Public health laws

PUBLIC HEALTH LAWS
Namita Batra Guin
Associate Professor
Deptt. of Community Health Nursing

What is LAW ?
• Law is defined as the written and unwritten
body of “rules largely derived from custom
and formal enactments which are recognised
as binding among those persons who
constitute a community or State, so that they
will be imposed upon and enforced among
those persons by appropriate sanction”

Law comprises of
• Constitution of India.
• Legislations of Acts passed by the legislators
(Parliament at Central level and State legislatures at
the State level).
• Ordinances passed by the Central and State
Governments.
• Delegated legislation

Law comprises of
• Personal laws: These are laws laid down in religious
scriptures, mainly relating to marriage, divorce,
adoption and succession.
• Customs: Custom means uniformity of conduct of
people under like circumstances. It is a very
important source of law, but its importance is
diminishing now because most customary laws have
been codified.

Law comprises of
• Judicial Precedents: A precedent means a previous
instance or case which is or may be taken as, an
example or rule for subsequent cases or by which
some similar acts or circumstances may be justified
or supported.
• Supreme Court Decisions: Constitutional cases
decided by the Supreme Court are of binding nature
and have the force of law within the whole of India.
Article 141 of the Constitutional reads “The law
declared by the Supreme Court shall be binding on
all courts within the territory of India.”

Types of LaW
• Legal Systems: Each country has its own laws.
Laws of no two countries are alike.
• National and International Law: means law of
the land or the country, which unique for and
limited to the nation or the country
concerned. This is usually referred to as
municipal law. Laws which govern relations
with other countries are international laws.
• Public and Private Law: Public law is that
which governs the relationship between the
state and the members of the community.
Examples are constitutional law and criminal
law. Private laws concern the relationship of
members of community among themselves.

Types of LaW
• Criminal and Civil Law: Criminal law deals with
crime. In India, the criminal law is codified in
the form of Indian Penal Code, 1860. Civil law is
diverse.
• Substantive and Procedural Law: Substantive
law includes various Acts etc. That law down the
law. Procedural law is that which lays down the
legal procedure for administration of justice in
courts of law.
• Constitution and Legislation: Constitution is the
basic law of land from which all other laws
derive their authority.

Functions of law in nursing
• Laws are regulating instruments of any society
and country.
• In nursing law serves following:
– It provides guidance for nursing action in medico-
legal cases
– It helps to set the limitations of independent
nursing actions.
– It helps in maintaining standards of nursing
practices.
– It differentiates the nurse’s responsibilities from
other health professionals.

• Public health laws are essential for effective
regulation of health system. In every aspect of
community health, public health laws are
important.
• According to Grade : in the absence of public
health laws, the entire structure of public
health can disintegrate. To solve public health
problem, effective laws are utmost essential.

Definition
According to Gostin: “Public health laws are
such legal forces and duties of organized
society, by which conditions for maintaining
citizen’s health are ensured”.
In short, with public health laws, people’s health status
can be improved, they can be protected from
epidemics; availability of services can be improved
and environmental health can be protected

Factors important for making
effective health laws
• Useful health system for problem
solving.
• Proper economic policies.
• Community participation
• Effective system for implementation of
health laws.
• Constitutional support
• Periodic review of the health laws.
• Strong political will to implement laws.
• Proper resources.
• Proper social environment

Steps in formation of public health
laws
Health problems
Finding various options
Norms and standards
International public
health laws
National public health
laws
Evaluation
Health protection and
promotion

Objectives of public health laws
• To eradicate heath risks for global
environment or minimize them.
• Legal interventions by making health
policies and laws to prevent non-
communicable diseases.
• Introduction and management of new
techniques in the area of health. E.g.
telemedicine etc.
• To prevent health risks which may
happen due to international travel and
trade.

Objectives of public health laws
• To make achievements of health laws
and health services easily available.
• To improve the participation for health
among public and private sector and
society.
• To assist international agencies and
institutions in health management and
regulation.
• To increase awareness and interest
regarding health in the entire world.

