Samia - Chapter 5

Question 1

What are the four proposed “new governance mechanisms”?

Answer 1

1. Emissions Trading
2. Negotiated Rule Making
3. Self-Regulation
4. Public Disclosure (Gostin, 173)

Question 2

Much of Public health regulation takes place at which level of government?

Answer 2

The local level - and involves the status of cities (Gostin, 150)

Question 3

What were the outcomes of the oldest sanitary law enacted in 1634?

Answer 3

• Prohibited Boston residents from depositing fish or garbage near the common landing
• A series of ordinances in 1652 prohibiting dumping of garbage onto public thoroughfares and waterways, impounding stray animals from streets, and removing dead animals and offal. (Gostin, 150)

Question 4

What did the first Massachusetts General Assembly in 1692 due in regards to regulations of hazardous trades & businesses?

Answer 4

Empowered selectmen in market towns to prohibit slaughterhouses, the drying out of tallow, and currying of leather, except in assigned locations. (Gostin, 150)

Question 5

What did the Laissez-faire politics reinforce by the mid-nineteenth century (during the industrial revolution)?

Answer 5

Belief in free markets which led to the expansion of industry and consequent migration of workers to the city to secure jobs and livelihood. (Gostin, 150)

Question 6

What safety risks did the Public Health Advocates (sanitary engineers, physicians, and sanitarians) observe as a direct result of the new industrial civilization?

Answer 6

• Factories caused injury to workers
• Industrialization led to overcrowding of communities, slum conditions, homelessness, squalor, and violence
• Realization that disease caused by garbage, sewage, pollution, and contaminated food/drinking water affected the whole community. (Gostin, 151)

Question 7

What kinds of violations were used to ensure compliance of health and safety regulations in the late 19th century?

Answer 7

Misdemeanor, but conviction facilitated imposition of strict liability, and convicted entrepreneurs faced short terms of imprisonment. (Gostin, 151)

Question 8

How did Paris native, Louis-Rene Villerme (1782-1863), contribute to PH sanitary reform?

Answer 8

• Life/death aren’t just biological but social circumstances. - - Lower SES lead to higher mortality rate.
• Cotton production and pneumonia study lead to campaign against child labor
• Enactment of Child Labor Act of 1841 (Gostin, 152)

Question 9

How did Mass native, Lemuel Shattuck (1793-1859), contribute to PH sanitary reform?

Answer 9

• 1850 Report on Sanitary Commission of MA, which linked environmental & social conditions to health
• Failed to implement reforms but after his death, first State of Board of Health in MA was established in 1869
  (Gostin, 152)

Question 10

How did England native, Edwin Chadwick (1800-1890), contribute to PH sanitary reform?

Answer 10

• 1842 report on Sanitary Conditions of Laboring Population of Great Britain
• Life expectancy lower in towns than in countryside
• Challenged Laissez-faire (working class caused air pollution by dead animals and vegetable substance, damp/filth and overcrowdedness
• Fear of Cholera along with his report led to the first British Public Health Act in 1848
  (Gostin, 152)

Question 11

How did Rudolf Ludwig Karl Virchow (1821-1902), contribute to PH sanitary reform?

Answer 11

• High infant mortality due to poor housing, declining milk supply, and sepsis
• Campaigned for PH measures (sewage disposal, hospital architecture, improved meat inspections, school hygiene)
  (Gostin, 152)

Question 12

Although during this time, PH officials had no qualifications, career advancements, or job security, when and who were the earliest local health departments established in the US?

Answer 12

• Baltimore in 1793
• Philadelphia in 1794
• Massachusetts’ Municipalities in late 1790s
  (Gostin, 154)

Question 13

Industrial Social Problems led legislatures to form a more elaborate & proper PH board, what CITY established one of the earliest proper board and what tasks did legislatures grant them?

Answer 13

• NYC in 1866 under “an act to create a metropolitan sanitary district and board of health”
• Tasks Included: Enact detailed admin regulations, inspect businesses and property owners to ensure compliance, adjudicate and sanction those who violated regulatory standards
  (Gostin, 155)

Question 14

What was the first working STATE health board and when did that take place?

Answer 14

• Mass in 1869
• Other states followed in the 1870s (CA, MD, MI, VA)
  (Gostin, 155)

Question 15

What are the challenges that persist in PH professionalism to this day?

Answer 15

• Lack of leadership in PH
• Failure to constructively engage with elected officials
• Short tenure of politically appointed PH officials
  (Gostin, 155)

Question 16

What federal role occurred during Roosevelt’s New Deal?

