Public health policy and legislations refat2021

“Public Health Policy & Legislations” For Postgraduate Students Dr. AhmedRefat 2021
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www.slideshare.net/ahmedrefat
For Postgraduate Students
Prof. AhmedRefat AG Refat
Community Medicine Department FOM-ZU 2021
Module Objectives
Through this module, students will explore public health law and policy and how
they can advance (and hinder) the public’s health. By the end of this course,
students should be able to:
1. Define some legal terminology
2. Identify and describe significant national and international public health
laws and regulations
3. Explain how law affects health;
4. Define and describe basic legal epidemiology principles
5. Explain the role of law in public health practice
6. Describe the health policy process
7. Compare legislation, regulation, and litigation as public health tools
8. Discuss how laws affect the social determinants of health
9. Advocate for legal solutions to public health problems;
10. Collaborate across disciplines.

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Module Contents
 Topic Page
 Introduction  3
 Unit One
 The right to health in international human right law 5
 Health laws 6
 Health Impact Pyramid: The Power of Policy & Systems 8
 Power of Policy and Laws 10
 Hierarchy of Laws 12
 Legal authority relevant to & the five basic legal sources.. 14
 Some relevant concepts and terms 15
 legislative Process 17
 Policy Formulation Process 18
 Health Laws in the 10 Essential Public Health Services 19
 Health in All Policies HiAP. 22
 Unit Two
 Some Public Health Egyptians Regulations in the field of Public Health
Issues
 Egypt's Constitution of 2014 24
 Decree 268/1975 the mission and objectives of the Ministry of Health (MOH) 26
 Law. 137/1958, Amended by Law. 55/1979: Combating Contagious Diseases 27
 Comprehensive Social Insurance Law 31
 Rights of Persons with Disabilities 33
 Law on the National Food Safety Authority (NFSA) enacted by 35
 Work Law 12/ 2003 40
 Law for Environment, 43
 Waste Management 46
 Comprehensive Health Insurance Scheme 48
 Profession Ethics Regulations Issued By the Resolution of the Minister of
Health & Population No. 238/2003
51
 Unit Three
 Family of International classifications
 ICD purpose and uses 55
 International Classification of Functioning, Disability and Health (ICF) 56
 International Classification of Health Interventions (ICHI) 57
 International Health Regulations 58
 Some related international laws 60
 Guidelines on occupational safety and health management systems ILO - 62
 Unit Four
 MODELS OF LEGAL INTERVENTION
 Actual and Hypothetical Examples of the Legal Models of Intervention Applied
to Food and Nutrition
65
 Legal Epidemiology 67
 Five models of public health regulation: 69
 Policy as a “Critical Content of the Core Msc of PH Degree.” 70
 Cited References and Helpful Resources 71

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Introduction
Health is the right of all persons and the duty of the State and is
guaranteed by means of social and economic policies aimed at reducing
the risk of illness and other hazards and at universal and equal access to
all actions and services for the promotion, protection and recovery of
health.
The greatest public health challenges today are complex and require
broad, multifaceted solutions. Policies , laws and regulations are beneficial
in that they have the potential to affect both the environment and behavior
to reduce health risks. Policies that result in systemic improvements in
economic, physical, and social environments can provide opportunities,
support, and clues for healthy behavior.
Laws can alter social norms by influencing environments. As stricter
bans on smoking in public places increased, the expectation of smoke-free
air became the norm. Another benefit of using policies to promote health is
that they have a broad scope. Unlike clinical or individual-level approaches,
policies have the potential to reach a large population. Policy changes can
benefit all people exposed to the environment rather than focusing on
changing behaviors one person at a time.

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5
The right to health in international
human right law
The right to health is a human right that is well established in international
human right law, that 1imposes a number of core obligations. These include the
obligations to:
• ensure the right of access to health services without discrimination;
• ensure access to food that is safe and nutritionally adequate and to ensure
freedom from hunger;
• ensure access to basic shelter, housing and sanitation, and an adequate supply
of safe and potable water;
• provide essential medicines, as defined by WHO from time to time;
• ensure equitable distribution of health facilities, goods and services;
• adopt and implement a national plan of action addressing the health concerns
of the population.
In addition to the core obligations above, there are a number of obligations of
“comparable priority”. These include the obligations to:
• ensure reproductive, prenatal and postnatal maternal and child health care;
• provide immunization for priority diseases;
• prevent, treat and control epidemic and endemic diseases;
• provide education about the major health challenges facing the community;
• provide appropriate training for health personnel.

