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Public Health Bill Workshops


Public Health Bill Workshops PHA February 2008 * PH functions of DHBs Lost opportunity to use WHO approach to the essential functions of public health Essential PH ... – PowerPoint PPT presentation

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Title: Public Health Bill Workshops

Public Health Bill Workshops
  • PHA
  • February 2008

PHA workshops
  • Help PHA make an excellent submission to
  • Inform others about the Bill and encourage them
    to make submissions supportive of public health

Governments can -
Fund things
Have staff do things
Talk up ideas
Pass laws
Pass laws
Legal context
Mental Health (CAT)
Determinants of health
Health laws
Health Act / PH Bill
Mental Health (CAT)
Act, Bills and Regulations
  • Bill a proposed law
  • being considered by Parliament
  • Act a law passed by Parliament
  • Regs further detailed laws under a
  • specific Act, if that Act permits the making
    of such regulations

Achieving healthy public policy
  • Parliament makes or changes laws
  • MMP environment
  • We have (and have had) minority governments
  • Government alone cannot pass laws
  • Role for minority parties
  • Deals for support

  • Select Committee must report back in 6 months
    (dec 07 6/12 June 08)
  • Election date?

  • SC has the options
  • Send to the vote advising yes
  • Send to the vote with changes
  • Send to the vote advising no
  • Delay needs more work

Purpose of the Bill
  • to improve, promote, and protect public health in
    order to help attain optimal and equitable health
    outcomes for Maori and all other population

The Public Health Bill
  • A law that propose the ways in which
  • normal rights and freedoms can be bypassed
  • to control risks to public health

Fundamental tension
  • The rights of individuals and businesses to go
    about their affairs free from interference
  • and
  • The rights of individuals and communities to be
    free from avoidable risks to health

Or building community
  • Valuing the common good
  • Sanctioning those who betray their fellows
  • Enabling joint action for mutual good

Overview context
  • 1900 plague in Sydney
  • NZ - 1901 Health Act
  • Population and social changes
  • 1956 Health Act
  • TB Act 1948
  • Social and technological changes
  • Public Health Bill

Social and technological changes
  • New and emerging health issues, eg
    non-communicable conditions, SARS
  • New strategies to prevent ill-health, eg
    immunisation and screening
  • New technologies
  • Attention to human rights
  • RMA, Fair Trading Act, HSNO, LGA etc

International obligations
  • International Health Regulations 1951, 1969
    (yellow fever, cholera, plague)
  • Since then, globalisation, air-travel , SARS,
    avian influenza, radiation, chemical risks
  • Need to improve (world-wide and in NZ)
  • emergency management
  • border health control,
  • communicable disease management
  • New IHRs all risks in scope

Human Rights
  • The Health Act 1956 shows its age
  • No attention to privacy issues
  • No procedural rights eg appeal or review for
    persons detained
  • Enhancing human rights can help support public
    health objectives

Legal context
  • Every sector should do its work safely
  • Workplaces - OSH
  • Health/Hospitals - HD Services Safety,
    - HPCAA
  • Roads - Land transport
  • Goods - Fair Trading
  • Regulation under health should be by exception.

New approaches needed
  • risk-based approach
  • human rights and consultation
  • international law

PH Bill
  • Roles
  • Information
  • Non-communicable diseases
  • Conditions posing health risks
  • TAs
  • Regulated activities
  • Emergencies and border health
  • Miscellaneous

Maori references purpose
  • (s 3) to improve, promote, and protect public
    health in order to help attain optimal and
    equitable health outcomes for Maori and all other
    population groups
  • aim to reduce health inequalities by improving
    health outcomes for Maori and other population

Maori references - NCDs
  • (s 80)
  • the Director-General must take into account the
    importance of---
  • (d) the well-being and mutual interdependence of
    families and their communities, including whanau,
    hapu, and iwi
  • (g) Working towards social and cultural
    environments conducing to health and well being