Important areas of
International Health of WHO
• Control of communicable diseases.
• Bio-terrorism
• Control of tobacco
• Determine standards for the
preparation of bio-technology,
medicines.
• International trade of blood and human
organs
• Misuse of anti microbial drugs.
• International human rights laws
• International trade

Public health laws in India
• In India, it comes in concurrent list.
• So it is responsibility of state as well as central
Govt.
• Several international organizations and
voluntary agencies also play important role in
the implementation of public health laws.

Departments in enactment of public health laws
• Ministry of health and family welfare.
• Ministry of forestry and environment
• Labour ministry
• Dept. of women and child welfare
• PWD
• Urban housing dept.
• Transport and communication dept.
• Dept. of local bodies.
• Central pollution board
• Ministry of food
• Public health engineering dept.

National importance of Public
health laws
• Strengthen nation’s health infrastructure.
• Following international health laws
• Encouragement of unified group activity
for health
• Identification of Govt’s limitations
• Making necessary financial provision for
health.
• Maintaining federal form of nation.
• Proper utilization of national resources.
• Better coordination between health
planning and finance dept.

National importance of Public
health laws
• Maintaining economic discipline in the area of
health.
• Protection of environmental health
• Protection of food and maintaining nutritional
level.
• Protecting citizens from drug addiction,
alcoholism and other unhealthy and dangerous
habits.
• Protection of consumers of health services.
• Protection from environmental pollution
• Following codes of ethics in health and medical
services, education, training and research.
– In addition to above, protection from violence and
accidents, control over private health services etc.

Articles in Constitution Relatedto Health
Article 21: The Article reads: “No person shall be deprived
of his life or personal liberty except according to
procedure established by law.” Thus right to life is
fundamental right guaranteed by the Constitution.
Article 23: This article is indirectly related to health.
Article 23(1) prohibits traffic in human beings. It is well-
known that traffic in women leads to prostitution,
which, in turn, is a major factor in spread or AIDS.
Article 24: This article reads “No child below the age of
fourteen years shall be employed to work in any
factory or mine or engaged in any other hazardous
employment”. Thus this article is of direct relevance to
child health.

• Act means a statute or law adopted (enacted) by
a national or state legislative or other governing
body.
• Rules are explicit statements that tell an
employee what he or she ought or ought not to
do

Categorization of Important Indian
legislations

A. To Improve and Maintain High Standards in the Medical
Education and Services:
• The Indian Medical Council Act,1956 and Regulations
2002.
• The Indian Nursing Council Act 1947.
• The Dentists Act, 1948.
• The Pharmacy Act,1948.
• The Consumer Protection Act (CPA), 1986.
B. Public Registration to Assess Mortality and Enumeration
of Population.
• The Registration of Births and Death Act,1969.
• The Census Act 1948.
C. To Prevent Public Health Problems:
• The Epidemic Diseases Act,1897
• The International Health Regulation

D. To Achieve Maternal Health and to Empower the Women:
• The Medical Termination of Pregnancy(MTP) Act,1971
• The Maternity Benefit Act,1961
E. To Safeguard the Children and Young
• The Juvenile Justice Act,1986
• The Child Labour (Prohibition & Regulation) Act,1986
• The Child Marriage Restraint Act,1929
F. To rehabilitate and provide equal opportunity to disabled
and disadvantaged groups:
• The Persons with Disabilities (Equal opportunity,
• Protection of Rights and Full Participation) Act,1995
• The Mental Health Act,1987

G. To Prevent Drug Addiction and Substance Abuse and Safe
Manufacturing of drugs, Distribution and Storage:
• The Narcotic Drugs and Psychotropic Substances Act,1985
• The Drug and Cosmetics Act,1940
H. To Protect Workers and to Provide Social Security:
• The Factories Act,1948
• The Employees State Insurance(ESI) Act,1948
I. Environmental Legislation
• The Environment (Protection) Act,1986
• The Biomedical Waste (Management & Handling)
Rules,1998
J. To Promote Voluntary Work:
• The Red Cross Society (Allocation of Property) Act,1936

MEDICAL
TERMINATIO N OF
PREGNANCY ACT,
1971

• MTP act, 1971 lays down:
–Conditions under which the
pregnancy can be terminated.
–Person or persons who can
perform such terminations and
–The place where such
terminations can be performed.

