Bridging the Gap: Integrating Legal Education Into Public Health Continuing Education

Law is a fundamental tool of public health interventions, shaping health outcomes and social determinants of health. This commentary is the third in a series aiming to explore legal education and training for public health practitioners. As previously noted, ¹ and as articulated in the first 2 commentaries in this series, law is a crucial, yet often underemphasized, component of public health education and training. The first commentary, “Legal Work of Public Health Professionals: The Case for Better Professional Education,” emphasized the role that legal knowledge and skills play in the effectiveness of public health systems and the need for legal literacy among public health practitioners. ² The second commentary, “How to Advance Legal Education for Future Public Health Professionals,” outlined strategies for embedding legal principles into public health curricula and advocated for the incorporation of law into public health education. ³ This third commentary expands the conversation to law-related continuing education for public health professionals, asserting that integrating public health law into continuing education equips professionals with essential competencies to navigate the complex legal landscape and enhance public health practice.

The development of this commentary did not involve human data or participants; therefore, institutional review board assessment was not necessary per the policy of the Office of Science and Medicine at the US Department of Health and Human Services, Office of the Assistant Secretary for Health.

Importance of Embedding Legal Principles in Public Health Continuing Education

The intersection of law and public health has garnered major attention, especially in the wake of global health crises. The COVID-19 pandemic revealed knowledge gaps among workers in public health on laws that shape effective policymaking and practice. In addition, public health practitioners are increasingly concerned about the reduction or elimination of their legal powers in many jurisdictions. The public health field has also experienced substantial turnover, with some 46% of public health practitioners leaving during the COVID-19 pandemic, ⁴ highlighting the urgent need for continuing education in public health law across all levels of experience within the profession.

Continuing education allows ongoing professional development for people in the workforce. Continuing education may include degree credit courses, workforce training initiatives, conferences, experiential learning programs (eg, fellowships, residency training programs), on-the-job training, or self-directed learning. ⁵ Continuing education in public health law can enable practitioners to stay up-to-date on best practices, current developments, ⁶ new knowledge, and research, and training in strategic legal thinking may help public health practitioners make informed decisions. Whether public health practitioners are interpreting health regulations, navigating legal constraints, or addressing ethical dilemmas, a solid grasp of the law enhances their problem-solving capabilities. Having a solid grasp of the law, which enhances problem-solving capabilities, leads to more effective and legally sound public health interventions. Understanding legal requirements, liabilities, and risks can reduce the risk of violations and associated penalties and can enable public health practitioners to implement strategies that mitigate these risks, ensuring safe and efficient public health practices. ¹

Moreover, bringing law into continuing education opportunities in public health is a potentially powerful strategy to advance health equity in a sustainable and long-lasting way. Legal frameworks shape the social determinants of health, such as access to health care, housing, education, and employment. By incorporating legal principles into public health continuing education, practitioners gain a comprehensive understanding of how laws and policies influence health outcomes. Knowledge of legal principles equips public health practitioners to better identify and address the systemic barriers that contribute to health disparities. For example, an understanding of the legal tools for addressing environmental injustices enables public health professionals to take steps toward legal action that can protect populations who are at increased risk from harmful public health exposures.

Practitioners who infuse public health law into public health practice can engage more effectively and efficiently with policy makers. Knowledge of legal structures and public health powers can enable practitioners to make credible, evidence-based legal arguments and to contribute to the development of robust legislation that furthers public health efforts. This advanced level of advocacy is crucial for addressing social determinants of health, achieving sustainable health improvements, and advancing health equity.

The integration of legal principles into public health continuing education fosters collaborations between public health professionals and legal experts, allowing public health professionals to provide relevant and timely training content for the workforce. This interdisciplinary approach enhances the overall effectiveness of public health initiatives. Legal professionals can offer valuable insights into legal authorities, regulatory compliance, and risk assessment, whereas public health practitioners can provide expertise in health promotion and disease prevention. In addition, the inclusion of training and workforce development experts and public health educators ensures that adult learning principles are applied and relevant competency models are aligned. Together, legal professionals, public health practitioners, training and workforce development experts, and public health educators can design and implement comprehensive strategies that address complex health challenges—combining legal expertise with scientific insight.

