Workshop on Pu lie Health Law in Pacific Island Countries
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(WP)HSD/ICPIHSP/3.1/001-E Report Series No.: RS/2007/GE/S(NEZ)
English only
REPORT WORKSHOP ON PUBLIC HEALTH LAW FOR PACIFIC ISLAND COUNTRIES
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
Auc~land,
New Zealand 12-15 February 2007
Not for sale Printed and Distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines
May 2007
WHOIWPRO LmRARY MANILA. PIIILIPPINES
0 6 AIJG 2007
NOTE The views expressed in this report are those of the participants in the Workshop on Public Health Law for Pacific Island Countries and do not necessarily reflect the policies of the World Health Organization.
This report was prepared by the World Health Organization Regional Office for the Western Pacific for governments of Members States in the Region and for the participants in the Workshop on Public Health Law for Pacific Island Countries, held in Auckland, New Zealand, from 12 to 15 February 2007.
CONTENTS
SUMMARY ............................................................................................................... I
1.
INTRODUCTION ..................................................................................................... !
1.1 Background infonnation .................................................................................... I 1.2 Objectives .......................................................................................................... I 1.3 Participants ........................................................................................................ 1 1.4 Organization ...................................................................................................... 1 1.5 Opening remarks ................................................................................................ 2
•.
2.
PROCEEDINGS ........................................................................................................ 3 2.1 Public health Jaw ............................................................................................... 4 2.2 Human rights and public health Jaw .................................................................. 5 2.3 The Siracusa Principles ..................................................................................... 5 2.4 General frameworks for Public Health Acts ...................................................... 5 2.5 Risk-based approaches to public health Jaw ...................................................... 6 2.6 An introduction to IHR (2005) .......................................................................... 8 2. 7 The four diseases specified as notifiable to WHO .......................................... II 2.8 Legislative interfaces with respect to IHR (2005) ........................................... II 2.9 Planning for legislative implementation ofiHR (2005) in the Pacific ............ 12
3.
CONCLUSIONS ..................................................................................................... 13 ANNEXES: ANNEX 1 LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISER, REPRESENTATIVES/OBSERVERS AND SECRETARIAT ..................................................................................... 23 TIMETABLE ........................................................................................ .31 LIST OF DOCUMENTS DISTRIBUTED ............................................. .33
ANNEX 2 ANNEX 3
Keywords: Legislation I Public health -legislation and jurisprudence I Human rights I International health regulations I Communicable diseases -prevention and control
SUMMARY
The Workshop on Public Health Law for Pacific Island Countries was conducted in Auckland, New Zealand, from 12 to IS February 2007 by the WHO Regional Office for the Western Pacific. The objectives of the meeting were to discuss: (I)
up-to-date frameworks and risk-based approaches for public health law, including requirements for implementing the International Health Regulations (2005) and for the control of communicable diseases and other public health risks; the implications of international agreements on human rights for public health law; and the legislative interface between all laws that impact on public health, including those related to local government responsibility for public health.
(2) (3)
Twenty-one participants from Cook Islands, Fiji, French Polynesia, Guam, Kiribati, , the Federated States of Micronesia, New Caledonia, Niue, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu attended the workshop. Observers included representatives from Allen & Clarke, Policy and Regulatory Specialists, Wellington, New Zealand; the Public Health Agency of Canada; and the Secretariat of the Pacific Community (SPC). One WHO temporary adviser, one WHO consultant and seven WHO staff members serving as the secretariat, supported the workshop. The proceedings comprised presentations, discussions and small group activities acknowledging that public health law is a central component of every government's attempts to improve and promote health for its citizens, especially when facing the sudden emergence of new health threats, such as severe acute respiratory syndrome (SARS) and avian influenza. At the same time, the challenges of long-standing communicable diseases like tuberculosis continue. It is necessary for each Member State to have a range of effective options and mechanisms available to deal with a variety of public health risks and situations. Legislation is a necessary part of a health protection framework that enables Member States to effectively detect, assess and appropriately respond to these health threats. The International Health Regulations (2005), which will enter into force in June 2007, are also part of this framework. These Regulations aim to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade and human rights. For these Regulations to be effective, it is important that a number of aspects are carefully integrated into individual national health protection frameworks including, where appropriate, through legislation. Presentations addressed the scope of public health law and the need to ensure human rights principles in its operation; frameworks for legislation protecting and promoting public
health; modern risk-based approaches to public health legislation; and extensive consideration of the International Health Regulations (2005), including core capacity requirements necessitating legislative interfaces between the Ministry of Health and other ministries/departments. Activities enabling planning for legislative implementation of IHR (2005) in the Pacific were also conducted. The meeting acknowledged the timetable for implementation of IHR (2005) and recognized the opportunity it presents for review of laws impacting upon public health, reaching two sets of conclusions. The first set of conclusions relates to public health law in general and actions that would enable Member States to consider and maintain up-to-date approaches to public health law: (I) It would be beneficial if Pacific island countries gave consideration to including support for updating legislation that promotes and protects public health in their national budgets and WHO Programme Budgets for 2008/2009. (2) Pacific island countries would benefit from provision of further WHO guidelines and tools to check whether legislation promotes and protects public health. The second set of conclusions relates specifically to the IHR(2005), as follows: (3) Pacific island countries that have not yet officially designated their National IHR Focal Points (NFP) are advised to do so immediately and to establish standard operating procedures for the NFP to communicate with other ministries/sectors and WHO. (4) Pacific island countries should put in place an interministerial task force and make administrative arrangements for implementation of IHR (2005) before 15 June 2007. (5) It would be beneficial if Pacific island countries could make essential amendments to their Quarantine Act (or equivalent) or other relevant legislation to include Annex Ill (Ship Sanitation ControVShip Sanitation Control Exemption Certificates) of IHR (2005) by 15 December 2007 at the latest. (6) Collaboration between Pacific island countries and ship operators would be useful, to ensure awareness oflHR (2005) obligations. (7) Continued close collaboration between WHO, the International Maritime Organization and any other relevant agencies would help to ensure that ship operators are aware of how IHR (2005) will affect them. (8) Continued Pacific island and WHO advocacy for consistency between IHR (2005) and new biosecurity requirements would be useful.
I.
