Public health law

“ PUBLIC interest in the preservation of health has generally found expression in a demand for legislation increasing the powers of governmental agencies charged with the protection of health. Boards of health, state and local, are more liberally sustained, have greater facilities for the investigation of disease and are armed with greater powers than heretofore, but nevertheless common law, that is, the great body of law which the colonists brought with them from England, has an important bearing on public health, chiefly in two ways. ”

“ All the increased activity of the Public Health Authorities in searching out and treating sickness may coincide with a systematic enforcement of personal responsibility in respect to personal hygiene, and with regard to the maintenance in health of dependents, which we, in fact, recommend. The break-up of the Poor Law implies, in short, not only the adoption of a systematic crusade against the several preventable causes of destitution, but also a far more effective enforcement of parental responsibility than is at present practicable. ”

“ The complexity of local authorities concerned in the treatment of disease was wilfully increased under the National (Health) Insurance Act; and, contrary to the advice of public health workers and of the Royal Commission on the Poor Laws a golden opportunity for securing the merging of poor law into public health work and for initiating a unified system of State Medicine for all who need it was lost.
Poverty to a preponderant extent is due to sickness. ”

“ What the public welfare requires is, as is now admitted, that these sick persons should be treated with a single eye to arresting the course of their disease, and restoring them as soon as possible to physical health. Moreover, as sickness is plainly, to an undefined extent, the result of bad environment—of overcrowding, insanitation, unwholesome food, polluted water, or injurious conditions of employment—it is important that it should be in the hands of an authority officially cognisant of this environment, and empowered to alter that which is producing the sickness. ”

“ When the right to health is granted health laws are made, and all men within the jurisdiction of the lawmaking power own health machinery that provides for the administration of those laws. A system of public baths takes the place of a bathhouse supported by charity; a law restricting the construction and management of all tenements takes the place of a block of model tenements, financed by some wealthy man; medical examination of all school children takes the place of a private dispensary ”

“ The right to the protection of health is guaranteed. The State shall be bound to take measures to ensure public hygiene and health. The organization of the medical care and social security system in case of sickness, accidents, maternity and recovery, the control over the exercise of medical professions and paramedical activities, as well as other measures to protect physical and mental health of a person shall be established according to the law. ”

“ No arrangements are made to bring the effects of the absence of drainage to the knowledge of those bodies for their guidance in the performance of their duties, nor does it appear to enter into their conception that the protection of the public health forms any part of the objects of their service. ”

“ Health administration cannot rise far above the hygienic standards of those who provide the means for administering sanitary law. The tax-paying public must believe in the economy, utility, and necessity of efficient health administration. ”

“ If, upon the face of the statute, the court can see no possible relation to the public health or safety, or, possibly, general welfare, it will hold the law null in so far as it invades either property or liberty rights because not under the police power. If, on the other hand, they can see some relation to the public health, safety, or general welfare, even though they do not think it the best method of bringing about the desired result, they will not presume to run counter to legislative opinion. Of the expediency of the statute, the legislature must be and is the final judge. ”

“ Medical treatment is needed for school children and for the poor generally. Why separate this into two administrations? Hospitals are required for paupers with tuberculosis, and for non-paupers with tuberculosis. Why have two authorities for this work? The separate existence of Education and Poor-Law Authorities qûa medical attendance on those children needing it erred, not only in this fundamental respect, but also because neither of these authorities had the preventive facilities and powers possessed by Public Health Authorities, who were also partially engaged in the treatment of disease. ”

“ This law also provides much-needed help to nearly 1,400 Community Health Centers that serve our most vulnerable populations, who are at the highest risk of infection and adverse outcomes from COVID–19. ”

“ Any attempt to enumerate even a few of the public health laws which crowd our statute books would here be tedious and out of place, though the community in general ought to be better acquainted than it is with its powers and obligations. For, truth to tell, fifty years of public health administration has proved that human beings are not yet consumed with a sufficiently strong desire for health and efficiency to be willing to change objectionable or unwholesome habits or to sacrifice their conception of comfort at the 224 suggestion of officials. ”

“ But if it be within the power of a legislature to adopt such means for the protection of the lives of its citizens, it is difficult to see why precautions may not also be adopted for the protection of their health and morals. It is as much for the interest of the State that the public health should be preserved as that life should be made secure. ”

“ We must not only teach the individual how to guard his life against preventable disease and accident, we must educate our communities to the need of an effective public health service to enforce sanitary regulations and otherwise guard the health and lives of their members. ”

“ The passing of sanitary laws, and the granting to a certain department the power to enforce these laws, will not ensure good public health unless the public at large supports those laws intelligently, and it can only do this through State and municipal sanitary organizations. ”

“ Equally well settled is the principle that if a regulation enacted by competent public authority avowedly for the protection of the public health has a real, substantial relation to that object, the courts will not strike it down upon grounds merely of public policy or expediency. ”

“ Nobody will deny that much has already been done in the development of preventive medicine and sanitary science. It will be claimed, and with justice, that more has been done than the public is willing and prepared to accept and live up to. We know that today municipalities continue to permit the unnecessary sacrifice of lives to epidemic disease, that politics is permitted to disorganize efficient boards of health in large and small communities and to put the best material interests of family and social life into untrained hands. ”