Conditions under which the pregnancy can be
terminated are:
• Therapeutic: when the continuation of pregnancy
endangers the life of women or may cause grave
injury to her physical or mental health.
• Social: a) when economic & social environment is
not suitable for continuation of pregnancy. b)
contraceptive failure.
• Humanitarian reasons: e.g. rape
• Eugenic reasons: when there is a risk that the child
born would be with the serious physical or mental
abnormalities as to be seriously handicapped.

Conditions under which the pregnancy can be
terminated are: contd..
• When the pregnant woman is mentally not
sound (e.g. schizophrenia, mania etc). Written
consent of the guardian is necessary for
abortion of such women.
• Failure of contraceptive devices : this
condition is unique feature of Indian law and
virtually allows the abortion on request.
• A written consent of guardian is necessary before
performing abortion in women under 18 years of age.

The person or persons who can perform
abortion:
• A Registered Medical Practitioners (RMP)
having exp. in gynecology and obstetrics
where length of pregnancy does not exceed
12 weeks.
• Two RMP where pregnancy exceeds 12 weeks
and is not more than 20 weeks.

Where the abortions can be done:
No termination of pregnancy shall be made at
any other place other than a hospital
established or maintained by govt. or a place
approved for the purpose of this Act by the
govt.

MTP RULES
• Approval by board: under the rules, the CMO
of the district is empowered to certify that a
doctor has necessary training in Gyn/Obs to
do abortions.
• Qualifications required to do abortion: if the
doctor has assisted a RMP in performance of
25 cases of medical termination of pregnancy
in an approved institution.
• Place of abortion: non- govt. institutions may
also take up abortions provided they obtain a
license from CMO of the district.

MTP RULES
• Termination of pregnancy by unregistered
person or at unregistered place shall be an
offence.
• Rigorous imprisonment for a term which shall
not be less than 2 years but which may not
extend to 7 years under the Indian penal code
(45 of 1860).

The Consumer
Protection Act, 1986

Six rights of the consumers
• Right to safety
• Right to be informed
• Right to choose
• Right to be heard
• Right to seek redressal and
• Right to consumer education.

According to the law:
Consumers with complaints can approach the
Commissions at District, State and Central level.
There is no court fee and the consumer does not have
to go through lawyers

Under the act
• The complaint means any allegation in writing made
by a complainant in regard to one or more of the
following:
• loss or damage as a result of any unfair trade practice
adopted by any trader
• goods/ services mentioned in the complaint suffer from
one or more defects.
• Goods are excessively charged which is more than the
printed price on the goods.

Definitions Under the act
• Consumer: A consumer is any person who buys any goods
for a consideration, any person who hires/avails of any
service for a consideration , any beneficiary of such
services, where such services are availed of with the
approval of the person hiring the service.
• Goods: Goods mean any movable property and also
include shares, but do not include any auctionable claims.
• Service: Service of any description such as banking,
insurance, transport, processing, housing construction etc.

Definitions Under the act
• Nature of complaint:
a) Any unfair trade practice or restrictive trade practice
adopted ;by the trader
b) Defective goods
c) Deficiency in service
d) Excess price charged ;by the trader
e) Unlawful goods sale, which is hazardous to life and safety
when used
• Consumer Courts: A three-tier-system
a) National Consumer Dispute Redressal Commission: claims
above Rs. 20 lakh
b) Consumer Dispute Redressal Commission or State
Commission: Claims from Rs 5 to 20 lakh.
c) Consumer Dispute Redressal Forum or District Forum: Claims
upto Rs 5 Lakh

The Drugs and
Cosmetics Act, 1940

This act is effective for :
• The standardization of medicines and cosmetics,
• Control of quality,
• To give recognition to new medicines and such
activities.
• Under this act, Central Drug Standardization control
Organization (CDCSO)is formed.
• Under the act, functioning of laboratory, advisory
committee, Indian Pharmacopia, etc. are included.

FUNCTIONS OF CDSCO
• Implementation of medicine laws and policies.
• Keeping control over the quantity of imported
medicines.
• Establishing better co-ordination in the work of drug
control officer.
• Recognition to new drugs made in the country.
• Establishing the standards of medicines and
instruments.
• Regulation of human blood transfusion, parenteral
drugs.
• Providing license for the preparation and sale of serum
and vaccines.

