1. 1 BC Health Act Renewal Project May 2005 Dr. Brian Emerson BC Ministry of Health Services Brian.emerson @ gems1.gov.bc.ca Ph 250-952-1701

2. 2 Outline of Presentation Project overview Public Health Legislation Framework Proposed Public Health Act Content Policy Issues Public Health Law Network

3. 3 Rationale for the Project Public Health legislation is a cornerstone of effective public health action. Current legislation is outdated, fragmented, and has many gaps. New health challenges require new public health legislation that is modern, coherent and connected, comprehensive, and flexible to meet emerging needs.

4. 4 Rationale for the Project Failure to update the act may have the following consequences: Public health practitioners lack tools available in other jurisdictions. Public health service delivery barriers. Reduced ability of government to protect and improve health, and respond adequately to public health issues and emergencies, with potential serious consequences for the government and the public.

5. 5 Goal Public health legislation will be improved and streamlined through a greater focus on the outcomes, and the repeal of redundant and outdated clauses. Ultimately, a new public health act will contribute to increasing effectiveness and efficiency of the public health services, with greater prevention of premature death, disease, injury and disability.

6. 6 Project Outcomes Framework for public health legislation New public health act Supporting regulations, policies, and procedures Complementary changes to other public health legislation

7. 7 Sources BC legislation Other Canadian provincial legislation Model State Public Health Act Other Countries Literature reviews

8. 8 Structures Steering Committee Working Committee Task Groups

9. 9 Processes Policy analysis, discussion papers Targeted consultation – email, website, attend meetings, teleconferences, conference presentations Public Health law network

10. 10 Public Health Legislation Framework (proposed) Public Health Act is a source document for prescribing powers, duties, functions, structures, personnel, organisations. Public Health Act includes issues that are central to public health, those which for Public Health officials are the lead, and those of limited scope. Separate statutes for matters in which others are the primary players, who whose actions impact the public’s health i.e. Food, Water, Tobacco.

11. 11 Public Health Legislation Framework (proposed) Other ministry statutes may regulate public health matters i.e. waste disposal, fish sales. Public health provisions may be included in other statues where there is a public health component to that statute for specific reasons i.e. School Act. A rationale of what should be included in an act or regulation will be developed.

12. 12 Principles - General Proactively improving and protecting the public’s health A focus on the health of populations Collaborative partnerships with communities Attention to inequalities in health status

13. 13 Principles – Specific to exercise of Authority Least restrictive or intrusive alternatives should be used initially Restrictions of liberty for prevention of harm to the public’s health Due process in decision making will be followed to ensure rights and fairness.

14. 14 Principles – Specific to exercise of Authority Reciprocity – Reasonable consideration should be given to providing assistance, support and other alternatives in situations where individuals are adversely impacted by public health actions as part of a measure to protect the health of the population

15. 15 Content of proposed Public Health Act Draft Purpose – “The purpose of the Act is to provide the authority for the Minister and Health Officials to establish organizational arrangements and take action to protect and promote the health of the population of British Columbia.”

16. 16 Draft Definition “Public Health” Public Health is the organized effort of society to protect and improve the health and well-being of the population through  health monitoring, assessment, and surveillance;  health promotion;  reducing inequality in health status;

17. 17 Draft Definition “Public Health”  prevention of disease, injury, disability and premature death; and  protection from environmental and other health hazards. This will be done through an appropriate balancing of the rights and responsibilities of individuals and organizations and the responsibility of government to protect and promote health.”

18. 18 Content of proposed Public Health Act Draft Objectives Establish powers, duties, functions of minister, PH officials, agencies, etc. Establish a common terminology. Establish core public health functions in broad terms. Define requirements for population health planning. (continued)

19. 19 Draft Objectives Continued Provide measures for central public health functions I.e. Communicable Disease Control, Health Hazards, Public Health Emergencies Provide for regulations and other procedures to deal with specific issues. Provide for penalties, immunities, and administrative processes Provide linkages between public health statutes. Ensure individual privacy protection and public interest information release.

20. 20 Policy Issues Definitions, purpose, objectives, values, principles Modernization of powers of minister and other health officials regarding communicable diseases, public health emergencies, testing, treatment, isolation, quarantine, contact tracing, vaccination, health hazard abatement, expropriation Organism culture regulation Blood exposures Persons in need of care (continued)

21. 21 Policy Issues continued Core functions in the act Capacity and infrastructure Training and qualifications Registries Surveillance, mandatory reporting, screening Protection of advocacy role of Provincial Health Officer, Medical Health Officers, other Public Health staff (continued)

22. 22 Policy Issues continued Provincial, regional, and local planning prescriptions Legislative options for health promotion and chronic disease prevention Aboriginal issues Local boards of health, joint boards of health, health districts, (continued)

23. 23 Policy Issues continued Powers in respect of persons in need of care Vaccine adverse effect compensation Indoor and outdoor air quality Protection of individual privacy and release of information of public protection How to evaluate public health legislation

24. 24 Potential Barriers Discussion about exercise of public health powers can result in fears that these will be used excessively These are necessary to have but are only used as last resort and only when health of public is threatened, after careful consideration of all alternatives.

25. 25 Potential Barriers Proposals regarding “core public health functions” could result in reactions from Health Authorities that their autonomy and flexibility is being undermined This is to provide for consistency of public health services across the province, while recognizing the need for local flexibility. There will be minimal requirements in legislation, but rather these will be required through performance agreements.

26. 26 Next Steps Update website for consultation. http://www.healthservices.gov.bc.ca/ phact/index.html Posting of discussion papers. Targeted consultation on policy issues. Preparation of legislative proposals.

27. 27 Public Health Law Network Informal group established to share information, ideas regarding public health law All provinces, territories, Health Canada, USCDC invited Preparing for the possibility of a formal public health law group

28. 28 Public Health Law Network Example Topics discussed Emergency Public Health Legislation Compensation for quarantine Principles of Public Health legislation Model Public Health Legislation Lab cultures with bioterrorism potential Federal Health Protection Renewal Blood Exposures Linkages to other national processes

29. 29 Questions and Suggestions Thank you! Contact Brian.emerson@gems1.gov.bc.ca Ph 250-952-1701