The document discusses the role of law and policy in achieving health equity and protecting public health, emphasizing the government's ability to regulate individual behavior for the common good. It highlights historical examples like tobacco control and outlines the powers and limitations of federal, state, and local governments in public health initiatives. The importance of balancing individual rights and public health needs, with legal frameworks and constitutional considerations, is also examined.

1. ACHIEVING HEALTH EQUITY
through
Law Policy
Marice Ashe, JD, MPH
Founder & CEO

2. Healthy communities
for all through better
laws & policies

3. Disclaimer
The information provided in this discussion is for informational
purposes only, and does not constitute legal advice. ChangeLab
Solutions does not enter into attorney-client relationships.
ChangeLab Solutions is a non-partisan, nonprofit organization that
educates and informs the public through objective, non-partisan
analysis, study, and/or research. The primary purpose of this
discussion is to address legal and/or policy options to improve
public health. There is no intent to reflect a view on specific
legislation.
© 2016 ChangeLab Solutions

4. Legal HISTORY reveals both
the POWER & LIMITATIONS
of government authority
to protect the public’s
health

5. Let’s go back in time

6. The Mayflower Compact

7. …covenant & combine ourselves
together into a civil body politic;
for our better ordering, and
preservation and furtherance of
the ends aforesaid; and by virtue
hereof to enact, constitute, and
frame, such just and equal laws,
ordinances, acts, constitutions,
and offices, from time to time, as
shall be thought most meet and
convenient for the general good
of the colony; unto which we
promise all due submission &
obedience.”

8. The Broad Street Pump

9. New York before sanitation reform

10. …and New York after the reform

11. The story of a
1902 smallpox
outbreak in
Massachusetts

12. But the liberty secured by the
Constitution of the United States
to every person within its
jurisdiction does not import an
absolute right in each person to
be, at all times and in all
circumstances, wholly freed from
restraint. There are manifold
restraints to which every person is
necessarily subject for the
common good. On any other
basis, organized society could not
exist with safety to its members.”

13. The government
can regulate
individual
behavior to
protect health.
TRUE
or
FALSE

14. The government can regulate
individual behavior to protect
health.
TRUE
As long as it is a
reasonable
regulation aimed
at protecting the
public’s health
and safety.

15. This history forms the
foundation for public
health law today

16. Consider the history of
tobacco control

17. Public policy
drove the decline of tobacco use
1900 20101930s 1960s
SmokingRates
WWII
Education
First Surgeon
General’s Report
Federal
Cigarette
Tax Doubles
Policy Change
Start Nonsmokers
Rights Movement
First Great
American
Smokeout

18. 25% fewer tobacco-related
diseases (compared to the
rest of the nation)
California 1989-2008
$134 billion saved
6.79 billion fewer packs

19. Education
Clinical
Interventions
Long-lasting
Protective Interventions
Changing the Context to
Make Individuals’ Default
Decisions Easier
Socioeconomic Factors
Source: Friedman T.R. (2010). A Framework for Public Health Action: The Health Impact
Pyramid. American Journal of Public Health, 100(4), 590-595.

20. This story applies to
other public health
challenges

21. Create transportation infrastructure

22. Maintain healthy housing

23. Prevent drug overdose deaths

24. Ensure food safety

25. Provide access
to healthy foods

26. Prepare for
emergencies

27. Who has the power
to shape public
policy to improve
public health?

28. Look to the US Constitution

29. What are the public
health powers of the
federal government?

30. MULTIPLE
CHOICE
Which of the following
are examples of the
federal government’s
enumerated powers?
a) Taxing
b) Interstate commerce
c) Zoning
d) a and b
e) a and c
f) a, b, and c

31. MULTIPLE
CHOICE
Which of the following
are examples of the
federal government’s
enumerated powers?
a) Taxing
b) Interstate commerce
c) Zoning
d) a and b
e) a and c
f) a, b, and c

32. Federal regulations
can incentivize
local action

33. Federal government
can also prohibit or
preempt action

34. The states have the primary responsibility
for public health

35. “A county or city may make & enforce within its limits all
local, police, sanitary, & other ordinances and regulations not in
conflict with general laws.”

36. What about tribal
sovereignty?

37. Police Power
Promotes the public health,
safety, & the general well-
being of the community
Enacts & enforces laws for
general welfare
Regulates private rights in
the public interest

38. Can’t violate state & federal
laws or constitutions
Some
REQUIREMENTS:
Can’t be arbitrary
or oppressive
Must be rationally related to
public health, safety, or general
welfare
Must be reasonably designed to
correct a condition adversely
affecting the public good

39. TRUE
or
FALSE
1. Local governments have
legislative independence
apart from states.
2. The federal government
can control all aspects of
state and local laws.

40. FALSE
1. Local governments have legislative
independence apart from states.
Local governments generally
act within the authority
delegated to them by states.
2. The federal government can control all
aspects of state and local laws.
The Constitution divides control
between the federal and state
governments.

