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Centralised Public Health Law: A Game Changer In Medical And Health Administration

In recent times, efforts were made to fill in the lacunae created by advancements in health science. In the light of such exertions the Public Health (Prevention, Control and Management of Epidemic, Bioterrorism and Disaster) Bill, 2017 is drafted. Lately, the bill garnered attention when the administrators from the Union Ministry of Health and Family Welfare and other government departments started the process of finalizing various provisions of the upcoming Bill.

The public health bill, of 2017 is likely to supersede the 125-year-old, Colonial Era law - The Epidemic Disease Act 1897 (EDA) which was implemented by the British administration to control the Bubonic plague. This is because the Epidemic Disease Act is not only archaic to counter the problems of the contemporary world but also rendered ineffective when the whole of India was combating the spread of Coronavirus.

Hence, this article would be overviewing the upcoming central public health law, its need, its limitations and how this law would be different from the previously implemented health laws.

About the Public Health Bill
On March 20, 2017, a meeting was hosted by the WaterAid India to discuss the draft public health bill 2017. The discussion was fostered in the presence of Mire Shiva (initiative for health and equity in society), Indira Chakravarty (public health resource network), Arun Srivastava (national health systems resource centre), Indranil Mukhopadhyaya (public health foundation of India) and the officials of WaterAid.[1] Members present in the meeting scanned through the draft bill and raised concerns related to the intent behind this precipitous introduction of the bill by the ministry and the implications if it gets passed in the current form.

During the meeting, the WaterAid, along with the other experts, stressed the need for further in-depth discussion and consultations with a much ampler group, including the key health groups and other stakeholders. They were undisputed in their opinion that government should not pass this bill in its current form and should call for a larger consultation to address its pros and cons.

Resultantly, the Public Health Bill 2017 was prepared cooperatively by the National Center for Disease Control (NCDC) and the Directorate General of Health Services (DGHS) keeping in mind the need to empower local government bodies during the pandemic or emergencies. It amalgamated provisions to give more teeth to the government machinery so that they can tackle any emergency swiftly. [2]

The proposed law deals with restructured, wide-ranging, and scientific provisions on surveillance, public health emergencies, disease notifications, disasters, and bioterrorism. The bill aimed to meticulously address health emergencies that India might face in the future.

The bill is to be introduced in the monsoon session of the parliament before the third covid wave hits the country as speculated. Once the draft is ready it will be placed in the public domain for consultation before being sent to the union cabinet.

Nature and scope of the bill
The public health bill, of 2017 is comprehensive legislation that will encompass all the aspects related to health, environment, food, and road safety because sundry disease needs a multidisciplinary approach and interdepartmental coordination as in the case of animal to human and human to animal transmitted diseases. The latest legislation not only covers many aspects of health, but also allusions mean to quarantine a patient, accountability of departments and punitive actions in case of letdowns.

The bill sought to define appealing and analytical terms such as "bioterrorism", "public health emergency", "social distancing" and "quarantine".

The bill defines lockdown as a "restriction with certain conditions or complete prohibition of running any form of transport" on-road or inland water. The definition includes "restrictions on movement, gathering of the person in any place whether public or private". It also prohibits/restricts the working of factories, plants, mining, construction or offices or educational institutions or marketplace.

Section2(d) provides the definition of the term "clinical establishment" and gives a far-reaching and extensive meaning to it. Every medical facility, unrelatedly of its composition, ownership, size, and specialty, is brought under the scope of clinical establishments for the purpose of the bill. The eclectic ambit of clinical establishments even includes the neat clinics of individuals doctors and all kinds of research and diagnostic labs. The solitary exception in this regard is clinical establishment owned, managed, and controlled by armed forces.[3] The utility of this definition is put forth in section 3 of the draft legislation.

Section 3 confers a barrage of powers to the state government, union territories, district, and local administration.[4]These instrumentalities may mandate health measures including quarantine, isolation, and social distancing to any person(s) or any class of persons, destroying animals or birds, isolating infections, and agents.

