EPH4017: Public Health Law and Governance
Maastricht University
Faculty of Health, Medicine and Life Sciences (FHML)
MSc Governance and Leadership in European Public Health
,Table of Contents
1. Public Health Law ................................................................................................................................ 3
1.1 Public Health Law Research .......................................................................................................... 7
2. The Five Essential Public Health Law Services ................................................................................... 11
3. Public Health Law Service 1: Policy Development............................................................................. 13
3.1 Haddon Matrix ............................................................................................................................ 17
3.2 Causal Diagrams .......................................................................................................................... 20
3.3 Identifying Public Health Problems ............................................................................................. 23
3.3.1 Childhood Injuries ................................................................................................................ 25
3.3.2 Childhood Injury Prevention ................................................................................................ 30
4. Public Health Law Service 2: Choosing the Legal Form ..................................................................... 37
4.1 Choosing a Legal Approach ......................................................................................................... 40
4.1.1 Illicit drug use....................................................................................................................... 43
4.1.2 Removal of Cannabis and its Derivates from Schedule IV of the 1961 Single Convention on
Narcotic Drugs .............................................................................................................................. 51
4.1.3 Regulatory Models of Medical Cannabis ............................................................................. 52
4.1.4 Health Professionals Involved in the Prescription and Supply of Medical Cannabis........... 56
5. Public Health Law Service 3: Enactment ........................................................................................... 57
5.1 Public Health Advocacy ............................................................................................................... 62
5.2 Developing an Advocacy Campaign ............................................................................................ 66
5.3 Stakeholder Analysis/ Mapping .................................................................................................. 70
5.3.1 Healthy school food programmes ....................................................................................... 73
6. Public Health Law Service 4: Implementation, Enforcing, Defending ............................................... 76
6.1 Models of Regulation .................................................................................................................. 79
6.2 The Enforcement Process ........................................................................................................... 84
6.2.1 Vaccinations ......................................................................................................................... 90
7. Public Health Law Service 5: Surveillance and Evaluation ................................................................ 97
7.1 Scientific Evaluation in Transdisciplinary Public Health Research and Practice ....................... 101
7.1.1 Tobacco Control ................................................................................................................. 109
7.1.2 Monitoring of Policy Surveillance and Evaluation as a Part of Law Implementation ........ 122
7.1.3 Effectiveness of the Tobacco Age-of-Sale-21 Law ............................................................. 123
7.1.4 Intervening Variables ......................................................................................................... 125
2
,1. Public Health Law
Law has a powerful influence on health and therefore, law is crucial in public health. Below are ten
examples of great public health achievements stated, each of these depended on law (US, 1900-
1999; CDC, 1999):
- Vaccination
- Motor-vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer and healthier foods
- Healthier mothers and babies
- Family planning
- Fluoridation of drinking water
- Recognition of tobacco use as a health hazard
Public health law focusses on changing behaviour or environment. Law is the biggest social
intervention we have. We want to make our behaviour and environment safer in order to improve
public health.
Different types of public health law
- Interventional public health law
Laws which are being used to explicitly and deliberately influence behaviour or environment.
For example:
o Law requiring people to wear safety belts
o Environmental toxins law for clean indoor air
▪ Smoking bans for tobacco control
- Infrastructural public health law
Laws that establish the power, duties, and structure of public health agencies or systems. For
example:
o State and local infrastructure law that affect population health outcomes
▪ Disease control and prevention
• International Health Regulations (IHR)
▪ Pharmaceutical regulation
3
, - Incidental public health law (most important/ biggest category, since it is particularly
important to social determinants). Incidental laws are laws that originally may have been
adopted for reasons unrelated to public health, but ultimately have resulted in an
unintended public health impact. For example:
o Civil rights law on reducing inequalities due to gender, age, disability. Workplace
hierarchies, relationships and happiness turn out to be very important for people’s
long-term health. These laws are intended to protect public health, but incidentally,
civil rights law has that effect.
o Tax law
o Employment law
Law is everywhere
Law on the books vs. organizational rules:
- Left triangle: official law by the governments (what people think law is)
- Right triangle: organizations within the private sector (NGO’s) create law like rules (e.g.,
employee handbooks).
- Policy transformation process is a process that goes on one a law is written down. This
process is comparable in the for both triangles.
Law has powerful health effects because of great science
- Tobacco control
- Alcohol control
- Road safety
→ We can use law strategically, scientifically and effectively.
