Public health law and disaster medicine: understanding the legal environment

Disaster medicine specialists, policy makers, and the public often feel frustrated when they encounter the complex legal framework that surrounds public health emergencies and disasters. Such a framework is particularly difficult to understand when one considers that the federal government has no express powers over public health or disaster management. In fact, under the US Constitution, the states, rather than the federal government, possess public health governance. Although public health sovereignty formally resides within the states, and notwithstanding the federal government's lack of express constitutional powers over public health crises and disaster management, the federal government has gradually taken on a greater leadership role in managing public health emergencies. In order to clarify the state and federal responsibilities surrounding public health emergencies and disasters, this article explores necessary and pertinent legal topics. These topics include public health duties, public health disasters, state sovereignty, governmental coercion, de facto constitutional empowerment, separation of powers, limited powers, federalism, state police powers, general and federal declarations of emergencies, the Model State Emergency Health Powers Act (MSEHPA), and public health and national security.