INTRODUCTION
1.1
Background Information
One of the cornerstones of public health is the ability of governments to efficiently implement a range of effective health protection measures to guard their citizens against potential or actual health hazards and risks. Legislation is a necessary part of the framework that enables Member States to effectively detect, assess and respond to public health threats, including those aspects necessary to fulfil commitments under the International Health Regulations (2005). The Workshop on Public Health Law for Pacific Island Countries, held in Auckland, New Zealand, from 12 to 15 February 2007, provided a forum for health policy advisers from the Pacific to discuss up-to-date approaches to public health law and an opportunity to discuss related aspects of human rights requirements, as well as legislative interfaces with other sectors. For the pul"j)Ose of the workshop, public health law was considered to be all legislation associated with health protection, including not only any "Public Health Act" but also any relevant parts of laws related to areas such as customs, immigration, agriculture, local government, environment and privacy. 1.2 Objectives To discuss: (I) up-to-date frameworks and risk-based approaches for public health law, including requirements for implementing the International Health Regulations (2005) and for the control of communicable diseases and other public health risks;
(2) and
the implications of international agreements on human rights for public health law;
(3) the legislative interface between all laws that impact on public health, including those related to local government responsibility for public health. 1.3 Participants
A list of participants, representatives/observers, temporary advisers and secretariat members is given in Annex I. Twenty-one participants from Cook Islands, Fiji, French Polynesia, Guam, Kiribati, the Federated States of Micronesia, New Caledonia, Niue, the Commonwealth of the Northern Mariana Islands, Palau, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu attended the workshop. Observers included representatives from Allen & Clarke, Policy and Regulatory Specialists, Wellington, New Zealand; the Fiji School of Medicine; the Public Health Agency of Canada; and the Secretariat of the Pacific Community (SPC). One WHO temporary adviser, one WHO consultant and seven WHO staff members, serving as the secretariat, supported the workshop. 1.4 Organization
The workshop programme is given in Annex 2 and a list of documents distributed during the workshop in Annex 3. The documents include background papers and Power Point presentations by the temporary adviser, the consultant and WHO secretariat members relating to
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the three ~eeting objectives. Copies of these papers can be obtained upon request from the WHO Reg10nal Office for the Western Pacific. The officers of the workshop were elected as follows: Chairperson: Vice-Chairperson: First Rapporteur Second Rapporteur Mr Pascoe Kase, Papua New Guinea Dr Nese Conway, Tuvalu Mrs Ngapoko Short, Cook Islands Dr Divi Oga Oga, Solomon Islands
For some discussions and exercises, participants were divided into three smaller groups, with countries sharing similar legal traditions being grouped together, these being: Group I: Participants from French Polynesia, Guam, the Federated States of Micronesia, New Caledonia, the Northern Mariana Islands and Palau. Group 2: Participants from Cook Islands, Niue, Samoa, Tokelau and Tonga. Group 3: Participants from Fiji, Kiribati, Papua New Guinea, Solomon Islands and Vanuatu. The temporary adviser, consultant, members of the secretariat and observers were distributed among the three small groups, seeking to ensure that at least one lawyer was available in the discussions of each group. For work utilizing the tool to help decide if domestic legislation is required to implement the International Health Regulations (2005), participants sought to complete the tool for their own countries, then came together for further discussion in the three smaller groups. 1.5 Opening remarks
Dr Dean Shuey, WHO Regional Adviser in Health Services Development, welcomed all He introduced the participants, representing 16 Pacific island countries and areas. Professor Alastair Woodward and Dr Colin Tukuitonga of the School of Population Health, University of Auckland, New Zealand, and expressed gratitude for the provision of the excellent venue for the workshop. Professor Woodward welcomed all participants to the School ·Of Population Health and expressed his pleasure that so many representatives of the Pacific islands, including from the northern Pacific, were able to participate in the workshop, which included topics that were fundamental to public health activities, especially the provision of legal frameworks, regulations and policies. Dr Chen Ken, WHO Representative in the South Pacific, welcomed participants on behalf of Dr Shigeru Omi, WHO Regional Director for the Western Pacific. He recognized that public health is a central component of every government's attempts to improve and promote health for its citizens. He acknowledged that, recently, we have faced the sudden emergence of new health threats, such as SARS and avian influenza. At the same time, we are still struggling with the continuing challenges of long-standing communicable diseases like tuberculosis. It is, therefore, clearly necessary for each Member State to have a range of effective options and mechanisms available, in order to deal with a variety of public health risks and situations.
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Legislation is a necessary part of a health protection framework that enables Member States to effectively detect, assess and appropriately respond to these health threats. The International Health Regulations (2005), which will enter into force in June 2007, are also part of this framework. These Regulations aim to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic, trade and human rights. For these Regulations to be effective, it is important that a number of aspects are carefully integrated into individual national health protection frameworks including, where appropriate, through legislation. He noted that the intention in holding the workshop was to provide a forum to discuss up-to-date approaches to public health law. The workshop would also provide an opportunity for participants to discuss related aspects of human rights requirements and legislative interfaces with other sectors and, in particular, to spend some time considering further the legislative implications and requirements for implementing the International Health Regulations 2005. Thanking the School of Population Health at the University of Auckland, Tamaki Campus, for use of their excellent facilities, and a£knowledging the opportunity for discussions with the academic staff on campus, he officially opened the meeting and concluded his opening remarks by wishing all participants well in their discussions, hoping that they would have a stimulating and interesting time during the workshop. 2. PROCEEDINGS
Dr Dean Shuey, WHO Regional Adviser in Health Services Development, expressed the key responsibility of all governments to protect their citizens against health risks, both real and potential. He recognized that public health legislation is a key tool, necessary but not sufficient in itself. He acknowledged that the revision of the International Health Regulations has created new obligations and posed the question "Why the interest now?" Using examples of increased risk created by SARS, avian influenza and drug-resistant TB, he illustrated that the potential for public health emergencies of international concern is increased by the impacts of globalization on trade and travel. Acknowledging the economic imP&£t of public health emergencies, he considered that a balance between the rights of individuals and public health is necessary- while decentralization of health systems has introduced even more challenges. Having introduced the objectives of the workshop, Dr Shuey presented the workshop format, comprising presentations and discussions both in plenary and in smaller groups. He encouraged free and open debate and discussion and welcomed the opportunities presented by the workshop for individual interaction between participants, observers and facilitators. He introduced the daily topics as being: Day I: Day 2: Day 3: Day 4: Public health law, human rights and public health law, and public health law frameworks. Risk-based approa£hes to public health law and introduction to the International Health Regulations (2005). Legislation and deciding if legislative action is needed. Planning for legislative Regulations (2005). implementation of the International Health
