
• It is of various forms,
• but social inequities in health are considered
the most unfair.
Equity
• Equity are measures taken to tackle
inequities.
• It has been defined as the absence
of avoidable, unfair, or remediable
differences among groups of
people,
• whether those groups are defined
socially, economically,
demographically or geographically or
by other means of stratification.
 09/07/2022

Equity 2 Social justice

• Achieving equity in health • Equity is achieved by ensuring social
involves treating unequals equal, justice,
and ensuring that everyone has • a concept of fair and just relationship
between the individuals in a society.
a fair opportunity to attain their
full health potential, irrespective
of: • Social justice is the process of
• Place of residence ensuring that:
• State of origin • individuals discharge their
responsibilities to their society, and
• Political affiliation • in turn, receive their due reward from
• Religion society.

Equity and social justice Equity and social justice 2

• Equity and social justice are often achieved by • Public health practice is governed by the principles of
• Taxing everybody, according to their ability to pay equity and social justice.
• Spending government’s revenue, to ensure that everyone has an
acceptable level of health • The concept of equity in health can be traced back to
the constitution of the WHO which states that:
• everyone, without the distinction of race, religion, political
• Spending to achieve equity and social justice are often belief, economic or social condition should be able to attain
achieved with their full health potentials.
• social insurance,
• public health,
• public school, • The principles are also reflected in the 1999 Nigerian
• public services, constitution.
• labor law and “The Federal Republic of Nigeria shall be based on the
• regulation of markets principles of democracy and social justice”

The practice of equity and social justice
• The operationising social justice means that
once a person has fulfilled his/her
responsibilities as a citizen or resident of a
country,
• the individual is entitled to a minimum set of
welfare packages,
• This is especially the case in Nigeria where
it is clearly stated in the constitution that
• the primary function of government is the
welfare of the people
The practice of equity and social justice 2
• Health is considered a fundamental human right
• Ensuring that everyone is granted the right to health
is the problem that faces public health officials
• a problem that introduces the dilemma of equity and
equality.
• Equality means giving equal share to everybody,
• Equity means sharing the resources according to the
needs of the person,
• such as persons in great need receive a higher share, to
bring them to the acceptable level of health.
09/07/2022
Fundamental human rights
• The minimum set of welfare packages
accruable to every person as a human
being is called fundamental human
right.
• Fundamental human rights are the
rights an individual has as a human
being
• that must be guaranteed or provided by
every government,
• no matter how poor or rich the country is.
The practice of equity and social justice 3
• Equity is achieved by:
• “levelling up” the health status of the most
disadvantaged groups,
• Not the “levelling down” the health status of
advantaged groups,
• This is achieved by having something for
everybody,
• but more for the disadvantaged, in proportion to
need.

The practice of equity and social justice 4
• The efforts of the ministry of health are to
ensure that everybody in the community
enjoys a level of health that guarantees a
socially and economically productive life.
• This is the bottom-line to which all efforts
are made to push the disadvantaged
members of the society to the level
• Disabled persons should be provided with aids
to enable them function
The practice of equity and social justice 6
• Getting every member of the community to the
bottom-line is better achieved by empowering
the disadvantaged groups
• to enable them overcome social and economic
barriers to their development.
• This is the reason for world-wide programmes
such as:
• Health-For-All,
• the Millennium Development Goals (MDGs) and
• the Sustainable Development Goals (SDGs)
09/07/2022
The practice of equity and social justice 5
• Getting every member of the
community to the bottom-line
requires a lot of balancing act
• to ensure that health spendings are
carried out in such a way that all
sections of the community are
covered,
• with more resources channeled
towards improving the health of the
disadvantaged.
Health-For-All
• Health-For-All is a programme launched by the WHO in the
1980s,
• to bring health within the reach of everyone in a given country,
• such that everyone is able to attain a state of health that enables
the person to lead a socially and economically productive life;
• HFA is designed to be achieved
• not just by the provision of medical services with doctors, nurses,
drugs and vaccines,
• but with the removal of the obstacles to health such as the
elimination of malnutrition, ignorance, contaminated drinking
water and unhygienic housing.
 09/07/2022

