In its 1988 report, The Future of Public Health, the Institute of Medicine found that state public health laws are, in many cases, seriously outdated. The Institute of Medicine expressed concern over this finding because it is through laws that government agencies derive their authority and responsibility to act. Without a strong legal infrastructure, governmental public health systems cannot be effective. The Institute of Medicine recommended that all states review their public health laws and update them to ensure that basic authorities and responsibilities entrusted to public health agencies are clearly delineated. The report also recommended that statutory reforms be enacted to support modern disease control measures, address contemporary health problems, and incorporate due process safeguards.

Noting the Institute of Medicine's landmark report on our country's public health system, the Centers for Disease Control and Prevention incorporated a chapter on public health infrastructure in their draft plan to improve the health of the nation over the next decade, Healthy People 2010. Recognizing the importance of the legal basis of public health, this plan includes an objective that calls for the development of a set of model statutes relating to essential public health services. This objective would also measure the proportion of jurisdictions that review their laws to ensure the delivery of essential public health services.

Public Health Law in Alaska

Alaska is a relatively new state, having attained statehood just 40 years ago. Even so, much has changed in the fields of health and public policy during this time, and our public health laws are outdated. In fact, Alaska's basic enabling statutes for public health have not been reviewed and updated since they were originally passed in 1949 (during territorial days). A variety of statutes dealing with disease control and authorities for various health programs have been added over time with no review for the adequacy and consistency of the total set of public health laws. Additionally, the section of Alaska law that addresses the roles and responsibilities of local governments does not include a definition of public health powers, and does not describe the relationship between state and local governments for public health.

These issues have caused concern in Alaska's public health community for many years. Alaska does not have a state health board to provide a forum for the development of public health policy. The Alaska Public Health Association has sponsored a number of conferences over the past two decades calling for the development of a clear state policy for public health. Whether due to the lack of a strong political mandate, or the lack of funding to support the process, Alaska never made significant progress in attempts to clarify public health policy through legal reforms - until now.

Creating a Plan for Public Health Policy Reform

Assessment of Alaska's public health law is one of the cornerstones of our state Turning Point project. For help with this effort, we were extremely fortunate to enlist the services of Lawrence Gostin of the Georgetown University Law Center. His charge is to assist the Alaska Public Health Improvement Partnership in understanding the current constitutional and legal structure for public health powers in Alaska, with a view toward improving the legal infrastructure.

Professor Gostin's work began last summer with a fact-finding trip to Alaska to meet with key informants so that he could become more familiar with the uniqueness of Alaska's political, legal, health care, and public health environments. During this trip he was able to meet with state legislators, local government officials, tribal government representatives, public health agency managers, and community members in a number of cities and villages across the state. Through these meetings he was able to gain information on their perspectives of current legal powers, deficiencies in those powers, and existing and anticipated future needs to improve the public's health.

Professor Gostin and his associate, James Hodge, are now in the process of completing a review of the laws supporting the public health system in Alaska, and will soon finalize their report on reforming Alaska's public health law. This report will include a discussion on the constitutional, statutory, and regulatory basis for public health powers (including a description of the differentiation of state, local, and tribal roles in public health); will provide a general review of public health law; will examine the current status of public health law in Alaska; and will provide guidelines for reforming Alaska's public health law.

Creating Model Public Health Statutes

We are currently investigating avenues for gaining financial support through the U.S. DHHS and private foundations for development of a set of model public health statutes for states. Having this tool would greatly benefit Alaska's Turning Point project as we move beyond the assessment of our public health laws to discussions on the need for public health law reform, and ultimately development of a bill to modernize our public health laws. Alaska's Turning Point partners are hopeful that we will be successful in working through a law reform process that will result in a strengthened public health system, ensuring that Alaska's public health agencies have adequate authority, responsibility, and support to deal with contemporary public health problems.


Deborah Erickson is a Health Program Manager with the Alaska Division of Public Health and the Turning Point Coordinator for the Alaska Public Health Improvement Partnership. The Alaska Public Health Improvement Partnership includes representatives from state; federal, and local government agencies; private and tribal health care organizations; statewide associations; the local public health improvement partnership in Kotzebue, Alaska; and Turning Point partnerships in Kenai, Fairbanks, and Sitka, Alaska.