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2.1
Public health law
Ms Josephine Cooper, WHO Consultant, provided an overview to answer the question 'What is public health law?' with reference to the background paper to Session 3. She referred to a number of defmitions of public health law, including that proposed by Gostml that it is 'the legal powers and duties of the state to ensure conditions for people to be healthy ... and the limitations on the power of the state to constrain the autonomy, privacy, liberty, proprietary, or other legally protected interests of individuals for protection or promotion ofcommunity health",
She recognized law to be a powerful tool to facilitate public health strategies, including those that protect and promote public health and those designed to prevent illness, injury or disability. It was posed that, in any given nation, public health law comprises far more than just a particular law known as a Public Health Act, and extends beyond laws that Ministries of Health typically administer and enforce, concluding that, put simply, public health law can be said to be all law that concerns, acts upon or protects the public health. Drawing upon the work of 2 . Bidmeade and Reynolds , core areas of public health can be recognized as being standards of sanitation and standards concerning food, drugs, poisons, therapeutic goods, tobacco and radiation. Other laws that have significant effect upon public health outcomes are part of an 'outer' group of public health laws, such as those relating to product safety and traffic laws that address the public health aim of reduction of injury, of which wearing seatbelts and requirements for the use of child restraints in vehicles are examples. Taking this broader view, over 30 subjects can be identified that are often included in laws with the legislative intent to improve public health outcomes. Consideration was given to the need to identify a country's existing public health laws by building or acquiring a 'legislative snap-shot' of all primary and secondary laws that may affect the public health and the example of an Inventory of Laws of the Republic of the Fiji Islands was provided. The legislative picture is more complex in those nations that have federal systems where both federal or central parliaments and state or other regional parliaments may be lawmakers. The legislative interfaces of public health laws (where a range of ministries or departments might share operational responsibilities) will be revealed by expanding an inventory of laws to include annotations describing the key matters and provisions contained in the text of the laws. The absence of consolidation of laws in some nations presents significant challenges to obtaining a complete picture of public health laws. The ideal resource was considered to be the creation and maintenance of an electronic, web-based version of a nation's laws. Such an application of information technology results in enormous gains in accessibility to, knowledge and understanding of, and compliance with, a nation's laws. I
Gostin L, 2000, Public Health Law: Power, Duty, Restraint, University ofCalifomia Press, Berkeley and Los Angeles, California. Bidmeade I and Reynolds C, Public Health Law in Australia: Its current state and future directions, Commonwealth of Australia, National Public Health Partnership, I June 1997, 3 (no longer available in hard copy) but found at http://www.health.gov.au/intemet/wcms/publishing.nsf/Contentlhealth-pubhlth-publjcat-<Jthers-
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2.2
Human rights and nublic health law
An address concerning human rights and public health law was given by Mr Fernando Gonzales-Martin from the International Health Regulations Office in the Department of Epidemic and Pandemic Alert and Response, WHO Headquarters, drawing upon background papers to Agenda Item 4, prepared by Ms Genevieve Pinet, Senior Health Lawyer, WHO Global Programme on Evidence for Health Policy. Mr Gonzales-Martin made reference to the work of the Evidence for Health Policy Cluster, in collaboration with the Center for Law and ·the Public's Health at Georgetown and John Hopkins Universities in the United States of America, with the objective of creating a framework of public health legal issues in order to produce model, universal provisions of public health law that advance the health-related Millennium Development Goals (The Comprehensive Legislative Approach to Essential Elements of Public Health Action). The tool, for use by Member States in revising public health laws, is intended to provide a framework of essential elements that a comprehensive Public Health Act should address. The secretariat undertook to circulate updated information to participants regarding development of the tool. 2.3 The Siracusa Principles
The Siracusa Principles require that only as a last resort can human rights be interfered with to achieve a public health goal. Such interference can only be justified when all of the narrowly defined circumstances stated in the Siracusa Principles, are met, these being: • • • • • The restriction is provided for and carried out in accordance with the Jaw. The restriction is in the interest of a legitimate objective of general interest. The restriction is strictly necessary in a democratic society to achieve the objective. There are no less intrusive and restrictive means available to reach the same objective. The restriction is not drafted or imposed arbitrarily, i.e. in an unreasonable or otherwise discriminatory manner.
Even then, such limitations should be of limited duration and subject to review. Application of international human rights principles and options available to public health authorities, were considered in a small group setting, each group addressing a different scenario. Case I concerned a polio outbreak in an area where the disease had been declared eradicated and the human rights concerns associated . with the public health authorities recommending administration of oral polio vaccine to all children under the age of 12. Case 2 involved a homeless person with drug-resistant tuberculosis who had previously absconded from treatment. Case 3 addressed the case of a person who, upon seeking permanent residence in a country, is required to reveal his HN-status as a condition of entry. 2.4 General frameworks for Public Health Acts
General frameworks for Public Health Acts were presented by Ms Josephine Cooper, WHO Consultant, referring to the background documents to Agenda Item 5. Older approaches to public health led to Acts that, to a large extent, relied on 'lists' of diseases and recognized nuisances to health. Such Acts prevent a modem 'risk-based' approach to public health being taken. A primary role of Public Health Acts is to establish processes for the exercise of regulatory powers in the event that they are needed, with relevant checks and balances, especially 1 clear accountabilities for relevant authorized people to exercise such powers. The exercise of such powers is becoming increasingly important to a world that is unable to predict all diseases.
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Modern Public Health Acts have to enable a scaled response that is appropriate to the possible health risk that is faced and should ensure the provision of essential public health services and functions. In some countries, specific public health issues and functions remain covered by the Public Health Act, even when they are perhaps not the responsibility of the health agency, whereas, in others, some specific public health issues are the subject of separate legislation. It is argued that, even where specific public health issues are not normally directly regulated by the health agency, there should be reserve powers given to that agency by the Public Health Act that permits action by it should another agency be unable, or refuse, to act in response to a public health emergency. Some matters have to be included in a Public Health Act if they are not regulated in some other way. Environmental health risks are a good example, as they can be dealt with separately if there is an environmental health agency or Ministry of Environment, but otherwise might remain within the jurisdiction of the health agency.
