Keeneland Conference: Law and Public Health Services and Systems
Last week’s Keeneland Conference included a session that looked at research in the area of law and legal process. The session was moderated by Scott Burris, JD, director of Public Health Law Research, a program of the Robert Wood Johnson Foundation, based at Temple University.
Burris noted several key presentations during the conference including one by Julia Costich, JD, PhD, who is an associate professor in the Department of Health Services Management at the University Of Kentucky College Of Public Health. Costich presented on the importance of how health agencies enforce the power they have. Burris says there is a huge body of literature from regulatory and governance sources on how effective regulators regulate—and that public health is only beginning to draw on. “That’s really opening a big important door, and we’ll see a lot more about that in future years.”
Jennifer Ibrahim, PhD, MPH, an associate professor of public health at Temple University, looked at how law is being figured out at the local level. Burris said that researchers both at the Public Health Law Research Program and collaborators have conducted research on the relationship between state and local health officers and their lawyers.
“This is where the rubber meets the road,” says Burris. “What is it we’re looking at? Is it the odd couple or mom and dad? Do they understand each other, have the same goals, speak the same language? We’ve always wanted to know that. Now we’re finding out and the applications, once we know what is working and what doesn’t will give us successful models for training and to get the most out of health officials.” Burris says it’s also an opportunity for realignment. Maybe being in the same building is the best model. Or maybe it's paying a lawyer by the hour, or perhaps having dedicated counsel who can talk to people early and help them figure out where the legal issues are.
“Both of these presentations,” says Burris, "are examples of ways in which research on what the law is and how it works, can be transferred into changes in local and state public health practice.”
Scott Burris said he has also worked on an upcoming paper with Jennifer Ibrahim, as well as Douglas Scutchfield, MD, and Glen Mays, PhD, of the University of Kentucky, on the intersection of public health law and Public Health Systems and Services Research (PHSSR). “We want to have public health law research and PHSSR integrated together and not just occasionally interacting.”
Burris mentioned a presentation at the Keeneland Conference by Scott Hayes, a PHLR grantee, and a researcher at the University of Illinois, on the legal structure of boards of health. Burris says ultimately Hayes will be looking at their effectiveness but right now he is looking at how different kinds of compositional rules—who is on the board of health, who appoints them—seems to be associated with better or poorer outcomes.
“There are a lot of other explanatory factors in that story and that’s how PHSSR brings to bear great ability to measure organizational and other characteristics of health agencies. That study can’t work just as law, any more than a study on non-law factors such as personnel, competencies and resources can work alone,” says Burris. “You have to put them together.”
Burris said the presentation by American Hospital Association president Richard Umbdenstock, emphasizing the creation of an integrated health and health care system, “is something we all have to be thinking about.” Burris says PHSSR is about a system and that system has many players besides the public health agency. For example, a board of health is a place where many of these different players come together. So if the board includes someone from the health department, the hospital community, the medical community and an insurance company, they’re not just coming together as individuals, they represent institutions that are all part of the system. Says Burris: “We just have to keep expanding our view until we can say: this kind of system works, this one doesn’t.”