Critical Opportunities for Public Health Law: A Call for Action

Although legal interventions are responsible for many sentinel public health achievements, law is underutilized as a tool for advancing population health. Our purpose was to identify critical opportunities for public health lawmaking. We articulated key criteria and illustrated their use with 5 examples. These opportunities involve significant health problems that are potentially amenable to change through law and for which an effective legal intervention is available: optimizing graduated driver licensing laws, increasing tax rates on alcoholic beverages, regulating sodium in foods, enacting laws to facilitate reversal of opioid overdoses, and improving mental health interventions in the college setting. We call for a national conversation about critical opportunities for public health law to advance evidence-based policymaking.Many of the greatest public health achievements in the United States are the result of legal interventions.1,2 From the control of infectious diseases, to the reduction of coronary heart disease, to improvements in maternal and child health, the law has exerted a powerful effect on environmental and behavioral health risks. Evidence continues to mount about law’s effectiveness in addressing a gamut of health problems, with recent successes including prevention of childhood lead poisoning and workplace injuries.3In light of such achievements, law’s role in advancing public health is receiving greater attention by agenda-setting organizations such as the Centers for Disease Control and Prevention4 and the Institute of Medicine (IOM).5 Last year, an IOM committee recommended with “a sense of urgency” that government at all levels “make the most of … law and public policy to improve population health.”^5(p14) To advance this goal, the Robert Wood Johnson Foundation now supports a national program in Public Health Law Research,6 focusing on evaluation of legal interventions to improve population health, and the Network for Public Health Law,7 which provides legal technical assistance. The Centers for Disease Control and Prevention operates a Public Health Law Program8 and the American Public Health Association recently elevated its Health Law Special Primary Interest Group to the status of a full-fledged Law Section.9Despite this attention, law remains an underutilized resource in public health. Because of information gaps, opposition from industry, failure to capture lawmakers’ attention, and other factors, there are legal interventions that could have powerful effects on a wide range of health threats yet are not widely disseminated or well implemented. Some interventions require new law, whereas others simply require stronger or more creative use of existing authority. At the same time, some laws with unintended adverse effects have not been amended, clarified, or repealed.What are the most promising legal interventions to address important health problems? Where is the evidence for likely benefit most compelling and the barriers to policy change least formidable? Answering these questions successfully requires a framework in which researchers and policymakers can think strategically, apply common criteria, and bring evidence to bear to highlight the most fruitful areas of action. A national discussion to identify and prioritize critical opportunities for public health law is therefore needed.We have aimed to stimulate such a conversation and offer a framework for organizing it. We have proposed criteria for identifying critical opportunities, illustrated with 5 diverse examples. Our purpose is not merely to advance these particular examples on the policy agenda but to encourage policymakers and scholars to further engage in a public dialogue about how legal authority can be used for maximum population health impact.     

Local Legal Infrastructure and Population Health

Objectives. We explored the association between the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, and local population health outcomes.Methods. Our unit of analysis was public health jurisdictions with at least 100 000 residents. The dependent variable was jurisdiction premature mortality rates obtained from the Mobilize Action Toward Community Health (MATCH) database. Our primary independent variables represented local public health’s legal infrastructure: home rule status, board of health power, county government structure, and type of public health delivery system. Several control variables were included. We used a regression model to test the relationship between the varieties of local public health legal infrastructure identified and population health status.Results. The analyses suggested that public health legal infrastructure, particularly reformed county government, had a significant effect on population health status as a mediator of social determinants of health.Conclusions. Because states shape the legal infrastructure of local public health through power-sharing arrangements, our findings suggested recommendations for state legislation that positions local public health systems for optimal impact. Much more research is needed to elucidate the complex relationships among law, social capital, and population health status.To understand law’s contribution to community health, we must identify the association between legal structures and population health indicators. This study addresses the broad legal foundations for public health improvement known as infrastructural public health law, those “laws that create and empower public health agencies and jurisdictions.”1^(p17)The observation that public health systems vary in legal infrastructure and its expression is not new. In 1981, DeFriese et al. classified local public health systems as centralized, decentralized, or shared-control and observed that “statutes could not be relied upon to provide accurate indications of actual health department organization.”2^(p1114) This insight foreshadowed a fundamental tenet of public health law research: the text of a statute or regulation alone cannot account for the full effect of law on population health.3–5 Authority granted by state law to local agencies is a necessary but not sufficient condition of local decisional autonomy.6The Institute of Medicine’s 2003 report The Future of the Public’s Health in the 21st Century pointed to the need for research in this area by characterizing the legal foundation of public health as “replete with obsolete and inconsistent laws and regulations,” a “state of affairs [that] sometimes complicates rather than facilitates governmental contributions to the public health system.”7(p26) Likewise, Mays et al. noted,