The meeting considered the content of the Public Health Acts listed below, recently adopted in different jurisdictions, in order to ascertain whether common content could be discerned. The review involved: Public Health Act 1991 ofNew South Wales, Australia; Health Act 1996 of British Columbia, Canada Public Health Act 1997 of Australian Capital Territory, Australia Public Health Act 2005 of Queensland, Australia Commonwealth Environmental Health and Sanitation Act of2000 of the Commonwealth of the Northern Mariana Islands A table comparing Long Titles, Objects of Act and Terms Defined within the Act was presented to the workshop. Analysis of the different laws revealed that, instead of being able to identiry core or minimum matters that different jurisdictions have found necessary to include in their Public Health Acts, there were significant differences between them, apparently because they were drafted to be appropriate to their particular legislative settings. It was noted that the law with the most terms defined was the Public Health Act 2005 of the State of Queensland, Australia. This was reflected in the length of the statute and the breadth of subject matter regulated. The Turning Point Model State Public Health Act, presented by the Public Health Statute Modernization National Excellence Collaborative, September 2003, and designed to serve as a tool for state, local and tribal governments in the United States of America to use, revise or update public health statutes and administrative regulations, was also compared, but there were no ascertainable common features. 2.5 Risk-based approaches to public health law
Ms Louise Delany, WHO Temporary Adviser, explained risk-based approaches to public health law based on background materials for Agenda Item 6. A risk-based approach aims to consider the risks inherent in particular activities, products and behaviours (e.g. of a factory, business or person) in order to ascertain whether a risk is of sufficient significance to merit society exercising some control over the activity. 'Risk' has many different definitions, but it is usually considered to be a combination of the degree of probability of something going wrong coupled with a consideration of the gravity of the consequence in such an event. Risk involves consideration of: • What can go wrong?
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• •
How likely is it? What are the consequences if it does go wrong?
Controls or 'regulations' might occur in an effort to prevent the occurrence of the undesirable consequence. Risk-based regulations/laws were initially seen in environmental law and, in the last 20 or 30 years, the idea of risk-based regulation has been applied in many different contexts. Examples can now be seen across a broad range of subject matter, such as in banking and insurance law, professional regulation and many other aspects of the health sector, such as drug regulation. Newer forms of law set out particular risk categories as being high-risk, medium-risk or low-risk, with sets of procedures and controls that change according to the level of risk. In public health, a fundamental aim of regulation is to prevent, reduce and manage public health risks. Risk regulation is both preventative and proactive and can be contrasted with traditional approaches to public health that tend to be purely reactive to the occurrence of a consequence. Risk regulation can also achieve other aims, such as reduction of inequalities and enhancement of democratic values.
The concept of risk can guide a decision or response as to when to regulate. A fundamental consideration is whether the risks in a particular activity or behaviour mean that some governmental measure is appropriate? As different societies perceive risks differently in terms of the level of risk that is acceptable, the answer to this question will depend upon societal values. Ascertaining the acceptable level of risk in a society is dependent upon consultation. Decisions as to how, and whether, to regulate can also take account of cost considerations, including which approach might be more costly for the government, for the business that is being regulated, or for both. Assessing the level and nature of a risk is a scientific question. Hazards can be identified, together with the likelihood or probability of the occurrence of a given consequence. If there is a degree of uncertainty regarding risk, the precautionary principle may be relevant, where it is accepted that it is better to regulate in order to prevent the occurrence of the undesired outcome. In that instance, it may be accepted that it is "better to be safe than sorry". A risk-based approach concludes that, if the threat is of serious or irreversible damage, lack of scientific certainty about the degree of risk is not a reason to do nothing. It may even be decided that although a particular activity does present risks, regulation will not help prevent the undesirable outcome, or only partially, or might be at too high an economic cost. Conversely, as is the case with tobacco control, activities might present risks that regulation will help. If it is accepted that regulation must occur, consideration must be given to what kind of law or regulation would be most appropriate. Regulation might be by law or by alternative measures, such as imposition of taxes, conduct of education, provision of resources etc., or by a mix of such approaches. Principles employed in the risk-based approach include: • • • • • performance/outcomes versus prescriptive measures; flexible versus inflexible responses; self-regulatory controls versus more prescriptive responses; development of bottom-up controls versus controls imposed from the top down; and participatory measures versus those that are imposed.
Some concepts used in laws are more risk-based than others. For example, a law might focus on performance or outcomes, or specify the means by which objects are to be achieved. Flexibility can be apparent in how much a regulated entity has choice in the manner in which a
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stated objective is achieved, or whether the entity has certain behaviours or activities prescribed in order to achieve the objective. Enforcement of laws can also provide for flexible responses, the concept of responsive regulation often being included in modern laws to enable an appropriate response to breach that seeks to ensure compliance being achieved, rather than the automatic imposition of a particular penalty. It might involve incentives and disincentives to act in certain ways. Regulation might also be performance-based or even goal-based, where a law sets a goal to be achieved but allows individuals or business to decide the actions to meet that goal, rather than being told precisely what to do. There can also be mixes of regulatory tools used in a law, such as prescribing that a licence is required for a particular activity, but allowing those carrying out the activity to set their own standards that will achieve a stated goal of minimizing risk or where flexible tools to check compliance might be employed, such as permitting a business to carry out self-assessment. Three New Zealand examples of risk-based public health laws were considered and analysed to show employment of the risk-based approach, these being Jaws relating to drinking water, communicable disease, and emergency management The three small groups then utilized the checklist for ideas for public health Jaws, prepared by Ms Delany, to consider taking risk-based approaches in their own countries to regulate the practice of tattooing, the provision of sewerage disposal and measures to control obesity. 2.6 An introduction to the International Health Regulations (2005)
Dr Li Ailan, Medical Officer, Communicable Disease Surveillance and Response, WHO Western Pacific Region, introduced IHR (2005) with the assistance of PowerPoint presentations produced as background papers to Agenda item 8. The IHR (2005) were adopted by the World Health Assembly on 23 May 2005 by way of resolution WHA58.3. They will replace the existing International Health Regulations adopted in 1969 when they come into force on 15 June 2007. IHR (I 969) focused on just three diseases: cholera, plague and yellow fever. Those regulations cannot address the multiple and varied public health risks that are being faced today, particularly from emerging and re-emerging infectious diseases and from non-infectious disease agents. Experiences with both SARS and avian influenza highlighted the limitations of IHR (1969). In addition, some unwarranted and damaging travel and trade restrictions have led to reluctance by some countries to report disease outbreaks and other events promptly. IHR (2005) establish a legal framework for the rapid gathering of information, for determining when an event constitutes a public health emergency of international concern, and for providing the international assistance sought by countries. New reporting procedures are aimed at expediting the flow of timely and accurate information to WHO about potential public health emergencies of international conc.ern. WHO, as a neutral authority with an extensive communications network, can assess information, recommend actions and provide direct technical assistance when needed, tailored to events as they unfold, while minimizing interference with world travel and trade. The purpose and scope of IHR (2005) are contained in Article 2:
To prevent. protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.