“ No precise limits have been placed upon the police power of a state, and yet it is clear that legislation which simply defines the qualifications of one who attempts to practice medicine is a proper exercise of that power. Care for the public health is something confessedly belonging to the domain of that power. ”

“ The right of the state to regulate certain occupations which may become unsafe or dangerous when unrestrained, in the exercise of the police power, with a view to protect the public health and welfare, has been so often and so recently before this court that it is only necessary to refer to some of the cases which sustain the proposition that the state has a right, by reasonable regulations, to protect the public health and safety. ”

“ We are sorry, indeed, to observe, that the power of the magistrate is seldom exerted in this country for the preservation of health. The importance of a proper medical police is either not understood, or little regarded. Many things highly injurious to the public health are daily practiced with impunity, while others, absolutely necessary for its preservation, are entirely neglected. ”

“ It is a great pity that we Americans have taken so long to learn that laws do not enforce themselves, that even good motives and good intentions in the best of officials do not insure good deeds. Thousands of lives are being lost every year, millions of days taken from industry and wasted by unnecessary sickness, millions of dollars spent on curing disease, the working life of the nation shortened, the hours of enjoyment curtailed, because we have not seen the great gap between health laws and health-law enforcement. ”

“ Laws define rights. Men enforce them. For definitions we go to books. For record of enforcement we go to acts and to conditions. [3] What health rights a community pretends to enforce will, as a rule, be found in its health code. What health rights are actually enforced can be learned only by studying both the people who are to be protected and the conditions in which these people live. A street, a cellar, a milk shop, a sick baby, or an adult consumptive tells more honestly the story of health rights enforced and health rights unenforced than either sanitary code or sanitary squad. ”

“ Preventable sickness costs too much, causes too much wretchedness, and hampers too many modern educational and industrial activities to be neglected. If the medical profession does not fit itself to serve general interests, then cities, counties, and states will take to themselves the cure as well as the prevention of communicable and other preventable sickness. Human life and public health are more precious than the medical profession, more important even than theories and traditions against public interference in private matters. ”

“ That the work done on behalf of the community, plus the work accomplished by private medical practitioners, is not equal to national needs is obvious to any one considering the vast amount of avoidable disease in our midst. Why is this and what is the remedy? A partial answer is given by English experience. The medical provision made in a large proportion of cases is belated and inadequate; and in perhaps a still larger proportion of cases medical advice is not obtained, or being obtained, is not followed. This applies even more to hygienic than to clinical medical advice. ”

“ Without doubt the day will come when the National Board of Health will be by act of Congress, with the consent of all the States, the real superior council of public hygiene of the American Union." E. Sève, On the General Organization of Public Hygiene (Proceedings, International Sanitary Conference, 1881) . "The General Government [of the United States] can do little in the way of compulsory legislation, which might interfere with the action of the several States to control their own sanitary affairs. ”

“ If these complete services were provided, the medical treatment now provided largely at the expense of the community could be made a means for advancing the public health. This it can not at present claim to be. For nothing is more certain than that the prompt and adequate treatment of disease curtails its duration, diminishes its severity, and prevents its spread to others. ”

“ The public health and general welfare of the people of the state are hereby declared to be matters of primary public concern. The legislature shall pass suitable laws for the protection and promotion of the public health. ”

“ It is true, the United States government bestows on public health and preventive medicine no where near the attention it finds necessary for the prevention of disease in stock and for agricultural improvement, but none the less there are certain well-organized and efficiently operated agencies which have for their function the improvement of public hygiene and sanitation, the eradication of preventable disease, and the study of causation and methods of control of diseases. ”

“ More than a year and a half ago, I asked Congress to pass a strong, enforceable Patients' Bill of Rights that ensures critical protections for Americans in managed care, from the right to see a specialist if your doctor recommends it to the right to emergency room care whenever and wherever you need it to the right to keep your doctor through a treatment—even if your employer changes HMO coverage—to the right to hold health plans accountable for harmful decisions. ”

“ No recipe has ever been found for bringing up a healthy baby on unclean, infected milk; for avoiding tuberculosis among people who are [217] compelled to work with careless consumptives in unclean air; or for making a five-story leap as safe as a fire escape. Perfect habits of health on the part of an individual will not protect him against enervation or infection resulting from inefficient enforcement of sanitary codes by city, county, state, and national authorities. ”

“ Whereas health care policies should emphasize public health and encourage the use of quality services and evidence-based treatment that is appropriate and safe and that discourages unnecessary treatment ”

“ The second main branch of public health work is the suppression of communicable diseases. Suppressive measures include the establishment of quarantine, the isolation of patients, disinfection, vaccination and the management of epidemics. Contrary to the custom of twenty years ago, all the best work in these directions to-day is based upon a scientific knowledge of what we may call the natural history of disease. In all these matters of control the dictum of the health authority is supreme. It can be resisted only through intervention by the courts. ”