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State Public Health Law Reform Assessing the Policy Impact of the Turning Point Model State Public Health Act

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State Public Health Law Reform Assessing the Policy Impact of the Turning Point Model State Public Health Act Benjamin Mason Meier, JD, LLM, MPhil – PowerPoint PPT presentation

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Title: State Public Health Law Reform Assessing the Policy Impact of the Turning Point Model State Public Health Act


1
State Public Health Law ReformAssessing the
Policy Impact of the Turning Point Model State
Public Health Act
  • Benjamin Mason Meier, JD, LLM, MPhil
  • Columbia University

March 30, 2009
CENTER FOR HEALTH POLICY
COLUMBIA UNIVERSITY
2
Outline
  • Background
  • Framework
  • Methods
  • Results
  • Analysis
  • Implications/Limitations
  • Future Research

3
Public Health Law Reform
  • Law as a Determinant of Health
  • Future of Public Health
  • Public Health Law Reform
  • Assessment of State Public Health Enabling Laws
  • Healthy People 2010

Public health law in the United States is ripe
for reform
State public health laws are, in many cases,
seriously outdated
  • the Nations public health infrastructure would
    be strengthened if jurisdictions had a model law
    and could use it regularly for improvements.

4
Turning Point Statute Modernization Collaborative
  • Mission
  • To transform and strengthen the legal framework
    for the state public health system through a
    collaborative process to develop a model state
    public health law.
  • The Turning Point Model State Public Health Act
  • Phase I State Public Health Law Assessment
  • Phase II Development of a Model Law
  • Turning Point Model State Public Health Act -
    released September 2003
  • Phase III Dissemination Education

5
Turning Point Act - Topics
  • Topics addressed within the Acts 9 substantive
    Articles include
  • Mission and Essential Services
  • Public Health Infrastructure
  • Collaboration and Relationships
  • Public Health Authorities and Powers
  • Public Health Emergencies
  • Public Health Information Privacy
  • Administrative Procedures, Criminal/Civil
    Enforcement

6
Turning Point Act - States That HaveIntroduced
and Passed Bills or Resolutions
  • Legislative Tracking
  • States have used the Act as the basis for state
    public health law reforms
  • Wisconsin Act 198, An Act Related to Public
    Health, is based on multiple articles
    /provisions of the Act

7
Transforming National Collaboration into State
LegislationStudy Design
  • Natural Experiment
  • Objectives - Assess the Impact of the Turning
    Point Act
  • Compare how the Turning Point Act is used by
    policy-makers in public health law reforms
  • Describe the effectiveness of the Turning Point
    Act as a model for state law
  • Apply lessons from the Turning Point experience
    to future reform efforts and empirical research

8
Conceptual Framework
  • Reasons for Reform (Grad 1990, Gostin 2000)
  • Antiquated
  • Unfocused
  • Inconsistent
  • Why
  • How
  • Process of Reform (Gebbie 1998, 2000)
  • Stages
  • Actors
  • Forces

9
Working Assumption
  • Policy consideration of the Turning Point Act
    will differ in form, substance, and process
    according to
  • state political institutions,
  • individual actors, and
  • perceived imperatives in public health

10
Methods - Comparative Case Study
  • Informant Sample
  • Legislators
  • Bureaucrats
  • Advocates
  • Semi-Structured Interviews
  • Public health problems addressed by reforms
  • Obstacles to reform
  • Subsequent changes in public health programs
  • Content Analysis
  • Comparative Method
  • Varied Responses to the Same Model
  • Case Selection Congruence with the Turning
    Point Act
  • Legal Analysis of Reforms in Comparison with
    Model Act
  • Individual Case Studies
  • Wisconsin
  • Alaska
  • Nebraska
  • South Carolina