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IHR (2005) will be legally binding on all Member States who did not reject the new regulations, make reservations against them or make a Declaration to the Director-General of WHO by 15 December 2006, as provided by Articles 21 and 22 of the WHO Constitution. IHR (2005) were subject to a further resolution of the World Health Assembly in 2006, this being resolution WHA59.2. In response to the risk posed by avian influenza and pandemic influenza, the World Health Assembly requested the WHO Director-General to undertake several activities to support immediate compliance, on a voluntary basis, with relevant provision of regulations that would help the world to prevent, detect and respond to a potential pandemic of human influenza. Dr Li emphasized that the key to implementation of IHR (2005) is the designation of a National Focal Point for each State Party. Some countries have seen this requirement as an opportunity to attract and mobilize resources, accepting that IHR (2005) comprise an agreement between Member States that was the subject of negotiation before adoption by the World Health Assembly. It provides opportunities for building of core capacity and strengthening of cooperation with global partners. 2.6.1 Core capacity requirements Participants received detailed information on the core capacity requirements for surveillance and response, contained within Annex I A, and for designated points of entry, contained within Annex IB, that are to be developed, strengthened and maintained by State Parties as soon as possible, but not later than 15 June 2012 (unless the Party obtains an extension of two further years for implementation or, in exceptional circumstances, a further two-year extension until 2016). Each State Party is required to assess, by 15 June 2009, the ability of existing national structures and resources to meet the minimum requirements both for surveillance and response and for designated points of entry. State Parties must develop plans of action to ensure that such core capacities are present and functioning. Capacity for surveillance and response: Capacity is to be developed at three levels that may mean different things to different State Parties: the local leveVprimary public health level; the intermediate response level; and the national level. At the local community leveVprimary public health level, the three key elements for attaining capacity are to be able to: (I) (2) detect unusual events involving disease or death above the levels expected for the particular time and place; report all available essential information to the intermediate level (including the reporting of epidemiological data, risk factors and, in some countries, preliminary laboratory data and information regarding what measures are being implemented); and implement preliminary control measures immediately (such as avoiding close contact, using surgical masks etc. in cases of infectious disease).
(3)
At the intermediate public health response level (as defined by the State Party), the key capacity elements are to be able to: (I) confirm the status of reported events, such as number of people affected in one family in one village; (2) support additional control measures;
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(3) implement additional control measures; and (4) assess reported events immediately and, if found urgent, report all essential information to central level. At national level, the capacity to: (I) (2) (3) (4) provide a direct operational link with senior officials; provide direct liaison with other ministries; provide links with hospitals, laboratories and points of entry; establish, operate and maintain a national public health emergency response plan assessing all reports of urgent events within 48 hours (using Annex II of IHR-Decision Instrument for the assessment and notification of events that may constitute a public health emergency of international concern) and notification to WHO within 24 hours of assessment of events which may constitute a public health emergency of international concern (notification being by way of the NationallliR Focal Point); and (5) provide the above on a 24-hour basis (necessitating a duty officer system).
Capacity at designated points of entry: At all times, there are standard core capacity requirements of: (I) access to an appropriate medical service, including diagnostic fucilities, with adequate trained staff, equipment and premises, that can manage sick travellers and have the capacity to carry out basic examinations (A basic medical service must be maintained at tbe point of entry, although the staff might need to be present only at times when international travellers are received. As long as preliminary treatment is available, travellers can be referred to a local hospital providing more extensive services.) (2) access to equipment and personnel for the transport of ill travellers to an appropriate medical facility; (3) availability of trained personnel to inspect conveyances; and (4) a safe environment for travellers using point-of-entry facilities (including potable water supplies, public washrooms, clean eating establishments, appropriate solid and liquid waste disposal services, etc.) For responding to events that may constitute a public health emergency of international concern, designated points of entry should have in place: (I) a public health emergency contingency plan (including the nomination of a coordinator and contact points for the relevant points of entry, public health and other agencies and services); (2) the capacity to assess and care for affected travellers or animals (including establishing arrangements with local medical and veterinary facilities for isolation, treatment and other support services that may be required); (3) an appropriate space, separate from other travellers, to interview suspect or affected travellers; (4) facilities for the assessment/potential quarantine of affected travellers (preferably in facilities away from points of entry);
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(5) the means to apply recommended measures (e.g. to disinfect etc.) to baggage, cargo, containers, conveyances, goods or postal parcels; ( 6) the ability to apply entry or exit controls for arriving and departing travellers; and (7) access to specially designated equipment, and to trained personnel with appropriate personal protection, for the transfer of passengers who may carry infection or contamination. When facilities cannot be located at the designated point of entry, systems need to be established to ensure their provision by local hospitals, to which referrals can be made. Mr Fernando Gonzales-Martin explained key concepts included in IHR (2005) and emphasized that State Parties should look at local structures that already exist in order to ascertain what strengthening is required.
2. 7
The four diseases specified as notifiable to WHO (in addition to ootential public health emergencies of international concern)
In addition to potential public health emergencies of international concern, the Decision Instrument (Annex II of IHR) requires notification to WHO of cases of: • • • • smallpox, poliomyelitis due to wild-type poliovirus, human influenza caused by a new subtype, and severe acute respiratory syndrome (SARS).
Case definitions will be provided by WHO before 15 June 2007.
