Overview of Public Health Act
The Public Health Act consists of 10 parts. An overview of each part and division of the act is summarized below along with some examples for which the act could be applied. Examples are provided in italics.
- Division 1 - Making Public Health Plans
- Division 2 - After Public Health Plan is Made
- Division 3 - Reporting Disease, Health Hazards and Other Matters
- Division 1 - Preventing Disease and Other Health Hazards
- Division 2 - Regulating Activities that May Cause Health Hazards
- Division 3 - Regulating Health Impediments
- Division 1 - Inspections
- Division 2 - Order of the Minister
- Division 3 - Orders Respecting Infectious Agents and Hazardous Agents
- Division 4 - Orders Respecting Health Hazards and Contraventions
- Division 5 - Making and Reviewing Orders
- Division 6 - Enforcement of Orders
- Division 1 - Application of this Part
- Division 2 - Emergency Powers
- Division 3 - When Authority to Act under this Part Ends
- Division 1 - Minister
- Division 2 - Provincial Health Officer
- Division 3 - Medical Health Officers
- Division 4 - Environmental Health Officers
- Division 5 - Other Matters Respecting Health Officers
- Division 6 - Local Governments
This Part provides the definitions needed for the Act. Updated public health terms include: communicable disease, infectious person, thing or agent; preventive measures; health hazard; health impediment, and syndrome.
This Part of the Act provides the tools to require making of public health plans, identifying urgent public health matters, and assessing the health of the public. The purposes of public health plans may include: promoting and protecting health and well being, identifying the needs of specific populations (i.e. aboriginals, new immigrants) addressing mental health and substance use issues, and preventing and mitigating the adverse affects of diseases, disorders, disabilities, and injuries.
To support the implementation and coordination of health promotion, health protection, and disease and injury prevention across the continuum of health the minister may require development of public health plans.
For example, public health plans could be used to support localized planning for West Nile virus prevention and response, community wide contamination events such as lead contamination, and community mental health and substance use services planning.
The provincial government or local governments may be required by Cabinet to ensure that public health plans are consistent with statutory decisions, bylaws, and planning processes.
For example, these provisions could be used to support planning processes to facilitate decision making about locating mental health and substance use services, or support a local air shed improvement plan by ensuring that provincial and local government decisions are consistent with improving air quality.
The mandatory reporting of public health indicators such as infections, exposures to environmental toxins and poisonings, health hazards, and other public health matters enhances the ability of public health officials to monitor, respond to, and prevent public health problems. Public health officials are given authority to collect samples, perform diagnostic examinations, and request and disclose information for the purposes of monitoring and controlling infectious and hazardous agents, and other public health issues. To protect privacy personal information may only be collected, used, or disclosed if necessary and only for certain purposes.
For example, reporting of toxin levels in blood, such as lead and mercury, could be used to identify potential environmental health contamination problems. Reporting bat bites could be used to ensure rapid vaccination. This section could also be used to expedite disclosure of personal information to other jurisdictions to enable follow up of communicable disease exposure e.g. sports team members names and contact information from other provinces and states who have all eaten at a banquet and many have started getting very ill.
This Part of the Act provides a regulatory framework for mandating preventive measures and dealing with health hazards or health impediments by ensuring that government and health officials have the authority they need to take actions to protect the health of the public.
Examples of protective actions include quarantine and isolation measures, and closures of public places to help prevent the spread of a disease or health hazard. Medical health officers are empowered to quarantine and isolate individuals who pose a significant risk of spreading serious communicable diseases to others, but enforcement of these powers would only be used for individuals who do not voluntarily comply with medical health officers’ directions or orders.
An additional provision is included to allow a quarantine order to be made to a group of people to expedite the prevention of disease. This could apply, for example, if employees at a work site or a group of people at a social gathering were exposed to a disease that posed a serious public health risk.The ability to quarantine groups of individuals was an important power that had to be provided to deal with the SARS situation in Ontario.
The Act ensures administrative fairness by allowing for reconsideration of orders by the health officer, and review of orders by a senior health officer or the Provincial Health Officer. Judicial review is also available.
