I. Introduction
There is no public health without law. From the creation of a health department by statute, to a law mandating disclosure of calories on restaurant menus, laws create the framework that helps make healthy choices the norm. For example, laws influence when and how public health practitioners require and enforce mandatory vaccinations.1 Laws also affect when and how health officials invoke isolation and quarantine orders, or take other control measures, to protect the public's health.2 Laws are used to prohibit smoking in multi-unit housing to protect fellow residents from harmful and offensive secondhand smoke.3 In fact, the resolution of almost every public health challenge today involves a legal or policy contribution.
Public health expectations and practices evolve in response to social, technological, and financial changes. So modern public health practitioners must have a clear understanding of our legal system and its role in improving overall population health.4 The complexities of the public health system, and the challenges raised by the increasing focus on addressing the social determinants of health,Reference DeSalvo, O'Carroll, Koo, Auerbach and Monroe5 also require public health practitioners to understand how to use law and policy to address local public health burdens and foster health equity.
To thrive in what is increasingly a transdisciplinary field, today's public health practitioners, particularly those at the state, tribal, local, and territorial levels, must have knowledge of and access to public health law resources and tools. Yet, understanding and analyzing the connection between laws and health outcomes is one of the primary knowledge gaps among the public health workforce, and most public health professionals do not receive any formal public health law training.Reference Wilcox, Majestic, Ayele, Strasser and Weaver6 According to the Association of State and Territorial Health Officials' 2014 Public Health Workforce Interest and Needs Survey, the top two self-identified areas of need for training among public health professionals are: (1) how to influence law and policy development and (2) how to better understand the effects of law and policy on population health.Reference Sellers, Leider, Harper, Castrucci, Bharthapudi, Liss-Levinson, Jarris and Hunter7
The Public Health Law Academy8 promises to address this gap by providing trainings and tools to help the public health workforce understand public health law and its role in improving population health outcomes. The Academy's overall strategy is to infuse the public health workforce with legal and policy tools and evidence-based strategies that can be utilized to improve public health.
According to the Association of State and Territorial Health Officials' 2014 Public Health Workforce Interest and Needs Survey, the top two self-identified areas of need for training among public health professionals are: (1) how to influence law and policy development and (2) how to better understand the effects of law and policy on population health. The Public Health Law Academy promises to address this gap by providing trainings and tools to help the public health workforce understand public health law and its role in improving population health outcomes.
II. Components of the Public Health Law Academy
The Public Health Law Academy is a core project of a cooperative agreement between ChangeLab Solutions and the Public Health Law Program (PHLP) at the Centers for Disease Control and Prevention (CDC). The purpose of this cooperative agreement is to build the capacity of state, local, tribal, and territorial health departments to effectively use evidence-based legal and policy strategies to improve health outcomes throughout the nation. To further this purpose, the Public Health Law Academy has designed a suite of tools and powerful new resources to assist public health agencies and their nongovernmental and community-based partners in the understanding and use of law and policy to positively impact population health. These resources are also designed to enhance working relationships between public health practitioners and their attorneys.
There are three key components of the Public Health Law Academy: online, on-demand trainings; facilitator toolkits; and the Legal Epidemiology Center.
A. Public Health Law Academy Online On-Demand Trainings
At its core, the Public Health Law Academy is an online, on-demand set of trainings, tools, and resources to help public health practitioners better understand and use law as a public health tool. The self-paced courses have been created for state, tribal, local, and territorial public health professionals, as well as public health lawyers, nurses, educators, advocates, and faculty and students in graduate and undergraduate programs.
The Public Health Law Academy currently has nine trainings in three clusters: (1) Introduction to Public Health Law, (2) Hot Topics in Public Health Law, and (3) Legal Epidemiology Overview.
1. introduction to public health law
These introductory trainings explore the integral role of law in the everyday practice of public health. They explore the transdisciplinary nature of public health, provide tips on using this information in everyday practice, and offer tools to help increase public health law competency. The three trainings address common questions such as, “What is the history of public health law?”, “How do public health practitioners balance the common good against the rights of affected individuals?”, “What does the Constitution require if the government regulates individual behavior?”, “What is preemption, and how does it affect public health?”, and “What is the basic structure of our federal, state, and local governments?” To answer these questions, the Academy offers three courses: Public Health Law: Past and Present; Preemption and Public Health; and Structure of Government: Exploring the Fabric and Framework of Public Health Powers.
2. hot topics in public health law
Public health law is constantly evolving due to emerging public health threats. The Hot Topics in Public Health Law cluster currently includes three courses: Public Health Threats and the US Constitution: What Responders Need to Know; Legal and Policy Approaches to Reducing Prescription Drug Overdose; and Your Guide to Collaborative Practice Agreements.
3. legal epidemiology overview
Legal epidemiology is a relatively new field of study. It is defined as the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population.Reference Burris, Ashe, Levin, Penn and Larkin9 For example, a practitioner concerned about variations in life expectancy across communities can use legal epidemiological methods to explore how law and its enforcement might play a role in that variation. One community might have regulations about smoking, road safety, or clean water. Or, two communities might have identical ordinances but differ in how they enforce the law. The Academy's legal epidemiology trainings help public health practitioners develop the necessary skills to assess how specific variables in the law affect health outcomes. The Legal Epidemiology Overview cluster includes three trainings: Introduction to Legal Epidemiology, Legal Mapping, and Advanced Legal Epidemiology Methods.
B. Facilitator Toolkits
The Public Health Law Academy also provides tool-kits that prepare and empower trainers, educators, and faculty to integrate legal principles, theories, and concepts into courses that already exist or to develop customized trainings. Each course in the Academy is accompanied by a facilitator's guide, script, and checklist, along with customizable presentation slides that can be tailored to incorporate jurisdiction-specific laws or be truncated or expanded to meet audience-specific needs.
In some states, lawyers might qualify for continuing legal education (CLE) credits for teaching Pubic Health Law Academy trainings. As of May 2018, at least forty-four states allow attorneys to receive credit for teaching CLE courses to other lawyers.10 However, twenty-two of those states do not allow attorneys to receive CLE credits for training non-attorneys, such as public health professionals.11 To help navigate these parameters, the Academy features a summary and map of CLE rules by state.
C. The Legal Epidemiology Center
The Legal Epidemiology Center officially launched in October 2018 at the Public Health Law Conference. It features high-quality educational resources and products for use by public health lawyers and the entire public health workforce to build their capacity to participate in and conduct legal epidemiological studies. Temple University's Public Health Law Research program, in collaboration with PHLP, ChangeLab Solutions, the Network for Public Health Law, the Public Health Law Center, and many expert volunteers, has undertaken a series of research and consultation projects to advance the understanding and practice of legal epidemiology at CDC and state, tribal, local, and territorial health agencies, with special focus on policy surveillance. The results of these projects will be shared on the Legal Epidemiology Center's website and updated regularly as new publications become available.
The Legal Epidemiology Center also features a Learning Library that offers the legal epidemiology trainings described above, along with PHLP's Legal Epidemiology Competency Model, which describes the skills and competencies needed to complete policy surveillance and legal mapping projects.
III. Conclusion
Law and policy influence public health practice and outcomes in a myriad of ways, so it is important for the public health workforce to understand and apply laws to advance public health goals. The trainings, tools, and resources offered by the Public Health Law Academy are designed to assist all public health professionals in the development of essential skills and knowledge needed to deepen their understanding of the legal foundations for public health practice, and the potential uses of law to drive enduring improvements. The Public Health Law Academy exists to fill this critical competency gap in the public health workforce.
Disclaimer
The findings and conclusions in this article have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.
