Complementarity in Public Health Systems: Using
Redundancy as a Tool of Public Health Governance
Lance Gable* & Benjamin Mason Meier**
Modern notions of public health law embody an astounding complexity.
Layers of authority arise from the accretion of legislative, regulatory, and
common law developments over many years and across many subjects and
jurisdictions.1 As recognition of the variety and interconnectedness of public
health threats has grown to encompass both proximal and distal determinants
of health, the application and relevance of law has evolved to address these
challenges.2 Traditional understandings of public health law focused
primarily on alleviation of infectious diseases, promotion of sanitation, and
the constitutional powers authorizing these activities;3 however, the current
scope of public health law recognizes an expanded role of law to establish
and support health infrastructure, regulate activities and behaviors that may
threaten health, and grapple with disease prevention and health promotion
across populations and jurisdictions.4 Accordingly, public health systems—
and the laws that enable and govern them—have evolved over time to include
a wide array of participants governed by disparate legal regimes.
As with all complex systems of governance, many aspects of public health
governance overlap or contain duplicative features. Public health problems
transcend political, geographical, and jurisdictional borders. Consequently,
public health governance cannot be neatly compartmentalized into discrete
efforts and activities.5 Moreover, the changing risks created by evolving
* Associate Dean and Associate Professor of Law, Wayne State University.