Millennium Development Goals (MDGs) Sustainable Development Goals (SDGs)

• Millennium Development Goals • The Sustainable
(MDGs) were eight international Development Goals (SDGs)
development goals, signed by came into force in 2015,
the member states of the after the expiration of the
United Nations, at the dawn of MDGs,
the 21st century
• They are also aimed at
• They were aimed at reducing reducing the different
the different ramifications of ramifications of poverty, but
poverty by the year 2015. by the year 2030.

The practice of equity and social justice 7
• Even as efforts are being made by health
officials to provide health services to all,
extra care should be taken to ensure that
the most vociferous groups within the
community,
• for example, the volatile youths and the most
politically powerful
• are not given special consideration to the
exclusion of the less privileged members of
the community.
The practice of equity and social justice 8
• It is clear that this is not the case
in Nigeria as shown by:
• The Amnesty programme
• The selective employment of
children of high-ranking
government officials into high
paying civil service jobs, while
children of the ‘not-so-connected’
are given N-Power jobs
 09/07/2022

1978 Alma Ata Declaration 1978 Alma Ata Declaration 2

• Nevertheless, primary health care gives public • Primary health care was chosen as
health officials the wherewithal for the a method for achieving HFA
equitable provision of health services. because:

• This is clearly stated in Article 5 of the 1978 • it is cheap and effective; and
Alma Ata Declaration: therefore,
• “A main social target of governments … should be • can be mass duplicated to take care
the attainment, by all peoples ….of a level of health of all members of the community,
that will permit them to lead a socially and
economically productive life. Primary health care is • irrespective of their socioeconomic
the key to attaining this target..” circumstance.

1978 Alma Ata Declaration 2

• Primary health care was defined in Article 6 of the Alma Ata Declaration as:
• “Essential health care based on practical, scientifically sound and socially acceptable
methods and technology, made universally accessible to individuals and families in
the community through their full participation, and at a cost that the community and
country can afford to maintain at every stage of their development in the spirit of
self-reliance and self-determination.
Lecture Eight
• It forms an integral part both of the country’s health system, of which it is the central
The right to health
function and main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family and community
with the national health system bringing health care as close as possible to where
people live and work, and constitutes the first element of a continuing health care
process.”

Introduction
• Equity and social justice are closely related
to human rights.
• Human rights are rights an individual has as
a human being that cannot be denied him
by any government.
• Disregard and contempt for the human
rights of the citizens is one of the few
reasons the international community can
use to intervene in the internal affairs of a
sovereign country.
Health as a fundamental human right 2
• The right to health is also firmly endorsed in a wide
range of international and regional human right
instruments including the Universal Declaration of
Human Rights
• Article 25 of the Universal Declaration of Human
Rights clearly recognized the right to health when it
stated:
“Everyone has the right to a standard of living adequate for
the health and wellbeing of himself and his family, including
food, clothing, housing and medical care and necessary social
services, and the right to security in the event of
unemployment, sickness, disability, widowhood, old age or
other lack of livelihood in circumstances beyond his control”
09/07/2022
Health as a fundamental human right
• The right to the highest attainable
standard of health (referred to as “the
right to health”) is considered one of the
fundamental human rights.
• It was first reflected in the WHO constitution
• Reiterated in the 1978 Declaration of Alma
Ata, and
• World Health Declaration adopted by the
World Health Assembly in 1998.
Government’s commitment to right to health
• Health is internationally recognized
as a Fundamental Human Right, and
therefore binding on governments.
• Governmental obligations with
regard to human rights fall under
the broad principles of:
• respect,
• protect and
• fulfill

