P
Health andthe Law A
Bicentennial Review
BY
WILLIAM J. CURRAN, J.D., S.M.HYG.,
I have been asked to begin again a series of monthly commentaries on public health law. The occasion of the bicentennial will be used, and over-used, by every writer this year for a review of American progress. This place will be no exception. The Founding Fathers gave little, if any, attention to matters of health or medicine. Neither public health nor medical care are mentioned in the Federal Constitution as legal powers of the new government. The first hundred years of the Republic were not very productive of change, either in health science or law. In 1876 there were only 12 states with state health departments and only 4 states had county-level health departments. In preparation for a speech in Philadelphia at a centennial meeting, Bowditch conducted a national survey among the 38 states and 9 territories concerning their official efforts in public health.' On the overall question of the state and territorial legislatures' appreciation of the need to protect the people's health, he found only 8 states and no territories acting effectively at all. The great majority of the jurisdictions were found to be unwilling to spend any public monies to protect the purity of foods, to control nuisances (a large field at that time), or to carry out preventive medical services. On the federal level, attention was largely concentrated upon public health controls at the ports of entry on the Atlantic coastline and in the Gulf of Mexico. It is interesting how many important events in public health and health law did occur in and around the first centennial. Rosen dates the beginning of scientific preventive medicine, the "bacteriological era," from 1875.2 The first and only National Board of Health was enacted into law in 1879, although it was allowed to expire in 5 years. The first medical examiner system for the public investigation of death was enacted in Massachusetts in 1877 abolishing the ancient English office of the coroner. An effective death investigation system is the cornerstone of medicolegal work and one of the essentials of an effective public health surveillance and statistical program. And what do we see in 1976? The changes are very great. We have state health departments and county health departments in every state. Most of the contagious diseases are controlled, or irradicated entirely. The federal government has moved to very aggressive action in health science AJPH January, 1976, Vol. 66, No. 1
research and manpower training, it has a generally effective regulatory program in the areas of foods and drugs, it is making efforts in pollution control and industrial safety, and most recently has entered the field of financial support for general medical care for selected population groups. We still do not have a national board of health in the sense of a legally controlling body over the state public health agencies. However, the National Health Planning and Resources Act of 1974 (P.L. 93-641) enacted in January of 1975 creates for the first time a system of national health policy, planning, and development. This piece of legislation could be the most significant national health law to be passed on or about this second centennial period. But what are our problems? The concentration of political interest is on the delivery of medical care. It carries the danger of neglect of public health in all of its breadth, in all of its imagination. The local health departments we worked so diligently to establish are dying on the vine in too many places. State health departments have become largely regulatory agencies. This trend would not be so disconcerting if the regulation was devoted to public health protection in modern society, a clear need; but it is moving more and more to watchdog and statistical activities in control of the costs of medical care and other public benefit programs. We are not yet dealing well with the study and control of accidents, or with accidental trauma, or death. The overall issue of violence in our society is hardly considered a public health problem at all. (One of my later columns this year will examine this subject.) The future issues in public health law will, I believe, relate to matters of personal freedom and economic equality. In the first area we will be concerned with the individual citizen's scope of allowable activity to harm himself and others by bad nutrition, cigarette smoking, alcohol consumption, drug abuse, all types of so-called accidental behavior, all types of pollution, and the general use of the world's resources. It will also be concerned with freedoms in sexual activity and child bearing and child care and the inevitable searches for alternatives to the family unit of social organization which is affected, properly or not, by advances in these freedoms. In the second area we will be coping with the acclaimed right to medical care and the equal distribution of medical care resources. This is a new concern. The nine93
PUBLIC HEALTH AND THE LAW
teenth century Marxist, Fabian, or other radical or mild forms of socialism gave little attention to medical care as a fundamental goal of their new societies. The current socialist and liberal political philosophies include medical care as a continuously needed, economically based service to all of the people. It requires national planning and the control of health manpower and resources. Most of the governments of the world are already at this point, or are moving toward it, the United States included, although two American Presidents in succession have used the veto power, with President Nixon adding use of impoundment, in an extensive effort to frustrate or slow down the process. (The latter area will also be the subject of a later column this year.) The immediate future of public health law should be
very exciting. We will try to report on it in the Journal over the coming months. I will be joined in the writing this year by some of my colleagues in the field who will write occasional pieces while I am on sabbatical leave in Europe until that climactic bicentennial month of July. My next column, in fact, will be a review of some of the developments in health law in this part of the world.