The Act also requires accountability for emergency powers exercised by health officials, and individuals affected must be given written reasons and/or rights to reconsideration or re-assessment once the emergency ends
Privacy protection is an important feature of the Act, and the conditions under which health officials may request or disclose information are limited and specific. Information collecting, use and disclosure is subject to the Freedom of Information and Protection of Privacy Act, or the Personal Information Protection Act.
A regulatory framework to control the spread of infectious diseases and health hazards is included. People infected with specific agents may be required to take preventive measures such as vaccinations, or comply with medical instructions to prevent disease transmission. Individuals subject to preventive measures regulations may register an objection for reasons of conscience or personal health concerns.
For example, this section could require that people with sexually transmitted diseases obtain treatment and not spread their disease, or require that new born infants have their eyes treated to prevent eye infections with Chlamydia.
To assist in the prevention and control of health hazards operators of regulated activities (e.g. swimming pools, personal services operations such as tattoo parlours) are required to prevent, recognize and respond to health hazards. Licenses and/or permits for regulated activities may be cancelled or varied by a health officer if the operator is causing a health hazard or contravening the Act. The process for reviewing license or permit applications, or suspending, cancelling, or varying licenses or permits is clearly defined to provide transparency and accountability.
Currently regulated activities include sewage systems, swimming pools, personal services establishments (i.e. tattoo parlours, body piercing operations), tanning facilities, and industrial camps. This division provides for regulation of a wide variety of other activities such as human breast milk donation and distribution, and unconventional therapies that may pose a health risk such as hyperbaric oxygen chambers.
Health impediment regulations help mitigate public health hazards that result from long-term, cumulative exposures. Health impediment regulations may place restrictions on activities that contribute to the burden of chronic diseases or disabilities, interfere with the prevention of injuries, or result in poorer population health. People subject to health impediment regulations must ensure that employees are properly trained and equipped to comply with regulatory requirements.
Regulating trans fats in food service establishments and tanning services for minors are health impediment regulations that have been made. Examples of health impediment regulations that could be made include access to vending machines with unhealthy food by children, or advertising of unhealthy food to children.
This Part ensures that public health officials have the powers necessary to monitor for health hazards and health impediments, and ensure compliance with the Act, while protecting individual rights under the Charter of Rights and Freedoms. It outlines the ability of the minister and health officers to make orders to address public health issues. It ensures that public health officials have the tools necessary to deal with the full range of communicable diseases and health hazards that arise, especially based on experiences with SARS, West Nile virus and the threat of pandemic influenza. This Part also recognizes the potential impacts of public health powers, and includes safeguards to protect liberty and privacy interests.
In addition, this Part provides mechanisms to recover costs incurred in abating health hazards.
Health officers are given the authority to inspect vehicles and places to investigate health hazards and ensure compliance with the Act. Health officers may collect and request information provided that the inspection is conducted for public health protection purposes and the owner of the vehicle or place is notified e.g. inspecting a train to evaluate an outbreak of gastroenteritis among passengers.
The minister’s authority to designate a temporary quarantine facility to control communicable diseases and respond to environmental health hazards is clearly defined. Included is the ability to compensate owners of facilities so designated.
The powers of medical health officers to investigate and prevent the transmission of infectious or hazardous agents are strengthened and clarified. Medical health officers have the ability order individuals to be supervised by a medical practitioner; be quarantined or isolated; undergo a medical or diagnostic examination; and provide relevant information, samples or records.
Health officers (which include medical health officers and environmental health officers) have the legislative authority to identify, prevent and mitigate health hazards and enforce compliance with the Act. Health officers’ powers are broad given that health hazards may include many things that adversely affects public health e.g. sewage contamination, unhealthy or dangerous swimming pools, mercury contamination of an apartment building. Costs incurred may be recovered from the individual who created the health hazard. Notices may be placed on the land title if a health hazard is associated with the land e.g. wells with high levels of arsenic.
Processes for health officers to issue orders are updated; how orders are made and served and when orders are terminated is clearly defined. The rights of individuals affected by a health officer’s orders are also protected by provisions that allow a request for reconsideration, review and reassessment of the order.
Health officers may take enforcement measures in situations where individuals are not compliant with the Act, or pose a threat to their personal health or public health. Health officers may: obtain a warrant to enter and search a place; obtain an injunction to stop a person from violating the Act; obtain an order to detain an infected individual; order an individual to submit to public health protective measures; or order an individual to move to a residence where the person’s health is not endangered.
