To integrate law and science in public health, lawyers, scientists, and public health institutions must all change. Lawyers in a Transdisciplinary practice must embrace and become competent in the language, concepts, and frameworks of public health science and tune their work to its maximum scientific value. Thus, for example, policy surveillance draws on both traditional legal research and scientific methods within a public health practice concept of surveillance 1.
Lawyers must be able to conceptualize and communicate in behavioral and social scientific terms how law achieves its effects Lawyers can and should acquire the basic grasp of research methods and tools needed to bring their legal expertise to bear in Transdisciplinary evaluation research teams As key links in the chain of translating evidence into policy, lawyers should participate in defining research needs and translating research knowledge into policy form.
Progress has been limited. That does not address legal training for MPHs, which needs to be more substantial and more transdisciplinary in the ways we have outlined here. New chapters address such topics as the structure of law in US public health systems and practice, the role of the judiciary in public health, and law in chronic disease prevention and control. Don't have an account? The results of this collaboration have been impressive: CDC and its partners are working vigorously toward full legal preparedness throughout the public health system, developing and deploying new legal tools that policymakers and front-line practitioners will apply to the entire spectrum of 21st-century public health challenges and opportunities.
Public health professionals must accept law as a mode of behavioral and environmental influence that can be scientifically theorized, measured, and manipulated like any other. The legal epidemiologist engages law as an important factor in health, understands that law shapes behavior and environments in ways that go beyond simple deterrence models, and avoids black-box studies that fail to take advantage of sociolegal and behavioral theories that account for the many ways that law affects behavior and the social and physical environment The expeditious evaluation of deliberate legal health interventions is recognized as important, but so is the effort to understand how nonhealth laws contribute to poor health and health inequities.
At its best, public health science is already transdisciplinary, drawing on fields as diverse as urban planning, economics, sociology, anthropology, and epidemiology. It is, in truth, a small step to incorporate a scientifically informed dimension of law. A transdisciplinary practice requires structural changes in institutions, funding streams, and professional hierarchies More than a decade ago, an IOM committee on public health education recommended that law and policy be strengthened in the public health curriculum to train lawyers, scientists, and health practitioners to transcend disciplinary boundaries Progress has been limited.
The reason, we suspect, is that law has continued to be taught, if at all, as public health law practice. While it is important for students to acquire a grasp of how the legal system operates, future public health practitioners and researchers need a solid grounding in legal epidemiology.
That does not address legal training for MPHs, which needs to be more substantial and more transdisciplinary in the ways we have outlined here. When it comes to training researchers, the goal should not be to build a large cohort of legal specialists within the health research world. The more useful aim is for all social and behavioral researchers to have the willingness and competence to study law as a factor when it is present in a given health phenomenon. This goal is consistent with the view that law is not fundamentally different from other social and environmental influences on health.
Public health law practice has never been better supported. However, there has been little progress in increasing dedicated, qualified legal counsel for health agencies or in finding a feasible model for doing so among the many small agencies that make up local public health 44 , Like many other public health services, public health law relies on discretionary foundation and government funding that could be redirected at any time. Legal epidemiology remains too low a priority among research funders. In alcohol and auto safety, we have outstanding examples of how to build an infrastructure of data and career opportunities that can lead to rigorous methods and compelling results Perhaps the most important example of this inconsistency has been in the lack of NIH emphasis on rapidly evaluating state and local public health law innovations.
The CDC, too, could have a broader impact on the evidence base by organizing its investments in legal epidemiology more productively. Although the CDC appreciates and invests in legal and policy research, projects are often farmed out in small contracts designed to meet short-term needs of specific programs. Opportunities include more actively coordinating policy surveillance and other mapping work, leading the charge for standard methods and tools that support higher quality and easier data sharing and bringing more transdisciplinary lawyers into the work.
Transdisciplinary public health law represents an opportunity for more effective collaboration to advance public health through law and policy. A federal appellate panel ruling on graphic cigarette warning labels went so far as to question whether the government had any interest in influencing consumption of otherwise legal products Preemption—the authority of state or federal lawmakers to bar lower governmental units from rule-making in particular topics—is too often used to stifle innovation and regulation that respond to local needs The majority of Americans seem to support vigorous use of the law to improve health 56 , but public consensus on specific policies does not always translate into the election of officials ready to promote and implement them.
In both the courts of public opinion and the courts of law, public health needs to argue more effectively for resources and collective action A transdisciplinary model links research, advocacy, and practice more organically so that a when policy makers face problems, they have the evidence and expertise they need to adopt proven interventions or to design plausible innovations; b advocates promoting a specific course of policy action have the tools they need to engage and inform stake holders, including the knowledge of policy trends and where similar policies have been adopted so far; c practitioners charged with enforcing policy can draw on methods and insights tested by implementation research; and d when public health law practitioners are assessing legal risks or defending a measure in court, they have the scientific evidence they need readily available.