Empirical studies are needed to describe the range of legal structures currently used for distributing governmental public health powers among state and local agencies and to compare the effectiveness of these structures.^8(p263)

Examinations of the nature, extent, and mechanisms of local public health systems’ impact on population health were infrequent until the emergence of public health systems and services research as a focused area of inquiry.9,10 Public health systems research has now identified typological models that can support comparative studies to identify variation in performance.11,12 A stronger evidence base for change can inform health law reform initiatives and improve their likelihood of success.     

Moving from intersection to integration: public health law research and public health systems and services research

Context: For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods: Expert commentary. Findings: This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health (“infrastructure”); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws (“implementation”); and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health (“innovation”). Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions: The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the usefulness of research in supporting practice and the long‐term improvement of system performance.     

Law and public health at CDC

Public health law is an emerging field in U.S. public health practice. The 20th century proved the indispensability of law to public health, as demonstrated by the contribution of law to each of the century's 10 great public health achievements. Former CDC Director Dr. William Foege has suggested that law, along with epidemiology, is an essential tool in public health practice. Public health laws are any laws that have important consequences for the health of defined populations. They derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies. Government agencies that apply public health laws include agencies officially designated as "public health agencies," as well as health-care, environmental protection, education, and law enforcement agencies, among others.     

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013.The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts.Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.Innovative policy solutions to address public health problems are becoming increasingly important, particularly because chronic diseases constitute a growing share of the disease burden in the United States. Public health policies increasingly aim to shape an environment that encourages healthy behaviors, such as physical activity or healthy eating.1,2Although traditional public health programs often target smaller groups, such as those infected with or at elevated risk of particular infectious diseases, public health policies can influence the behavior or environment of large populations. Such policies, which include laws, regulations, rules, or operational decisions intended to improve population health, can help jurisdictions meet population health goals because they work “upstream” of heath care services and even many traditional health promotion programs.The Public Health Division (PHD) of the Oregon Health Authority (OHA) is working to enhance the competencies of the state and local health agencies in Oregon to develop, implement, and evaluate public health policies; these competencies receive limited attention in existing degree programs or in-service training. The PHD funded Oregon State University (OSU) to develop a Public Health Policy Institute (PHPI) tailored to the state’s institutional and political environment, and designed to train public health professionals to address public health problems with upstream policy solutions. We describe the existing public health policy background and training resources nationwide and in Oregon, and outline the structure and content of the PHPI curriculum. We present the results from the evaluation of the first offering of PHPI and reflections on lessons for other states.     

Describing local boards of health: insights from the 2008 National Association of Local Boards of Health Survey

Objectives

We examined findings from the 2008 National Association of Local Boards of Health Survey to provide information about this understudied entity to the public health community.

Methods

The survey instrument consisted of 196 items covering five parts: (1) demographics; (2) composition and organizational structure; (3) roles, responsibilities, and authorities; (4) telecommunications infrastructure; and (5) concerns and needs. The survey was sent to chairs of local boards of health (LBHs) in 2008 (n=3,276). After six months of follow-ups and reminders, and a month of data cleaning and screening, the final sample consisted of 870 respondents, for a return rate of 27%.

Results

LBHs tend to represent smaller communities and are primarily appointed. Governing and policy-making boards are more prevalent than advisory boards. Most boards do not have official websites or e-mail addresses of board members available to the public; however, most report the capability to receive training via webcasts. Boards express concerns and needs in a variety of areas, particularly public health law, strategic planning, and accreditation.