They are empowered to veto certain activities, ban, or standardize drugs and other hazardous substances, conduct medical tests, and commence diverse decontamination measures. It empowers any official or person to enter and scrutinize, minus prior notice, any premises where public health emergency has either occurred or is likely to occur.

The bill aims to squeeze in an assortment of laws related to public health emergencies like the Indian Ports Act, Livestock Importation Act, Aircraft Rules, Drugs and Cosmetics Act and Disaster Management Act 2005. The bill aims to put all these pre-existing laws in a single framework.

The bill proposes:
  1. A four-tier health administrative architecture
    The Public Health bill 2017 proposes a four-tier health administration architecture with "multisectoral" national, state, district and block level public health authorities which will have well-defined powers to setting up a public health cadre and even defining a lockdown. It is anticipated that that the national public health authority will be commanded by the Union health ministry and chaired by the health minsters of the state.

    The district collector will lead the subsequent tier, block-level will be directed by block medical superintendents or executives. The bill proposes that the above authorities will have the power to take obligatory measures for the prevention of non-communicable diseases and emerging infectious diseases.
     
  2. Collaboration and regulating private sectors
  3. Shift from sick case to wellness
  4. Increase in life expectancy birth from 67.5 to 70 by 2025.
  5. Reduction of TFR to 2.1 at national and sub national level by 2025
  6. Reduction under 5 mortalities to 23 by 2025 and MMR from current level to 100 by 200.
  7. Reduction in infant mortality rate to 28
  8. Reduction in neonation mortality to 16 and still birth to single digit by 2025
  9. Reduction in premature mortality from cardiovascular disease, cancer, diabetes, chronic respiratory disease by 2025.

Challenges in implementation of the Public Health Bill
  • Without a steadfast heath cadre. It would be challenging to implement the proposed health bill effectively.
  • With the laid-back access to the internet, many fabricated claims and false warnings can supper, causing fear and panic among the people. Addition of penalties to prevent such activities should be considered. Provisions of payment of compensation to the people affected by the government orders during an epidemic may be considered.
  • All the power of the government at each level are clearly mentioned, but still conceivable violation of rights during public health emergency have not been considered and its redressal mechanism are not lucidly defined. Appeal can be made under this act, but still the extent to make an appeal is very limited in the context of the sections of the bill.
  • Maintaining an equilibrium between the rights provided by the constitution and the powers of the government is essential for the public health law.
  • It has restricted reference to ethical frameworks or the protection of human rights during the response to epidemics.

Epidemic Disease Act 1897
The Epidemic Disease Act, 1897 is a colonial era legislation that is still used as primary law to control a mass epidemic. It was legislated to control the deadly bubonic plague in Bombay. As the plague assumed epidemic proportions, the colonial response was typical- one driven by panic, high handedness, ill planning, and severe measure. The Epidemic Disease Act was a result of "stringent measure" which Queen Victoria had directed her government to take to tackle the plague outbreak.

The act is one of the shortest legislations in the country, containing four sections only. Section 2 of the act vests the state government to take such measures and prescribes transitory regulations as maybe required to control an epidemic disease. Section 2A empowers the central government to scrutinize any ship leaving or arriving in port and for the custody of any person sailing or arriving therein.

Section 3 provides for chastisement under section 188 of the Indian Penal Code for any person flouting the act. If any disobedience by a person causes or tend to cause danger to human life, health, or safety, then they may be punished with imprisonment up to six months and/or fine up to Rs. 1000. Section 4 provides legal protection to persons for anything done under the act.[5]

Limitations of Epidemic Disease Act
The act has major inadequacy in this era of changing dynamics in public health emergency management. Communicable diseases and their spread have changed over the years. The novel viral disease, which are more virulent and potent in form, pose relentless challenges for us.

There is increased intercontinental travel, global connectivity, greater migration, boosted urbanization, closed urban spaces, climate change, man-made ecological changes, increasing intensity of contact with animals and birds, fluctuating climate conditions, technologies of mass food production, breakdown of public health measures and biosafety lapses, and more pressure on natural resources. The act is not in consonance with changing prerequisite of modern-day epidemic disease prevention and control.