For example, this section could be used to detain people with tuberculosis that refuse to go on treatment and stay isolated until they are no longer infectious; or to remove people living in squalid conditions which threaten their health and for whom all other avenues to assist them have been exhausted.
This Part provides health officials with the ability to act in emergency situations, and to act outside the normal scope of the Act if compliance with its provisions would hinder the official in reducing an immediate and significant public health risk. This Part recognizes that such powers are exceptional; it provides accountability for such actions ensures that such actions cease as soon as they are not required.
The circumstances under which public health emergency powers may be invoked are specified to ensure that emergency powers are only used to protect the public from immediate and harmful health risks. Health officers can respond to a local public health emergency if immediate action is required and complying with the Act will hinder their actions e.g. needing to immediately stop a sewage discharge that is flowing into a ditch running past a school by issuing a verbal order, or needing to verbally require people to remain in a place for evaluation due to a potential bioterrorist event, or needing to verbally order immediate evacuation of a tent city due to an outbreak of meningitis and not allow for all the people at risk to have the decision reconsidered.
A regional or provincial public health emergency may be determined by the provincial health officer if a serious, unusual, or highly infectious health threat exists e.g. need for the Provincial Health Officer to direct the province wide public health response to the sudden emergence of pandemic influenza.
Public health officials have powers to respond immediately to emergencies to protect the public from significant harm; they can be authorized to act outside their area of designation and are exempt from the Act’s formal requirements (e.g. conduct an inspection without a warrant). During a public health emergency, health officers may order individuals to take preventive measures or be detained. The Provincial Health Officer may order that a specific infectious or hazardous agent is reportable to enable the surveillance of a new or unknown health hazards e.g. SARS. In addition, the minister may make emergency regulations to provide health officials with the necessary authority and means to protect public health.
The use of emergency powers ceases as soon as they are no longer necessary. After an emergency is over, public health officials are held accountable for exercising emergency powers by being required to provide individuals affected during an emergency written reasons and/or rights to reconsideration or re-assessment of an order once the emergency ends. Public health officials must also meet any requirements of the Act that they omitted during the emergency.
This Part updates public health legislation by identifying the relevant entities involved in public health, and by assigning clear powers and duties. It clarifies the relationship of public health officials to regional health authorities and local governments.
The role and powers of the minister in public health promotion and protection are defined in order to clarify the relationship between the minister, other health officials, the provincial and local governments, and health authorities. The minister has the ability to establish: public health directives; health standards that must be met by certain facilities, places, persons or procedures; and standards of public health training and practice for environmental health officers.
The minister evaluates and advises about the health impact of actions by other parts of government.
As the senior public health official for British Columbia, the Provincial Health Officer is provides independent advice to the minister and public officials on public health issues. The Provincial Health Officer is required to annually report on the health of the population and the government’s progress in achieving population health targets. The Provincial Health Officer also establishes standards of practice for, and conducts performance reviews of medical health officers.
The powers and duties of medical health officers are consistent with those of the Provincial Health Officer, such as providing independent advice to health authorities and local governments about public health issues and making public reports. The appointment process for medical health officers and the medical health officer’s training and education qualifications are outlined.
For example, this section provides the legislative base for medical health officers to issue public reports/advice on issues which may not be popular such as safer sex, smoking restrictions, milk pasteurization, water treatment, harm reduction, health based regulation of psychoactive substances, or immunization of children against sexually transmitted diseases. Requiring medical health officers to consult with the Provincial Health Officer, and local governments or health authorities affected by the report will ensure that careful consideration of the implications of the report and notice of affected parties is provided.
The powers and duties of environmental health officers are described elsewhere in this Act and other public health legislation; environmental health officers’ powers are limited to their designated geographic region. A health authority may designate an environmental health officer provided that the minister’s training and qualification requirements are met. An environmental health officer’s designation ends when he/she is no longer an employee or the health authority withdraws the designation.
To assist with situations in which other legislation provides powers and duties to health officers, the Public Health Act provisions will apply.
If a number of health officers have the same designated geographic region, they may act independently or cooperatively.
Medical health officers are responsible for responding to public health threats within their designated areas and health authorities must provide their medical health officers with the necessary staff and resources for responding to local public health threats.
