Controlling public health nuisances: guidelines for local health departments.
* sort through the many possible types of nuisance complaints, and
* more clearly define the problem and determine the most appropriate response.
This involves answering some basic questions about the nuisance complaints, how the board is organized and about other entities' authority to abate nuisances. A formal policy can help a board systematically sort through these questions and make sound determinations.
Methods and materials
A work group was convened to study public health nuisance control, focusing on questions such as:
* Who is responsible for nuisance control at the local level?
* What constitutes a public health nuisance?
* How can a public health nuisance control program be organized?
* What kind of coordination is needed with other agencies, such as social services and public safety?
A survey form was developed in which respondents were asked to identify types of nuisances that their board of health has encountered on a routine basis. It was assumed that all respondents would be familiar with nuisance complaints. Table 1 represents a summary of the survey.
A literature search was conducted by the Minnesota Department of Health Library staff; however, they were unable to locate current materials in journal publications relating to public health nuisances. On the other hand, the work group found recent articles, written by nationally syndicated columnists and local news reporters, that provided coverage of public health nuisances.
Last, state health departments across the country were contacted and asked if they had developed policies or guidelines for local health departments to use in responding to public health nuisances. Only one state responded and provided a one-page guide for local agencies. However, 20 states responded enthusiastically to the news that Minnesota had developed a guide--Controlling Public Health Nuisances: A Guide for Community Health Boards--and wrote to the Minnesota Department of Health to receive a copy of the guide. Upon presentation of a paper on public health nuisance control at the Annual Educational Conference co-sponsored by the National Environmental Health Association and the Canadian Institute of Public Health Inspectors on July 16, 1992, 54 additional requests were received. This response only serves to emphasize the need to provide information on this public health concern.
A key finding of the project involved developing a basic set of questions that are universally applicable to all nuisance complaint problems. When properly used, the questions help to quickly sort through policy, legal and procedural questions that arise when responding to nuisances.
The following questions are adapted from those developed by the group, and are designed to clearly define the problem, determine the appropriate type of remedy and clarify the board's legal authority.
1. Does the condition affect the "public?"
This question is intended to help determine whether something is a public nuisance. If the answer to this question is "no," the problem is of a private nature and may be subject to civil remedies, but is not within the scope of the board's authority. It is the rare exception that a condition is so isolated as to not affect anyone other than the one individual; it is reasonable to expect that the public will be affected as this individual relates to other persons in work and social situations. If the answer is "yes," go to the next question.
2. Does the condition affect "health," (i.e., is there a real or potential health risk)?
This question is intended to help determine whether the problem is affecting health. The following questions may help specify the nature of the health risk or help to quantify the degree of risk.
* Can the condition cause or be expected to cause transmission of disease?
* Does the condition cause or is there a potential for the condition to cause trauma or injury to the public?
* Does the condition constitute or is there a potential for the condition to constitute an exposure to hazardous elements or substances that could adversely affect the health of the public?
* Is the nature of the complaint an unsafe or potentially unsafe structural or environmental condition?
It is important to describe the risk as completely as possible. This will help in defending the judgment that the problem represents a risk to the public health. If the answer to this question is "no," the problem is not of a health nature and is not within the board's scope of authority, unless the board has authority for non-health related nuisances. If the answer is "yes," continue with the next question.
3. Does the problem require enforcement action?
This question is intended to determine if non-legal remedies may be used. If the answer to this question is "no," the board may use public information, education, consultation or other non-legal remedies to relieve the problem. If the answer is "yes," it will be important to clarify the board's ability to enforce nuisance abatement authority.
4. Is the problem specifically addressed in a local ordinance or in state statute?
This question is intended to help determine which provision of state law is most appropriate to the particular problem. Without answering this question, a board of health might take enforcement action using its general authority, when action could have been taken using separate and more specific authority for enforcement. If the answer to this question is "no" (but the answer to the previous questions are "yes"), the problem is a public health nuisance and the board's only legal option is to use its general authority for enforcement. If the answer to this question is "yes," the specific provision of law must be identified. Go to the next question.
5. Is the specific provision enforceable by a legal entity other than the board of health?
The purpose of this question is to identify the legal authority (i.e., town, city, county) with the authority to enforce the specific provision of law identified in question four. If the answer to this question is "no," the board of health is the only legal entity with the ability to enforce the provision of law requiring abatement of the public health nuisance. The board should prepare and serve an abatement order, specifically citing its authority in the order. If the answer is "yes," that there is another entity with specific authority to enforce abatement, the board must decide whether to refer the complaint to the legal entity with the specific authority to enforce the abatement or to abate the nuisance using its own general authority.
6. Will the board of health refer the problem to another entity (or abate the problem using its legal authority to do so)?
This question recognizes that other entities may have the authority to abate the nuisance. The decision as to which entity takes action will depend on the circumstances TABULAR DATA OMITTED of the complaint and on the relationship of the board with the other entities and agencies. As a general rule, the entity with the authority which is most specific to the problem in question will take the action. If the board chooses to refer the problem, it may be helpful to specify the authority it has identified as enforceable by that entity. If the board chooses not to refer the problem to another agency or entity, it must enforce the abatement using the authority it has identified.
7. Is the problem resolved?
This question is intended to determine if the abatement activity was effective. Whether the abatement activity included enforcement or involved education and consultation exclusively, it is important to determine that the nuisance has in fact been abated.
Commitment and teamwork among the board of health, its attorney and public health professionals are critical to a successful public health nuisance control program. Public health nuisances may be both a legal matter and a public health matter. A board should rely on its public health staff to determine whether a nuisance is a public health nuisance and rely on its legal staff for advice to determine suitable legal remedies.
Perhaps one of the greatest difficulties in dealing with a nuisance complaint is determining whether or not the subject of the complaint is, in fact, a public health nuisance. Also, confusion regarding the scope and authority of the board can create time-consuming delay in abating a problem. A policy that provides for a decided response to each of the basic questions can help in making that determination.
Given a clear definition of the problem and a determination that a public health nuisance does exist, the board is in a better position to determine which tools to use for the job. In some cases, education and consultation may be used to prevent or control a nuisance problem. In other cases, the problem may require enforcement action. If enforcement is required, it is very important that the board and its staff have an accurate understanding of its enforcement authority.
It is recognized that cultural differences among communities may affect tolerance levels, so the events that may be considered a public health nuisance in one area may be status quo in another. The work group of the Minnesota Department of Health acknowledged this condition, yet considered these key questions and the policy and procedures that were developed to be consistent in philosophy with general public health principles and actually allowed for professional judgment to accommodate regional differences. A carefully developed nuisance control policy can help assure that the board and staff use a variety of tools for the job, and that they use them appropriately and effectively.
1. Minnesota Dept. of Health, State Community Health Services Advisory Committee, (1992), Controlling Public Health Nuisances: A Guide for Community Health Boards, Minneapolis, MN.
Karen A. Holmes, B.S., R.S., Environmental Health Policy Analyst, Minnesota Dept. of Health, Div. of Environmental Health, 925 S.E. Delaware St., Minneapolis, MN 55414.
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|Publication:||Journal of Environmental Health|
|Date:||Nov 1, 1993|
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