Legislative goals, principles health laws
The public health functions of government cover a wide range of activities. In considering public health law reform, governments need to consider the way in which these functions can best be supported by legislation. It is important for public health laws to explicitly set out the mandate, powers and responsibilities of government, and of public health officials. This not only ensures that health ministries and public health officials have the powers they need, but also helps to ensure that they remain accountable for the discharge of their statutory duties and functions. It also ensures that health ministries do not overlook critical functions or responsibilities or adopt an unduly narrow definition of public health
The core public health functions of government
- Surveillance and monitoring of the health status of the population, and of health risks.
- Public health protection and assurance, including through the performance of regulatory functions and the discharge of legislative responsibilities relating to the investigation of health risks and the prevention of disease and injury.
- Health promotion, including education and partners to support community-based health programs and to empower individuals to live healthy lives.
- Financing of public health interventions, including financing essential medicines and technologies and health care services.
- Training and capacity-building, including accreditation and renewal of the public health workforce.
- Research and evaluation, including funding research and developing research capacity.
There is no single way of expressing the goals and objects of public health legislation, since these goals will reflect the specific needs of each country and the distribution of powers and responsibilities between treaties and levels of government. In the Australian state of Victoria, the Public Health and Well-being Act 2008 states that the objective of the Act is: “to achieve the highest attainable standard of public health and well-being by:
(A) protecting public health and preventing disease, illness, injury, disability or premature death.
(B) promoting conditions in which people can be healthy.
(C) reducing inequalities in the state of public health and well-being.
This legislative mandate encompasses three important themes.
- Firstly, governments have a duty to protect and promote the health of the population as a whole. This duty extends to those who, for example, live in remote parts of the country, or who can not afford to pay for services.
- Secondly, governments have a duty to work to reduce health inequalities. This means giving special attention to the health needs of the neglected and vulnerable: those people whose health needs might be forgotten if government focused only on improving the average level of health. Both of these ideas are encompassed by the obligation of Governments to ensure that health facilities, goods and services are accessible – economically, physically and without discrimination – to all members of the population.
- Thirdly, by recognizing the goal of promoting the conditions for healthy living, the legislation recognizes the concept of sustainability, understood here to mean that people should possess the resources that enable them to lead a healthy life, now and into the future. Sustainability also has an important intergenerational dimension: Governments have a duty to develop policies to protect the health of future generations from emerging threats, such as the health consequences of climate change.
The legislative goals set out in South Africa’s National Health Act provide another example. This Act establishes a national health system with the goal of providing equitable access to the “best possible health services that available resources can afford” . In view of the severe and persistent health inequalities suffered by large parts of the population as a result of the Policies of apartheid, the Act draws attention to the goal of providing “uniformity in respect of health services across the nation”. The Act acknowledges that the achievement of this goal is assisted By the obligation of the State to protect, respect, promote and fulfill key constitutional rights affecting health. These include the right to health care services, including reproductive health care, an environment that does not harm health or well-being, and basic nutrition for children. The Act gives strong expression to the need for government to protect vulnerable groups, including women, children, the elderly and those with disabilities.
In some countries, public health legislation includes statutory principles that are intended to provide guidance to those who administrate the legislation. For example, Victoria’s Public Health and Well-being Act, discussed above, provides that decisions about public health interventions, and the use of resources to promote and protect public health, should be evidence-based. However, when faced with a serious public health threat, “lack of full scientific certainty should not be used as a reason for postponing measures to prevent or control the public health risk”. Balancing the need to act on the basis of evidence with the need to prevent significant threats to public health is an important function of government. In order to ensure accountability, members of the public should have access to reliable information about risks to public health and the opportunity to participate in the development of policies and programs.