Can I Leave the House? A Coded Analysis of the Interpretation of the Reasonable Excuse Provision by NSW Police During the COVID-19 Lockdown

This article looks at the recent Public Health (COVID-19 Restrictions on Gathering and Movement) Order 2020, which was in force in New South Wales from 31 March 2020 to 14 May 2020. The order allowed police to fine people who left their houses without a ‘reasonable excuse’. This article considers the confusion around the order in the community and upper levels of the government. Publicly available information about the fines issued by the police is analysed and it is argued that an overly narrow application of the order by police meant that its application was not reasonably proportionate to the authorising legislation, the Public Health Act 2010 (NSW). It is concluded that if future lockdowns are required, care will need to be taken to ensure that Ministerial orders are crafted in line with the legislation and that police officers clearly understand their operation.

Tension between the individual's fundamental human rights and the protection of the public from infectious and formidable epidemic diseases

SUMMARY Emerging infectious and formidable epidemic diseases are a cause for concern and a serious threat to the global health. At the time of writing a number of these diseases have no cure. States in their domestic legislation applicable to matters of public health have come up with approaches to deal with such diseases. Zimbabwe has enacted primary legislation and regulations dealing with public health in an effort to suppress and prevent these diseases. The Zimbabwean Public Health Act, for example, authorises the notification of infectious and formidable epidemic diseases and the inspection of infected premises. The Act further empowers the Minister of Health and Child Care to enact regulations. Through the Public Health Regulations, the government of Zimbabwe declared COVID-19 a formidable epidemic disease. Warranted by the Health Act, the Minister of Health and Child Care made treatment, testing, detention and isolation compulsory during the period in which COVID-19 is declared a formidable epidemic disease. This article seeks to provide a critical analysis of these measures as provided in the Public Health Act and health regulations in light of the constitutionally-guaranteed rights of privacy, freedom of security, liberty and freedom of movement. The question sought to be answered by the author is whether these measures justifiably trumps the rights of individuals. Key words: infectious diseases; formidable epidemic diseases; public health; fundamental human rights; legislation

Princess Marina Hospital HIV rates:Interrupted time series analysis for policy review

ObjectiveWe aimed to assess the effect of the amended Public Health act of 2013 on facility-based HIV testing in Princess Marina Hospital.IntroductionHIV testing remains the mainstay of optimal HIV care and is pivotal to control and prevention of the disease, however efforts to attain optimal testing levels have been undermined by low HIV testing especially in developing countries. Botswana in response, amended its Public Health Act in September 2013 but the effect of this action on facility based HIV testing rates has not been evaluated.MethodsWe carried out an effect assessment using interrupted time-series analysis method, where we accessed electronic medical records of patients seen in Princess Marina Hospital from June 2011 to May 2015. Rates were developed from the proportion of patients that tested each month out of the number that registered, and that figure used that as our data point in the series. September 2013 served as our intervention period in the series. We ran the (i) crude and (ii) sex-stratified model regression models in stata® yielding Newey-West coefficients with their 95% confidence intervals. Graphical display of the models were also produced to visual appreciation and inspection.ResultsTwo hundred and twenty-nine thousand six hundred and ninety two patients were registered between June 2011 and May 2015. Of those tested the significant majority being females (65%). From the Newey-regression output there was no significant change in the level of HIV testing immediately after the intervention however there was a change in trend(p=0.002) post the intervention. Stratification by gender, revealed no statistically significant difference between males and females, either in the levels nor the trend post intervention compared to pre-intervention.ConclusionsThe amendment of the Public Health act of 2013, has brought about trend change in HIV testing however there has not been any apparent difference in the levels nor trends on HIV testing between males and females. Nationwide health facility-based studies could assist assess the overall effect of the amended act on HIV testing rates.References1. Provider Initiated HIV Testing and Counseling: One Day Training Programme, Field Test Version. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2011.2. Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. The Lancet. 2010;375(9731):2092-8.3. Lawn SD, Harries AD, Anglaret X, Myer L, Wood R. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. Aids. 2008;22(15):1897-908.4. McMahon JM, Pouget ER, Tortu S, Volpe EM, Torres L, Rodriguez W. Couple-based HIV counseling and testing: a risk reduction intervention for US drug-involved women and their primary male partners. Prevention science : the official journal of the Society for Prevention Research. 2015;16(2):341-51.5. Shan D, Duan S, Gao J, Yang Y, Ye R, Hu Y, et al. [Analysis of early detection of HIV infections by provider initiated HIV testing and counselling in regions with high HIV/AIDS epidemic in China]. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2015;49(11):962-6.6. Hensen B, Baggaley R, Wong VJ, Grabbe KL, Shaffer N, Lo YRJ, et al. Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider initiated testing & counselling. Tropical Medicine & International Health. 2012;17(1):59-70.7. Ijadunola K, Abiona T, Balogun J, Aderounmu A. Provider-initiated (Opt-out) HIV testing and counselling in a group of university students in Ile-Ife, Nigeria. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception. 2011;16(5):387-96.8. Baisley K, Doyle AM, Changalucha J, Maganja K, Watson-Jones D, Hayes R, et al. Uptake of voluntary counselling and testing among young people participating in an HIV prevention trial: comparison of opt-out and opt-in strategies. PloS one. 2012;7(7):e42108.9. Topp SM, Chipukuma JM, Chiko MM, Wamulume CS, Bolton-Moore C, Reid SE. Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia. Bulletin of the World Health Organization. 2011;89(5):328-35A.10. Tlhakanelo JT, Mulumba-Tshikuka JG, Molefi M, Magafu MG, Matchaba-Hove RB, Masupe T. The burden of opportunistic-infections and associated exposure factors among HIV-patients admitted at a Botswana hospital. 2015.11. Bernard EJ. BOTSWANA’S DRACONIAN PUBLIC HEALTH BILL APPROVED BY PARLIAMENT, BONELA WILL CHALLENGE IT AS UNCONSTITUTIONAL ONCE PRESIDENT SIGNS INTO LAW (UPDATE 3). HIV justice Network. 2013.12. Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prevention science : the official journal of the Society for Prevention Research. 2000;1(1):31-49.

