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									 Modernizing Public Health Laws in the
   21st Century: The Impact of the
   Turning Point Model State Public
Health Act on State Legislative Reforms

              James G. Hodge, Jr. J.D., LL.M.
Center for Law and the Public’s Health, Georgetown & Johns Hopkins

     Benjamin Mason Meier, J.D., LL.M., M.Phil. &
           Kristine M. Gebbie, Dr.PH, R.N.
  Center for Health Policy, Columbia University School of Nursing
A Brief Overview
   Public Health Law Reform in the 21st Century
   The Turning Point Statute Modernization
   The Turning Point Model State Public Health
       Scope
       Parameters
       State Legislative Update
   Assessing the Turning Point Act – Analyses
    from Key Jurisdictions
Public Health Law Reform in the
21st Century

           The Institute of Medicine,
 The Department of Health and Human Services,
        The Trust for America’s Health,
     Dozens of State Legislators and Health
    The Turning Point Statute Collaborative,
             and others agree . . .
Public Health Law Reform in the
21st Century

  Public health law in the United
     States is ripe for reform
    Assessment of State Public Health Law

   Antiquated. Public health statutes are outdated and may fail to
    reflect modern constitutional norms, public health and biological
    sciences, individual and population ethics, and public health practices,
    policies, and relationships
   Unfocused. Public health law does not always articulate a clear
    mission for public health, nor reflect core or essential public health
   Inconsistent and Complicated. Public health law is varied and
    complicated, difficult for the public to comprehend, and challenging
    at times for health officials to implement
Benefits of Public Health Law Reform
   Modernize and amend antiquated laws to keep pace
    with scientific developments
   Reflect modern constitutional, legal, and ethical
   Clarify public health legal powers and duties
   Stimulate public health dialogue with policy makers
    and communities
   Improve communication and working relationships
    within the public health system
   Improve public health programs/outcomes
Risks of Public Health Law Reform
 Statutory editions may change the landscape
  of public health practice
 Changes in public health laws may add costs
  without matching resources
 Statutory reform in state legislatures is
  fraught with potential complications and
 Modernizing public health laws does not
  assure improved public health practices
State Public Health Law Reform

 Despite the risks, the essential question
 concerning public health law reform
 among state law- and policy-makers is
 not why, but how?
State Public Health Law Reform

―…the Nation’s public health
infrastructure would be strengthened if
jurisdictions had a model law and could
use it regularly for improvements.‖

          DHHS, Healthy People 2010
          (similarly stated in IOM, Future of Public Health . . ., 2003)
Turning Point Mission

  To transform and strengthen the
  legal framework for the state public
  health system through a
  collaborative process to develop a
  model state public health law.
Turning Point Timeframe
Phase I: State Public Health Law Assessment -
     completed May 31, 2001

Phase II: Development of a Model Law -
     completed August 31, 2003

Turning Point Model State Public Health Act -
     released September 16, 2003

Phase III: Dissemination & Education -
Core Collaborative Partners
   Alaska         NACCHO
   Wisconsin      National Governors’
   Colorado        Association
   Nebraska       National Conference of
   Oregon          State Legislatures
   CDC            National Indian Health
   HRSA            Board
   APHA           National Association of
                    Local Boards of Health
                   Institute of Medicine
The Turning Point Model State
Public Health Act

 Scope
 Parameters
 StateLegislative Update
 Case Studies in Specific States
The Turning Point Act - Scope

The Turning Point Act is the most
comprehensive model state public
health act ever produced in the
United States.
The Turning Point Act - Topics
Topics addressed within the Act’s 9 substantive
Articles include:
  Mission and Functions
  Public Health Infrastructure
  Collaboration and Relationships
  Public Health Authorities and Powers
  Public Health Emergencies (re: MSEHPA)
  Public Health Information Privacy (re: the
  Administrative Procedures, Criminal/Civil
The Turning Point Act –
What It Is
   Legislative provisions for states to use as a tool to
    compare to their existing public health laws
   Balance of community and individual interests to
    protect the public’s health while respecting civil
   Incorporation of an intersectoral public health
   Essential public health services and functions that can
    be used in a wide array of public health responses.
   Attempt to incorporate modern scientific methods of
    public health practice consistent with key policy
The Turning Point Act –
What It Is Not

