Public Health Law

Condensed Notes
What is the function of public health?
Function = assure CONDITION where people can be health! "not to ensure that people #$% health!&
WHO 'oal = pro(ide the 'reatest health for each indi(idual as possible
Di)ensions of Causation * Inter(ention for Health * Disease "$ose #rticle&
Population (s+ Indi(idual Health Perspecti(es
o Population,-ased Perspecti(e. Can ha(e either -$O#D or N#$$OW focus/ which affects de'ree that consider
political factors
-road = loo0 at the distal deter)inants of health "funda)ental deter)inants of health&
Narrow = loo0 at the pro1i)ate "biolo'ical 2 )icrobial& causes of ill health
o Indi(idual Health Perspecti(e. Focuses on the pre(ention of INDI3ID4#L C#%
5Hi'h $is06 approach see0s to protect susceptible indi(iduals
$ose #rticle. #r'ues that need population,perspecti(e that focuses on disease incidence "not the causes of indi(idual cases&
o If focus on causes of cases/ then will not detect all health ris0s7 case2control and cohort )ethods will fail to detect
e1posure if e1posure is ho)o'enous within the population
o %+'+ Population,based perspecti(e/ which focuses on disease incidence/ is not concerned with 'enetics since of little
i)portance outside of deter)inin' indi(idual susceptibilit!
-alea #rticle "5%sti)ated Deaths #ttributable to ocial Factors in the 46&
o Conclusion. %sti)ated nu)ber of deaths attributed to social factors in the 4 is co)parable to the nu)ber attributed
to pathoph!siolo'ical and beha(ioral causes "e+'+ education&
o u''ests $ose #rticle assertion that need to focus on causes of disease incidence "i+e+ funda)ental deter)inants of
health&
List the Co))on The)es of Public Health
8+ 9o(ern)ent power and dut! "powers&
:+ Coercion and Li)it on tate Power
;+ The Population Focus "see $ose #rticle&<
=+ Focus on Co))unities and Ci(il Participation
>+ Pre(ention,Oriented<
?+ ocial @ustice<
The Constitution.
The Three Functions of the Constitution
o 8& Federalis)
Federal Powers are LIAIT%D. li)ited to enu)erated powers
Necessar! and Proper Clause of Constitution "#rt I/ B C& pro(ides )eans to utiliDe powers
tate Powers are PL%N#$E "8F
th
#)end)ent&
tates retain powers possessed prior to ratification of the constitution
The reser(ed powers of the state include the "8& police power of the state and ":& parens patriae
power of the state
Federal Pree)ption of tate Powers
upre)ac! Clause of Constitution pro(ides that if conflict between federal and state law/ then
federal law controls
%1press and I)plied Pree)ption. I)plied Pree)ption = 5Field Pree)ption6 or 5Conflict
Pree)ption6
o Field Pree)ption. fed 'o(ern)ent re'ulates so )uch that no doubt that onl! it can re'
o Conflict Pree)ption. when conflict of law
o :& eparation of Powers. er(es as a restraint for polic!,)a0in'
#rticle I. Le'islati(e
#rticle II. %1ecuti(e
#rticle III. @udicial -ranch
o ;& Li)itation of Powers. Constitutional desi'n is to pro(ide certain freedo)s that are be!ond the reach of
'o(ern)ent
Ne'ati(e (s+ Positi(e Constitution. The 4 Constitution is written al)ost entirel! as a ne'ati(e ri'ht
Ne'ati(e ri'ht = state cannot infrin'e on ri'ht
Positi(e ri'ht = can co)pell the co(ern)ent to pro(ide ri'ht
Cases. Deshane! "ubstanti(e Due Process&7 Castle $oc0 "Procedural Due Process&
9o(ern)ent Powers "tate (s+ Federal&
F%D%$#L Powers.
o %N4A%$#T%D Powers
The Power to Ta1 "#rticle I/ B C&.
