Major Components and Themes of Local Public Health Laws in Select U.S. Jurisdictions

Abstract

The Institute of Medicine (IOM) has concluded that an effective public health system must work collaboratively with the entire community, including political, legal, and governmental processes.1 Correspondingly, legal structures and the authority vested in health agencies and other partners within the public health system are quintessential to improving the public's health.2 Although federal and state public health laws have been extensively studied during the past 20 years, less attention has been directed to the broad range of local public health regulations in the United States. In view of the decentralized nature of public health law,3 local health entities (e.g., boards of health, city councils, or county councils) can be expected to have a significant impact on community health status,4 but existing schol arly work on local public health law has thus far largely focused on specific topics such as firearms,5 housing,6 or smoking regulations.7 More than 18,000 local jurisdictions (e.g., counties, cities, boroughs, and special districts) exist in the U.S., each of which may have some legal authority (albeit minimal in some cases) to regulate in the interests of protecting the public's health.8 Local conditions and problems often stimulate local governments to adopt and promulgate rules and ordinances to address the pressing health concerns of a given community. Some local health issues such as food handling are common across many local governments, but are handled differ ently depending on multiple factors, including rural or urban setting, population size, local governance, extent of home rule, and existence and powers of boards of health. Other health issues (e.g., physical activity,9 outside burning,10 and smoking11) are uniquely addressed at the local level in ways that contrast with federal or state approaches. Local governments address public health issues through regulations based on the extent of authority bestowed by the state. Home rule statutes authorize local governments, depending on their size, class, and other factors, to direcdy address specific local public health issues through local laws.12 Forty-eight states have constitutional or statutory home-rule law.11 At times, local ordinances fill gaps in federal or state public health laws by addressing critical areas of public health concern not otherwise regulated.13 In some jurisdic tions, innovative local public health legal approaches have trickled up to the state level as seen prominently in the areas of tobacco control14 and firearms.15 In other jurisdictions, where state law preempts local ordinances, local governments may be obligated to carry out state health regulations while adapting them to address local needs and priorities.16