Public Health Bill Workshops

1
Public Health Bill Workshops

• PHA
• February 2008

2
PHA workshops

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

3
Governments can -
Fund things
Have staff do things
Talk up ideas
Pass laws
4
Today
Pass laws
5
Legal context
Mental Health (CAT)
6
Determinants of health
7
Health laws
Health Act / PH Bill
SOL, SFE GA,
Mental Health (CAT)
8
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

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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

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Timing

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

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Timing

• 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

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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
  groups

13
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

14
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

15
Or building community

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

16
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

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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

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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

19
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

20
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.

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New approaches needed

• risk-based approach
• human rights and consultation
• international law

22
PH Bill

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

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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
  groups

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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

25
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

26
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)

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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
  Maori?

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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
  groups

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Equity principles NCDs

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

30
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

31
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

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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?

33
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)

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PH functions of DHBs

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

35
Essential PH functions according to WHO WPRO

• Health situation monitoring and analysis
• Epidemiological surveillance/disease prevention
  and control
• Regulation and enforcement to protect public
  health

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Essential PH functionsaccording to WHO WPRO
ctd

• Health promotion, social participation and
  empowerment
• Development of policies and planning in public
  health
• Human resources development and planning in
  public health

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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

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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

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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

40
Information Part 2

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

41
Conditions posing health risks
42
Notification (part 2) a more flexible framework

• Case, condition, cluster or contaminant (s31)
• Medical practitioner labs others /- vets (s
  33-36)
• Option for temporary status (s38)
• quarantinable becomes epidemic

43
Conditions posing health risks

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

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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)

45
Conditions posing health risks

• Respects individual more (s92-93)
• Gives a wide range of disease containment options
  (s95)
• Requires use of least restrictive option (s91)
• Strengthened safeguards
• eg appeals (s112-123), time restrictions (s 96)

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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
  correct?
• What else should be included?

47
Balancing individual choice with supportive
environments

• - the dreaded Nanny State or sensible controls?
• Non-communicable diseases

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Non-communicable diseases
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Non-communicable diseases

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

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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)

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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?

52
Environments and Activities
53
Environments and Activities

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

54
Environments and Activities

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

55
P5 Role of Territorial Authoritiescontinuing
their existing functions

• Duties to protect public health
• Duties to abate nuisances
• Duties to provide for Environmental Health
  Officers
• Discretion re bylaws
• Role with activities (consent authority
  Assessors, subject to regulations)
• Role with sanitary works

56
Territorial Authorities

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

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Nuisances

• 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

58
P7 Border health protectionPublic health
security

• 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

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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.

60
P8 Miscellaneous

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

61
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

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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
  suffering.

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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
  consent.
• 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
  investigation

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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?