Answer 16

• Asserted regulatory jurisdiction over harmful (food, drugs, and cosmetics)
• National Standards for drinking water
• Enactment of veneral disease control program
• Formed federal grant-in-aid program requiring states to establish/maintain PH services & training for professionals
  (Gostin, 155)

Question 17

What did Presidents Lyndon Johnson and Reagan contribute to Public Health?

Answer 17

• Johnson: Aid to Education, Urban Renewal, Established Medicare/Medicaid
• Nixon: Mandate for executive agencies to conduct a cost-benefit analysis, which still occurs to this day
  (Gostin, 158)

Question 18

What were the Federal Regulation milestones during the 1700’s?

Answer 18

• 1796: National Quarantine Act limited to state requests
• 1798: Act for Relief of Sick/Disabled Seamen (now FDA)
  (Gostin, 159)

Question 19

What were the Federal Regulation milestones during the 1800’s?

Answer 19

• 1813: Act to Encourage Vaccination (via mail)
• 1878: National Quarantine Act led to federal regulations to detain ships with possible contagions on board
• 1879: National Board of Health created
• 1891: Immigration Act requires health inspections
• 1892: Cholera epidemic led Harrison signing a NEW NQA for foreign port vessels signed bill of health by US consul
  (Gostin, 159)

Question 20

What were the KEY Federal Regulation milestones during the 1900’s through 2003?

Answer 20

• 1930: Ransdell Act creates NIH
• 1935: TItle VI SSA (PH Title) authorizes $ to investigate disease & sanitation creating national health program
• 1946: Malaria Control in War Areas Program converted to Communicable Disease Center then CDC known today
• 1965: Medicare/Medicaid created
• 1970: EPA created
• 1979: HEW converted to DHHS
• 1993: Free vaccines to kids in low income families
• 1996: HIPPA
• 2002: DHS focus on terrorism
• 2003: Medicare Prescription Drug Improvement and Modernization Act
  (Gostin, 160)

Question 21

Who determines the organization, mission, and functions of PH agencies?

Answer 21

State Legislation

Gostin, 161

Question 22

What standard services do LHDs provide to their communities?

Answer 22

• Data Collection & Analysis
• Disease Control
• Epidemiology & Surveillance
• Community/Personal Health
• Environmental Health
• Licensing
  (Gostin, 164)

Question 23

What are the forms and structures of a local PH agency?

Answer 23

• Centralized (directly operated by state)
• Decentralized (formed and managed by local government)
• Mixed
  (Gostin, 164)

Question 24

What are the three sources of local government powers?

Answer 24

• Constitution (delegates power directly from people to municipalities)
• State Legislation (granted delegated powers)
• Municipal or County Charter (approved by local voters and expresses the powers of corporations)
  (Gostin, 164)

Question 25

What is Dillon’s Rule that’s used to interpret sate-delgated powers?

Answer 25

Local governments can exercise only those powers expressly conferred, necessarily or fairly implied, or essential to the objects and purposes of the municipality.
(Gostin, 165)

Question 26

How can states deny cities or counties the power to exercise control?

Answer 26

By either withholding grants of power or resources OR by preempting local regulation
(Gostin, 165)

Question 27

Briefly explain the facts, holding, and PH importance of FDA v. Brown & Williamson Tobacco Corp (2000)

Answer 27

FACTS:
- FDA issues a ruling of regulating cigarettes as a “nicotine delivery device” therefore, a medical device to be regulated under FDAs authority
- Tobacco companies sue claiming that FDA doesn’t have authority to regulate cigarettes under the FDCA
HOLDING:
- Court holds that FDA doesn’t have authority and if congress intended tobacco to be regulated, they would have included it in the FDCA
PH IMPORTANCE:
- Agencies can only regulate where Congress has delegated power

Question 28

Briefly explain the 3 powers modern PH agencies can exercise that are characteristics of the branches of government.

Answer 28

• Legislative Power (Rule-Making): Sets health & safety standards
• Executive Power (Enforcement): Investigates rule violations & prosecutes offenders
• Judicial Power (Adjudication): Interprets rules and adjudicates disputes
  (Gostin, 166)

Question 29

List and briefly explain the two different procedural (rule making) forms of the federal Administrative Procedure Act (APA).

Answer 29

• Informal Rule Making: 1. Prior notice, 2. Witten Comments by Interested Persons, and 3. Statement of Basis and Purpose for Rule Making
• Formal Rule Making: 1. Agency to conduct a hearing, 2. Provide interested parties with an opportunity to testify and cross examine adverse witnesses before issuing a rule\
  (Gostin, 168)

Question 30

Briefly explain the the facts, holding, and PH importance of Vermont Yankee Nuclear Power Corp. v. NRDC (1978).

