On February 27, public health advocates filed a lawsuit against Massachusetts Acting Governor Jane Swift for cutting funding to smoking cessation and other tobacco-control programs. The suit is a classic example of the intersection between public health and law, an interface that is gaining increasing attention at HSPH.

Last year, Michelle Mello and David Studdert, both assistant professors of health policy and law in the Department of Health Policy and Management, were hired at the school to expand HSPH’s offerings of law-related courses. They joined Troy Brennan, a professor in the Department of Health Policy and Management, MD, JD, MPH, and a group of adjunct faculty who teach in HSPH’s Program in Law and Public Health (LPH).

"Public health is framed by legal boundaries," said Studdert. "The law is also arguably the most important tool to try to enforce changes in people’s behavior."

LPH now offers eight courses with topics such as health care law and policy, legal and ethical issues in the AIDS epidemic and malpractice suits.

The students are from varied backgrounds. Students undertaking a concentration in LPH within the MPH program are lawyers interested in public health and health policy. LPH courses are also attended by other public health students wanting to know more about law, policymaking and practice.

A roll call in Mello’s current class, "Public Health Law," revealed students interested in the implications of welfare reauthorization, abortion rights, control of infectious diseases and the US Constitution. One student works for the Ministry of Health in Japan and wants to know more about the American legal system. Another is a dentist simply curious about the course material.

"Law school is very general and does not offer the interdisciplinary training required for those interested in making an impact in public health," said Sarah Elisabeth Curi, a working lawyer and MPH student in the LPH program. "HSPH has helped me look at the health care environment from many different perspectives. This makes me a more effective practitioner. Without an understanding of health care and public health in relationship to law, we can’t write laws that are good for public health."

The variety of the students’ interests reflects a trend.

"The traditional focus of health care law has been on doctor-patient relationships, malpractice, that sort of thing," said Mello. "Now, there is a new recognition that we need to be more attentive to the boundaries and possibilities of public health law."

Mello and Studdert attribute the broadening perspective to several factors. Coverage denials by some health maintenance organizations have rankled Americans, creating debate in Congress about patients’ rights to sue their HMOs.

With the recent public attention to the problem of medical errors, there is new interest in the ways in which malpractice litigation may help or hinder efforts to improve health care quality.

Gun control laws continue to be argued about.

Tobacco control, with its accompanying multimillion dollar settlements, has benefited social programs but has also created rancor, as the lawsuit against Swift indicates.

This past fall, bioterrorism came to America and, with it, debates about the potential implications of infectious disease outbreaks. Should people be permitted or required to be vaccinated against smallpox, for example? What other measures might be necessary in the event of an outbreak?

The Centers for Disease Control and Prevention has the authority to detain people to prevent "the introduction, transmission or spread of such communicable diseases as may be specified from time to time in executive orders of the President upon the recommendation of the National Advisory Health Council and the Surgeon General." How should the state’s responsibility to protect the public be balanced against the basic civil rights of the individual?

"There have been a number of issues in the past few years that have touched people like never before, and the result is this greater awareness of the role law plays in health care," said Mello.

The LPH faculty is currently exploring the possibility of creating a joint program between HSPH and Harvard Law School. Students in the program would receive a joint JD and MPH.

There are similar programs at other universities, but, said Studdert, "It’s rare that you have a top law school and top public health school in close proximity, so we’d like to take advantage of that."