What is the practice of public health?

Practicing “public health” means protecting and promoting the health and well-being of all people by improving the ways our whole community influences our lives, including during crises: from ensuring that water, air, and food are safe, to controlling the spread of infectious diseases.

What is public health authority?

“Public health authority” refers to a government body’s—usually a health or public health department or agency—legal ability to further public health by using tools such as data collection, scientific research, laws and regulations, enforcement, community-engaged processes, and the many methods of sharing information and guidance with those who need it most.

It makes sense that our community influences our health outcomes; where do “the social determinants of health” come in?

The term “social determinants of health” describes non-medical factors in our daily lives that have a huge influence on our health, such as “employment, income, housing, transportation, childcare, education, discrimination, and the quality of the places where people live, work, learn, and play.” That definition includes our whole community and the different opportunities it provides to different people to be healthy and well.

What is health equity, and why does it come up so often in public health?

More than merely offering public health services to all, “health equity” strives to meet each person and each community where they are, supporting their health according to their different goals and needs, and different starting places. Health equity is the state in which “everyone has a fair and just opportunity to be as healthy as possible.”

What are some of the best examples of using public health authority to improve health equity?

Some common examples of public health successes include:

• vaccines that have saved countless lives and eradicated deadly illnesses;
• inspections that ensure what we eat and drink is clean and safe;
• rules to protect clean air in our restaurants, workplaces, and neighborhoods; and
• regulations that require life-saving technologies, like seatbelts, for everyone and not just those who can afford them.

Public health successes aimed at improving health equity by focusing on community-wide determinants of health include:

• laws to protect workers and consumers from companies that treat people unfairly, secure minimum wages and paid leave, and restrict misleading marketing;
• agreements to secure community-wide broadband access, bringing work, education, and health care opportunities with it; and
• zoning and other policies that protect and promote safe, stable, housing, like proactive rental inspections (to regularly check home safety and fix issues before they become problematic) and inclusionary zoning (to ensure housing options for community members at a range of income levels).

How are public health agencies organized?

Government bodies with public health authority sit at every level of government: federal, tribal, state, and local. They include agencies such as the CDC and local health departments. State public health authority is generally shared with local governments, in different ways depending on the state.

State agencies often oversee or support local agencies and may implement population-based public health services like disease tracking and epidemiology. Local agencies tend to coordinate local public health services like inspections, immunizations, and disease screening. Some local agencies provide public health services to such a large population that their capacity resembles, or may even surpass, that of many state agencies.

What are some other ways public health agencies use their authority to help advance public health?

State and local public health agencies can engage in a wide range of activities to promote public health, such as monitoring population health; creating, championing, or implementing policies, plans, or laws; utilizing legal and regulatory actions; and improving and innovating through evaluation, research, and quality improvement. For more information on these and other types of public health activities, please see the 10 Essential Public Health Services framework.

What’s happening to public health authority in the wake of COVID response efforts?

Most states and decisionmakers have supported and improved public health’s response to COVID-19, reducing the cost—in both lives and dollars—of the pandemic. But some anti-regulatory decisionmakers (legislators, legislatures, and judges) have challenged and curbed state and local public health authority, limiting how agencies can respond to COVID-19, as well as future outbreaks, other public health emergencies, and even day-to-day local public health needs.

How are legislatures proposing to limit public health authority?

Some state legislatures have restricted, or proposed to restrict, public health authority by, for example: (1) preempting (i.e., prohibiting) certain lower-level government actions; (2) broadening exemptions from life-saving public health measures to include “personal belief” objections; and (3) shifting authority away from public health officials and staff, subjecting urgent public health activities to unwieldy political processes.

How are courts limiting public health authority?

Some courts have decided to narrow their interpretation of the scope of public health authority and emergency powers delegated by legislatures to public health agencies. Some have also backtracked on their historical deference to public health expertise and science as tools to inform balanced responses to complex, rapidly changing health crises.

How does limiting public health authority impact the practice of public health?

Rolling back public health authority changes the practice of public health in significant ways, including by wrestling control away from the officials closest to the communities they serve, hampering effective responses to rapidly evolving public health emergencies, and elevating politics over public health expertise and evidence-based decision making.

How does limiting public health authority impact the health of our communities and health equity? 

By thwarting public health officials’ ability to respond quickly and effectively to identified community needs, reactionary rollbacks in public health authority jeopardize the health of our communities and further compound existing community health inequities.