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Modernizing Public Health Laws in the
21st Century: The Impact of the
Turning Point Model State Public
Health Act on State Legislative Reforms
James G. Hodge, Jr. J.D., LL.M.
Center for Law and the Public’s Health, Georgetown & Johns Hopkins
Universities
Benjamin Mason Meier, J.D., LL.M., M.Phil. &
Kristine M. Gebbie, Dr.PH, R.N.
Center for Health Policy, Columbia University School of Nursing
A Brief Overview
Public Health Law Reform in the 21st Century
The Turning Point Statute Modernization
Project
The Turning Point Model State Public Health
Act
Scope
Parameters
State Legislative Update
Assessing the Turning Point Act – Analyses
from Key Jurisdictions
Public Health Law Reform in the
21st Century
The Institute of Medicine,
The Department of Health and Human Services,
The Trust for America’s Health,
Dozens of State Legislators and Health
Departments,
The Turning Point Statute Collaborative,
and others agree . . .
Public Health Law Reform in the
21st Century
Public health law in the United
States is ripe for reform
Assessment of State Public Health Law
Antiquated. Public health statutes are outdated and may fail to
reflect modern constitutional norms, public health and biological
sciences, individual and population ethics, and public health practices,
policies, and relationships
Unfocused. Public health law does not always articulate a clear
mission for public health, nor reflect core or essential public health
services.
Inconsistent and Complicated. Public health law is varied and
complicated, difficult for the public to comprehend, and challenging
at times for health officials to implement
Benefits of Public Health Law Reform
Modernize and amend antiquated laws to keep pace
with scientific developments
Reflect modern constitutional, legal, and ethical
norms
Clarify public health legal powers and duties
Stimulate public health dialogue with policy makers
and communities
Improve communication and working relationships
within the public health system
Improve public health programs/outcomes
Risks of Public Health Law Reform
Statutory editions may change the landscape
of public health practice
Changes in public health laws may add costs
without matching resources
Statutory reform in state legislatures is
fraught with potential complications and
compromises
Modernizing public health laws does not
assure improved public health practices
State Public Health Law Reform
Despite the risks, the essential question
concerning public health law reform
among state law- and policy-makers is
not why, but how?
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 -
ongoing
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
ASTHO
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
MSPHPA)
Administrative Procedures, Criminal/Civil
Enforcement
The Turning Point Act –
What It Is
Legislative provisions for states to use as a tool to
compare to their existing public health laws
Balance of community and individual interests to
protect the public’s health while respecting civil
liberties
Incorporation of an intersectoral public health
infrastructure
Essential public health services and functions that can
be used in a wide array of public health responses.
Attempt to incorporate modern scientific methods of
public health practice consistent with key policy
choices.
The Turning Point Act –
What It Is Not
A mandate to states to improve their public health laws.
Design for a model state and local public health system.
An attempt to cover all areas of public health relevance
(e.g., mental health, substance abuse, environmental
health).
Specification of public health powers based on certain
diseases (e.g., HIV/AIDS, tuberculosis) or conditions (e.g.,
obesity, injuries).
The only acceptable policy choices for public health
practice.
The Turning Point Act –
Legislative Update
The subject matter of the Act has been featured in over
110 different state legislative bills or resolutions
introduced in 33 states since January 1, 2003. Of
these bills, 44 have passed in 25 different states.
Many states have used or are using the Act (in whole or
part) to assess their existing state public health laws
(e.g., AK, AZ, CO, DE, MT, NE, MI, NM, OR, TN, WI)
Alaska HB 95, ―An Act relating to the duties of the Dept
of Health & Social Services,‖ passed in June 2005, is
directly based on multiple provisions of the Act.
The Turning Point Act - States that have
Introduced Bills or Resolutions
HI WA VT NH
AK MT ME
ND
MN
OR MA
ID
SD WI NY RI
WY MI
CT
IA PA NJ
NE
NV DE
IN OH
UT IL
CA CO WV VA MD
KS MO KY DC
NC
TN
AZ OK
NM AR SC
AL GA
MS
TX LA
MSEHPA
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
ND
MN
OR MA
ID
SD WI NY RI
WY MI
CT
IA PA NJ
NE
NV DE
IN OH
UT IL
CA CO WV VA MD
KS MO KY DC
NC
TN
AZ OK
NM AR SC
AL GA
MS
TX LA
MSEHPA
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
efforts
Public Health Law Reform Pursuant
to the Turning Point Act
METHODS
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
CAROLINA
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
Champion
* 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
Experience
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
Conclusions
The Turning Point Act is a comprehensive model for state public health
authorities to assess their existing laws.
The objective is to use law as a tool for targeted reform initiatives that
collectively seek to improve public health infrastructure and outcomes
Different states have incorporated various parts of the Turning Point
Act into their law based upon individual, political, and institutional
factors.
For more information, please see the Center for Law and the Public’s
Health website at: www.publichealthlaw.net/Resources/Modellaws.htm
or the Center for Health Policy website at:
http://www.nursing.hs.columbia.edu/research/ResCenters/chphsr/law_pubHealth.html.
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