Scope of public health act in protecting the health of the community

By
DR.I.SELVARAJ, I.R.M.S
B.SC., M.B.B.S., D.P.H (MADRAS MEDICAL COLLEGE).,D.I.H.,PGCH&FW (NIHFW, New Delhi) Sr.D.M.O (SELECTION GRADE OFFICER) ON STUDY LEAVE

Post Graduate student in M.D Community Medicine SREE RAMACHANDRA MEDICAL COLLEGE & RESEARCH INSTITUTE,CHENNAI,TAMILNADU

Dr.I.Selvaraj

1.The effectiveness of public health service to the community depends on the way the public health laws prevailing in the community. 2. Political support 3. People co-operation 4.Public health laws includes very many acts (MTP Act, Prenatal Diagnostic sex determination act, Indian medical council Act ,Indian nursing council Act, Indian Pharmacy act, PFA Act, Public health Act etc.,) 5. In this presentation the importance public health act and its role in the health of the community will be discussed. 6. The public health managers and community medicine experts have to play a key role in this field 7. This presentation which I made it as a gift to public health personnel and community medicine experts in my country. This will enrich their knowledge while teaching undergraduates and post graduates in community medicine, and post graduate diploma in public health. 8. This presentation will be able to disseminate various sections and other provisions of Tamil Nadu public health act to the public health specialists and make them to understand their importance in the community.

PUBLIC HEALTH
Public health is what we, as a society, do collectively to assure the conditions for people to be healthy.

TEN ESSENTIAL PUBLIC HEALTH SERVICES

Develop policies, and plans that support individual and community health efforts Diagnose & Investigate the health problems & Health hazards in the community Mobilize community partnerships Inform, educate,& empower people about health issues Link people to needed personnel health services and assure the provision of comprehensive health care when otherwise unavailable Assure a competent public health & personnel health care workforce Monitor health status to identify the community health problems Monitoring & evaluation of population based health care services Operational research to find out new innovative solution to the health problems Enforce laws and regulations that protect health and ensure safety Courtesy- Super Course

SIX PUBLIC HEALTH RESPONSIBILITIES

Prevention of epidemics & spread of disease Protection of people against environmental Hazards Prevention of injuries Promotion & encouragement of healthy behavior changes Quick response to the disaster & to assist the communities in recovery phase To assure quality, accessible, and affordable comprehensive health care services Courtesy- Super Course

THE TAMIL NADU PUBLIC HEALTH ACT (1939) A Pioneering Act 1939 Steered by Great Scholar and Minister for Health Dr.T.S.S.Rajan The Death Relief Act To improve the Health of the people of Madras province

Highlights of Tamilnadu public health act Tamil Nadu is the first state in the country to enact a law for public health Tamil Nadu Public Heath Act 1939 remains as a model till today for the entire country. Amendments in 1941, 1944 and 1958 The Act was modified in 1970 The Act was translated in Tamil in the year 1986. Tamil Nadu to its credit had the first Act in the country for Food Adulteration also Tamil Nadu Prevention of Food Adulteration Act 1918. The Act was repealed by the Central Act, 1954. Constitution of the Public Health Board. Regulations for construction of new buildings. Powers of the Police Officers to arrest offenders Powers of the Executive Officers and Public Health Staff to arrest Offenders. Act to over right other Enactments Public Health Act is supreme Power to the Government to remove difficulties in implementation of the Act as and when they appear. Powers of the Government and of the Director of Public Health and his Staff to advise local authorities There is a provision in this act for Fairs and Festivals

 Vision Healthy people in healthy community Mission To promote physical and mental health To prevent disease, injury, and disability Goal Prevention of disease Prolongation of life Improvement of quality of life Elimination of health disparity Organizing community efforts to achieve above

THE TAMIL NADU PUBLIC HEALTH ACT (1939)