Government’s obligation to respect right to
health
• The obligation of government to respect the
right to health requires that government
should not directly or indirectly interfere with
the enjoyment of the right to health.
• The Nigerian government therefore has the
obligation to:
• Ensure that no government practice, policy or
programme violates the right to health, and
• That services are provided to all population groups
on the basis of equality and freedom from
discrimination, with particular attention to
vulnerable and marginalized groups.
Government’s obligation to fulfil right to
health
• Government’s obligation to fulfil
human rights requires government to
put in place the appropriate
legislation, administrative, budgetary,
judicial, promotional and other
measures that ensure the full
realization of human rights.
• The allocation of the needed resources
is the first step in realizing the right to
health
09/07/2022
Government’s obligation to protect right to
health
• Government’s obligation to protect human
rights requires governments to take measures
that prevent third parties from interfering with
the enjoyment of the right to health
• Third party in this case include providers of
health products and services
• It is the responsibility of government that:
• The third parties are not exploitative
• Ensures equal access to their services and products;
and
• Are not discriminatory
Government’s obligation to fulfil right to
health 2
• In April, 2001, the African Union
countries met in Abuja and
pledged to set a target of
allocating at least 15% of their
annual budget to improve the
health sector,
• This is being referred to as the
Abuja Declaration

The right to health is for all
• When health is seen as a human right, the health
of the poor is not seen as a charity or
benevolence, or a question of purchasing power,
• it is seen as an entitlement of everyone by virtue of
being born human.
• It is the responsibility of the government to
provide a level social playing field,
• to ensure that all have the desired standard of health.
The minimum package for right to health
• The Committee on Economic, Social and Cultural Rights (CESCR) issued a
General Comment on the right to health, to specify the minimum core
obligations of government. These require governments to at least:
• 1. Ensure the right of access to health facilities, goods and services on a non-
discriminatory basis, especially for vulnerable and marginalized groups;
• 2. Ensure access to minimum essential food, which is sufficient, nutritionally
adequate and safe, to ensure freedom from hunger to everyone
• 3. Ensure access to basic shelter, housing and sanitation, and an adequate supply of
safe and potable water
• 4. Ensure equitable distribution of all health facilities, goods and services
09/07/2022
The right to health is for all 2
• The right to health extends well beyond health care,
• to include basic preconditions for health, such as potable
water and adequate sanitation and nutrition.
• These are enormous responsibilities that prompted the
former UN High Commissioner for Human Rights, and
former President of Ireland, Mary Robinson to remark:
“The right to health does not mean the right to be healthy, nor does it
mean that poor governments must put in place expensive health
services for which they have no resources. But it does require
governments and public authorities to put in place policies and
actions plans which will lead to available and accessible health care
for all in the shortest possible time”
The minimum package for right to health 2
• 5. Adopt and implement a national public health strategy and plan of action, on
the basis of epidemiological evidence, addressing the health concerns of the
whole population;
• 6. Ensure reproductive, maternal (pre-natal as well as post-natal) and child health
care
• 7. Provide education and access to information concerning the main health
problems in the community, including methods of preventing and controlling
them
• 8. Provide appropriate training for health personnel
 09/07/2022

The minimum package The minimum package 2

• These are the least that are expected from governments, • The Commission on Macroeconomics
• Failure to provide them cannot be justified by any government under any and Health of the World Health
circumstance Organization estimated that it would
cost US $35 per person per year to
• Countries constrained by lack of funds are required to give it their best provide the minimum core obligations
effort, using the maximum of the available resources, according to the in poor countries,
principle of progressive realization

• It is widely accepted that 15% of the

• When this has been done, it becomes the responsibility of the international total government expenditure can be
community to support the country, in the form of Official Development
Assistance (ODA) for health. taken as the maximum use of the
available resources.

Introduction
• Even as the respect of human rights forms
part of the guiding principles of the practice

Lecture Nine
of public health;
• there still exist several instances like in the
control of epidemics, where the rights of the

Individual rights and public health individual need to be curtailed for the common
good.