Conclusion

Little is known about the more than 3,000 LBHs across the United States that are often charged with making and enforcing public health law. This article is a first step toward providing the public health community with information about LBHs based on survey data.A growing field of research, sometimes described as a “sister” discipline to health services research, examines public health systems. Public health services and systems research is defined as a “field of study that examines the organization, financing, and delivery of public health services within communities, and the impact of these services on public health.”¹ As a relatively new field of inquiry, part of the challenge is developing and disseminating data on public health systems to inform the public health research, practice, and policy community. Toward this end, this article addresses several questions about an understudied public health entity, local boards of health (LBHs), which are the cornerstone of the public health system in many communities.Broadly, the mission of LBHs is to protect and promote the health of the community. LBHs were first and last surveyed in 1997 by the National Association of Local Boards of Health (NALBOH).² Since that time, the public health system has experienced multiple shocks (e.g., natural disasters, rising obesity rates, increased attention paid to the dangers of smoking, and heightened attention given to the threat of terrorism). In addition, while accreditation of local health departments is just around the corner today, it was not even an issue in 1997. Hence, given the key role LBHs often play in determining local response to the public health climate, it is important to understand their role in the public health system.First, how are LBHs organized, who serves on them, and whom do they serve? Second, how do LBHs exercise their statutory authority? Third, what are the telecommunications capabilities of LBHs? Fourth, what concerns and needs do LBHs report with accreditation on the horizon? In this article, we answer these questions using results from a 2008 survey of LBHs, the first such survey conducted since 1997.³     

Recommendations for Advancing Health Literacy Measurement

Health literacy has become a national priority in the United States. Although less is known about the rate, outcomes, and costs associated with health literacy globally relative to the United States, the subject has received increasing attention internationally as well. Definitions, conceptual models, and health literacy measures have proliferated in recent years, and consensus does not exist regarding which of these to use. This article offers the following 5 recommendations for setting a research agenda to advance the science of health literacy measurement: (a) develop a comprehensive unified conceptual framework, (b) leverage the measurement knowledge the field has gained thus far, (c) empirically test frameworks and measures using robust research methods, (d) use a tiered approach to measuring health literacy, and (e) advocate for ongoing research and dissemination. These recommendations seek to ensure clarity, rigor, and transparency as part of a systematic approach to health literacy measurement. Once these steps are taken, the field of health literacy can move forward more effectively.     

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine

BACKGROUND: There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. METHODS: The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. RESULTS: Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. CONCLUSIONS: The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.     

The Scientific Basis for Law as a Public Health Tool

Systematic reviews are generating valuable scientific knowledge about the impact of public health laws, but this knowledge is not readily accessible to policy makers. We identified 65 systematic reviews of studies on the effectiveness of 52 public health laws: 27 of those laws were found effective, 23 had insufficient evidence to judge effectiveness, 1 was harmful, and 1 was found to be ineffective. This is a valuable, scientific foundation—that uses the highest relevant standard of evidence—for the role of law as a public health tool.Additional primary studies and systematic reviews are needed to address significant gaps in knowledge about the laws’ public health impact, as are energetic, sustained initiatives to make the findings available to public policy makers.Law is a traditional public health tool that has made vital contributions to the major public health achievements of the 20th century. Examples include school immunization laws that helped reduce the rates of infectious disease and tobacco control laws that helped reduce the rates of chronic disease.¹ Indeed, many, if not all, government public health endeavors rely on laws crafted to address specific health conditions or risk factors (“interventional” public health laws), laws that create and empower public health agencies and jurisdictions (“infrastructural” public health laws), or the general police powers of state governments. In addition, many laws not designed principally for public health objectives nonetheless have public health consequences (e.g., taxation and education laws). While potentially powerful legal tools for public health, these latter laws are not considered here.Policy makers weigh many factors as they consider adopting and promoting public health laws. A central question—especially in this time of emphasis on evidence-based practice and policy—is whether there is sound scientific evidence that a given public health law is effective. The number of peer-reviewed publications reporting on the impact of interventional public health laws is growing, as is the number of systematic reviews and meta-analyses of such primary studies.² However, this body of scientific knowledge, although potentially of great value, to date has not been summarized and made readily accessible to policy makers. We begin to address this gap.Systematic reviews and meta-analyses apply the most sophisticated methodologies currently available to assess the findings of multiple primary studies focused on a given intervention.³ Systematic reviews have been defined as

review[s] of a clearly formulated question that use[s] systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review.⁴

Often considered a subset of systematic reviews, meta-analyses are

quantitative statistical analyses … applied to separate but similar experiments of different and usually independent researchers and that involve[s] pooling the data and using the pooled data to test the effectiveness of the results.⁵

For the sake of simplicity, we use the term “systematic review” for both.We report on a survey of systematic reviews of peer-reviewed primary studies of individual interventional public health laws. It is thus a report on the highest-quality scientific evidence currently available on the effectiveness of such laws. In addition, we identified recommendations contained in those reviews for future research on interventional public health laws.     

Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender‐Nonconforming People

Context

Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, Massachusetts law has provided protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not, however, protect against discrimination in public accommodations (eg, hospitals, health centers, transportation, nursing homes, supermarkets, retail establishments). For this article, we examined the frequency and health correlates of public accommodations discrimination among gender minority adults in Massachusetts, with attention to discrimination in health care settings.

Methods

In 2013, we recruited a community-based sample (n = 452) both online and in person. The respondents completed a 1-time, electronic survey assessing demographics, health, health care utilization, and discrimination in public accommodations venues in the past 12 months. Using adjusted multivariable logistic regression models, we examined whether experiencing public accommodations discrimination in health care was independently associated with adverse self-reported health, adjusting for discrimination in other public accommodations settings.

Findings

Overall, 65% of respondents reported public accommodations discrimination in the past 12 months. The 5 most prevalent discrimination settings were transportation (36%), retail (28%), restaurants (26%), public gatherings (25%), and health care (24%). Public accommodations discrimination in the past 12 months in health care settings was independently associated with a 31% to 81% increased risk of adverse emotional and physical symptoms and a 2-fold to 3-fold increased risk of postponement of needed care when sick or injured and of preventive or routine health care, adjusting for discrimination in other public accommodations settings (which also conferred an additional 20% to 77% risk per discrimination setting endorsed).

Conclusions

Discrimination in public accommodations is common and is associated with adverse health outcomes among transgender and gender-nonconforming adults in Massachusetts. Discrimination in health care settings creates a unique health risk for gender minority people. The passage and enforcement of transgender rights laws that include protections against discrimination in public accommodations—inclusive of health care—are a public health policy approach critically needed to address transgender health inequities.     

Development of an online tool for public health: the European Public Health Law Network

Background

The European Public Health Law Network was established in 2007 as part of the European Union (EU) co-funded Public Health Law Flu project. The aims of the website consisted of designing an interactive network of specialist information and encouraging an exchange of expertise amongst members. The website sought to appeal to academics, public health professionals and lawyers.

Methods

The Public Health Law Flu project team designed and managed the website. Registered network members were recruited through publicity, advertising and word of mouth. Details of the network were sent to health organizations and universities throughout Europe. Corresponding website links attracted many new visitors. Publications, news, events and a pandemic glossary became popular features on the site. Although the website initially focused only on pandemic diseases it has grown into a multidisciplinary website covering a range of public health law topics.

Results

The network contains over 700 publications divided into 28 public health law categories. News, events, front page content, legislation and the francophone section are updated on a regular basis. Since 2007 the website has received over 15,000 views from 156 countries. Newsletter subscribers have risen to 304. There are now 723 followers on the associated Twitter site.

Conclusion

The European Public Health Law Network has been a successful and innovative site in the area of public health law. Interest in the site continues to grow. Future funding can contribute to a bigger site with interactive features and pages in a wider variety of languages to attract a wider global audience.     

Expected Ethical Competencies of Public Health Professionals and Graduate Curricula in Accredited Schools of Public Health in North America

