However, decision-makers have no difficulty in taking into account the obligation to act in the best interests of others. The vaccination policy, for example, encourages individuals to be vaccinated, even though the vaccination policy serves to protect the herds rather than the immunized individual. Most states have formulated vaccination guidelines that include advocacy programs to promote vaccination on the basis that individuals may have to make sacrifices in the interest of the public good. States rarely impose mandatory vaccinations, although legal challenges to state powers over mandatory vaccination have generally been unsuccessful, confirming that mandatory vaccination may well be a legitimate use of the state`s power to compel individuals to act for the public good (Jacobson v. Commonwealth of Massachusetts). Historically, however, violent vaccination attempts, such as smallpox vaccination programs in England, the United States, and South Asia, have proven counterproductive. Such programmes have provoked violent resistance and lack of cooperation, weakened the effectiveness of emergency response, and caused administrative and financial problems for public health authorities (Albert et al., 2001, Wellcome Trust, Centre for the History of Medicine at UCL). The role of law as an instrument of social norms plays an important role in the implementation of an operational health policy. Public health policies on tobacco smoke, while supported by extensive public health promotion activities and public health education, have done little to reduce the incidence of tobacco use. Voluntary codes of conduct have not been successful (Jones et al., 1999).
Although it is still too early to talk about the success of legislation in reducing smoking levels, there is evidence that in places where smoke-free laws are in place, cigarette sales have declined (Euromonitor International, 2006), that workers` health has benefited from protection from second-hand smoke (Allwright et al., 2005) and that the law has helped change attitudes towards smoking (Fichtenberg & Glantz, 2002). There is also evidence that citizens of states that do not have smoking laws are educated by legal developments elsewhere to question the absence of laws in their own state (Pilkington et al., 2006). CDC increasingly views public health law as an integral part of the arsenal of each of its programs and the competencies of its professionals. CDC and its partners are working vigorously to provide comprehensive legal readiness across the public health system, developing and implementing new legal tools that policymakers and practitioners will be at the forefront of applying to the full range of public health challenges and opportunities of the 21st century. International agreements, strategies, conventions and regulations also apply across borders. These international instruments deal with the actions of states and can dictate strategic policy, and although they generally do not directly address the actions of private entities and individuals or dictate functional policy issues, they can be an important public health tool. Functional policies stemming from internationally agreed strategic policies are then incorporated into national legislation. The TRIPS Agreement (Trade-Related Aspects of Intellectual Property Rights), administered by the World Trade Organization (WTO), is an agreement which, inter alia, establishes a strategic policy for the patenting of medicines with the aim of achieving a balance between technological innovation and the social and economic well-being of consumers. In 2003, it was amended by the Doha Declaration to allow developed countries to export pharmaceuticals to other countries where national health concerns have been identified, provided that the products are not exported under a trade agreement. The agreement is based on the enactment by signatory states of appropriate laws and justifies national laws that deviate from the rights of patent holders in circumstances such as national emergencies. WHO`s DOTS (directly observed therapy) strategy is a TB strategy that establishes standardized TB treatment practices, some of which may require legal support.
Russia, for example, has adopted regulations to support the fight against TB in line with the DOTS strategy to address its serious TB threat (Marx et al., 2007). Equally important is the fundamental role that the law plays in the daily practice of public health. Law and policy are essential instruments for protecting and promoting public health. However, public health law is not part of most training in the field of public health, medicine or nursing. To fill this training gap, the trainings listed at the end of this page provide an introduction to the key concepts of public health law that all public health practitioners need to be aware of: Drafting new laws, whether by parliament or the courts, is a slow and often arduous process that is both a good and a bad thing. The complexity of the legislative process makes the law inflexible and powerless in the face of unforeseen harm, so the law may be useless when the public threat is new. At the same time, once the law is in force, amending or removing it requires a new process, and new governments may find it difficult to unceremoniously repeal laws passed in response to policies set by a previous government. The advantage of the law lies in its weight. It is difficult to challenge, it provides enforcement powers by the authority or custom of the state, and it has a strong influence on the attitudes and behaviour of citizens. Although many policies are never implemented, laws should and generally are. In fact, the applicability of the law is an important factor that distinguishes it from politics. Finally, legislation can play a role in implementing the ideas and values of traditional and new thought and philosophy in the field of public health.
It can do this by incorporating these public health ideas and values into law as objectives and principles. One example is the 2003 Swedish Public Health Objectives Act. Formal objectives and principles serve as an accountability mechanism for governments and their public health administrators, as well as a means of supporting administration, as some commitments and programs must be financially maintained because they are required by law.