REFERENCES 1. Bowditch, H. I., Address on Hygiene and Preventive Medicine, Transactions of the International Medical Congress of Philadelphia, 1867, Ashurst, ed., Philadelphia: Collins Printer, 1877. 2. Rosen, G., A History of Public Health, New York: M.D. Publications, 1958, P. 294.
HARVARD UNIVERSITY SHORT COURSES ANNOUNCED The Department of Environmental Health Sciences, Harvard School of Public Health, has announced the scheduling of the following two courses for presentation during 1976: "Planning for Nuclear Emergencies", scheduled for May 17-21, is directed primarily to personnel from public utilities, regulatory agencies, and other groups responsible for the design and implementation of emergency action plans. The course is designed to provide detailed coverage of all aspects of emergency planning, including discussions of instrumentation required to determine the nature and to follow the course of an accident; standards and guides for emergency action; interrelationships between the nuclear power plant operator and federal, state, and local agencies; and procedures for population evacuation. "Environmental Radiation Surveillance for Nuclear Power", directed to engineers and scientists with responsibilities in planning, conducting, and interpreting environmental surveillance programs, is scheduled for June 14-18. The course will provide a comprehensive examination of the principles and practices of environmental radiation surveillance around nuclear power facilities. Class instruction will include coverage of radiation standards, source terms, surveillance design, sample collection and measurement, and emergency surveillance. The fee for each 5-day course is $400, payable in advance to Harvard University. A limited number of fellowships are available for employees of state and local agencies. Further details may be obtained by contacting: Dr. Dade W. Moeller, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115.
94
AJPH January, 1976, Vol. 66, No. 1
Health andthe Law A
Bicentennial Review
BY
WILLIAM J. CURRAN, J.D., S.M.HYG.,
I have been asked to begin again a series of monthly commentaries on public health law. The occasion of the bicentennial will be used, and over-used, by every writer this year for a review of American progress. This place will be no exception. The Founding Fathers gave little, if any, attention to matters of health or medicine. Neither public health nor medical care are mentioned in the Federal Constitution as legal powers of the new government. The first hundred years of the Republic were not very productive of change, either in health science or law. In 1876 there were only 12 states with state health departments and only 4 states had county-level health departments. In preparation for a speech in Philadelphia at a centennial meeting, Bowditch conducted a national survey among the 38 states and 9 territories concerning their official efforts in public health.' On the overall question of the state and territorial legislatures' appreciation of the need to protect the people's health, he found only 8 states and no territories acting effectively at all. The great majority of the jurisdictions were found to be unwilling to spend any public monies to protect the purity of foods, to control nuisances (a large field at that time), or to carry out preventive medical services. On the federal level, attention was largely concentrated upon public health controls at the ports of entry on the Atlantic coastline and in the Gulf of Mexico. It is interesting how many important events in public health and health law did occur in and around the first centennial. Rosen dates the beginning of scientific preventive medicine, the "bacteriological era," from 1875.2 The first and only National Board of Health was enacted into law in 1879, although it was allowed to expire in 5 years. The first medical examiner system for the public investigation of death was enacted in Massachusetts in 1877 abolishing the ancient English office of the coroner. An effective death investigation system is the cornerstone of medicolegal work and one of the essentials of an effective public health surveillance and statistical program. And what do we see in 1976? The changes are very great. We have state health departments and county health departments in every state. Most of the contagious diseases are controlled, or irradicated entirely. The federal government has moved to very aggressive action in health science AJPH January, 1976, Vol. 66, No. 1