2.8
Legislative Interfaces with resoect to IHR (2005)
Utilizing the background document to Agenda item 9, Ms Josephine Cooper, WHO Consultant, considered the legislative interfaces that exist between laws administered by the Ministry of Health and laws administered by other ministries/departments or functions performed by staff of those other ministries/departments. Legislative interfaces are important in assuring that someone is responsible for carrying out particular IHR functions, the responsibilities being those of the State Party and not solely those of the Ministry of Health. Functions under IHR (2005) are 'collegiate'. Certainly a single ministry is unlikely to have the resources, personnel or expertise to do everything that is prescribed. If possible, existing areas of expertise and division of functions should be utilized in order to ensure a coherent and cohesive IHR system. IHR (2005) includes both State Party functions and functions of a body termed the 'Competent Authority'. It is sometimes apparent that the State Party and the Competent Authority are synonymous, with a particular responsibility stated to be one belonging to the State Party, whereas the context makes it clear that it could be performed by the Competent Authority. To be competent, such an Authority must be empowered and able to perform the required tasks. The scope of tasks is large and it is apparent that a conglomerate of existing authorities filling certain roles can be declared to, together, be the Competent Authority of the State Party. The Competent Authority is defined to mean "an authority responsible for the implementation and
12
application of health measures" under illR (2005). General Obligations given in Article 19 require a State Party to identity the Competent Authority at each designated point of entry in its territory. Thus it is likely that a Competent Authority will be required to have a presence at more than one location, e.g. at least one international seaport and one international airport. This does not necessarily mean that a separate Competent Authority has to be declared for each designated point of entry, as long as the 'umbrella' Competent Authority has a presence at each location where the State Party considers that the Annex I capacities should be developed. The starting point for designating the Competent Authority should be to recognize the interface betWeen the health authority and other authorities that carry out existing health-related functions at points of entry. These might include:
• • • • • • • • •
•
•
Health Customs Agriculture Biosecurity Authority Environment Ports Authority Waste Management Authority Postal Authority Police Local Authority/Council State or Regional Authority
Is new or amended domestic legislation needed to implement IHR (2005)? Participants, initially in country groups, utilized the tool contained in the background paper to Agenda item I 0 to consider this question. The tool mirrors the language of illR (2005) and is intended to provide a comprehensive check-list of all responsibilities. It was acknowledged that many of the referenced matters clearly do not require legislation, and participants suggested that these might be removed with any further development of the tool to include simplification of the language and grammar. Participants worked through the entire tool and became familiar with the scope of action required to imp lenient IHR (2005). 2.9 Planning for legislative implementation ofillR 12005) in the Pacific
Ms Josephine Cooper, WHO Consultant, introduced a draft generic Cabinet Paper that could be used, adapted as required, by Ministers of Health and other senior officials for briefing Cabinet and other colleagues regarding the responsibilities undertaken by State Parties under IHR (2005). The first part of the Paper gives a synopsis of IHR (2005) that could stand alone to serve as an introduction to the International Health Regulations. It then groups together related responsibilities with full footnotes referring back to the paragraphs, Articles and Annexes of IHR (2005), dividing them according to type as being requirements to: (I) (2) (3) (4) identifY, designate or establish a position or entity; enable or empower activities to be undertaken; ensure prescribed activities are carried out in response to certain conditions; and prohibit certain behaviours or activities.
The detailed analysis could become the basis of instructions for implementing legislation that could take the form of an International Health Regulation (Implementation) Act. A tenet of statutory interpretation, often expressed in Interpretation Acts, is that later enacted legislation prevails over an earlier adopted law to the extent of any inconsistency between the earlier and
13
later enactment. This consequence can also be expressly stated in a law, thus lessening the need to amend all previously enacted inconsistent provisions. Subsequent plenary discussion included reference to the need to ensure that the new model Ship Sanitation Control Certificates and Ship Sanitation Control Exemption Certificates contained in Annex III be adopted for use by State Parties by 15 December 2007 at the latest. Recent developments in domestic biosecurity legislation, frequently within the administrative control of a Ministry of Agriculture, may include provisions giving some responsibilities with respect to human health that are similar or identical to some requirements of IHR (200S). Participants appreciated that it is necessary to ensure consistency between biosecurity laws and any law enacted to give effect to the International Health Regulations. 3. CONCLUSIONS
The meeting acknowledged the timetable for implementation of IHR (200S) and recognized the opportunity it presents for review of laws impacting upon public health, reaching two sets of conclusions. The first set of conclusions relates to public health law in general and actions that would enable Member States to consider and maintain up-to-date approaches to public health law: (I) It would be beneficial if Pacific island countries gave consideration to including support for updating legislation that promotes and protects public health in their national budgets and WHO Programme Budgets for 200812009. (2) Pacific island countries would benefit from provision of further WHO guidelines and tools to check whether legislation promotes and protects public health. The second set of conclusions relates specifically to the IHR(200S). These Regulations, which will enter into force in June 2007, aim to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. (3) Pacific island countries that have not yet officially designated their National IHR Focal Points (NFP) are advised to do so immediately and to establish standard operating procedures for the NFP to communicate with other ministries/sectors and WHO. (4) Pacific island countries should put in place an interrninisterial task force and make administrative arrangements for implementation of!HR (200S) before IS June 2007. (S) It would be beneficial if Pacific island countries could make essential amendments to their Quarantine Act (or equivalent) or other relevant legislation to include Annex III (Ship Sanitation Control/Ship Sanitation Control Exemption Certificates) of IHR (200S) by IS December 2007 at the latest. (6) Collaboration between Pacific island countries and ship operators would be useful, to ensure awareness of!HR (200S) obligations.