LEGISLATION ABOUT BLOOD BANK
• Under this act the blood should not be taken from
the professional donors.
• Every unit of blood should be tested for the
infections like: HIV, hepatitis B, malaria, Syphilis and
HCV also.
• All the standards set for the establishment of the
blood banks, sale of blood, separating blood
components, blood bank staff and blood storage ,
are ensured to be followed.

The Registration of
Births and Deaths
Act, 1969

• The aim of the act is to collect and compile
vital statistics which is necessary for planning
and administration.
• The act has given statutory authority to the
Registrar General, India to coordinate the
work of civil registration. Director of Health
services is the Chief Registrar.
• In rural areas, local registrars are mainly
drawn from Panchayat, police, health or
revenue department.

In this Act,
(a) “birth” means live-birth or still-birth;
(b) “death” means the permanent
disappearance of all evidence of life at any
time after live-birth has taken place.

• Every registrar has to registers births and deaths
occurring within his/her administrative area.
• The information regarding occurrence is to be
supplied within 21 days in both the events.
• Events not registered within prescribed times are
registered as delayed events, on payment of
prescribed fee if it is done within one month.
• On the basis of the annual vital statistics returns
received from states, the Registrar General, India
brings out a comprehensive annual report entitle, “
Vital Statistics of India”.
• The act provides for medical certificate of cause of
death.

• A medical practitioner has to certify free of cost and
in prescribed format, the cause of death if he/she is
attending the deceased during last breath or illness.

The Transplantation
of Human Organs
Act, 1969

• The aim of the act is to regulate the removal
of organs from cadavers and living persons
and prohibiting commercial dealings in human
organs.

Various terms defined under the Act
• Brain stem death- the stage at which all the
functions of brain stem have permanently and
irreversibly ceased and is so certified by
registered medical practitioners or authority
which have power to do so.
• Deceased person – a person, in whom
permanent disappearance of all evidence of
life occurs, by reason of brain stem death or in
cardio-pulmonary sense at any time after live
birth has taken place.

Various terms defined under the Act
• Donor- any person, not less than 18 years of
age, who voluntarily authorizes the removal of
any of his human organs for therapeutic
purpose.

• Any person more than 18years or parents in case of
less than 18years authorizes the removal, before his
death, of any human organ of his body. Any written
authority given before his death can be accepted.
• Before removal of body organs, at least registered
medical practitioners should certify that life or brain
stem functions have ceased.
• An unclaimed body within 48 hrs from the time of
death, the person in-charge or any other authorized
person who strongly believes that body will not be
claimed, is authorized to remove human organs
unless appropriate authority authorizes or registers
it.

• Any illegal supply or publishing to supply human
organs on payment by individual or society or
organization or agent are considered an offence and
punishment may be awarded.
• Person shall be punished for a term not less than two
years but which may extend upto 7 years and shall
be liable to fine which shall not be less than 10,000-
20,000.
• Name of the doctors shall be reported to the MCI or
state authority for taking necessary actions including
removing his name from register for 2 years for the
1st conviction and permanent for the subsequent
offence.

• By this act, the brain death is now legally recognized
as clinical death so that organs can be harvested
from brain dead patients. The treatment can be
terminated once then brain death is certified.
• In public hospitals with lot of resource constraints,
certification of brain death, independent of
transplant potential, would rationalize usage of vital
instruments like ventilators.

Indian Nursing
Council Act, 1947

• The aim of the act is to regulate uniform
standard of training for nurses, midwives and
health visitors.
• It extend to whole of India except the state of
Jammu and Kashmir. This council is composed
of 24 members from different departments
like – Indian Medical Council, DGHS, Chief
Administrative Medical Officer.

In this Act
• (a)"the Council " means the [Council] constituted
under this Act.
• (b)" prescribed means prescribed by regulations
made under section 16
• (c)" State Council" means a Council (by whatever
name called) constituted under the law of a State to
regulate the registration of nurses, midwives or
health visitors in the State ;
• (d) "State register" means a register of nurses,
midwives or health visitors maintained under the law
of a State.