Maori references consultation re individuals
  • (s 110, 131) If a medical officer of health is
    considering applying to the Court
  • the medical officer of health may, at his or her
  • discretion, consult with the individual's
    family or whanau
  • Can an order be avoided by assistance on the part
    of the family or whanau

Maori references powers of entry and search
  • Marae treated as private dwellings (s 255, 270,
    306, 327)
  • (s353) (1) Every entry and search power
    authorises the person exercising it---
  • (b) to request any person to assist with
    the entry and search (including, without
    limitation, a member of a hapu or iwi if the
    place to be entered is of cultural or spiritual
    significance to that hapu or iwi)

Improving health outcomes for Maori?
  • Tiriti references?
  • Consultation as in LGA and PHDA?
  • Principled action to prioritise health of those
    most affected
  • What other things can be put into the law to
    improve health and increase health equity for

Equity - purpose
  • (s3) Statement of purpose
  • optimal and equitable health outcomes for Maori
    and all other population groups
  • aiming to reduce health inequalities by improving
    health outcomes for Maori and other population

Equity principles NCDs
  • (s80) take into account
  • the health of communities
  • broad determinants of health
  • involving communities
  • consultation
  • mutual interdependence of families and
  • health status of general population and
  • social and cultural environments

Equity objectives
  • (s 47) Cervical screening programme
  • The objectives of the NCSP are to---
  • inform women and the community of the risks,
    benefits, and expected population health gains
    from participation in the NCSP

Equity definitions
  • (s4) public health
  • health of all of the people of New Zealand or a
    community or section of those people
  • (s4) health impact assessment
  • assess health of a population or part of a
    population and the distribution
  • (s79) risk factor
  • ... incidence of non-communicable diseases in
    the general population or in communities or in
    sections of the general population or communities

Equity questions
  • Who will be most affected?
  • Who will benefit the most?
  • What other things can be put into the law to
    increase health equity?
  • What is the evidence (references, please) that
    changing environments improves equity?

PH functions of DHBs
  • Employ MOsH and HPOs
  • Monitor risks to public health
  • Assess (and report to the DG) those risks
  • Take steps to contain and manage those risks
    (where appropriate)
  • (can arrange for another to do)

PH functions of DHBs
  • Lost opportunity to use WHO approach to the
    essential functions of public health

Essential PH functions according to WHO WPRO
  • Health situation monitoring and analysis
  • Epidemiological surveillance/disease prevention
    and control
  • Regulation and enforcement to protect public

Essential PH functionsaccording to WHO WPRO
  • Health promotion, social participation and
  • Development of policies and planning in public
  • Human resources development and planning in
    public health

Essential PH functions according to WHO WPRO- ctd
  • Research, development and implementation of
    innovative public health solutions
  • Ensuring the quality of personal and
    population-based health services
  • Strategic management of health systems and
    services for population health gain

Information Part 2
  • Grab-bag of
  • Subsidy compliance verification
  • Cervical screening programme
  • Notification
  • Anonymous hospital data collection (now includes
    private hospitals)
  • Disclosure to authorised authorities
  • Blood collection(????)
  • Retention of records

Information Part 2
  • No principles
  • DG annual report on the state of the public
    health elsewhere
  • DHBs may require a report on risks to health from
    TAs but can be charged for it

Information Part 2
  • This is a lost opportunity to align
  • DHB obligation to do 3 yearly health needs
  • TA obligation to survey the district for serious
    risks to health
  • TA obligation to 3 yearly report community

Conditions posing health risks
Notification (part 2) a more flexible framework
  • Case, condition, cluster or contaminant (s31)
  • Medical practitioner labs others /- vets (s
  • Option for temporary status (s38)
  • quarantinable becomes epidemic

Conditions posing health risks
  • Protects public health more
  • Allows examination on suspicion (s97)
  • Can have urgent orders (s106)
  • Offense to recklessly spread (s126)

Conditions posing health risks
  • New provisions for contact tracing
  • Authorises contact tracing where it doesnt
    happen voluntarily (s138-149)
  • Medical practitioner / MOH may approach employers
    etc for contact details (s145)
  • Medical practitioner / MOH may disclose
    information on risks posed to them to sexual
    partners / household members (s 150-152)

Conditions posing health risks
  • Respects individual more (s92-93)
  • Gives a wide range of disease containment options
  • Requires use of least restrictive option (s91)
  • Strengthened safeguards
  • eg appeals (s112-123), time restrictions (s 96)

Your views
  • How should the balance between individual rights
    and community protection be reflected in law?
  • How do we defend the rights of communities to be
    safe when there are those who trivialise the
    risks by saying that we are too politically
  • What else should be included?

