阿拉斯加州公共卫生改革:迈向模范公共卫生法

The Public Health Improvement Process in Alaska:Toward a Model Public Health Law

公共卫生的使命是通过确保人们的健康来实现社会利益,因此维护公共卫生是政府最重要的目标之一,而法律对于帮助实现这一目标至关重要。各州现有的法规无法有效应对疾病对公众健康威胁,原因在于这些法规通常早于现代科学和宪法的发展;没有赋予公共卫生官员控制传染病所需的一系列灵活权力;缺乏足够的隐私标准、正当程序和风险评估;基于与现代疾病威胁或流行病学感染控制方法无关的任意疾病分类方案。阿拉斯加州的法律改革应该表达对公共卫生的清晰愿景,以促进公共卫生的最佳理论与实践。公共卫生法规应以适用于所有健康威胁的统一规定为基础。这将消除根据需要防控的疾病类型或条件而对法律进行不必要的分割。公共卫生干预措施应根据风险程度、应对措施的成本和效果以及对保障人权的责任而定。通过改革公共卫生可以实现许多社会效益,包括更新过时的法律;结合现代科学对疾病和不健康状况的认识;使当前的标准现代化;以及也许最重要的是明确各个州、地方和部落参与者之间的法律权力、法律职责和法律关系。具体来看,阿拉斯加州可以通过以下方式来促进公共卫生的改革:确定公共卫生的宗旨和目标;在当地可容许的灵活范围内授权和限制公共卫生行动;创造更健康的条件作为预防手段;促进政府和非政府卫生活动的规划和协调。

The mission of public health is fulfilling society’s interest in assuring conditions in which people can be healthy,so preserving the public health is among the most important goals of government,and law is essential in helping to achieve this goal.The existing states’statutes are ineffective in responding to contemporary health threats for many reasons,including these statutes often pre-date modem scientific and constitutional developments;fail to equip public health officials with a range of flexible powers needed to control infectious disease;lack adequate standards of privacy,due process,and risk assessment;and are based on arbitrary disease classification schemes that no longer relate to modem disease threats or epidemiologic methods of infection control.Law reform in Alaska should express a clear vision for public health,promoting the best theories and practices in public health.Public health regulations should be based on uniform provisions that apply equally to all health threats.This would eliminate the unnecessary fragmentation of laws according to the type of disease or condition to be regulated.Public health interventions should be based on the degree of risk,the cost and efficacy of the response,and the burden on human rights.Many benefits could be achieved through a public health improvement process,including the following:updating antiquated laws;incorporating modem scientific understanding of diseases and unhealthy conditions;modernizing current standards;and,perhaps most importantly,clarifying the legal powers,duties,and relationships of various state,local,and tribal actors.Specifically,the legal reform in Alaska may advance public health by defining the purposes and objectives of public health;authorizing and limiting public health actions within a permissible degree of local flexibility;serving as a tool of prevention to create healthier conditions;and facilitating the planning and coordination of governmental and non-governmental health activities.