Objectives. We assessed expected ethics competencies of public health professionals in codes and competencies, reviewed ethics instruction at schools of public health, and recommended ways to bridge the gap between them.Methods. We reviewed the code of ethics and 3 sets of competencies, separating ethics-related competencies into 3 domains: professional, research, and public health. We reviewed ethics course requirements in 2010–2011 on the Internet sites of 46 graduate schools of public health and categorized courses as required, not required, or undetermined.Results. Half of schools (n = 23) required an ethics course for graduation (master’s or doctoral level), 21 did not, and 2 had no information. Sixteen of 23 required courses were 3-credit courses. Course content varied from 1 ethics topic to many topics addressing multiple ethics domains.Conclusions. Consistent ethics education and competency evaluation can be accomplished through a combination of a required course addressing the 3 domains, integration of ethics topics in other courses, and “booster” trainings. Enhancing ethics competence of public health professionals is important to address the ethical questions that arise in public health research, surveillance, practice, and policy.Public health as a profession has a long history of expecting ethical behavior by its providers, scientists, and decision-makers. With early influences from medicine and nursing, laboratory science, and epidemiology, to more contemporary disciplines (e.g., behavioral science and engineering), public health consists of diverse professions,1 each of which contributes unique training, expectations of professional behavior, and discipline-specific codes of ethics. The common link that brings these disparate professionals together is the need for collective effort to improve health through a population focus.2Public health’s population focus presents unique ethics considerations that differ from those reflected in biomedicine and clinical care. Interactions between health care providers and patients emphasize the clinician’s obligation to the patient and the patient’s autonomy. Emphasis on the individual presents a challenge to public health professionals whose “patient” is the community or population. Since the early 2000s, at least a dozen public health ethics frameworks offered by scholars and practitioners have discussed the tensions that occur between autonomy and community responsibility.3 Public health professionals, many of whom are trained in medicine and allied health, understand that ethical challenges arise in the population setting, in public health practice, and public health research. The purpose of this assessment was to assess the expected ethical competencies of public health professionals as reflected in published codes and competencies, review current ethics instruction at schools of public health (SPH), and recommend ways to bridge the gap between what is expected and what is currently taught in graduate level courses.     

从字义内涵角度剖析我国假药定义

本文结合药物制度研究与汉语言分析方法,从字义和产品内涵角度分析假药的定义,并结合我国现行法律制度对假药界定条款进行法条解析.本文研究认为“假”和“药”分别具有不同的内涵,目前从法律角度定义的假药概念是不完善的.建议应在现有假药定义基础上进行完善,同时结合字义内涵和立法目的对假药进行分类,并提出法条修改建议,为《药品管理法》的修订提供参考,以期合理完善假药定义,促进医药政策与产业健康发展.     

Methods for Leveraging a Health Information Exchange for Public Health: Lessons Learned from the NW-PHIE Experience

The intent of this article is to provide public health and health information exchanges (HIEs) insight into activities and processes for connecting public health with clinical care through HIEs. In 2007 the CDC issued a Request for Proposal (RFP) for the “Situational Awareness through Health Information Exchange” project. The project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. This article describes the approach and methodology used by the Northwest Public Health Information Exchange to achieve the project’s goals. The experience of the NWPHIE Collaboration provides an organizational and operational roadmap for implementing a successful regional HIE that ensures secure exchange and use of electronic health information between local and state public health and health care entities.     

突发公共卫生事件应急现场装备模块化设计研究

目的:提升疾病预防控制队伍的突发公共卫生事件现场处置能力,加强卫生应急装备的快速与机动能力,提高公共卫生应急现场装备的模块化、标准化和专业化水平。方法:根据突发公共卫生事件的处置原则和疾病预防控制工作的特点,结合疾病预防控制队伍的实际使用情况,并参照国家有关的法律法规,按照处理不同疫情的性质和工作流程,确定模块的功能和模块内物品的种类。结果:设计出采样、现场快速检测、流行病学调查、消毒和个人防护等5个模块,每个模块配备有相应的具体工作箱。结论:突发公共卫生事件应急现场装备模块适合现场应急处置使用,实现了装备模块化、标准化和专业化的要求,有利于提高现场处置突发公共卫生事件的能力。     

Public Health, Pr?vention und F?deralismus: Erkenntnisse aus der Umsetzung des Bundesgesetzes über die Krankenversicherung

Public health, prevention and federalism: insights from the implementation of the federal law on health insuranceObjetives:In 1996, the new Swiss law on health care insurance (KVG) introduced the coverage of certain preventive measures. This provided an opportunity to include research-based public health issues in federal health policy. The present article examines the problems with which the realization of those goals in a federalist health care system with strong cantonal autonomy as it is found in Switzerland was confronted.     

