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ABSTRACT Public health law needs to differentiate more clearly between public health analysis and public health authority, that is, between the scientific boundaries of epidemiology and the legal and regulatory boundaries of public health. These boundaries matter because public health law confers tremendous authority on government officials, including some powers that are justified only in situations of extreme urgency. The extent of this legal power explains the inclination of activists to apply public health paradigms to various social problems beyond the traditional origins of public health law; once a causal connection to a widespread health problem is identified, it falls within the authority of public health officials to take whatever actions are necessary to eradicate the threat to health. This approach might lead to dangerous conditions in which public health officials overstep the proper bounds of public health law, even though they arguably are continuing to exercise proper analytical tools for understanding public health problems. Public health authority should remain grounded in traditional conceptions of disease, which depend on a specific agent or behavior that threatens health in a direct and clear manner, and for which a targeted and effective remedy that requires collective action is available. It should not extend to diseases viewed as resulting from social, economic, and political conditions.
THIS ESSAY EXPLORES THE PROPER SCOPE of public health legal authority in response to compelling scientific evidence about the social determinants of health. It does so using four stories from my own experience. I take this rhetorical approach because the core of legal method is to focus on cases. Cases serve as precedent, they interpret important texts (such as statutes and constitutions), and they serve as the basis for instructive stories that help lawyers reason by analogy and example. In the latter vein, legal academics are not limited to judicial decisions. They can also find their stories from real life-a branch of scholarship known as narrative.
FOUR STORIES ABOUT PUBLIC HEALTH LAW
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