Chapters 15 Sections 145 Schedules 2

Chapter

section From To 3 7 16 26 36 40 51 61

Outline of Public Health Matters

I II

1 4 8

Short Title and Extent, Commencement and Definitions Public Health Board-Constitution and Functions Powers of Govt & DPH Public Health Establishments of Local Authorities Water Supply Drainage Sanitary Conveniences Abatement of Nuisances Prevention, Notification and Treatment of Diseases - Part - I: Infectious Diseases in general Part - II: Notified Infectious Diseases Part - III: Venereal Diseases Part - IV: Powers to Make Rules

III IV V VI VII

17 27 37 41 52

62 78 81

77 80

VIII

82

Maternity and Child Welfare

IX X

83 89 94 98

88 93 96 100 107 115 125A 127 135 145

Mosquito Control Sanitation and Buildings Part - I : Residential Areas Part - II : Control over In Sanitary Buildings Part - III : Abatement of Overcrowding (Sce.97 omitted) Lodging House Food Control Fairs and Festivals Finance Rules, By-Laws, Penalties Etc., Miscellaneous: Appeals, Method of Serving Notice, Compounding, Punishment for malicious abuse of powers, Overriding etc

XI XII XIII XIV XV

101 107A 116 126 128 136

Schedule - I Schedule II

Ordinary Penalties Penalties for continuing breaches

Public health board

The Minister of public health The Minister of local administration Three members of the Tamil Nadu legislatures nominated by the Government The Director of Public Health Surgeon General The sanitary engineer One more state Government officer nominated by the Government

The Main Focus on: Environmental Health Communicable Disease Control Food Hygiene Maternity & Child Health measures

Environmental Health: Water Drainage Housing Rats, Mice and Mosquito control Nuisance Sanitation

Water Establishment of Technical Assistance for maintenance of Water works. Surveillance of Water sources Control over bottled water supply Govt. ensure local authority to provide adequate continuous, wholesome water (Sec. 17, 18, 19) Role of Govt. and other authorities in Water supply (Sec. 20, 21) Role of Railway Administration (Sec.22) Periodical Examination of Water (23) Action over the unsanitary sources (24) Prevention of Pollution of Water (36, 57) Supply of Water during Fair or Festival (120) Control over Private Water Sources (124)

Drainage: Responsibility of Local authority and private in construction of Drains and Cesspool (27, 28, 29, 30, 31, 32) Prevention of Let out of Sullage in the Streets (34) Prevention of Disposal of injurious refuse into the Drain (35)

H o u s i n g :Prohibition of Occupation of House

If it is without water supply (26) If it is without Drain (33) If there is nuisance (46) If there is notified disease (63, 70) If it is unfit for Habituation (96) Prohibition of Over crowding (98, 99, 100) Not to be erected on certain places (94) Registration, Renewal and Maintenance of Lodging House (101, 102, 103, 104, 105, 106) New house should be provided with sanitary conveniences (38)

Communicable Diseases: List of infectious diseases - Section- (52)

1. Acute influenza pneumonia 2. Anthrax 3. Cerebrospinal fever 4. Chickenpox 5. Cholera 6. Diphtheria 7. Enteric fever 8.Leprosy

9.Measles 10. Plague 11. Rabies 12. Relapsing fever 13. Scarlet fever 14. Small pox 15. Tuberculosis 16. Typhus fever

List of Notified Diseases SECTION- (62) Cerebrospinal fever Chickenpox Cholera Diphtheria Leprosy Measles Plague Rabies Scarlet fever Small pox Tuberculosis Infectious Hepatitis Epidemic Influenza Whooping cough

Viral Encephalitis Hemorrhagic fever Malaria Tetanus Poliomyelitis AIDS

 Information by Medical practitioners (56) Persons responsible for giving information (64) Appointment of Health staff, medicines appliances (53) Isolation wards, ambulance (54, 155) Disposal of bodies of person died from notified diseases (74) Venereal diseases control (78,79) a) Provision of Diagnosis and Treatment (78) b) Education of Patients (79) Destruction of Rats and Mice (77) Prevention of spread of disease (57, 58, 59, 60, 61) To prevent spread of disease in public places (63, 65, 66, 67, 68, 69, 70, 71, 72, 75) Control of other Diseases during Epidemic and Endemic (81)