research and manpower training, it has a generally effective regulatory program in the areas of foods and drugs, it is making efforts in pollution control and industrial safety, and most recently has entered the field of financial support for general medical care for selected population groups. We still do not have a national board of health in the sense of a legally controlling body over the state public health agencies. However, the National Health Planning and Resources Act of 1974 (P.L. 93-641) enacted in January of 1975 creates for the first time a system of national health policy, planning, and development. This piece of legislation could be the most significant national health law to be passed on or about this second centennial period. But what are our problems? The concentration of political interest is on the delivery of medical care. It carries the danger of neglect of public health in all of its breadth, in all of its imagination. The local health departments we worked so diligently to establish are dying on the vine in too many places. State health departments have become largely regulatory agencies. This trend would not be so disconcerting if the regulation was devoted to public health protection in modern society, a clear need; but it is moving more and more to watchdog and statistical activities in control of the costs of medical care and other public benefit programs. We are not yet dealing well with the study and control of accidents, or with accidental trauma, or death. The overall issue of violence in our society is hardly considered a public health problem at all. (One of my later columns this year will examine this subject.) The future issues in public health law will, I believe, relate to matters of personal freedom and economic equality. In the first area we will be concerned with the individual citizen's scope of allowable activity to harm himself and others by bad nutrition, cigarette smoking, alcohol consumption, drug abuse, all types of so-called accidental behavior, all types of pollution, and the general use of the world's resources. It will also be concerned with freedoms in sexual activity and child bearing and child care and the inevitable searches for alternatives to the family unit of social organization which is affected, properly or not, by advances in these freedoms. In the second area we will be coping with the acclaimed right to medical care and the equal distribution of medical care resources. This is a new concern. The nine93
PUBLIC HEALTH AND THE LAW
teenth century Marxist, Fabian, or other radical or mild forms of socialism gave little attention to medical care as a fundamental goal of their new societies. The current socialist and liberal political philosophies include medical care as a continuously needed, economically based service to all of the people. It requires national planning and the control of health manpower and resources. Most of the governments of the world are already at this point, or are moving toward it, the United States included, although two American Presidents in succession have used the veto power, with President Nixon adding use of impoundment, in an extensive effort to frustrate or slow down the process. (The latter area will also be the subject of a later column this year.) The immediate future of public health law should be
very exciting. We will try to report on it in the Journal over the coming months. I will be joined in the writing this year by some of my colleagues in the field who will write occasional pieces while I am on sabbatical leave in Europe until that climactic bicentennial month of July. My next column, in fact, will be a review of some of the developments in health law in this part of the world.
REFERENCES 1. Bowditch, H. I., Address on Hygiene and Preventive Medicine, Transactions of the International Medical Congress of Philadelphia, 1867, Ashurst, ed., Philadelphia: Collins Printer, 1877. 2. Rosen, G., A History of Public Health, New York: M.D. Publications, 1958, P. 294.
HARVARD UNIVERSITY SHORT COURSES ANNOUNCED The Department of Environmental Health Sciences, Harvard School of Public Health, has announced the scheduling of the following two courses for presentation during 1976: "Planning for Nuclear Emergencies", scheduled for May 17-21, is directed primarily to personnel from public utilities, regulatory agencies, and other groups responsible for the design and implementation of emergency action plans. The course is designed to provide detailed coverage of all aspects of emergency planning, including discussions of instrumentation required to determine the nature and to follow the course of an accident; standards and guides for emergency action; interrelationships between the nuclear power plant operator and federal, state, and local agencies; and procedures for population evacuation. "Environmental Radiation Surveillance for Nuclear Power", directed to engineers and scientists with responsibilities in planning, conducting, and interpreting environmental surveillance programs, is scheduled for June 14-18. The course will provide a comprehensive examination of the principles and practices of environmental radiation surveillance around nuclear power facilities. Class instruction will include coverage of radiation standards, source terms, surveillance design, sample collection and measurement, and emergency surveillance. The fee for each 5-day course is $400, payable in advance to Harvard University. A limited number of fellowships are available for employees of state and local agencies. Further details may be obtained by contacting: Dr. Dade W. Moeller, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115.
94
AJPH January, 1976, Vol. 66, No. 1