14
(7) Continued close collaboration between WHO, the International Maritime Organization and any other relevant agencies would help to ensure that ship operators are aware of how IHR (2005) will affect them. (8) Continued Pacific island and WHO advocacy for consistency between IHR (2005) and new biosecurity requirements would be useful.
15
ANNEX 1
LIST OF PARTICIPANTS, CONSULTANT, TEMPORARY ADVISER, REPRESENTATIVES/OBSERVERS, AND SECRETARIAT
• 1. COOK ISLANDS P ARTIClP ANTS Ms Natalie Ngapoko SHORT Director of Public Health Ministry of Health P.O. Box 109 Rarotonga Telephone: (68) 2 9110 Facsimile : (68) 2 9100 E-mail: n.short@gov .ck Mr Waisale Delai National Adviser Environmental Health Ministry of Health Suva Telephone: (679) 330 6177 Fax: (679) 330 6163 E-mail: wdelai@health.gov.fj Mr Nakil Navioesb Prasad Legal Officer Ministry of Health Suva Telephone: (679) 322 1436 Email: nakil.Prasad@health.gov.fj FRENCH POLYNESIA Ms Maoava LABORDE Bureau des Affaires Juridiques Direction de Ia Sante BP 611 Papeete 98713 Tahiti Telephone: (689) 460061 Facsimile: (689) 430074 E-mail: manava.laborde@sante.gov.pf; or : manava22@hotmailo.fr Ms Loordes DUGUIES Communicable Disease Control Coordinator III Supervisor Bureau of Communicable Disease Control Department of Public Health and Social Services 123 Chalan Kareta, Route 10 Mangilao 96923 Telephone: (671) 735-710117154 Facsimile: (671) 734-5910/2103 E-mail: lourdes.duguies@dphss.guam.gov; lou82mph@yahoo.com
FIJI
GUAM
KIRIBATI
16 Dr Teraira Bangao Anaesthetist Registrar Ministry of Health and Medical Services P.O. Box 237 Bairiki Tarawa Telephone: (686) 28100 Facsimile: (686) 28152 E-mail: t.bangao@yahoo.com Mr Marcus SAMO Assistant Secretary for Health Department of Health, Education and Social Affairs P.O. Box PS 70 Palikir Telephone: (691) 320-2619 Facsimile: (691) 320-5263 E-mail: mhsamo@mail.fm Mademoiselle Christelle DENAT Juriste au service des actions Direction des affaires sanitaires et sociales Service des actions sanitaires 5 rue du General Gallieni BPN4 9885 I Noumea-Cedex Telephone: (687) 970152 E-mail: christelle. denat®gouv. nc Chris12_fr@yahoo.fr Mr Manila NOSA Chief Public Health Officer Public Health Division Niue Health Department Aloti Telephone: (683) 4100 Facsimile: (683) 4265 Email: rna nosa®yahoo. com ; mnosa@mail.gov .nu Mr David LOCHABAY Assistant Attorney General Litigation Counsel to the Department of Public Health Office of the Attorney General Caller Box I 0007 CURB Saipan MP 96950 Telephone: (670) 664-2331 Facsimile: (670) 664-2349 E-mail: lochabay@gmail.com Ms Erin JOHNSON Assistant Attorney General Counsel to the Ministry of Health Office of the Attorney General P.O. Box 1365 Koror 96940 Telephone: (680) 488-2481 Facsimile: (680) 488-3329 E-mail: agoffice@palaunet.com
FEDERATED STATES OF MICRONESIA
NEW CALEDONIA
NIUE
NORTHERN MARIANAS, COMMONWEALTH OF
PALAU
PAPUA NEW GUINEA
17 Mr Pascoe KASE Director Policy, Planning & Legal Health Department P.O. Box807 Waigani Telephone: (675) 301-3762 Facsimile : (675) 323-9670 E-mail: pascoe_kase@health.gov.pg
SAMOA
Mr Andrew PETERU Assistant Chief Executive Officer Health Promotion & Prevention Ministry of Health Private Bag Motootua Telephone: (685) 21212 Facsimile: (685) 21106 E-mail: AndrewP®heal th. gov. ws Ms Frances BREBNER Assistant Chief Executive Officer Strategic Development & Planning Ministry of Health Apia Telephone: (685) 21212 Facsimile: (685) 21106 Email:FrancesB®health.gov.ws
Mr Malietau MALIETOA Parliamentary Counsel Office of the Attorney General P0Box27 Apia Telephone: (685) 20295 Email: taumalietoa@ag.gov.ws SOLOMON ISLANDS Dr Divinol OGA OGA Permanent Secretary Ministry of Health P.O. Box349 Honiara Telephone: (677) 28610 Facsimile : (677) 20085 E-mail: cpitakaka@moh.gov.sol Ms Tekave REUELU Nutritionist Health Educ. Health Department Atafu Atoll Telephone: 690-2112 Facsimile : 690-4119 E-mail: telalokolo@yahoo.co.nz
TOKELAU
18
TONGA
Dr Malakai 'AKE Chief Medical Officer Public Health Ministry of Health P.O. Box 59 Nuku'alofa Telephone: (676) 23-200/8778418 Facsimile: (676) 24-291 E-mail: drmalal<aiake@hotmail.com make@health.gov .to MrTu'Akoi 'AHIO Principal Health Administrator Ministry of Health P.O. Box 59 Nuku'alofa Telephone: (676) 28-233 Facsimile: (676) 24-291 Email: tahio@health.gov.to
I
I
TUVALU
Dr Nese Ituaso CONWAY Chief Public Health Princess Margaret Hospital Ministry of Health Vaiaku Funafuti Telephone: (688) 20480 Facsimile: (688) 20481 Email: n_ituaso@yahoo.com Mr Morris Willie AMOS Public Health Legislation Officer Ministry of Health Private Mail Bag 9009 Port Vila Telephone: (678) 22512; (cell) 43519 Facsimile: (678) 25438 E-mail: mamos@vanuatu.gov.vu 2. CONSULTANT
VANUATU
Ms Josephine COOPER 33 Letchworth Parade Balmoral, NSW 2283 Australia Telephone: (612) 4975 2205 Facsimile: (612) 4921 6931 E-mail: sosefinacooper@yahoo.com.au
19
3.
TEMPORARY ADVISERS
Ms Louise DELANY Principal Analyst Public Health Legislation Review Communicable Disease & Environmental Health Policy Public Health Directorate Ministry of Health Wellington New Zealand Telephone: (644) 495 4451 Facsimile: (644) 4962191 E-mail: Louise_Delany@moh.govt.nz
4.
OBSERVE~PRESENTATIVES
ALLEN & CLARKE POLICY AND REGULATORY SPECIALIST Dave Clarke Director Level I 7, Morrison Kent House I 05 The Terrace POBox 10730 Wellington 6143, New Zealand Telephone: +64 4 890 7302 Mobile: +64 27 599 0002 Fax: +64 4 890 7301 E-mail: dclarke@allenandclarke.co.nz Matthew Allen Director Level 17, Morrison Kent House I 05 The Terrace PO Box 10730 Wellington 6143, New Zealand Telephone: +64 4 890 7302 Mobile: +64 27 599 0003 Fax: +64 4 890 7301 E-mail: mallen@allenandclarke.co.nz
PUBLIC HEALTH AGENCY OF CANADA Dr Luc Jean FRANc;::Ois Director Policy and Partnerships Division Office of Public Health Practice Public Health Agency of Canada 130 Colonnade Road Room327B Ottawa, Ontario Telephone: (416) 595-0006 Facsimile: (416) 595-0030 E-mail: jfluc@phac-aspc.gc.ca