Answer 30

FACTS:
- APA establishes the max procedural requirements that congress was willing to have the courts impost upon federal agencies in conducting rule making proceedings.
HOLDINGS (not in book):
- While federal agencies are free to grant additional procedural rights in the exercise of their discretion, reviewing courts are generally not free to impose them if the agencies have not chosen to grant them.
PH IMPORTANCE (not in book):
- Although there may be an environmental impact upon granting an operating license for the nuclear power plant near CT river, the nation still lacks a means of storage for high-level nuclear wastes.

Question 31

Under the constitutional power of “enforcement”, how do health departments enforce these powers?

Answer 31

• Legislatures set penalties for violation of health and safety standards
• Executive branch monitor compliance
  (Gostin, 168)

Question 32

Under the federal Administrative Procedure Act (APA), explain when formal adjudications are applied.

Answer 32

Only in relatively rare cases where agency’s authorizing statute directs the agency to hold an evidentiary hearing. Conducted by an administrative law judge, followed by an appeal to the agency head. Includes notice, right to present oral & written evidence, cross examination of hostile witnesses, agency findings of fact and law, and reasons for decisions.
(Gostin, 169)

Question 33

What’s the “non-delegation doctrine”?

Answer 33

Legislatures may not delegate full legislative authority to agencies or any other body (Rarely used by fed court to limit agency powers)
(Gostin, 170)

Question 34

Briefly explain the the facts, holding, and PH importance of Whitman v. American Trucking Associations (2001).

Answer 34

FACTS:
- Trucking companies challenged EPA’s authority in regulating the ozone and air quality
HOLDING:
- Clean Air Act’s directive to the EPA to protect the public health with an adequate margin of safety was not so “standardless” as to amount to an unconstitutional delegation of power
PH IMPORTANCE:
- Put the brakes on attempts by lower courts to overturn federal laws that grant agency broad rule making authority

Question 35

Briefly explain the the facts, holding, and PH importance of Chevron v. Natural Resources Defense Council (1984).

Answer 35

FACTS:
- Congress delegated power to the agency to make a policy decision AKA agency interprets statues
HOLDING:
- 2 step process created. #1 if Congress has “directly spoken on the precise question at issue” the agency must abide to that congressional intent and courts must enforce Congress’ mandate #2 where there is statutory ambiguity courts usually defer to the agency action so long as the interpretation isn’t arbitrary or capricious
PH IMPORTANCE:
- Chevron deference granted only when it appears Congress has granted the agency the authority to generally make rules carrying the force of law and the deference is granted in exercise of that authority. Otherwise the interpretation is entitled to respect only to the extent it has the power to persuade

Question 36

Briefly explain the the facts, holding, and PH importance of Gonzales v. Oregon (2006).

Answer 36

FACTS:
- Oregon passes a law allowing MD assisted suicide
- US Att. Gen. issues an interpretive ruling stating Oregon is violating the Controlled Substance Ace by allowing drugs to be used for not medically necessary purpose
HOLDING:
- Court rules that the Att. Gen. has no authority to determine what’s medically necessary and that it is outside of his role of interpreting the law. It falls under state powers
PH IMPORTANCE:
- Provides a system of “checks” on executive agencies. Court refused to grant Chevron deference because congress didn’t authorize Att. Gen. to make a rule declaring illegitimate a medical standard for patient care/treatment

Question 37

List the responses to perceived government failures.

Answer 37

• Deregulation: Allowing the market to influence business and consumer behavior
• Devolution: Residual regulation is focused at local level
• Privatization: Traditional gov. functions conduced by for-profit or volunteer entities
  (Gostin, 172)

Question 38

List the highlights of the “new governance” theory.

Answer 38

Innovative ways to control individual and corp. behavior:
- Emissions Trading (a market or incentive based regulation: permit X amount of emissions, penalized if over)
- Negotiated Rulemaking (voluntary process to promote interactive participation in drafting regulations)
- Self-Regulation (accreditation, consumer protection)
- Public disclosure (product labels, health warnings)
*Out of all 3: Public disclosure is the easiest. Less costly and minimal gov. monitoring
(Gostin, 172)

Question 39

What are some tips for success in Law & Public Health class?

Answer 39

• Always be present and attentive in class
• Read the chapters beforehand and if you have a hard time understanding, read the chapter again
• Highlight any cases found in the chapter
• Keep an outline of chapters with case facts, holdings, and - Public Health impact (sort them by category, e.g. cases on privacy)
• Watch Zita’s law overview mini lectures beforehand
• Sit in the front and pull out the notes taken from the readings
• Use the mid-term and final review sessions as a guide for studying important topics and cases
• Use flashcards or Brainscape for online flash cards
• Create a small reliable study group for support and always ask questions in class
• Relate the material to real life situations to stay engaged and to help with memorization of key concepts. Don’t forget to enjoy class!! :-)