According to this act
• Any person may enrol in register who has recognised
qualification. Any Indian person who has got foreign degree
may enrol temporary in the state register for employment in
particular hospital/ institution only for a particular period.
• Any institution which is engaged in training and distribution of
nursing diploma or degree have to submit information from
time to time. Such institution shall be examined and inspected
by the persons appointed by the executive body of council for
the purpose of adequacy of training and examination.
• Such inspecting body shall submit a report that the institution
has not adequate resources and has not maintained standards
then council may withdraw the recognition. The recognised
institutions are notified in the official gazette.

The Epidemic
Disease Act, 1897

• The Act provides power to exercise for the
control and to prevent any epidemic or spread
of epidemic in the states or country

Under this Act
• The states may authorize any of its officers or agency
to take such measures if the state feels that the
public at large is threatened with an outbreak of any
dangerous epidemic.
• The person who is inspecting, is empowered to
determine the process and authority to take
responsibility of all expenses incurred in
compensation, travelling, temporary
accommodation, segregation of the infected person,
etc.

Under this Act
• The state government can authorize the District
Magistrate or officials who can take any number of
vehicles needed for carrying man and equipments to
and from or transporting infected persons during the
epidemic or in threat of epidemic.
• State or central government may take measures and
prescribe regulations for the inspection of any ship
or vessel leaving or arriving at any port in the
territories.
• Violation of any of the provisions of this act is
punishable under the Section 188 of the IPC.

International Health
Regulation

• The International Health regulation(IHR) were
first adopted by the World Health Assembly in
1969 in an attempt to ensure maximum
security against the international spread of
disease with minimum interference with
world traffic.

• IHR are a set of regulations for the control of sharing
of epidemiological information on the trans
boundary spread of cholera, plague and yellow fever.
• To achieve this, the regulation provide for binding
obligations on WHO member states to notify WHO of
any outbreak of these three diseases in their
territories.
• The regulations is being revised in 1995. Under the
revised international regulations, the routine
occurrence of endemic disease will not be notifiable.

• The syndromes proposed for notification are:
• Haemorrhagic fevers
• Acute respiratory syndrome
• Diarrheal syndrome
• Jaundice and
• Neurologic syndromes
A category covering other notifiable syndromes of
presumed infectious origin which could be emerging
or re-emerging disease.

• Notification of a syndrome will normally be followed
by a report on the specific disease on the specific
disease once the diagnosis has been established.
• If the diagnosis is already known, the disease can be
notified rather than the corresponding syndrome.
• Since WHO, has no multinational army to enforce
sanctions on erring Member States, especially the
powerful ones, the implementation of regulation
usually fail to occur.

• The Child labour Act is to prohibit the
engagement of children in certain
employments and to regulate the conditions
of work of the children in certain other
employments.

The Act defines certain terms:
• “child“ means a person who has not completed his
fourteenth year of age;
• “day” means a period of twenty-four hours beginning
at midnight;
• “establishment” includes a shop, commercial
establishment, work-shop, farm, residential hotel,
restaurant, eating-house, theatre or other place of
public amusement or entertainment;
• “family” in relation to an occupier, means the
individual, the wife or husband, as the case may be,
of such individual, and their children, brother or
sister of such individual.

• “occupier”, in relation to an establishment or a
workshop, means the person who has the ultimate
control over the affairs of the establishment or
workshop
• “workshop” means any premises (including the
precincts thereof) wherein any industrial process in
carried on, but does not include any premises to
which the provisions of Sec. 67 of the Factories Act,
1948 (63 of 1948), for the time being, apply.

Under the act
• It is illegal to employ children below 14 years for
domestic work or as domestic servant, or in dhabas,
restaurants, hotels, mtels, tea-shops, resorts, spas
and other recreational centers.
• These occupations are hazardous for the children
according to the new Amendment 2006 and effected
from 10th October 2006.

Under the act
• No child shall work for more than 3 hrs
followed by an interval of rest for atleast 1 hr
and that shall not be spread over more than
six hours.
• No child shall be permitted to work overtime.
• Every child employed in an establishment shall
be allowed in each week, a holiday of one
whole day, which day shall be specified by the
occupier in a notice permanently exhibited .

Under the act
• Whoever employs any child or permits any
child to work in contravention of the
provisions of section 3 shall be punishable
with imprisonment for a term which shall not
be less than three months but which may
extend to one year or with fine which shall not
be less than Rs10,000 or with both.