Preparing for and Responding to Bioterrorist Attacks

Components of disease management that are applicable to the development of services for bioterrorism preparedness and response include collaborative practice models, population identification processes, reporting/feedback loops, process and outcome measurements, patient self-management education, and evidence-based practice guidelines. This management system should be flexible and applicable to all possible diseases associated with bioterrorism, while including specific management recommendations for each disease.There are many gaps in the US’s ability to respond to a bioterrorist attack that can only be filled by collaborative research among disciplines involved with bioterrorism preparedness; namely, basic, clinical, and behavioral sciences, public health, and law. Laboratory scientists will need to develop new and improved diagnostic tests, treatments, and protective measures. Behavioral science will have to treat many victims, both the sick and the ‘worried well’. While some states have adequate laws in place to facilitate public health authorities’ efforts to isolate sick patients and quarantine those exposed, many states do not, and their laws will require modification. Public health agencies must develop and evaluate information technologies and decision support systems for the early detection of a bioterrorist attack, for the tracking of victims who will require prophylactic treatment, and to assist physicians with diagnosis and treatment. Public health and hospitals must also prepare for the treatment of large numbers of patients by increasing surge capacity. Finally, one of the most notable deficiencies in response to recent bioterrorism events has been the inability of public health to provide timely and accurate information. Effective communication is a fundamental element of all aspects of an effective response to emergencies. Before a bioterrorist attack, the nation’s preparedness efforts should be evaluated through tabletop and full-scale exercises that are preceded by extensive professional and community education.The US Army Medical Research Institute of Infectious Diseases has identified six primary agents that may be potentially used in bioterrorism: Bacillus anthracis, variola virus, Yersinia pestis, Francisella tularensis, botulinum toxin, and the hemorrhagic fever viruses. These six were identified on the basis of the following criteria: availability of the agent, ease of production, lethality, infectivity, and stability. Disease management requires an understanding of exposure mechanisms and dose response because the route of exposure and the dose will impact on the way a disease presents. In addition to disease management strategies for bioterrorism in general, this article briefly reviews specific diagnosis, treatment, and infection control recommendations for the six primary bioterrorism diseases agents.     

浅谈突发公共卫生事件应对中健康促进工作的策略

突发公共卫生事件,是指一些突然发生的,可能或者已经造成社会重大传染病疫情、不明原因的群体性疾病或者造成大量人群食物中毒或者其他严重影响公众健康的紧急事件。在我国2003年颁布的《突发公共卫生事件紧急条例》中对其特征进行了定义:一是具有突发性;二是在公共卫生领域发生;三是严重危害公众健康。在面对突发公共卫生事件发生后,应该及时对事件进行分析、处置,开展广泛深入的健康教育和健康促进工作,可促进公众正确应对灾害,提高自我的防护意识和能力,可以对事件造成的损失进行补救,减少对社会、经济、政治和人民群众生命财产的损害,有利于维护公众健康和社会秩序。对于突发公共卫生事件,除了在发生之后及时应对以外,在平时要开展健康促进工作,对突发公共卫生事件进行预防,并且在其不可避免的发生时,将其危害降到最低。该文对突发公共卫生事件应对中健康促进工作进行探讨。     

The Public Health Statute Modernization National Collaborative: developing a model state public health law.

It is through laws that state governments set forth the policy statements describing their responsibilities and authorities for promoting and protecting the public's health. A number of Turning Point states identified the need for strengthening the legal foundation for their public health systems. The Public Health Statute Modernization National Collaborative is working to address this need by providing a tool for public health law reform in the form of a Model Public Health Act for states.     

Public health in the genomic era: will Public Health Genomics contribute to major changes in the prevention of common diseases?

The completion of the Human Genome Project triggered a whole new field of genomic research which is likely to lead to new opportunities for the promotion of population health. As a result, the distinction between genetic and environmental diseases has faded. Presently, genomics and knowledge deriving from systems biology, epigenomics, integrative genomics or genome-environmental interactions give a better insight on the pathophysiology of common diseases. However, it is barely used in the prevention and management of diseases. Together with the boost in the amount of genetic association studies, this demands for appropriate public health actions. The field of Public Health Genomics analyses how genome-based knowledge and technologies can responsibly and effectively be integrated into health services and public policy for the benefit of population health. Environmental exposures interact with the genome to produce health information which may help explain inter-individual differences in health, or disease risk. However today, prospects for concrete applications remain distant. In addition, this information has not been translated into health practice yet. Therefore, evidence-based recommendations are few. The lack of population-based research hampers the evaluation of the impact of genomic applications. Public Health Genomics also evaluates the benefits and risks on a larger scale, including normative, legal, economic and social issues. These new developments are likely to affect all domains of public health and require rethinking the role of genomics in every condition of public health interest. This article aims at providing an introduction to the field of and the ideas behind Public Health Genomics.