41. State & local
government
can…

42. Investigate disease outbreaks

43. Ban smoking in multi-unit housing

44. Create zoning for farmers markets

45. Require kids to wear helmets

46. Limit portion sizes

47. What are the
limitations on this
power?

48. THE COMMON
good
INDIVIDUAL
rights

49. The
Bill of Rights

50. CONSTITUTIONAL
rights
Due process
Freedom of speech & religion
Right to bear arms
Search & seizure
Equal protection

51. According to the 5th & 14th
amendments, the government
cannot deprive individuals of
life, liberty, or property without
due process of law

52. Procedural
Due Process
Did the government allow the
right to fair and impartial legal
proceedings before depriving
someone of life, liberty, or
property?

53. Substantive
Due Process
Does the government have
an appropriate justification
for depriving someone of
life, liberty, or property?

54. Some things are
more difficult
for the
government to
regulate than
others

55. What are fundamental liberties?

56. The Strict Scrutiny Test
Is the government action narrowly
tailored, or is it the least restrictive
alternative to achieve a
compelling goal?

57. Can the government
require parents to
vaccinate their
children?
What about in order to
attend public school?
What about in order to
attend private school?

58. MULTIPLE
CHOICE
Which of the following is
required for the government
to prohibit unvaccinated
children from attending
public school?
a) A compelling
government interest
b) A public health
emergency
c) Exceptions for religious
or personal /
philosophical beliefs
d) a and b
e) b and c
f) a, b, and c

59. MULTIPLE
CHOICE
Which of the following is
required for the government
to prohibit unvaccinated
children from attending
public school?
a) A compelling
government
interest
b) A public health
emergency
c) Exceptions for religious
or personal /
philosophical beliefs
d) a and b
e) b and c
f) a, b, and c

60. When fundamental liberties ARE NOT involved

61. The Rational Basis Test
Is the government action
reasonably related to a
legitimate government goal?

62. The government
must tread carefully
if a regulation affects
fundamental liberties
Rational
Basis Test
Strict Scrutiny
Test
Individual’s
interest is:
Government’s
goal must be:
Fit between
action & goal
must be:
Minimal Fundamental
Legitimate Compelling
Reasonable
Narrowly
tailored or least
restrictive
alternative

63. Matching
Match the government action (Column A)
to the corresponding test it must pass (Column B)
Column A
Prohibiting smoking in multi-unit
housing.
Removing a child from his/her
home because of a neglectful
or abusive parent.
Restricting K-12 students from
leaving campus during the
school day.
Requiring children to wear
bicycle helmets.
Column B
STRICT SCRUTINY
RATIONAL BASIS

64. According to
the 5th & 14th
amendments,
the government
shall not “deny to
any person within
its jurisdiction the
equal protection
of the laws”

65. Protected Classes

66. The Strict Scrutiny Test
Is the government action
narrowly tailored to achieve
a compelling goal?

67. Non-protected classifications

68. The Rational Basis Test
Is the government acting
reasonably related to a legitimate
government goal?

69. Can the government
pass a law
that imposes menu
labeling requirements
on large chain
restaurants, but not
on smaller chains or
independents?

70. A law that applies to
bigger but not smaller
businesses only needs to
be reasonably related
to a legitimate
government goal

71. Can the government
quarantine South Koreans
suspected of being
exposed to MERS?
What about limiting the
number of fast food
restaurants in certain
parts of the city?
What about putting an
age restriction on
buying harmful
products?
Questions to consider

72. Can the government
quarantine South Koreans
suspected of being
exposed to MERS?
TRUE
or
FALSE

73. Can the government quarantine
South Koreans suspected of being
exposed to MERS?
FALSE
The government must have a
valid justification for
distinguishing between
members of certain protected
categories, such as race or
national origin.

74. TRUE
or
FALSE
What about limiting the
number of fast food
restaurants in certain
parts of the city?

75. What about limiting the number of
fast food restaurants in certain
parts of the city?
TRUE
Zoning codes can restrict the
number of fast food chains in
certain parts of the city as long
as those distinctions are not
based on the race, national
origin, or ethnicity of a
community.

76. TRUE
or
FALSE
What about putting an age
restriction on
buying harmful
products?

77. TRUE
Minors do not receive special
protection under the Equal
Protection Clause. Therefore,
laws that treat them differently
from adults need only be
reasonably related to a
legitimate government goal.
What about putting an age restriction
on buying harmful products?

78. Recap
Can the government
quarantine South Koreans
suspected of being
exposed to MERS?
What about limiting the
number of fast food
restaurants in certain
parts of the city?
What about putting an
age restriction on
buying harmful
products?

79. Legal HISTORY reveals both
the POWER & LIMITATIONS
of government authority
to protect the
public’s health

80. ACHIEVING HEALTH EQUITY
through
Law Policy
Marice Ashe, JD, MPH
Founder & CEO