Definitions
• “mentally ill person” means a person who is in
need of treatment by reason of any mental
disorder other than mental retardation.
• “mentally ill prisoner” means a mentally ill
person for whose detention in, or removal to,
a psychiatric hospital, psychiatric nursing
home, jail or other place of safe custody.
• “psychiatric hospital” or “psychiatric nursing
home” means a hospital or, as the case may
be, a nursing home established or maintained
by the Government or any other person for
the treatment.

Under this Act
• Psychiatric hospitals and Nursing homes can
be established or run only on obtaining a
licence from state or central authority for
Mental Health services.
• Any person aged 18 and above can voluntarily
get admission for inpatient treatment. In case
of minor, guardian must present the ill as a
voluntary patient.
• Patients admitted on voluntary basis, if they
request for discharge, are obliged to be
discharged by the M.O incharge, within 24 hrs
of receiving the request.

Under this Act
• The Act provides for regular, thorough
supervision of mental hospitals and nursing
homes by monthly joint inspection of three
visitors designated by the Central or state
Authority for health services.
• The human rights of a mentally ill patient are
protected under section 81.

Bio-medical waste
(management and
handling) rules, 1998

Under this Act
• It shall be the duty of the every occupier of an
institution generating bio medical waste which
includes a hospital, nursing home, clinic,
dispensary, Veterinary institution animal
house, pathological laboratory, blood bank by
whatever name called to take all steps to
ensure-that such waste is handled without any
adverse effect to the human health and the
environment.

Definitions
• Act" means the Environment (Protection) Act,
1986 .
• "Authorisation" means permission granted by
the prescribed authority for the generation,
collection, reception, storage, transportation,
treatment, disposal and/or any other form
of handling of bio-medical waste.
• "Authorised person" means an occupier or
operator authorised by the prescribed
authority to generate, collect, receive, store,
transport, treat, dispose and/or handle bio-
medical waste.

Definitions
• "Bio-medical waste" means any waste, which
is generated during the diagnosis, treatment
or immunisation of human beings or animals
or in research activities pertaining thereto or
in the production or testing of biologicals, and
including categories mentioned in Schedule I;
• Bio-medical waste treatment facility" means
any facility wherein treatment. disposal of bio-
medical waste or processes incidental to such
treatment or disposal is carried out ( and
includes common treatment facilities).

Under the act
• Bio-medical waste shall not be mixed with
other wastes.
• Bio-medical waste shall be segregated into
containers/bags at the point of generation.
• If a container is transported from the
premises, the container shall, apart from the
label prescribed.
• No untreated bio-medical waste shall be kept
stored beyond a period of 48 hours

The Employees States
Insurance Act, 1998

This act provides certain benefits to the
employees in case of sickness, maternity and
employment injury and to make provision to
certain other matters in relation.
It is a social security scheme extends to the
whole of India

Definitions under the Act
• “Employee” means any person employed for
wages in or in connection with the work of
factory or establishment in department or to
which this Act applies.
• Factory” means any premises where 10 or
more persons if case of using power and 20 or
more in case of not using power are employed
or were employed for wages.
• “Employment injury” means a personal injury
to an employee caused by accident or an
occupational disease arising out of and in the
course of his employment.

Benefits
• Sickness benefit: daily rate of benefit is Rs.14 if daily
wage is Rs. 28-32. Rs.125 if daily wage is 236 and
above. Sickness benefit period could be maximum of
91days for any two consecutive benefit periods.
• Maternity benefit: at the rate of full wages for a period
of 12 weeks in case of pregnancy and 6 weeks in case
of miscarriage or MTP.
• Disablement benefit: the daily rate of disablement
shall be 40% more than the “standard benefit rate” is
given to the temporary disabled person during the
period of disablement.

Benefits
• Dependent benefit: widow or legitimate or adopted
child or widowed mother of the diseased person gets
the daily rate of dependent’s benefit that is 40% more
than the “standard benefit rate”
• Funeral benefit: an amount of Rs. 2500 is paid to the
eldest surviving member for the funeral purpose.
• Medical benefit: all member of the worker gets the
medical cover including the outdoor treatment,
domiciliary treatment facilities by the panel system,
specialist services and indoor services.

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