Mosquito control Prevention of Mosquito breeding (83) Protection of Anti Mosquito works (86) Power to entry and inspect (85,86) S a n i t a t i o n : Responsibility of Local authority to provide Sanitary conveniences (37, 40) Provision Sanitary arrangements during Fairs and Festival (120) Provision of Sanitary conveniences in Houses (28, 39) Maternity & child health Local authority is responsible in providing these services (82)

Food control
Section 107-A prohibition of sale of food without license in certain places (Hotel, Tea shop, Coffee house, Caf, Refreshment room, Mobile canteen, or catering establishment) Section-108 No person shall keep store or prepare for sale any animal intended for human consumption which is diseased If any child < 7 years of age commits offence u/s 108 (1), the employer or the parent of the child are punishable as if the offence was committed by him (Sec.109) Section -112 deals with the power of the health officer to enter premises used for food trade Section-113 deals with power of the health officer to deal with infected vendors Meat Hygiene (110, 111) Milk and Dairy products (114, 115) There is provision for prohibition of sale of unsound foods, power of the Health Officer to enter premises used for food and power of the Health Officer or a person duly authorized by him to destroy such food article and to incorporate expenses for such destruction from the owner himself.

FAIRS & FESTIVALS

Notification of Fairs & Festivals (116) Levy of pilgrim tax and vehicle toll (117 & 118)) Authority i/c of Festival to notify HO not less than 60 days in advance to the commencement (119.1) Sanitary arrangements (120. 1 - 12) Demarcation & Preparation of site / Roads Cleaning & Draining Drinking (&Cooking) Water Supply Accommodation for pilgrims Lighting Supply of wholesome food at reasonable price Collection, removal & disposal of refuse Provision & maintenance of latrines Detection and segregation of cases of Infectious diseases. Medical Relief Others as may be specified

Authorized Persons SECTION (122) HO or Authorized Persons to Seize & destroy any food believed to be unwholesome(& perishable or value does not exceed Rs3/-) If not destroyed by HO, to be produced to prescribed authority for destruction if unwholesome or for analysis to ascertain the fitness for human consumption In any case, the expenditure to be paid by the person concerned

SECTION-(121) - Supervision & Control of arrangements by HO or

SECTION 123

The local authority may, in case of emergency with the sanction of the District Collector, depute any person to enter upon, occupy and use, without resorting to Land Acquisition Act, 1894 any land or any building not being a Dwelling house in the notified Fair or Festival Centre which in the opinion of the Health Officer, is required and suitable for any purposes connected with the Fair or Festival, such as the construction of Pilgrim sheds, Water sheds, Hospitals, Segregation sheds, Latrines and the like.. This provision is unique for Public Health Act.
HO can direct to disinfect / close any Private Water Source (124) In default, HO can take necessary action and the expenditure to be recovered from the person (124) En route Arrangements, Where large number of persons halt on their way to or return from a festival site (125)

N u i s a n c e:

Nuisances and the powers of Health Officer for abatement of Nuisances (41 to 49) Any premises in such a state as to be prejudicial to health or a nuisance (41.1) Any pond, pool, latrine, watercourse which is so foul or in such a state as to be prejudicial to health or nuisance (41.2) Any accumulation or deposit of refuse which is prejudicial to health or a nuisance (41.4) Any factory or work place is not provided with adequate ventilation or not clean or not free from noxious effluence or over crowded while work is carried as to be prejudicial to health of those employed therein (41.5) Any fire place or furnace which does not as far as predictable consume the smoke arising from the combustible used therein (41.6) Any chimney sending forth smoke in such quantity as to be a nuisance (41.7) Any noise, vibration, dust, irritating smell or offensive odour produced by a factory or work place which is nuisance to the neighborhood(41.8) It deals with inspection from time to time to detect nuisance(42) Section-45 deals with power of the health officer to abate nuisance by serving notice to defaulter or the premises owner Section 47 deals with the powers of the health officer for disposal of articles removed it while abating nuisance Section-48 deals with the power of entry of any executive or any officer from the public health department Deposition of Rubbish in streets (51)

Power of Entry

48. a: If the entry is related to Abatement of Nuisance:

Any premises not to enter between sunset and sunrise except when the nuisance is committed between sunset and sun rise Consent of the occupier is obtained 24 hrs. Prior notice has been issued

48. b: In cases of dwelling houses

If the entry is related to Notifiable diseases Section 65.1: Any premises

Without any notice in cases of factories, workshops, work places, business houses After issuing a reasonable notice in other cases and in case of dwelling house

Entry relating to Mosquito Control: Section 88: Entry at reasonable time after issuing notice Entry relating to Lodging Houses: Section 106.2: Entry at all times Manager to allow Entry relating to Food Control: Section 112.1: Anytime Day or Night without notice Any person who prevents lawful entry shall be punishable with simple imprisonment (up to 1 month) or fine (Rs. Five Hundred) or both (section 135)

General Guidelines for Enforcement of the Act Periodic Inspection of the Places, Premises or Institutions etc., Investigation of Complaints related to Public Health matters Taking note of Violations, omissions, Nuisances, failure to adopt conditions or precautions etc., - if any Advising to rectify the above Taking action if required (64 penalties) described in this schedule Penalty ranges from 10 rupees to 1000 rupees)

Method of Taking Action

Taking note of Violations, omissions, Nuisances, failure to adopt conditions or precautions etc., - if any Issue of Notice: a) The time limit prescribed b) Method of writing and serving Power of Entry and Inspection If replied Inspection and Acceptance of reply If not replied to remind if desirable compounding as may be permissible In default / not compounded Prosecution

Procedure for prosecution Make a report Enclose Inspection report Enclose Served copy of notice Enclose Reply received and the opinion thereupon (or the fact of nonreceipt of reply) Prepare and enclose Charge Sheets induplicate / triplicate Consult public prosecutor Submit for sanction of Prosecution Filing of the charge sheet in the court Conducting prosecution Obtaining a copy of the judgment Reviewing the judgment Renewed action if necessary Further prosecutions for continuing breach if any

Miscellaneous
Power to compound Offences (138.A) Power of Police Officer to arrest offenders (139) Power of Health officers, Public health Staff to arrest Offenders (140) Punishment for malicious abuse of powers (143)

Penalties Breach of rules (129) Breach o by-laws (132) Offences under the Act (134.1) &Schedule I &II Preventing entry (135)

STRENGTHENING OF PUBLIC HEALTH ACT

Emerging and re-emerging diseases Increasing industries in food production Emerging social issues like Gender issues, adolescents, geriatric issues Increasing environmental hazards Ozone layer, weaning greenery, radiation, bio-degradation, environmental pollution due to changing life styles. Public Health Service Made as an essential service Control of Health Officer over Public Health staff need to be strengthened Education and Training of Public Health Staff

Provision of Public Health Laboratory for diagnosis of communicable diseases

Establishment of Sentinel surveillance

Special provision for treatment of other diseases like Tuberculosis, Leprosy, Hepatitis, Leptospirosis etc.

Licensing of hospitals, all type of laboratories, blood bank.

Control over the burial ground and burning ghat

The Penalty provisions has to be increased Stringent action should be taken against those violating the act
Prohibition of Tobacco and Related items Establishment of Health Education units

Medical institutions to maintain register of communicable diseases. Control over disposal from Hospitals

Places of swimming pools, Holiday resorts, Holiday camps to be monitored Fixing standards of pollution (use of Plastics, Air, Noise and Radiation hazards
Schools, Hostels, Colleges and Factories to be inspected periodically

Prevention of Quack practitioners.

Prevention of sale of Medicines across the counter

CONCLUSION:
The developing countries have to develop a model Public Health Act and modifications and amendments if and when necessary could be made at the appropriate time and appropriate level. Public Health Act if it has any weak areas, It has to be identified and modified by suitable amendment to suit the present needs.

Acknowledgement: 1.Supercourse 2.Dr .P. Krishnamurthy Rtd. Director of Public Health and Preventive Medicine, Government of Tamil Nadu - Chennai 600 006 3. Tamil Nadu Public health Act, 1939 4. Dr G. Palani, Professor, Department of community medicine, SRMC&RI