11
Comparative Results State Political and Policy
Efforts Matter
  • ALASKA
  • The Turning Point Experience
  • Top-Down Reform
  • Republican Support for a Democratic Bill
  • Politicization of Public Health
  • WISCONSIN
  • The Turning Point Experience
  • Stakeholder Collaboration
  • Bottom-Up Reform
  • Strong Legislative Champion
  • Non-Politicization
  • SOUTH CAROLINA
  • Lack of an External Galvanizing Force
  • Bureaucratic Expansiveness and the Risk of
    Backsliding
  • NEBRASKA
  • Stakeholder Collaboration
  • Lack of Legislative Support
  • Risk of Backsliding
  • Selective Incorporation by Regulation

12
AlaskaA Process Model of Successful State Public
Health Law Reform
  • Stage I Emergence and Utilization of the Act
  • Dominant Actors
  • Turning Point Collaborative
  • Division of Public Health
  • Key Forces
  • Agenda Setting
  • Result
  • Model Developed for Discussion of Issue
  • Stage III Legislative Action
  • Dominant Actors
  • Legislators
  • Division of Public Health
  • Advocacy Groups
  • Key Forces
  • Politicization of Public Health
  • Result
  • Reform of State Public Health Law
  • Stage II Development of Draft Law
  • Dominant Actors
  • Division of Public Health
  • Office of the Attorney General
  • Key Forces
  • Public Health Imperatives
  • Result
  • State Law Developed Pursuant to Turning Point Act

13
Analysis Correlates of Reform
Health Commissioner
Public Health Assn
  • Inhibitors

DOH
  • Facilitators
  • Unaltered Model Language
  • Gap Analysis
  • Agenda Setting
  • Lack of Impetus for Reform
  • Key Partnerships
  • Legislative Champions

Turning Point Act Completed
  • Fear of Backsliding
  • Lack of Legal Leadership

Assembly Chair
Activist
Governor
Contributing Partner Meetings Begin
Assembly Bill 881 Introduced
14
Analysis Common Correlates
  • Comparative Process Model Stages of Reform,
    Principal Actors and Decisive Forces

I. Utilization of the Turning Point Act II. Development of Draft Law III. Regulatory Action
Actors Public Health Partners Legal Counsel Legislative Champions
Forces Agenda Setting Gap Analysis Leadership Advocacy
15
Implications / Limitations
Meier, Hodge Gebbie (2007-2009)
  • Resources to support future reforms
  • Little understanding of current state of law
  • Need for additional research on
  • State of Public Health Legislation
  • Effect of Law on Performance

Transitions in State Public Health Law
Comparative Analysis of State Public Health Law
Reform
Journal of Health Politics, Policy and
Law
Report from the Field Alaska Public Health Law
Reform
16
Future Studies
  • Competencies for Applying Law
  • Gap Analyses for Public Health Law Reforms
  • Relationship between Public Health Law Reform and
    Health System Performance
  • Essential Services in Law (Meier, Merrill
    Gebbie 2009)
  • Law Performance (Merrill, Meier, Keening
    Gebbie 2009)
  • Link between Public Health Law, Individual Health
    Behaviors, and Public Health Outcomes

17
Conclusions
  • States selectively codify provisions of the
    Turning Point Act based upon individual,
    political, and institutional factors.
  • Additional research is necessary to determine the
    effect of these reformed laws.
  • For more information on legislative tracking and
    comparative case studies, see www.publichealthlaw
    .net/Resources.htm.

Benjamin Mason Meier, JD, LLM, MPhil Columbia
University bmm2102_at_columbia.edu
18
  • Legislative Tracking
  • Case Selection Congruence with the Turning
    Point Act

WISCONSIN
ALASKA
NEBRASKA
SOUTH CAROLINA
  • Alaska HB 95 An Act relating to the duties of
    the Dept of Health Social Services (June 2005)
  • AB 881 An Act Related to Public Health (March
    2006)
  • No Proposed Legislation or Regulation
  • 173 NAC 6 Directed Health Measures to Prevent
    or Limit the Spread of Communicable Disease,
    Illness, or Poisoning (Feb. 2007)

Passed Bills 26
19
  • Legislative Tracking
  • Little understanding of current state of law

Passed Bills 26
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