The origins of health promotion

This chapter examines the origins of health promotion in the UK. It begins with a discussion of diseases in Britain before and during the nineteenth century that made public health a major concern of governments, followed by an analysis of the role of William Farr in establishing a system that recorded the cause of death, along with three important pieces of legislation: Poor Law Amendment Act 1834, Public Health Act 1848, and Public Health Act 1875. The chapter then considers disease monitoring and surveillance before describing Charles Booth's work on poverty in the late nineteenth century, Benjamin Seebohm Rowntree's poverty surveys, and the consequences of the Boer Wars for public health. Finally, it explores key legislation in the twentieth century prior to the establishment of the NHS, the emergence of a new public health, and the impact of health promotion on the social determinants of health.

Tackling health inequality at the local level: Some critical reflections on the future of Norwegian policies

Aim: In this paper we discuss recent developments in the policy to reduce health inequalities in Norway in relation to challenges and opportunities associated with tackling health inequality at the local level. Methods: We discuss government documents and research findings on the implementation of policies to diminish health inequalities at the municipality level. Recent policy developments are briefly reviewed in relation to the 10-year strategy to reduce health inequalities passed by the Parliament in 2007. We then identify opportunities and obstacles to successful action on health inequalities at the local level. Results: The 2012 Public Health Act represented a powerful reinforcement of the strategy to reduce health inequalities at all three levels of government: the national, the regional and the local. However, some aspects of the policies pursued by the current government are likely to make local action to tackle health inequality an uphill struggle. In particular, health equity policies that have hitherto been based on universalism and had a focus on the gradient seem to be running out of fuel. Other challenges are an insufficient capacity for effective action particularly in smaller municipalities, and a rather weak knowledge base, including systems to monitor social inequalities and a general lack of evaluations of trials and new initiatives. Conclusions: We conclude that the Public Health Act opened up many new opportunities, but that a number of municipalities face obstacles that they need to overcome to tackle health inequalities comprehensively. Furthermore, local efforts need to be coupled with sustained national momentum to be efficient.

Capacity to reduce inequities in health in Norwegian municipalities

Aims: One of the goals of the Norwegian Public Health Act is to reduce health inequities. The act mandates the implementation of policies and measures with municipalities and county municipalities to accomplish this goal. The article explores the prerequisites for municipal capacity to reduce health inequities and how the capacity is built and sustained. Methods: The paper is a literature study of articles and reports using data from two surveys on the implementation of public health policies sent to all Norwegian municipalities: the first, a few months before the implementation of the Public Health Act in 2012; the second in 2014. Results: Six dimensions are included in the capacity concept. Leadership and governance refers to the regulating tool of laws that frame the local implementation of public health policies. Municipalities implement inter-sectoral working groups and public health coordinators to coordinate their public health policies and measures. Financing of public health is fragmented. Possibilities for municipalities to enter into partnerships with county municipalities are not equally distributed. Owing to the organisational structures, municipalities largely define public health as health policy. Workforce and competence refers to the employment of public health coordinators, and knowledge development refers to the mandated production of health overviews in municipalities. Conclusions: The capacity to reduce health inequities varies among municipalities. However, if municipalities build on the prerequisites they control, establishing inter-sectoral working groups and employing public health coordinators in authoritative positions, national governance instruments and regional resources may sustain their capacity.