The Bullitt County Board of Health adopted a regulation last March that would limit smoking in bars, restaurants, workplaces and public places, to protect the health of Bullitt County's citizens and workers. Similar restrictions are becoming more common, and already exist in 30 communities throughout Kentucky.
City and county officials in Bullitt who oppose the regulation have taken the fight to the courthouse and Bullitt Circuit Judge Rodney Burress decided last week that the board of health does not have the authority, under Kentucky law, to restrict smoking.
On the surface, this appears to be a local story with a local resolution.
Burress' decision has the potential to impact every health department in our state, in ways that reach far beyond the issue of smoke-free workplaces.
Departments of public health, in Kentucky and in other states, have been granted wide-ranging authority. Kentucky's health statutes give health departments the authority to abate "nuisances, sources of filth and causes of sickness," and they may use all the reasonably necessary public health tools to carry out their duty.
It's a broad grant of administrative power because the sources of sickness and disease can be found almost anywhere, appear suddenly, and have devastating consequences. Legislators have recognized this and provided health departments important instruments to deal with these sorts of threats to health.
The "police power" of the state is as important in preserving health as it is in dealing with felonies. Using this broad authority, Kentucky and other states have stopped major health threats. How long has it been since we have had cases of polio or smallpox? These public health interventions are powerful — and they work.
Since the turn of the century, health departments have worked to ensure clean water, safe food in restaurants and screening services for chronic diseases. Perhaps the most powerful public health tool at our command is the ability to promulgate and enforce health policy, one of the 10 essential public health services.
The result: The lifespan of Kentuckians is longer, and quality of life is better in many ways. For example, over the years a partnership developed among private business, local elected officials and the health department that protects the public from food-borne illness and indirectly protects the business from liability by serving food that can make patrons sick. Similar partnerships exist with regard to water quality and response to natural disasters: Local government, private businesses, other community partners and the health department work together to reduce the threat to health. Everyone benefits.
In oral arguments in the Bullitt County case, those who oppose the health department regulation argued that allowing the health department to limit smoking exceeds the health department's authority. But it is clear that the General Assembly intended the health departments to have that broad authority, and that decision has improved the public's health.
There is precedent in other states for Bullitt County's action. Appellate courts in West Virginia and Massachusetts litigated health department regulations, with similar language to the law in Kentucky, limiting smoking, and found that the health department did not exceed its authority.
Opponents of the health department's regulation argued that city and county employees would be required to act under the direction of the health department. But today, all across the commonwealth, health departments work with city and county governments on such wide-ranging issues as flood clean-up or septic field suitability.
Other health departments in Kentucky — for example, Woodford, Madison and Clark counties — have smoke-free regulations, and they're working fine. Our public health partnerships work for you.
Burress' decision that the health department has overstepped its bounds is a setback for the health of the people in Bullitt, the majority of whom favor the health department's regulation. Worse yet, he sets a dangerous precedent that stands in the way of the health department having the authority to intervene to prevent illness, a long standing legal precedent, and places obstacles in the way of the health departments doing their job of providing public health benefits in our communities.
He would unravel the relationships that have allowed health departments, working with community partners, to make a real difference in our life expectancy and our health.