#n! ta1 is constitutional unless it reGuires beha(ior confor)ance e1traneous to an! ta1 need
Cases Illustratin'
o %+'+ Ci'arette ta1ation to pre(ent unhealth! acti(it! and ta1 brea0 to those who Hoin '!)
to encoura'e health! acti(it!
The Power to pend "#rticle I/ B C&. Conditional #ppropriations are li)ited to followin' circu)stances
$eGuire)ents
o 8& Aust be in pursuit of 'eneral welfare "usuall! deference to Con'ress&
o :& Aust state una)bi'uous intent for condition
o ;& Aust be so)ewhat related to federal interest in pro'ra)
o =& Cannot induce states to en'a'e in acti(ities that would the)sel(es be unconstitutional
o >& Aust not be so coerci(e to pass the point at which 5pressure turns into co)pulsion6
Illustratin' Cases
o outh Da0ota (+ Dole. The conditional appropriation for hi'hwa! fundin' with re'ard to
drin0in' a'e is constitutional under the spendin' power of the state
The Power to Control Interstate Co))erce "#rticle I/ B C&. This is the 5co))erce clause6
Li)it of power = where there is no actual i)pact on co))erce
I)pact = restrains the 8F
th
#)end)ent
Illustratin' Cases
o 4nited tates (+ LopeD "8II>&. Court held that Con'ressJs prohibition a'ainst possessin'
'un in school Done e1ceeded powers 'ranted under the co))erce clause+ #lthou'h
Con'ress can re'ulate co))erce broadl! "channels/ instru)entalities/ 5substantiall!
related6 acti(ities&/ cannot re'ulate possession of 'un that does not 5substantiall! affect6
interstate co))erce+ Court reHected national producti(it! ar'u)ent
o 4nited tates (+ Aorrison ":FFF&. 3#W# e1ceeds scope of co))erce clause7 national
producti(it! ar'u)ent does not authoriDe Con'ress inter(ention
o 9onDales (+ $aich ":FF>&. tate statute 'i(in' ph!sicians and patients i))unit! for
)ariHuana possession 2 culti(ation was pree)pted b! federal law "Controlled ubstance
#ct& that prohibited possession or production of )ariHuana+
o Li)itations on Federal Power
8F
th
#)end)ent. The $eser(ed Powers Doctrine
ee T#T% POW%$. "8& police powers and ":& parens patriae
Con'ress cannot co)pel a state le'islature to enforce federal laws
o New Eor0 (+ 4nited tates. Federal pro'ra) re'ulatin' radioacti(e waste re)o(al in(al+
o PrintD (+ 4nited tates. struct down federal reGuire)ents of bac0'round chec0s for 'uns
88
th
#)end)ent. The Power to #bro'ate tate o(erei'n I))unit!
The 88
th
#)end)ent li)its Con'ressJs power to abro'ate so(erei'n i))unit!7 usuall! can 'et
public official liable/ but not state 'o(ern)ent
Note that because of 88
th
#+/ states are )ore li0el! to inter(ene with race2'ender issues
T#T% Powers.
o PL%N#$E2$%%$3%D
8& Police Powers. Powers to protect the "8& health7 ":& safet!7 ";& )orals7 and "=& 'eneral welfare
:& Parens Patriae Power. Power to protect those who cannot care for the)sel(es and assert public interests
#& tate )a0es decisions for those unable to care for the)sel(es7 e+'+ children and elderl!