- Siracusa Principle • In this situation, public health legislations

face the challenge inherent in all laws –
• that of balancing the interest of the individual
and the interests of the society.

Human right vs public interest
• To what extent may the rights of the
individual be curtailed in order to promote
the general welfare?
• The answer to this question is “it depends”:
• It depends on the degree of risk to the community
and the degree of intrusion on individual rights.
• For example, Epidemic diseases with high fatality
like COVID-19 and Ebola require more stringent
control measures compared to epidemics of lesser
fatality such as HIV/AIDS
Human right vs public interest 3
• To what extent may the rights of
the individual be curtailed in order
to promote the general welfare?
• It depends on the nature of the legal
system and its protection of
individual rights.
• The legal system should be strong
enough to protect the citizens
against over-zealous enforcement of
the restriction
09/07/2022
Human right vs public interest 2
• To what extent may the rights of the individual be
curtailed in order to promote the general welfare?
• It depends on the scientific and epidemiological evidence
pertaining to the issue being legislated or litigated.
• This relates to the amount of danger posed by an
infected person
• Respiratory diseases are more easily transmitted, hence
should attract greater restrictive measures
• Sexually transmitted Infections like HIV are often
consensual, and it is difficult to legislate against sex
The Siracusa Principles
• The Siracusa Principles, a UN human rights
document prescribe conditions that must be
met before the fundamental human rights of
an individual can be violated for public
health reasons.
• These conditions include:
• 1. The restriction is provided for, and carried out
in accordance with the law
• 2. The restriction is in the interest of a legitimate
objective of general interest

The Siracusa Principles 2
• 3. The restriction is strictly necessary in a
democratic society to achieve the objective
• 4. There are no less intrusive and restrictive
means available to reach the same objective;
and
• 5. The restriction is not drafted or imposed
arbitrarily, that is in an unreasonable or
otherwise discriminatory manner.
Individuals must play their part
• Although the power and importance of individual
freedom have been demonstrated,
• the need for partnership, citizenship, and community
is also recognized.
• Individuals and communities need to play their
parts in the control of public health emergencies
requiring the subjugation of certain fundamental
rights,
• By understanding and supporting the restrictions with
their actions
09/07/2022
Restriction must have a time limit
• Even when all the conditions
prescribed by the Siracusa principles
are met,
• the limitation of the fundamental rights
of individuals must not be indefinite,
• but of limited duration and subject to
constant review.
The role of public health officials
• It is the responsibility of public health officials
to properly educate members of the
community on the need to de-emphasize
their personal interest and comfort,
• to protect and defend the community against
threats to health, safety, and security.
• In the present corona pandemic, it is the
responsibility of public health officials to:
• educate the public on the need for lockdown,
social distancing and the other control measures
 09/07/2022

The role of public health officials 2 The writ of habeas corpus

• It is also the responsibilities of public health
officials to ensure that the control measures are
implemented with human face, without
compromising the effectiveness of the control
measures
• For example, lock down is required for the
control of the corona pandemic, but must be
implemented in ways that guarantee:
• Full access to food, water and the other necessities of
life
• Access to emergency health care
• Due process as outlined in the Siracusa
principles must always be followed
before curtailing individual liberty for
public health reasons;
• This is because the wrongful restraints
can be challenged in a court of law by a
judicial process called
• the writ of habeas corpus

The writ of habeas corpus 2

• Habeas corpus is the Medieval Latin for "we, the

END OF LECTURES
Court command that you have the body of the
detainee brought before us“.

• Habeas corpus is the legal recourse through which

a person can report an unlawful detention or
imprisonment to a court and request that the court
order the custodian of the person, usually a prison
official, to bring the prisoner to court, to determine Thanks for your attention
whether the detention is lawful.
Prof. Best Ordinioha, July, 2022