   A mandate to states to improve their public health laws.
   Design for a model state and local public health system.
   An attempt to cover all areas of public health relevance
    (e.g., mental health, substance abuse, environmental
   Specification of public health powers based on certain
    diseases (e.g., HIV/AIDS, tuberculosis) or conditions (e.g.,
    obesity, injuries).
   The only acceptable policy choices for public health
The Turning Point Act –
Legislative Update
   The subject matter of the Act has been featured in over
    110 different state legislative bills or resolutions
    introduced in 33 states since January 1, 2003. Of
    these bills, 44 have passed in 25 different states.
   Many states have used or are using the Act (in whole or
    part) to assess their existing state public health laws
    (e.g., AK, AZ, CO, DE, MT, NE, MI, NM, OR, TN, WI)
   Alaska HB 95, ―An Act relating to the duties of the Dept
    of Health & Social Services,‖ passed in June 2005, is
    directly based on multiple provisions of the Act.
The Turning Point Act - States that have
Introduced Bills or Resolutions

        HI          WA                                                                        VT NH
 AK                                  MT                                                                  ME
                 OR                                                                                           MA
                                               SD                   WI                         NY                RI
                                      WY                                  MI
                                                          IA                              PA           NJ
                      NV                                                                              DE
                                                                          IN    OH
                                UT                                   IL
               CA                         CO                                         WV VA            MD
                                                KS        MO                   KY                   DC
                           AZ                       OK
                                      NM                      AR                         SC
                                                                          AL        GA
                                               TX              LA
      Introduced Bills                                                                   FL

      Total: 33 States
                                                                                    PR - (Puerto Rico)

                                                               Data Current as of October 24, 2006
The Turning Point Act - States that have
Passed Bills or Resolutions

       HI          WA                                                                         VT NH
AK                                  MT                                                                  ME
                OR                                                                                            MA
                                              SD                   WI                             NY             RI
                                     WY                                  MI
                                                         IA                                  PA          NJ
                     NV                                                                                 DE
                                                                         IN    OH
                               UT                                   IL
              CA                         CO                                         WV   VA             MD
                                               KS        MO                   KY                       DC
                          AZ                       OK
                                     NM                      AR                         SC
                                                                         AL        GA
                                              TX              LA
     Passed Bills                                                                       FL

     Total: 25 States
                                                                                   PR - (Puerto Rico)

                                                              Data Current as of October 24, 2006
Transforming National Collaboration into
State Legislation—A Comparative Case Study
   Justification – Assess how the Turning Point Act is
    currently being used by state and local law- and policy-
    makers in legislative and regulatory reform initiatives

   Scope – Describe the effectiveness of the Turning Point
    Act as a means to promote public health through legal
    reforms at the state and local levels

   Implications – Apply lessons learned from the Turning
    Point Act experience to future state legislative reform
Public Health Law Reform Pursuant
to the Turning Point Act
 Case Study Method – Successes and Failures
 Legislators, Bureaucrats, Advocates
 Semi-Structured Interviews
   Role in the legal/regulatory changes
   Public health problems addressed by the changes
   Obstacles to changes in state law and the strategies used to
    overcome these obstacles
   Subsequent changes in public health regulation, organization
    or programs based on legal reforms
   Expected changes in public health outcomes
Preliminary Conclusions—State
Political and Policy Efforts Matter
    ALASKA               SOUTH              WISCONSIN
                                           The Turning
 The Turning                               Point
                      Lack of an           Experience
  Point                External
  Experience           Galvanizing         Stakeholder
 Politicization       Force                Collaboration
  of Public           Bureaucratic        Bottom-Up
  Health               Expansiveness        Reform
                       and the Risk
 Top-Down             of Backsliding      Strong
  Reform                                    Legislative

                                        * Preliminary Results
    Example—A Process Model of Successful
    State Public Health Law Reform: Alaska
      Stage I: The                 Stage II: The           Stage III: Legislative
      Emergence and                Development of                   Action
     Utilization of the               Draft Law               Dominant Actors
     Turning Point Act           Dominant Actors                 Legislators
   Dominant Actors                  Division of Public          Division of Public
        Turning Point                Health                       Health
         Collaboration               Office of the               Executive Branch
        Division of Public           Attorney General            Advocacy Groups
         Health                  Key Forces                  Key Forces
   Key Forces                       Public Health               The Turning Point
        Agenda Setting               Necessities
                                                                  Politicization of
   Result                           Political                    Public Health
        Model Developed         Result                          Executive
         for Discussion of           State Law                    Prerogative
         Issue                        Developed to            Result
                                      Pursuant to                 Reformed State
                                      Turning Point Act            Public Health Law

   The Turning Point Act is a comprehensive model for state public health
    authorities to assess their existing laws.

   The objective is to use law as a tool for targeted reform initiatives that
    collectively seek to improve public health infrastructure and outcomes

   Different states have incorporated various parts of the Turning Point
    Act into their law based upon individual, political, and institutional

   For more information, please see the Center for Law and the Public’s
    Health website at:
    or the Center for Health Policy website at:

   Thank you!

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