-& tate )a! also assert public interests affectin' the co))on 'ood "e+'+ sanitation&
o %+'+ tate sues four lar'e businesses that ha(e )ined in lar'e area and ha(e left )inin'
products that pollute the 'roundwater of )ost of stateJs drin0in' water
o Li)itations on tate Power
#rticle ?. The upre)ac! Clause. P$%%APTION
Note that pree)ption often pertains to AINIA4A ri'hts/ which states are per)itted to afford
'reater protection
Pree)ption is ne(er 5'i(en6 "e1cept Constitution and treaties&. Need to consider I)plied (s+
%1press Pree)ption
o %1press. sa!s pree)pted in statute
o I)plied Pree)ption
5Field Pree)ption6. Con'ress re'ulates so hea(il! it is assu)ed that states lac0
authorit! to re'ulate
5Conflict Pree)ption6. Laws conflict federal law controls
Cooperati(e Federalis). Con'ress can offer states choice of re'ulatin' accordin' to federal
standards or ha(in' federal re'ulation pree)pt state laws
Illustratin' Cases
o Lorillard Tobacco Co (+ $eill!. A# re'ulations on tobacco ad(ertisin'7 s)o0eless
tobacco and ci'ars outside scope of federal ci'arette labelin' and ad(ertisin' act/ so not
pree)pted7 Ci'arette ad(ertisin' outdoors unconstitutional b2c (iolate 8
st
#+
o $owe (+ New Ha)pshire Aotor Transport #ssociation. $eGuire)ent that retailers (erif!
bu!erJs a'e at deli(er! pree)pted b! Federal #(iation #d)in #uthoriD #ct/ which had
no public health e1ception
o 9eier (+ #)erican Honda Aotor Co. $eco(er! for da)a'es fro) accident in car without
airba' pre)epted b! federal law because liabilit! would conflict with obHecti(es of
federal law
o -uc0)an Co+ (+ PlaintiffsJ Le'al Co))ittee. tate clai)s for )edical de(ice fraud
pree)pted b! Food Dru' and Cos)etic #ct "co)pare with Warner,La)bert Co (+ Kent/
where not pree)pted&
#rticle I/ B C. The Dor)ant Co))erce Clause
Li)its state authorit! to re'ulate insterstate co))erce in wa!s that places an undue burden on
interstate co))erce "e(en if entirel! local re'ulation&
The Incorporation Doctrine "8=
th
2 >
th
#)end)ent&. Federal -ill of $i'hts applies to the states
#pplies to T#T% #CTION. Public NOT pri(ate acti(it!
What is state action? It is affir)ati(e )easures ta0en b! a 5public actor6
What is a public actor? "8& #ll public entities #ND ":& pri(ate entities with 5public functions6
o Public Functions = functions traditionall! e1clusi(el! reser(ed to the tate7 test is
whether there is a 5close ne1us6
Public Health or'aniDations are either public or traditional function reser(ed to the states
o Therefore/ )ust appl! procedural and substanti(e due process
The Principles 9i(in' $ise to ubstanti(e 2 Procedural Due Process "e1plored in @acobson (+ Aass&.
Fi(e Principles %1plored. 4nder @acobson/ C held that PH powers constitutionall! per)issible onl! if the! are e1ercised in
confor)it! with fi(e standards "Harm is ProNe to FaiMe)
o 8& Harm #(oidance. The control )easure C#NNOT pose a health ris0 to its subHect
4suall! this reGuires e1ceptions for certain population,based inter(entions "e+'+ (accination&
o :& Proportionalit!. The hu)an burden )ust not be wholl! disproportionate to e1pected benefit
This pron' balances the public 'ood with the personal in(asion
o ;& Necessit!. Inter(ention )ust be necessar! to pre(ent an a(oidable har)
There )ust be a de)onstrable health threat for this pron' to be satisfied
o =& Fairness. Aust appl! eGuall! 2 fairl! to )e)bers of a population
Aust consider the population who is tar'eted
o >& $easonable Means. # reasonable relationship )ust e1ist between inter(ention and achie(e)ent of a public health
obHecti(e
Aust ha(e a 5real or substantial relation6 to protection of PH
#pplication in @acobson (+ Aassachusettes
o Facts. tatute pro(ided that -oard of Health )a! reGuire (accination and re(accination with free (accines if it is
necessar! for the health or safet! of the population "or subHect to L>+FF fine&+ #n e1ception e1isted for children
where AD would conclude that dan'erous+ In the )idst of a s)allpo1 scare/ Ca)brid'e initiated co)pulsor!