The organic links contemplated in a transdisciplinary model can, by these means, shorten the time required to go from intuitive problem solving in the face of new problems to the identification and widespread adoption of those legal innovations that stand the test of evaluation: For many reasons, including diligent ideological campaigning, it is not difficult for opponents to cast even a proven health measure as one more bumbling, paternalistic government intrusion into individual rights or efficient markets The social and political campaign to delegitimize and defund regulation has moved in parallel with a legal effort to weaken the legal basis for public health action, most notably through a drastic expansion of First Amendment protections for corporations Lawyers, including academic public health lawyers, can develop normative frameworks 85 and legal strategies 61 , 77 to begin to reverse these trends.
Informed by social science and bitter experience , we in public health can learn to broaden our arguments. Public health advocacy traditionally speaks in the moral realm of preventing harm and reducing inequities.
These kinds of arguments tend to be well received by liberals. As the psychologist Jonathan Haidt has shown, a broader moral pallet—including appeals to loyalty, sanctity, and liberty—is needed to reach political conservatives and independents Law and policy, as a way of expressing our most important values, will play an important part in the cultural change we so badly need. Four major IOM reports over 25 years have lamented the state of public health laws, the practice of law, the training of public health officials in law, and the access of health officials to quality legal advice 22 , 42 — 44 , and this was all during a renaissance in the field.
We have argued that the continued marginalization of law in public health research, practice, and funding flows from a narrow view of the field as a domain reserved for lawyers doing legal work. We have described a more inclusive, interdisciplinary model of public health law, linking both its legal and scientific elements. Policy development, surveillance, implementation, and evaluation are all in the normal job description of public health practitioners and researchers, and without them public health would have no impact.
Breaking down enduring cultural, disciplinary, and resource barriers will promote full recognition of and an optimal role for law in public health. The authors are not aware of any other affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review. National Center for Biotechnology Information , U.
Annu Rev Public Health. Author manuscript; available in PMC Nov Paul, Minnesota Find articles by Donna Levin. The publisher's final edited version of this article is available at Annu Rev Public Health. See other articles in PMC that cite the published article. Abstract Public health law has roots in both law and science.
Thirty years later, Gostin 33 offered more nuance but the same view: As the IOM 44 put it, The health of a nation is shaped by more than medical care, or by the choices that individuals make to maintain their health, such as quitting cigarette smoking or controlling diabetes. Open in a separate window. Public health law encompasses both the a application of professional legal skills in the development of health policy and the practice of public health and b the scientific study of law as a factor in the cause, distribution, and prevention of disease and injury in a population.
Funding for policy surveillance and other legal and policy mapping work should be better coordinated to maximize usefulness and avoid duplication. Standard methods and tools will support better data, data sharing, and higher-quality legal and policy analysis and evaluation. Training of lawyers, policy professionals, public health practitioners, and scientists should embody and support a transdisciplinary perspective.
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Lopez W, Frieden T. Legal counsel to public health practitioners. Evaluating the impact of immigration policies on health status among undocumented immigrants: Associations between county and municipality zoning ordinances and access to fruit and vegetable outlets in rural North Carolina, General regulatory powers and duties of state and local health authorities.
Morain S, Mello MM. Survey finds public support for legal interventions directed at health behavior to fight noncommunicable disease. The scientific basis for law as a public health tool. County City Health Off. Higher First Amendment hurdles for public health regulation. Parker L, Worthington RH. Populations, Public Health, and the Law. The new public health litigation. The courts and public health: Assessing the impact of federal and state preemption in public health: Building a culture of health: Law in Public Health Practice.
Richard Alan Goodman , Mark A. Rothstein , Richard E. Hoffman , Wilfredo Lopez , Gene W.
This book provides a review of the legal basis and authorities for the core elements of public health practice and solid discussions of existing and emerging . It provides both a thorough review of the legal basis and authorities for core elements of public health practice and solid discussions of.
Public health practice subsumes epidemiology, medicine, law, biostatistics, microbiology, environmental studies and many other disciplines, all in the context of governmental practices and politics. Continually changing health threats, technologies, science, and demographics require public health professionals to have an understanding of law sufficient to address complex new problems.
Law in Public Health is designed to meet the need of public health practitioners, lawyers, health-care providers, law and public health educators and students.
The book is written jointly by experts in law and in public health. The first eleven chapters give a thorough review of the legal basis and authorities for core elements of public health practice. The remaining nine chapters focus on high-priority as well as emerging areas of law and public health, including genomics, communicable diseases, public health emergencies, reproductive health, tobacco prevention, and environmental, injury, and occupational issues. Principles and Applications of Administrative. Ethics and the Practice of Public Health. Criminal Law and Public Health Practice.
Surveillance and Outbreak Investigations. Public Health Research and Health Information. The Public Health Imperative and Individual.