In the Epidemic Disease Act the definition or description of a "dangerous epidemic disease" is not provided. There is no perfect definition of whether an epidemic is "dangerous" based on the magnitude of the problems, the severity of the problem, the age of population affected or its potential to spread internationally.[6] It is fundamental to know who decide or what a dangerous epidemic disease is and what criteria the definition is based on. [7]

The act is solely regulatory in nature and lacks specific heath focus. It does not describe the duties of the government in preventing and controlling epidemic. The act emphases the power of the government but is taciturn on the rights of citizens. It has no provisions that take the people's interest into consideration. The act is also silent on the ethical aspects or human rights principles that come into pay during the enforcement of laws.[8]

As for the ethical aspects of a national epidemic, it is necessary to address unbiassed access to healthcare. the ethics of public health actions taken in response to an outbreak should be considered as should the obligation of healthcare workers during an outbreak and obligations of society to them in return.[9]

How is Public Health Bill different from Epidemic Disease Act?
The two acts differ in context of the scope, inclusion of diseases which can be a threat to public health, penalties, division of powers among different administrative authorities and making appeal regarding any order passes under the act.

The Epidemic Disease Act only focused disinfecting railways and ports considering them the only entry points not mentioning the roads crossing and air travel, which are considers in public health bill. In case of any disputes the Epidemic Disease Act does not postulate powers which administrative authority will supersede, that are clearly mentioned in the Public Health Bill with provisions to amend.

To prevent any confusion, proper definition of disinfection, derating, isolation, quarantine, public health emergency of national concern etc. are clearly mentioned in the Public Health Bill but not in Epidemic Disease Act.

The concept of public health services is laid down in Public Health Bill which includes health promotion, immunization, prevention, treatment of disease services, environmental sanitation and includes looking after for such services which are relevant in case of pandemics like COVID-19 but are missing in the epidemic disease act.

Conclusion
There is a necessity to strengthen legal frameworks to thwart and control the entry, spread and existence of communicable diseases in India. A centralized public health law can turn out to be a game changer. As its implementation would warrant a legal framework for providing essential public health services and powers for an adequate response to public health emergencies through effectual collaboration between the center and the state. The bill adopts a right based approach and upholds the right to treatment and care. It clearly states the public health obligations of the government.

End-Notes:
  1. Rashmi Verma, Draft public health bill restrictive, unclear: Experts Down To Earth (2017), https://www.downtoearth.org.in/news/health/draft-public-health-bill-riddled-with-issues-say-experts-57430 (last visited Apr 9, 2022).
  2. Nozia Sayyed, 122-year-old epidemic diseases act to be replaced with new legislation Hindustan Times (2019), https://www.hindustantimes.com/health/122-year-old-epidemic-diseases-act-to-be-replaced-with-new-legislation/story-FfwNwi7yODWfysGwvYT6sO.html (last visited Apr 17, 2022).
  3. 2022. [online] Available at: [Accessed 16 April 2022].
  4. Samarth Luthra, S., 2022. Hindsight 2020: Retrospective analysis of the Public Health (Prevention, Control & Management of Epidemics, Bio-Terrorism & Disasters) Bill. [online] Bar and Bench - Indian Legal news. Available at: [Accessed 16 April 2022].
  5. Legislative.gov.in. 2022. [online] Available at: [Accessed 16 April 2022].
  6. Ijph.in, Epidemic diseases act 1897 to public health bill 2017: Addressing the epidemic challenges (2020), https://ijph.in/article.asp?issn=0019557X;year=2020;volume=64;issue=6;spage=253;epage=255;aulast=Bahurupi;type=5 (last visited Apr 17, 2022).
  7. Goyal, P., 2022. The Epidemic Diseases Act, 1897 Needs An Urgent Overhaul. [online] Economic and Political Weekly. Available at: [Accessed 16 April 2022].
  8. 2022. [online] Available at: [Accessed 16 April 2022].
  9. Indian Journal of Medical Ethics. 2022. The Epidemic Diseases Act of 1897: public health relevance in the current scenario. [online] Available at: [Accessed 16 April 2022].


Award Winning Article Is Written By: Ms.Ilika Grover

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