(accination+ @acobson refused and did not want to pa! fine+
o Le'al Issue. Whether state e1ceeded its police powers with co)pulsor! (accination and i)per)issibl! infrin'e on
the libert! interest of @acobson?
o Decision. #ffir)ed7 Court held that law was le'iti)ate e1ercise fo stateJs police powers to protect the public health
and safet! of its citiDens
o $easonin'. #pplied Fi(e Principles "Har) is ProNe to FaiAe&
Har) #(oidance. Here e1ception for (accination of children so does not increase health ris0
Proportionalit!. -urden of (accination is not disproprotionate to benefit
Necessit!. Current s)allpo1 outbrea0 satisfies that necessar!
Fairness. #ll people subHect to (accination7 so not an issue
$easonable Aeans. $easonable relationship between (accination and 'oal to a(oid spread
#pplication in Lochner
o tatute prohibited ba0ers fro) wor0in' )ore than 8F hours each da! or )ore than ?F hrs per wee0
o Issue. Whether state e1ceeded its police powers with restriction on wor0 hours and i)per)issibl! infrin'e on
indi(idualJs ri'ht to contract
o Holdin'. Ees M unconstitutional
o $easonin'
Har) #(oidance. Did not subHect people to health ris0
Proportionalit!. $is0 of har) did not outwei'h indi(idualJs ri'ht to contract
Necessit! . This was biggest issue7 need to show stron'er showin' that s)all a)ount of unhealthiness
warrants le'islati(e interference
Fairness. Tar'eted onl! ba0ers
$easonable Aeans. Had a reasonable relationship to public health 'oal
o Note that court so)ehow applied the rational basis test
#pplication in an Francisco Nuarantine Case. Would ha(e failed on har) a(oidance and fairness
P$OC%D4$#L D4% P$OC%
9o(ern)ent )ust pro(ide procedures to ensure that decision is fair prior to depri(in' an indi(idual of life libert!/ or certain
propert! ri'hts
T%P 8. Is the ri'ht at issue subHect to procedural due process protection
o 8& Life. Depri(ation of life clearl! reGuires )ost due process
o :& Libert!. Includes restrictions on ph!sical )o(e)ent7 ri'ht to contract/ en'a'e in occupation/ acGuire 0nowled'e/
)arr!/ establish a ho)e/ raise children/ worship 9od7 those pri(ile'es lon' reco'niDed as 5essential to the orderl!
pursuit of happiness of free )en6
o ;& Propert!. Propert! interest includes ph!sical propert! and 5le'iti)ate clai)s of entitle)ent6
-enefit is not protected entitle)ent if 'o( can use discretion "see Castle $oc0&
Includes licensin' of health care pro(iders/ hospitals and clinics/ inspections
T%P :. What de'ree of procedural due process is reGuired?
o 8& Consider the N#T4$% of the pri(ate interest. How intrusi(e or coerci(e is the state inter(ention
o :& Consider the $IK of erroneous depri(ation 2 -%N%FIT of alternati(e or additional safe'uards
o ;& Fiscal and ad)inistrati(e burdens in pro(idin' additional procedures "e+'+ durin' ti)e of e)er'enc!&
T%P ;. -ased on outco)e in T%P :/ what due process is reGuired
o tandard. "8& Notice7 ":& Hearin'7 ";& I)partial Fact,finder
o #dditional protecti(e )easures. #ppoint attorne!7 cross,e1a)ination7 5clear and con(incin' e(idence standard67
ri'ht to appeal
4-T#NTI3% D4% P$OC% #ND %N4#L P$OT%CTION
#ddresses whether there is Hustification for infrin'in' on an indi(idualJs ri'ht 2 treatin' different indi(iduals differentl!