Law in Public Health Continuing Education: Frameworks and Initiatives

The integration of law into public health continuing education should involve leveraging frameworks and initiatives designed to equip public health professionals to perform their roles effectively. For example, the 10 Essential Public Health Services ⁷ framework delineates core functions necessary for promoting and protecting population health. Among these public health services, 2 domains specifically highlight the role of law. However, all 10 services rely on legal knowledge to varying degrees. For example, the services related to monitoring health status; diagnosing and investigating health problems; informing, educating, and empowering people about health issues; and mobilizing community partnerships all intersect with legal requirements such as confidentiality laws, informed consent regulations, and the establishment of partnerships through formal agreements or regulations.

Complementing these services are the 5 Essential Public Health Law Services, ⁸ which emphasize legal capacities that are critical to public health practice. These public health law services include assessing and addressing the health effects of laws, regulations, and policies; ensuring compliance with laws and regulations; and advocating for laws, regulations, and policies that promote public health goals. These services connect with and expand on the foundational services outlined in the 10 Essential Public Health Services, ⁷ highlighting the symbiotic relationship between public health and legal frameworks and the critical role that law plays in the everyday practice of public health.

Standards from the Public Health Accreditation Board emphasize legal considerations in various public health activities, such as monitoring health status, developing policies, ensuring a competent workforce, and conducting research. ⁹ Accreditation standards aim to ensure that public health departments across jurisdictions of varying sizes, each responding to unique public health needs, meet established performance standards, many of which are grounded in legal requirements and principles.

The Public Health Law Competency Model ¹⁰ from the Centers for Disease Control and Prevention (CDC) outlines competencies for public health practitioners that are essential to understanding and applying legal principles effectively in their work. Similarly, the Legal Epidemiology Competency Model ¹¹ provides a framework for developing competence in legal research, analysis, and application to public health issues. These models guide the development of programs and resources that enhance the legal preparedness of public health professionals across all levels of experience.

Public Health Law–Related Continuing Education

Law-related continuing education for public health practitioners can encompass various formal and informal avenues. Ongoing professional development is supported by online courses and webinars from institutions such as the 10 regional public health training centers funded by the Health Resources and Services Administration of the US Department of Health and Human Services (https://phtcn.org). Formal training programs are also available, such as workshops and resources on legal epidemiology offered by the Center for Public Health Law Research. ¹² The Network for Public Health Law offers timely law-related continuing education on how public health law is being used and addressed in the field. ¹³ ChangeLab Solutions also offers comprehensive training and resources on public health law, policy development, and implementation (https://www.changelabsolutions.org). Of note is its Public Health Law Academy, ¹⁴ developed in collaboration with CDC’s Public Health Law Program, which provides a collection of online, on-demand training on public health law. Trainees can earn a certificate from the Public Health Law Academy by completing 7 modules.

Conferences, such as annual meetings of the American Public Health Association, ¹⁵ the National Network of Public Health Institutes, ¹⁶ and the Public Health Law Practitioners Convening hosted by the National Association of County and City Health Officials, feature presentations by experts who discuss developments in public health law and provide opportunities for public health practitioners to enhance their legal knowledge. ¹⁷

In addition, the Public Health Learning Navigator, hosted by the National Network of Public Health Institutes, offers curated, high-quality asynchronous training from various reputable training developers. ¹⁸ The Public Health Foundation’s TRAIN.org platform ¹⁹ also offers an array of public health training opportunities, including courses on legal principles relevant to public health practice. These initiatives collectively support the law-related continuing education and professional development of public health practitioners.

Gaps and Deficiencies in Law-Related Continuing Education for Public Health Professionals

Despite the availability of the aforementioned programs, gaps remain in law-related continuing education for public health professionals. Many existing programs often overlook the necessity for a more skill-based education, such as training in regulatory enforcement and legal design, which are essential competencies for public health professionals to effectively navigate the legal landscape. This lack of comprehensive legal training can leave public health professionals underprepared to navigate complex legal challenges in their work.

In addition, legal principles are often taught in isolation rather than being woven into the broader public health curriculum. This siloed approach can limit the ability of public health professionals to see the connections between legal frameworks and their practical applications in public health interventions. For example, understanding the legal underpinnings of vaccination policies or quarantine measures is crucial for effective implementation and compliance, yet these connections are frequently not emphasized in public health continuing education.

The accessibility of legal training and education can also be a barrier. Many public health professionals, particularly those with limited financial, staffing, or educational resources, may not have access to high-quality law-related continuing education or funding for travel to conferences. In addition, online resources and webinars, although helpful, may not provide the depth and interactivity needed to fully grasp complex legal concepts.

