The Exercise of Public Health Powers in an era of Human Rights: the particular problem of tuberculosis

Public health legislation provides powers of removal to hospital and detention in circumstances where a patient with active, infectious tuberculosis (TB) is unwilling to comply with the recommended treatment programme. However, these public health powers were drafted at a time of very different scientific understandings of the epidemiology of disease, and at a time of a very different appreciation of the balance between State paternalism and individual rights. The re-emergence of TB as a serious threat to public health in Britain, and the increasing incidence of multi-drug-resistant TB raises concerns about public health approaches to non-compliant patients. The Human Rights Act (1998) introduces into English domestic law, protections against interference with individual rights by public authorities. The Human Rights Act not only provides a new basis of challenge of the exercise of powers by a public body, but has also had implications for the development of traditional means of challenge such as judicial review and litigation for damages. The consequence is that NHS authorities and local authorities are now more vulnerable to challenge in the exercise of public health powers. Health bodies should explore all possible alternatives to detention of a patient suffering from TB. It is to be hoped that the heralded reform to public health legislation is undertaken as a priority.