T%P 8. %1a)ine the interest at issue 2 class of indi(iduals at issue7 what de'ree of scrutin! is reGuired
o ubstanti(e Due Process. Deter)ine if the ri'ht is funda)ental
Nor)all! either funda)ental or ordinar! ri'ht
T!pe of ri'ht %1a)ple
Funda)ental Procreation/ )arria'e/ parental autono)!
"5pri(ac!6&/ (ote/ speech/ free e1ercise
Ordinar! Wor0/ education/ econo)ic ri'hts
T%T. Court reGuires a "8& 5careful description6 of asserted libert! interest and ":& that the interest be
5deepl! rooted in NationJs histor! and traditions6
Note that Lawrence v. Texas ac0nowled'ed that histor! and tradition are the startin' point/ but not
the endin' point of substanti(e due process inGuir!7 Hust because 5traditionall! i))oral6 does not
)ean will satisf! substanti(e due process7 applied 5rational basis test with teeth6
o %Gual Protection. Deter)ine if )e)ber of suspect class
If law )a0es an e1press distinction between persons or 'roups "5discri)inator! on the face of statute6&
T!pe of
Classification
Le(el of crutin! Test %1a)ples
uspect trict crutin! Is law2classification necessar!
"narrowl! tailored& to achie(e a
co)pellin' 'o(ern)ent interest?
$ace/ reli'ion/
national ori'in/
aliena'e "le'al&
Nuasi,suspect Inter)ediate 2
hei'htened scrutin!
Is law2classification substantiall!
related to an i)portant
'o(ern)ent interest?
e12'ender/
ille'iti)ac!/ aliena'e
"undocu)ented&
Ordinar! $ational -asis Is law2classification rationall!
related to a le'iti)ate 'o(ern)ent
interest?
#'e/ class/ se1ual
orientation "in )ost
Hurisdictions&
If law is faciall! neutral/ in that it applies one standard to all people/ but ne(ertheless disproportionatel!
affects particular persons or 'roups/ )ust show that #CT4#L P4$PO% of 'o(ern)ent was to
discri)inate a'ainst that 'roup ")uch harder to satisf!&
T%P :. -ased on le(el of scrutin!/ what "8& )eans and ":& le(el of 'o(ern)ent interest is reGuired for balancin' test?
ANALYSIS
5L#W A4T -%
MEANS GOV INTEREST
9o(ern)ent
Interest6
trict
crutin!
N%C%#$E to
achie(e a
COAP%LLIN9
Inter)ediate
$e(iew
4-T#NTI#LLE
related to a
IAPO$T#NT
$ational
-asis
$#TION#LLE
$%L#T%D to a
L%9ITIA#T%
T%P ;. Perfor) -alancin' Test
o trict cruint!. $eall! $eGuires ; THIN9
8& Necessit!. Cannot be o(er,broad 2 o(er,inclusi(e or under,inclusi(e
O(er,inclusi(e. when polic! e1tends to )ore people than needed
4nder,inclusi(e. When does not appl! to 'roups who are in si)ilar position
:& Co)pellin'. Aust be 5trul! (ital to co))unit! well,bein'6
;& Least $estricti(e #lternati(e. 9o(ern)ent )ust de)onstrate that public purpose could not be achie(ed
as well throu'h less restricti(e or less discri)inator! policieso
o Inter)ediate $e(iew. Law )ust be substantiall! related to i)portant 'o(ern)ent obHecti(es
o $ational -asis. o)ewhat outco)e deter)inati(e al)ost alwa!s pass7 state not reGuired to present scientific
e(idence
Note )odified rational basis test
#bortion "post,Case!& 4ndue -urden. Does challen'ed law
place an undue burden on e1ercise of
ri'ht?
:=,hour waitin' period
"NO&
pousal notification "Ees&
e1ual Libert! "post,
Lawrence&
Hei'htened rational basis. Does
challen'ed law burden indi(idualJs
e1ercise of libert! interest in pri(ate
Pri(ate inti)ate conduct
alone or between
consentin' adults
se1ual conduct?