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Health Laws
Health law is the area of law concerned with the health of individuals and
populations, the provision of health care and the operation of the health
care system.Two fundamental tools that assist states in the task of
protecting people from threats to health, preventing disease, and striving
for healthy populations, are public health law and public health policy.
Public health law
Public health law is a field that focuses legal practice, scholarship and
advocacy on issues involving the government‟s legal authorities and duties
“to ensure the conditions for people to be healthy,” and how to balance
these authorities and duties with “individual rights to autonomy, privacy,
liberty, property and other legally protected interests.” The scope of public
health law is broad. Public health law issues range from narrow questions
of legal interpretation to complex matters involving public health policy,
social justice and ethics.
Health policy
Health policy, refers to „decisions, plans, and actions that are undertaken
to achieve specific health care goals within a society‟ The World Health
Organization states that „an explicit health policy can achieve several
things: it defines a vision for the future which in turn helps to establish
targets and points of reference for the short and medium term.It outlines

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priorities and the expected roles of different groups; and it builds
consensus and informs people‟
Public Health Policy
Public policy, is defined as laws, regulatory measures, courses of action,
and funding priorities concerning a given topic by a governmental entity or
its representatives. Public Policy encompasses the intentional actions or
inactions by government to address a problem affecting the public
What is the purpose of a policy?
The term “policy” is used in different senses related to governance:
 General state policy – the political principles and direction set by a
government, which forms the basis of its administration;
 Legislative policy – a statement of the political purpose to be achieved
with a new law, the way the purpose is to be achieved and a set of
instructions for the professional legislative drafters who will draft a bill;
and
 Administrative policy – statements and guidelines issued by an
authority regarding the way it intends to administer its duties and
exercise its discretion.

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Health Impact Pyramid: The Power of
Policy, Systems, and Environmental
Change
For prevention to be effective in improving public health, a comprehensive
approach that goes beyond education and providing direct services is
necessary. Policy change is a powerful way to affect meaningful,
sustainable, cost-effective improvements to public health. This a relatively
new way of thinking about public health.
Health Impact Pyramid
To illustrate this concept, the U.S. Centers for Disease Control and
Prevention developed the Health Impact Pyramid to describe the impact of
different interventions on health. At the base of the pyramid are
interventions with the greatest impact on the population. At the pyramid
narrows, the interventions require more individual effort and have less
population impact.
Near the base of the pyramid, the section labeled “Changing the Context to
Make Default Decisions Health” is achieved through “policy, systems and
environmental changes, “ which includes modifying the environment to
make healthy choices practical and available to all community members, as
well as influencing policy and legislation. By changing laws and shaping
landscape around us, a big and sustainable impact can be made, often with
fewer resources than one-time programmatic interventions with limited
reach.

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Power of Policy and Laws
The power of policy is exemplified by the fact that every one of the top 10
public health achievements in the last century was facilitated by some sort
of policy action to influence practice and prioritize.
● Vaccination, which has resulted in the control or eradieradication of
smallpox, poliomyelitis, measles, rubella, tetanus, diphtheria, Haemophilus
influenzae type b, and other infectious diseases;
● Motor-vehicle safety (through safer vehicles and highways, use of
safety belts, child safety seats, and motorcycle helmets, and decreased
drinking and driving), which has resulted in significant reductions in motor
vehicle related deaths;
● Safer workplace (particularly in mining, manufacturing, construction, and
transportation), which has resulted in significant reductions in fatal
ccupational injuries;
● Control of infectious diseases (from clean water and improved
sanitation, and antimicrobial therapy), which has resulted in the reduction of
typhoid, cholera, tuberculosis, and sexually transmitted diseases;

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● Decline in deaths from coronary heart disease and stroke
(through risk factor modification such as smoking cessation, blood
pressure control, and early detection);
● Safer and healthier foods (from decreases in microbial contamination
and increases in nutritional content), which has eliminated nutritional
eficiency diseases such as rickets, goiter, and pellagra;
● Healthier mothers and babies (through better hygiene and nutrition),
which has resulted in significant infant and maternal mortality reductions;
● Access to family planning and contraceptives, which has resulted in
smaller family size, fewer infant, child, and maternal deaths, and fewer HIV
and STDs;
● Fluoridation of drinking water, which has reduced tooth decay and
tooth loss.
● Recognition of tobacco use as a health hazard, which has reduced
smoking related deaths.

