Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

P lanning for the prevention and mitigation of morbidity, mortality, and environmental damage is fundamental to public health system preparedness for emergencies (1). An essential element in this planning process is the creation of a legal infrastructure to be activated during all phases of the emergency (2) from preevent to recovery. The existence of a legal framework is particularly important in large scale crises (3) and scenarios requiring humanitarian assistance (4). Public health legal preparedness (PHLP) involves more than legislation. Moulton et al. (5) defined PHLP as ‘legal bench-marks or standards essential to the preparedness of that system’. Accordingly PHLP includes 1) laws/legal authorities; 2) competencies of those who apply the law; 3) information relevant for the application of the law; and 4) coordination across sectors/jurisdictions. Benjamin et al. (6) state that although these components can be broadened the improvement of legal preparedness must address all Global Health Action  Global Health Action 2015. # 2015 Odeya Cohen et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. 1 Citation: Glob Health Action 2015, 8: 28871 - (page number not for citation purpose) four core elements and not focus on one element (e.g. legislation) only, which will lead to an incomplete solution (5). Globalisation requires integrated, joint actions aimed to facilitate management of international threats including the use of PHLP. The aim of this paper is to review recent theoretical and research trends regarding legal preparedness of the public health system for emergencies. In particular, the PHLP during the current Ebola crisis will be discussed. Methods Two parallel literature reviews were conducted to explore 1) theoretical and research trends of PHLP in developed countries, as well as in low- and middle-income countries (LMICs), and 2) the application of PHLP during the recent Ebola crisis. The reviews were conducted from September to December 2014 and encompassed peerreviewed articles published in English as well as reports, theses, and position papers. The study search encompassed eight electronic databases: Cochrane, LexisNexis, Proquest, PubMed, Science Direct, Scopus, Social Science Research Network, and Web of Science; the Google Scholar search engine was also employed. Review of theoretical and research trends of PHLP in developed states and LMICs The keywords used to extract relevant articles were public health, legal preparedness, and emergency. The year of publication was limited from 2011 to 2014. However, if one of the reviewed articles emphasised findings that were based primarily on specific previous models or legislative actions, these earlier articles were also reviewed. Due to the very limited findings concerning LMICs, and in order to identify elements within the context of PHLP that are implemented in those countries, additional keywords  regulation and legislation  were introduced to the review procedure. Articles were only included in this review if they dealt with legal aspects of emergency situations. An exclusion criterion was a focus on routine issues (e.g. the obesity epidemic). This criterion was used to screen all abstracts included in the study. In the final stage, the articles were grouped by themes. Review of application of PHLP during the current Ebola crisis Keywords used to extract relevant articles were Ebola, public health, legal preparedness, and emergency. The review was limited to 2014. Articles were included if they focused on legal issues regarding the Ebola outbreak. This criterion was used to screen all abstracts included in the study. In the final stage, the articles were grouped by themes. Results The role of PHLP in emergency response PHLP plays an important role in the overall functioning of the health system during emergencies (7, 8). Providing legal assistance in the midst of a disaster is central to any response plan (9, 10). Adini et al. (11) found that following standard operating procedures in an emergency is crucial for assuring preparedness. Other aspects of legal preparedness relate to the status of volunteers and their ability to provide humanitarian aid after a disaster (12). Orenstein (13) asserts that some laws, though appropriate for routine health activities, may hinder operations during emergencies. While declaring a state