‘Law, in All Its Manifestations, Creates and Shapes Health’.
From the Affordable Care Act, to state and federal steps against gun violence and reproductive rights, to immigration and discrimination, to the threats of climate change, public health issues and the laws that shape them have changed dramatically since Wendy Mariner and George Annas co-authored the first edition of the textbook Public Health Law in 2007, and even the second edition in 2014.
“The field of public health has grown up, and with it, the field of public health law,” says Mariner, Edward R. Utley Professor of health law, ethics & human rights at the School of Public Health.
“Public health was traditionally viewed as a matter of state and local law, with early textbooks concentrating on the regulatory authority of state and local boards of health and the regulation of health care professionals and facilities,” she says. “The field of public health has expanded well beyond these areas: Law in all its manifestations creates and shapes the social determinants of health.”
The third edition of Public Health Law, published in late 2019, is a major overhaul, designed to prepare students for an evolving landscape, focusing on foundational principles, Mariner says, “while also providing problems that enable students to see how such principles might be adapted to address new challenges.”
One of those challenges is the current COVID-19 pandemic, says Annas, William Fairfield Warren Distinguished Professor of health law, ethics & human rights: “The final chapter of the new edition includes materials that have immediate application to the public health response to coronavirus, both in the US and internationally,” he says, because it draws on fundamentals of state, national, and international law as they have developed in response to SARS, Ebola, and other past epidemics.
To write the new edition, Mariner and Annas were joined by colleagues from SPH’s Center for Health Law, Ethics & Human Rights: Nicole Huberfeld, professor of health law, ethics & human rights; and Michael Ulrich, assistant professor of health law, ethics & human rights.
The four authors will discuss the new edition of the textbook and their changing field at the Dean’s Seminar Law and the Health of Populations, held online on Monday, March 30.
Ahead of the event, they shared a few thoughts about where their field has been, where it is going, and how to prepare students to use law as a powerful tool for creating the conditions that allow populations and individuals to thrive.
How has your field changed in recent years?
Ulrich: Public health law used to be very topic specific, e.g., laws and policies dealing with obesity, tobacco, or contagious diseases. But as a broader understanding of public health has emerged, through concepts such as the social determinants of health, so too has a broader understanding of public health law. This is both in terms of topics that are now viewed as critical parts of public health, such as reproductive justice and gun violence, and the overlapping evolution of appreciation of how laws outside of the ‘traditional’ areas of public health can have dramatic impacts on health outcomes. Thus, I see a parallel trend in public health and public health law of a more nuanced and accurate awareness of the manner in which the law is an integral and inescapable influence on the health of populations.
Annas: Another major change in the field is taking human rights more seriously, and increased recognition of the Universal Declaration of Human Rights as the ethics code for public health. (This is, of course, especially true in global health and the WHO’s emphasis on health and human rights in epidemic planning and response.) The trend toward equality of all humans, and the trend toward recognition of health as a human right, make me optimistic.
How is the new edition of Public Health Law updated to prepare students for this changing landscape?
Mariner: We want to prepare students to recognize and grapple with legal issues that arise across all jurisdictions—state and local, federal, and international. To do so, we include fundamental legal principles at all levels of government. While specific problems and controversies vary, the constitutional foundations for addressing them remain fairly stable, so that students can use what they learn when facing new problems.
Ulrich: For example, rather than looking at gun violence as a subset of public health injuries, instead we focused on the Second Amendment and the manner in which interpretations of its limitations on government action can promote effective gun policies or inhibit gun control regulations. What this does is provide a useful legal foundation for non-law students to grasp essential legal concepts that will impact their ability to address public health problems in the future, while also providing law students with a practical, real-world understanding of the impact that the theoretical legal discussions they are used to can have on certain populations. In doing so, we provide a stronger connection between the law and public health, but also issues of social justice and equity.
Huberfeld: It was also important to me that students gain an understanding of the constant tension between government power to protect public health and welfare, and individual rights as protected by the US Constitution, laws, and courts. Additionally, I wanted to emphasize choices we make in governance (such as whether the federal or state government is the best choice for implementing a law or policy, or whether a direct or indirect approach to regulation is optimal) as key questions in public health law.
What else sets this book apart from other health law textbooks?
Huberfeld: We make sure students have a solid foundation in the basics of power and individual rights before working through some of the deeply complex issues in public health law. We also emphasize the role of human rights in public health, which is a unique perspective.
Ulrich: I think the book undertakes the important task of linking law, policy, public health, social justice, and equity in a variety of areas that makes it a useful tool for students in areas such as law, public health, medicine, public policy, and political science. In this sense, we are hoping this book becomes a mechanism to continue our goal of breaking down silos and training future colleagues who embrace a multidisciplinary approach to public health.
Mariner: Laws that create obstacles to education, environmental protection, housing, transportation, the food supply, fair employment, and adequate incomes undermine the population’s health. The book emphasizes the role of law as a key structural determinant of health and encourages students to recognize opportunities for change—to recognize that law is the arbiter of justice and fairness, not merely a tool to achieve partisan purposes.