4
Maastricht University
Faculty of Health, Medicine and Life Sciences (FHML)
MSc Governance and Leadership in European Public Health
,Table of Contents
1. Public Health Law ................................................................................................................................ 3
1.1 Public Health Law Research .......................................................................................................... 7
2. The Five Essential Public Health Law Services ................................................................................... 11
3. Public Health Law Service 1: Policy Development............................................................................. 13
3.1 Haddon Matrix ............................................................................................................................ 17
3.2 Causal Diagrams .......................................................................................................................... 20
3.3 Identifying Public Health Problems ............................................................................................. 23
3.3.1 Childhood Injuries ................................................................................................................ 25
3.3.2 Childhood Injury Prevention ................................................................................................ 30
4. Public Health Law Service 2: Choosing the Legal Form ..................................................................... 37
4.1 Choosing a Legal Approach ......................................................................................................... 40
4.1.1 Illicit drug use....................................................................................................................... 43
4.1.2 Removal of Cannabis and its Derivates from Schedule IV of the 1961 Single Convention on
Narcotic Drugs .............................................................................................................................. 51
4.1.3 Regulatory Models of Medical Cannabis ............................................................................. 52
4.1.4 Health Professionals Involved in the Prescription and Supply of Medical Cannabis........... 56
5. Public Health Law Service 3: Enactment ........................................................................................... 57
5.1 Public Health Advocacy ............................................................................................................... 62
5.2 Developing an Advocacy Campaign ............................................................................................ 66
5.3 Stakeholder Analysis/ Mapping .................................................................................................. 70
5.3.1 Healthy school food programmes ....................................................................................... 73
6. Public Health Law Service 4: Implementation, Enforcing, Defending ............................................... 76
6.1 Models of Regulation .................................................................................................................. 79
6.2 The Enforcement Process ........................................................................................................... 84
6.2.1 Vaccinations ......................................................................................................................... 90
7. Public Health Law Service 5: Surveillance and Evaluation ................................................................ 97
7.1 Scientific Evaluation in Transdisciplinary Public Health Research and Practice ....................... 101
7.1.1 Tobacco Control ................................................................................................................. 109
7.1.2 Monitoring of Policy Surveillance and Evaluation as a Part of Law Implementation ........ 122
7.1.3 Effectiveness of the Tobacco Age-of-Sale-21 Law ............................................................. 123
7.1.4 Intervening Variables ......................................................................................................... 125
2
,1. Public Health Law
Law has a powerful influence on health and therefore, law is crucial in public health. Below are ten
examples of great public health achievements stated, each of these depended on law (US, 1900-
1999; CDC, 1999):
- Vaccination
- Motor-vehicle safety
- Safer workplaces
- Control of infectious diseases
- Decline in deaths from coronary heart disease and stroke
- Safer and healthier foods
- Healthier mothers and babies
- Family planning
- Fluoridation of drinking water
- Recognition of tobacco use as a health hazard
Public health law focusses on changing behaviour or environment. Law is the biggest social
intervention we have. We want to make our behaviour and environment safer in order to improve
public health.
Different types of public health law
- Interventional public health law
Laws which are being used to explicitly and deliberately influence behaviour or environment.
For example:
o Law requiring people to wear safety belts
o Environmental toxins law for clean indoor air
▪ Smoking bans for tobacco control
- Infrastructural public health law
Laws that establish the power, duties, and structure of public health agencies or systems. For
example:
o State and local infrastructure law that affect population health outcomes
▪ Disease control and prevention
• International Health Regulations (IHR)
▪ Pharmaceutical regulation
3
, - Incidental public health law (most important/ biggest category, since it is particularly
important to social determinants). Incidental laws are laws that originally may have been
adopted for reasons unrelated to public health, but ultimately have resulted in an
unintended public health impact. For example:
o Civil rights law on reducing inequalities due to gender, age, disability. Workplace
hierarchies, relationships and happiness turn out to be very important for people’s
long-term health. These laws are intended to protect public health, but incidentally,
civil rights law has that effect.
o Tax law
o Employment law
Law is everywhere
Law on the books vs. organizational rules:
- Left triangle: official law by the governments (what people think law is)
- Right triangle: organizations within the private sector (NGO’s) create law like rules (e.g.,
employee handbooks).
- Policy transformation process is a process that goes on one a law is written down. This
process is comparable in the for both triangles.
Law has powerful health effects because of great science
- Tobacco control
- Alcohol control
- Road safety
→ We can use law strategically, scientifically and effectively.
4