Individuals may exercise powers and duties delegated by the Provincial Health Officer or medical health officers. The delegation can be removed at any time, may be subject to conditions; and the delegated individual may also be required to produce evidence of his/her authority.
To clarify the roles of local governments, the public health powers and duties of local governments are defined. Local governments must report and/or respond to health hazards. The local government must also designate a local government liaison to facilitate communication with public health officials. A local government may ask a medical health officer to issue a health hazard abatement order, and may ask the Provincial Health Officer to review the matter if the medical health officer does not issue the order.
The minister has the ability to order an inquiry to assess the health impact of a policy, legislation, plan, agreement, or a specific public health issue. Commissioners are appointed to conduct inquiries; they have the ability to gather information, maintain order during an inquiry, enforce compliance with the commissioner’s orders, and hire staff to conduct an inquiry.
For example, the minister could use this section to appoint a commissioner to investigate the use of improperly processed bone used in surgeries, or the response to an outbreak.
Inquiry commissioners and health officers may obtain the assistance of peace officers to obtain compliance from individuals (i.e. enforcing an order, carrying out an inspection).
To maintain confidentiality of personal information, individuals that have access sensitive information are not allowed to disclose it other unless they have the legislative authority to do so (e.g. to other health care providers for the purpose of tracing contacts of infected persons). This will help ensure that people trust that their information will remain confidential so that they do not hesitate to see health care workers, while allowing for the information to be used for health protection and improvement purposes.
Health officers, medical practitioners, commissioners and employers of individuals that perform duties under the Act are immune from litigation if they did not act in bad faith. The personal and financial interests of a person who assists public health officials in carrying out their duties under the Act are also protected against adverse actions such as intimidation or financial penalty. These provisions ensure that individuals who assist in the administration of the Act or perform their duties under Act are not prevented from acting out of fear of retaliation.
This part defines which actions constitute offences under the Act and describe a range of penalties to encourage compliance and act as deterrent to violating the Act.
A legislative framework for administrative penalties is provided as an alternative to court imposed fines and imprisonment and more immediate form of enforcing the Act. Administrative penalties could be used if an activity will potentially be subject to frequent sanctions and it is desirable to handle offences outside of a court process. Administrative penalties have the benefits of having more streamlined enforcement processes, relieving the pressure on the court system, and reducing enforcement costs. Administrative penalties may be recovered as debt owed to the government.
For example, it might be preferable to have infractions related to personal services such as tattoo parlours or sun tanning operations dealt with by an administrator rather than by the courts.
Actions committed by individuals that violate the Act or interfere with public health officials carrying out their duties under the Act are offences. Offences are clearly defined and separated based on their severity. A person may defend himself/herself against being convicted if it can be proven that every effort was made to avoid committing the offence, or that he/she acted on information or an order from a health officer.
Prior to sentencing, lawyers are to submit information about the offence’s mitigating or aggravating circumstances that should be considered by the sentencing judge. To ensure consistency in determining which penalty should be imposed, guidance is provided to judges regarding the objectives of sentencing. Alternative penalties such as remediation and compensation are also described; they may be imposed in combination with, or replace fines and imprisonment.
For example, if someone creates a health hazard, such as contaminating a public place with mercury, they could be required to clean it up or pay for the clean up rather than be fined.
In this Part, regulation making abilities that support the previous sections are described in detail. Significant regulation making abilities include the ability to:
- require a wide range of important public health issues to be reported e.g. cancer, toxic environmental exposures, congenital anomalies , non-communicable diseases, injuries and poisonings.
- regulate activities that can cause health hazards or health impediments.
- clarify or limit purposes and put constraints on how information may be collected, used, and disclosed.
- have local government plans, planning processes, and bylaws altered or set aside based on specific criteria.
- regulate public toilets (to prevent charging a fee) and rental accommodations for health and safety standards.
For example, this section could provide the basis for setting aside zoning bylaws which zone out harm reduction services from a community.
When a new piece of legislation has been enacted, there is a period of time that must pass before it comes into force. This Part of the Act allows for the orderly introduction and implementation of the new Act, repeals outdated legislation (e.g. the Health Act, the Venereal Diseases Act, the Public Toilet Act) and updates Acts that previously referenced the Health Act.