Balancing individual choice with supportive
  • - the dreaded Nanny State or sensible controls?
  • Non-communicable diseases

Non-communicable diseases
Non-communicable diseases
  • As proposed by Health Select Committee
  • report on the inquiry into
  • Obesity and Type II Diabetes

Non-communicable diseases
  • Non-binding codes and guidelines (s81-87)
  • Incentive awards
  • Parliamentary report back
  • within 3 years, can be extended
  • Can make regulations (s 374 x)

Your views
  • How should the balance between individual choice
    and supportive environments be reflected in law?
  • How do we defend the rights of communities to be
    free from health-harming commercial exploitation
    when there are those who say that the Nanny Sate
    has gone too far?
  • What else should be included?

Environments and Activities
Environments and Activities
  • an enabling regulatory framework
  • Activity specific regulations (eg, camping
    grounds, funeral directors or needle and syringe
  • Regulations may set mandatory objectives and
    performance measures
  • Licensing by Activity Consents
  • Option for public health risk management plans

Environments and Activities
  • Restrictions proportionate to risks
  • Duties of operators to identify risks, take all
    practicable steps

P5 Role of Territorial Authoritiescontinuing
their existing functions
  • Duties to protect public health
  • Duties to abate nuisances
  • Duties to provide for Environmental Health
  • Discretion re bylaws
  • Role with activities (consent authority
    Assessors, subject to regulations)
  • Role with sanitary works

Territorial Authorities
  • Clarifies that Building Act, HSNO, LGA RMA take
    precedence unless less appropriate (s192)
  • Nuisance re-defined to be injurious to public

  • Gays interpretation
  • Health law should only be used to control issues
    that have clear health risks to others
  • Future-proofing by allowing nuisance to cover
    unforeseen affairs likely to be injurious to
    public health

P7 Border health protectionPublic health
  • Give effect to existing and future WHO
    obligations as specified in the International
    Health Regulations
  • Public health inspection of, and clearance for,
    travellers and craft
  • Health measures at the border, eg, screening,
    examination, quarantine etc

P7 ctd Public health emergencies
  • Provisions for public health action to protect
    the community
  • Builds on and dovetails with other key statutes,
    eg CDEM Act, Epidemic Preparedness Act
  • Flexible provisions for Minister declarations and
    for emergency regulations.

P8 Miscellaneous
  • HIA non mandatory
  • Entry and inspection
  • Examination of children
  • Compliance orders
  • Incorporation by reference
  • Search warrants
  • etc

HIA (s 324-325)
  • HIA defined broadly
  • ..if undertaken have regard to any criteria
    specified by the Director-General
  • copy must be supplied to the DG

Examination of children now (HA s 125)
  • Person authorisedmay at all reasonable times
    enter any public school or child care centre and
    examine the children attending the school or
    centre, and may notify the parent or guardian of
    any such child of any condition which in his
    opinion is affecting the health or normal
    development of the child or of any disease or
    defect from which in his opinion the child may be

Examination of children proposed (PHB s 328)
  • A person aged under 16 years may not be examined,
    tested, or screened unless the parent has given
  • If consent not obtainable or refused and child
    may have a significant health condition that
    requires further investigation may advise the
    parent and refer the child for further

Examination of children
  • Now (HA s 125)
  • Enables population screening
  • Proposed (PHB s 328)
  • Restricts to significant health condition -?
    Hunting for abuse and neglect?
  • ? Follow option of cervical screening and have
    opt out?
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