Principles of Public Health Practice/Policy, regulation, legislation and treaties on public health



Public health is all about resources and their distribution. When we think about interventions, we are asking which resources need to be placed where, for whose use and whose benefit. Essential to this process of resource allocation are the more or less public processes of decision-making and enforcement that are associated with four related areas: policy, legislation, regulation and treaties. While the meaning of each of these words can, and often do overlap, we can think about them as distinct but related areas of interest. This week we will begin to explore these areas.

Learning activity instructions
Each week we hold a lectorial and a tutorial. A lectorial is a short lecture followed by a group activity, and the tutorials are for discussion and practising group activities.

Lectorial
 * 1) View the playlist here (or here)
 * 2) Review the introductory, background material and learning outcomes here.
 * 3) Scan any references and resources
 * 4) Attend the lectorial

Tutorial
 * 1) Download the tutorial sheet (here) and prepare as instructed
 * 2) Progress your assignment with your team mates via agreed upon methods (e.g., face-to-face, social media)
 * 3) Attend the tutorial to work through exercise and apply to your team-based assessment

What is the influence of public policy, regulation, legislation and treaties on public health practice?
One day we heard that the there were an alarming number of deaths in Canada from a influenza strain that might have been picked up in China. As the days went on, public alarm increased. Here was something that could slip through airports like some assassin on a mission to disrupt the intercourse of nations.

Our modern economic arrangements, facilitated by increasingly open borders which freed up travel between countries, was supposedly at risk. The irony soon became clear. The influenza had spread because public health and medical practitioners on one side of the world travelled to the other in order to investigate a mysterious outbreak. They seemingly did this witihout fully thinking through the issues. The virus was spread from the "natural" environment into an "artificial" environment because of the way that we handled our response.

The "natural" spread of the disease was more typically among the carriers in the region of its origin, the farm and livestock environments. Because of precautions in previous generations, our livestock were heavily quarantined. Regulations that had been in place for some time still had a powerful dampening effect. The overall effect on the population was extremely limited. When a similar outbreak occurred among the flocks of pigeon fanciers in Australia, they were disciplined enough to quarantine their stock. They followed the procedures that had been developed until the outbreak was checked. With in a relatively short period, the pigeon fanciers were racing again.

Policies helps us better distribute resources to all the participants of a groups, organisation, community or society. Legislation is a more formal establishment of authority, responsibility and liability. Regulations spell out the specifics of legislation in a particular context or at a certain time. Treaties allow policies, legislation and regulation to be coordinated beyond the boundaries of the modern nation state.

But, all of this is easily subverted when we do not have enough information to deal with new problems as they arise. In fact, a policy of rapid response may put people into harms way and spread an outbreak. How can we better deal with such incidents? That is what a new generation of public health practitioners will be seeking to discover.

Background
Treaties control what we might share with our international partners. In some cases, markets are forced to open out to other markets in order to reduce what is termed unfair competitive advantage. At other times, negotiations keep markets intact. For instance, it is to the advantage of US pharmaceutical companies to have access to our markets. However, because we subsidize our pharmaceutical industry by placing their products on our pharmaceutical benefits scheme (PBS), the US companies are block out. It has taken considerable skill on the part of our negotiators to keep our PBS function to our advantage.

Legislation can force recalcitrant employers to follow occupational health and safety practices that support workers and their families. Otherwise, these families would carry an unfair burden for practices that benefit the employer without passing any benefit to the worker. In fact, the worker's body or mind often had to bear the burden of unfair work practices. Regulations are introduced to ensure that the practices can be monitored and enforced. For instance, Legionnaire's Disease is controlled by a complex of requirements relating to the maintenance of rooftop cooling systems on high rise buildings. Otherwise, innocent passersby on the street level are susceptible to infection from droplets from cooling towers.

Yet, many basic health promotion practices are not supported by regulation or legislative mandate. They require voluntary cooperation. We can ensure that manufacturers follow basic food handling practices to ensure food safety; but, we cannot force retailers to place their stock which is high in fat, salt and sugar towards a less accessible location in the store. Children can pester parents for low nutrition products while they wait in line to buy the necessities. Stores say that they only stock what their customers want while they spend billions in advertising each year to influence consumer choice towards products with a higher return on investment.

However, we are not just concern with the creation of health policies. We desire that all policies should be healthy policies. For instance, part of our work is with planning boards to influence how much space a developer must leave for public activities and recreation. We are concerned with how much money councils should put aside for shade related, low impact pedestrian travel to reduce traffic congestion and increase safe physical activity is part of our work.

References and Resources Forthcoming...

Learning Outcomes
What is the influence of public policy, regulation, legislation and treaties on public health practice?

Upon completion of this topic, through your own investigations, group preparation, tutorial participation and lectorial explorations, you should be able to:


 * Outline and critically comment upon the similarities and differences between public health policy and healthy public policy in terms of PHP.
 * Identify and predict the impact of key public health policies on the processes, principles and priorities of public health practice in Australia.
 * Outline the similarities and differences between public health legislation and public health regulations and explain their influence on PHP.
 * Examine and explain the pertinence of relevant treaties on public health practice in Australia and predict trends that might adversely affect Australians.