ARTICLE IN PRESS Public Health (]]]]) ], ]]] www.elsevierhealth.com/journals/pubh Preface In 1988, one of my predecessors as Chief Medical Richard Coker and Robyn Martin have, by bringing Officer, Sir Donald Acheson, wrote that in England together public health and legal experts, addressed there is a ‘lack of clarity about the role and in this series of papers the complex problems that responsibilities in this field [of public health law] arise when government regulates to prevent injury which derives from the complexity of the legisla- and disease or to promote the public’s health. In tion and from a misunderstanding about its inter- doing so they, along with their colleagues, cause us pretation. The Public Health Acts comprise a to reflect on the nature, scope and purpose of complex body of legislation stretching back for public health law as well as the evidence base that more than a century. It is difficult to gain a informs judgments. coherent view of what is intended.’ In my 2002 strategy for infectious diseases in The state’s framing and application of public England, Getting Ahead of the Curve,Isuggested health laws reflect the contemporary balance that there was a need to review legislation on between the rights of the state, of society, and of infectious diseases in England with a view to individuals. And this balance changes, as does modernizing it. This review is currently ongoing. This our knowledge of public health, disease, and how valuable collection of papers and the commentaries our environment affects our health. The Public that accompany them form a powerful resource from Health Acts to which Sir Donald referred were which I, my colleagues in the Department of Health, framed in the 19th century and based upon 19th public health professionals, and lawyers with an century mores and 19th century scientific knowl- interest in public health can draw inspiration. These edge. papers highlight the fundamental role that the law Public health law is a fascinating and sometimes plays in securing public health. controversial field, highlighting as it does social and political tensions, and the perennial balancing act of protecting individual liberties whilst securing Chief Medical Officer for England public well-being. It is, therefore, surprising that so Sir Liam Donaldson few contemporary scholars have researched the Department of Health, Room 107 Richmond House, potential for law as a tool for the protection and 79 Whitehall, London SWIA 2NS, UK improvement of public health. E-mail address: [email protected] 0033-3506/$ - see front matter & 2006 Published by Elsevier Ltd on behalf of The Royal Institute of Public Health. doi:10.1016/j.puhe.2006.07.004 ARTICLE IN PRESS Public Health (]]]]) ], ]]]–]]] www.elsevierhealth.com/journals/pubh Editorial Introduction: The importance of law for public health policy and practice Background tion of public health law research, and has resulted in insufficient institutional capacity to respond to In 2005, the London School of Hygiene and Tropical the needs of public health professionals and policy Medicine in association with the Centre for Re- makers. This lecture series was an attempt to search in Primary and Community Care, and address this gap by highlighting a number of with the support of the Nuffield Trust, organized challenging and pressing contemporary areas of and hosted a series of lectures on Public Health public health and law overlap, with the objectives Law. This initiative, which attracted considerable of provoking constructive critical debate and of interest and attention from public health profes- identifying areas that will benefit from further sionals, lawyers, legislators, and policy makers, research and analysis. addressed a number of contemporary public If law is to be an effective tool for the public health themes. Each lecture was followed by health, then it must be framed on an evidence base audience discussion and later, at the Nuffield Trust, derived from public health law research. Public a smaller audience was invited to discuss issues health laws, the principles upon which they are raised in the lecture. A rapporteur with expertise founded and the legal framework of public health in the lecture subject was invited at the Nuffield practice need to be understood by a professional Trust discussion to reflect on the lecture, to lead audience, including public health policy makers, the discussion, and to summarize the debate in a legislators, public health practitioners and lawyers brief commentary. This publication contains working in the field. The United Kingdom, as other the collection of this series of lectures and states, needs to establish a body of scholarship on commentaries. the role of law in public health. This lecture series At the 2005 United Kingdom Health Protection explored the potential of law as a tool for the Agency conference, Rod Griffiths, president of the public health. Most of the contributors would not Faculty of Public Health, identified two profes- claim to have expertise in public health law as sional areas that demanded attention from the such. Rather they come from a wide range of areas public health profession: leadership and public of law and public health, and they were given the health law. Most law taught in the field of health brief of exploring the extent to which their own is focused not upon population perspectives but on area of expertise could be used for the benefit of individualized medical law. Following high profile the public health (in the case of the law con- media interest in rare cases involving difficult tributors), or of exploring the extent to which law medical decision-making (such as the separation might contribute to policy, practice, and public of conjoined twins, voluntary euthanasia or the health outcomes (in the case of the public health allocation of fertility treatment services) there is contributors). now a proliferation of centres for medical law, As a preliminary introduction to the public health medical policy and medical ethics in the UK and law lecture series, this first contribution examines elsewhere. We would contend that this focus has the evolution of law’s involvement in public health, served to distort the importance of medical law to in order to set the scene for the more focused the detriment of public health law, with conse- examinations of the role of law in public health to quent implications for the funding and dissemina- follow. 0033-3506/$ - see front matter & 2006 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2006.07.005 ARTICLE IN PRESS 2 Editorial The development of public health law authorities which have responsibility for the ex- ercise of public health powers. The importance of law as a tool for the protection Britain played a leading role on the world stage in of the public health in England was recognized well its recognition that law could provide powers and before the practice of medicine engaged with duties which would underpin strategies aimed at systemic approaches to illness and disease.1 From securing population health. Because of its impor- early times laws have been passed to provide tance in the development of processes of indus- powers necessary to counter health threats such as trialization and its high concentrations of poor sanitation, the adulteration of food, the population, Britain faced occupational and envir- health consequences of child labour and the onmental health threats before other nations, and epidemic spread of disease. Indeed many laws so needed to find ways of controlling the adverse pre-date modern scientific causal paradigms. These effects of its industries. Early English public health early laws were included in the powers of police to legislation became a model for legal regulation of secure law and order, in recognition that it was the public health harms in other states, and much of mandate of the state to protect its citizens from the world has a public health legal framework physical harm, including a duty to protect against which owes its jurisprudence to these early British health harms. attempts to use law for the benefit of public It was not until the late 18th century that health. medical officers began to play a part in government Scientific understanding was being transformed efforts to address in an organized endeavour the at the time of these first statutes. Knowledge health concerns of urban living. After the influenza around the role of microbes in disease causation and typhoid epidemics in 1837 and 1838, it was a was emerging and the importance of disease linked lawyer not a doctor, Edwin Chadwick, who was to waste, poor systems of drainage and refuse was asked by the British government to carry out an recognized. The legal mechanism applied to control enquiry into the causes of disease. His Report on disease was the old common law device of the legal the Sanitary Conditions of the Labouring Popula- nuisance, such that disease sources were classified tion of Great Britain, published in 1842, argued as statutory nuisances. Statutory classification of a that disease was directly related to living condi- disease source as a nuisance brought into play a tions and that coordinated measures should be range of legal duties and powers, enabling removal, taken to protect health by means of disease control and licensing of threats to public health. As prevention. In 1848 the term ‘public health’ was medical science developed to recognize new first used in legislation, when a Central Board of sources of disease, so responses to these new Health was established with powers to oversee sources of disease were either incorporated into street cleansing, rubbish collection, water supply the main public health acts or made subject of 4 and systems of sewerage.2 Even then, legislation separate, parallel legislation, with the end result was regional in application.