Integrating Legal Principles for Practical Application

A more structured and cohesive approach, rather than the current ad hoc and siloed programs, is necessary to address the present and anticipated gaps in public health workforce training. We recommend 7 approaches that public health workforce development programs can take toward embedding legal principles into continuing education.

The first approach is for developers and educators of public health training to intentionally infuse law and legal principles in public health continuing education across topics and subjects. This foundational step guarantees legal training and education are not just theoretically sound but also practically applicable, equipping health care practitioners with the knowledge needed to navigate the legal landscape of public health in their day-to-day work.

Second, the integration of law and legal principles in public health continuing education should leverage technology. Online modules and virtual reality can make learning engaging and accessible. Online modules allow public health practitioners to learn at their own pace, accommodating their busy schedules. Virtual reality can provide immersive learning experiences, such as simulated public health crises, where public health practitioners can interact with legal scenarios in a lifelike setting. Technology tools not only make learning more interactive but also bridge the gap between theory and practice. The use of technology can provide a flexible and scalable solution to delivering high-quality legal training and education to a wide audience of public health professionals.

Third, public health educators should include interactive and applied learning methods to translate theoretical knowledge into practical skills. The use of case studies, simulations, and role-playing scenarios can greatly enhance the learning experience for public health professionals. Interactive and applied learning methods allow public health practitioners to apply legal concepts to real-world situations, thereby improving their decision-making skills and problem-solving abilities. For example, a simulation of a public health emergency can serve as a practical exercise for public health practitioners to proactively assemble and present the necessary evidence to support quarantine orders and vaccination mandates, preparing them to justify these measures if contested in court, and to strategize effective implementation solutions.

Fourth, efforts should be made to improve the accessibility of legal training through partnerships with online platforms, professional organizations, and academic institutions. For example, state and local public health departments could explore integrated learning opportunities with law schools, similar to academic partnerships with schools of public health. Joint seminars and cross-disciplinary workshops can provide a deeper understanding of how legal and public health principles intersect and foster a multidisciplinary approach. Such collaborations can help public health practitioners appreciate the broader legal context of their work and encourage a more holistic approach to public health challenges.

Fifth, institutions should implement and support policy changes to embed law in public health training. This support can come in the form of dedicated budgets, partnerships with legal organizations, and integration of legal training and education into accreditation standards for public health programs. For example, the development of legal skills for public health practitioners could be contemplated and supported by funding mechanisms such as CDC’s capacity building and technical assistance ²⁰ services and investments. These services play a pivotal role in enhancing the capacity of public health agencies and practitioners to effectively address public health challenges through evidence-based practices and policies. By integrating legal expertise into cooperative agreements and grants, CDC and other funders can bolster the ability of public health professionals to navigate legal complexities, interpret and apply regulations, and advocate for health-promoting policies.

Sixth, efforts are needed to train the trainers, that is, public health educators, to teach legal content. Developers of public health training need specialized training and resources to ensure that the legal education programs that they create and deliver are both effective and relevant for public health practitioners. Developing partnerships with legal professionals for teaching can enhance the quality of law-related training and continuing education in public health programs. For example, involving attorneys or legal scholars in the training process can provide public health practitioners with expert insights and real-world perspectives. This collaborative teaching model can enrich the learning experience and ensure content is both accurate and practical.

Seventh, for continuous improvement, methods are needed to assess the effectiveness of law-related continuing education in public health. Surveys and performance metrics can be used to evaluate the effects of training programs on public health professionals and to identify areas for enhancement. Regular assessment and evaluation can be used to ensure that training remains relevant and effective, adapting to the evolving needs of public health professionals. By maintaining a commitment to quality and continuous improvement, those responsible for creating public health trainings—whether public health departments, schools, or other organizations—can ensure that law-related training and continuing education programs effectively prepare practitioners to navigate the complex legal landscape of public health.

Conclusions

Infusing law into continuing education for public health practitioners is essential for equipping the public health workforce with the necessary skills to navigate the complex legal landscape that forms the structures and systems of the everyday practice of public health. Integrating legal training and education into ongoing professional development ensures that public health practitioners are well-versed in the legal frameworks governing public health interventions, from vaccination mandates to quarantine regulations and health equity policies. This integration enhances the ability of public health professionals to make informed decisions, comply with legal requirements, manage risks, and advocate for policies that promote equity and justice in public health in meaningful and sustainable ways. Embedding legal principles in continuing education not only builds individual competencies but also strengthens the overall capacity of public health systems to respond effectively to evolving public health challenges, ultimately leading to more robust public health policies and improved health outcomes.