20 Ms Lina AI-Karkhi Manager Public Health Law and Ethics Program Office of Public Health Practice Public Health Agency of Canada 130 Colonnade 6503-D, Ottawa Ontario KIA OK9 Telephone: (416) 595-0006 Facsimile: (416) 595-0030 E-mail: lina_al-karkhi@phac-aspc.gc.ca SPC Ms Radha ETHERIDGE Project Coordinator Pacific Regional Influenza Pandemic Preparedness Project (PRIPPP) Secretariat ofthe Pacific Community B.P.D5 98848 Noumea-Cedex New Caledonia Facsimile: (687) 263 818 E-mail: radhae@spc.int
S. WHOIHQ
SECRETARIAT
Mr Fernando GONZALES-MARTIN International Health Regulations Office of the Director Department of Epidemic and Pandemic Alert and Response Telephone +41.22.791.28.77 Fax: +41.22.791.46.67 E-mail: gonzalezmartinf@who.int Dr DEAN SHUEY (Responsible Officer) Regional Adviser, Health Systems Development World Health Organization Regional Office for the Western Pacific United Nations Avenue Manila, Philippines Telephone: (632) 528 9806 Facsimile: (632) 521 1036 E-mail: shueyd@wpro. who.int Dr LIAilan Medical Officer Communicable Disease Surveillance a..J K.:sponse World Health Organization Regional Office for the Western Pacific United Nations Avenue Manila, Philippines Telephone: (632) 528 9784 Facsimile: (632) 521 1036 E-mail: lia@wpro.who.int
WHO/WPRO
21
DrCHENKeo WHO Representative in the South Pacific P.O. Box 113 Suv~ Fiji Telephone: (679) 330 4600 Facsimile : (679) 330 0462 E-mail: chenk@sp.wpro.who.int
Dr Juliet FLEISCHL Technical Officer Office of the WHO Representative in the South Pacific P.O. Box 113 Suva. Fiji Telephone: (679) 330 4600 Facsimile: (679) 330 0462 E-mail: fleischlj@sp.wpro.who.int
Dr Jacob KOOL Medical Officer Communicable Disease Surveillance & Response Office of the WHO Representative in the South Pacific P.O. Box 113 Suva. Fiji Telephone: (679) 330 4600 Facsimile : (679) 330 0462 E-mail: koolj@sp. wpro. who.int
Ms Frances LOLOMA Office of the WHO Representative in the South Pacific P.O. Box 113 Suv~ Fiji Telephone: (679) 330 4600 Facsimile : (679) 330 0462 E-mail: lolomaf@sp.wpro.who.int
WORKSHOP ON PUBLIC HEALTH LAW FOR PACIFIC ISLAND COUNTRIES 12·15 February 2007, Aucldlnd, New Zealand
ANNEX2
TIMETABLE Time 0815
Monday, 12 February_ Regis1ration
nme
Tulldav.13 February Announcements and points arising from previous day's discussions 6. Risl<-based approaclles 1o Public Health
Time
Wedneedav. 14 Febru!!l_ Announcements and points arising from previous day's discussions 8. IHR continued: Core capacily requirements under Annex 1 - Presentation and plenary discussion
Time
Thu~a~15February
0900
0900
0900
Announcements and points arising from previous day's discussions 11. Planning !Of legislative implementation of the IHR in the Pacific
0900
1. Opening ceremony and group photograph
0910
0910
0910
Law - Presentation and plenary discussion
• RepOfting back of group work • Presentation and plenary discussion
1000
COfFEE BREAK
1000 1020'
COFFEE BREAK 7. Applying the risk-based approacll to public health law: three examples in detail - Presentation and plenary discussion
1000 1020
COFFEE BREAK 9. Legislative Interfaces with respect to IHR (2005) • Presentation and plenary discussion
1000 1020
COFFEE BREAK 11 . Planning IOf legislative implementation of the IHR in the PacifiC: Draft generic Cabinet Paper • Presentation and plenary discussion
1030
2. Introduction: objectives of consultation, oveJView of agenda '
3. What is Public Health Law?- introduction and ovOIView .... -Presentation and plenary discussion
- Small Group Work
10. A tool to help decide~ legislative change is needed to comply with IHR • Presentation and plenary discussion
12. Conciuslons and recommendations - Plenary discussion 13. Closing ceremony 1200 LUNCH BREAK
t
1200 1330
LUNCH BREAK 4. Human Rights and Public Health Law - Presentation - Smatl Group WOfk
1200 1300
LUNCH BREAK 8. An introduction to the IHR • Presentation and plenary discussion • Major changes in IHR
1200 1300
LUNCH BREAK 10. A tool to help decide if legislative change is needed to comply with IHR - Country based work
1300
1500 1530 to 1700 1630
COFFEE BREAK 5. General frameworks !Of Public Health Acts - Presentation and plenary discussion
1430 1500 to 1630
COFFEE BREAK 8. IHR Continued • State Parties Obligations • C!lfnpliance with IHR in WPR - Plenaty
1430 1500 to 1630
COFFEE BREAK 10. .... continued work in Small Groups. Return to plenary discussion
1430 1500
to 1630
Reception
25 ANNEX3
' DOCUMENTS DISTRIBUTED DURING WORKSHOP
Agenda item 0 I Agenda item 02
Opening Speech Introduction to NZ Public Health Meeting PowerPoint handout
Prepared by Dean Shuey Agenda item 03 What is Public Health Law? What is Public Health Law? Addendum What is Public Health Law? Background paper PowerPoint handout
Prepared by Josephine Cooper Agenda item 04 Background paper Public Health Laws in WHO Member States Good Practice in Legislation and Regulation for Background paper TB Control: An Indicator of Political Will WHO Guide to a Public Health Act PowerPoint handout
Prepared by Genevieve Pinel Agenda item 05 General Frameworks for Public Health Acts (with Table) General Frameworks for Public Health Acts Background paper PowerPoint handout
Prepared by Josephine Cooper Agenda item 06 Risk-based Approach to Public Health Law Applying the Risk-Based Approach to Public Health Law: Three examples PowerPoint handout PowerPoint handout
Prepared by Louise Delany Agenda item 07 Checklist for ideas for Public Health Law: Drinking Water, Communicable Disease and Public Health Emergency Management
PowerPoint handout
Prepared by Louise Delany Agenda item 08 What are IHR? IHR (2005): Background and rationale IHR (2005): Key State Obligations: Notification/reporting and verification IHR (2005): National Capacities IHR (2005): Human Rights Provisions Complying with IHR (2005) in the Western Pacific Region National Core Capacities- Annex I PowerPoint handout PowerPoint handout PowerPoint handout PowerPoint handout PowerPoint handout PowerPoint handout PowerPoint handout
Prepared by Li Ailan
26 Agenda items 08 - II International Health Regulations (2005) Background paper State Party Functions by Subject World Health Assembly Resolutions 58.3 and 59.2 Prepared by Bruce Plotkin/Femando Gonzales-Martin Legislative interfaces of Public Health Acts Legislative interfaces of Public Health Acts Prepared by Josephine Cooper A Tool to assist Implementation of the International Health Regulations through Law Prepared by Josephine Cooper Draft generic Cabinet Paper concerning the International Health Regulations (2005) Prepared by Josephine Cooper PUBLICATIONS DISTRIBUTED DURING WORKSHOP
Agenda item 09
Background Paper PowerPoint handout
Agenda item I 0
Background paper
Agenda item II
WHO, Geneva (2006) International Health Regulations (2005) WHO, WPRO (2006) International Health Regulations 2005: Guidance for national policy-makers and partners [Pamphlet] · WHO, WPRO (2006) Enforcement of Public Health Legislation
ISBN 92 4 158038 0
ISBN 92 9061 223 I