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Hierarchy of Laws
All countries have a legal foundation, generally consisting of a founding
document, such as a constitution, and the laws passed by the national
legislature and other levels of lawmaking authority. These laws function in a
hierarchy, which determines how they rank in authority and how the
authority and scope of each level is derived from the constitution. The
hierarchical structure varies from country to country, and depends on the
form of government.
Respect for the hierarchy of laws is fundamental to the rule of law, as it
dictates how the different levels of law will apply in practice. In general, the
fundamental levels of hierarchy consist of: a constitution or founding
document; statutes or legislation; regulations; and procedures.
Treaties and international obligations, executive orders and presidential
decrees, common law/case law, codes of conduct, and policies. Each of
these elements fits into – or interacts with – the hierarchy of laws in
different ways, depending on the system of government in a particular
country .
Basic elements of the hierarchy,
1. A constitution states the grounding legal and democratic principles
that its government is obligated to uphold, and because of this is
considered the supreme law in a country to which all other laws must
adhere.

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2. A statute is a law enacted by a legislature to govern society, and its
authority is derived from the constitution or founding document of a
country, which authorizes the legislature to enact it.
3. Regulations are issued under the authority of a statute by a division
of the government or by a special body . For this reason, they are
sometimes referred to as “delegated” legislation, and they provide
administrative and technical detail to carry out the purpose of the
statute.
4. Finally, procedures describe the required steps necessary to
complete a process, and are generally written by an administrative
body to ensure that the law and regulations are applied consistently
and fairly to all parties

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Legal authority relevant to population health comes
from five basic legal sources ..
The Five basic legal sources:
1. Constitutions. All government action to advance public health must be
consistent with constitutional authority and constitutional protections of
individual rights.
2. International agreements. The President may bind the state to
international treaties and executive agreements that require creation of
domestic laws.
3. Legislation. The legislative branch (Congress, state legislatures and city
councils and other local legislative bodies) creates policies and distributes
public funds by enacting statutes, which are commonly called ordinances at
the local level.
4. Regulations.
Regulations (sometimes called rules or by-laws) are issued under the
authority of a statute by a division of the government or by a special body,
.. For this reason, they are sometimes referred to as “delegated” legislation.
5. Case law. The judicial branch, through courts, resolves disputes and
interprets laws, including balancing community needs with constitutionally-
protected rights of individuals.

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Some relevant concepts and terms
Constitution
Establishes the innate characteristics of the country and its authority;
outlines the rights and responsibilities of its citizens – as such it is the
supreme law.
* All other laws must adhere to the constitution.
* The constitution should reflect and adhere to a country‟s international
obligations.
International Laws
* Trans-border agreements that have different impacts on the country‟s law,
depending on the treaty language and the way a country‟s constitution
manages them.
* No legal way to enforce compliance, unless the treaty sets up a dispute
resolution process.
Statutes / Legislation
* Statutes are enacted by the legislative branch of government, and govern
a wide range of issues that require regulation in a modern, democratic state
– including elections.
* Must adhere to the constitution and international law.
* Amended by the same process as first enacted, and enforced by a
country‟s enforcement agencies.
Procedure
* A procedure is a description of the required steps necessary to complete
a process.
* Procedures are generally written by an administrative body to ensure that
the law and regulations are applied consistently and fairly to all parties.

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* Enforcement of a procedure is generally achieved by requesting
compliance as a condition of completing a process or receiving a benefit
(for example, candidacy) – rather than sanction or punishment.
Codes of Conduct
* A written set of rules, principles or standards to govern the behavior of
certain groups.
* It is a best practice for EMBs to develop codes of conduct to govern
external actors such as candidates, media, election observers, security
personnel, and election officials.
* Enforcement of codes of conduct depends on whether they are
considered “soft” or “hard” law. Codes of conduct are considered “soft law”
when they are not passed by a lawmaking body and thus rely on voluntary
compliance.
Guidelines, Instructions, and Policies
* Terms such as “guidelines” and “instructions” are uncertain in meaning
and can result in ambiguity, particularly with regard to enforceability.
* “Policies” are broad, informative statements of intent regarding principles
to be followed, priority of programs.
Treaties are agreements between two or more countries, entered into after
negotiation. Their purpose is to create international rules or standards by
which the involved parties agree to abide. Much of international law has
been written and enforced through treaties. Treaties have been used to end
wars, foster trade and promote human and civil rights, among other goals.
Presidential Decrees/Executive Orders
Executive orders are legally-binding directives to an executive agency by
the president or other executive acting within his or her constitutional
authority.

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Legislative Process
The legislative Process includes evaluating, amending, and voting on
proposed laws and is concerned with the words used in the bill to
communicate the values, judgments, and purposes of the proposal.
An idea becomes an item of legislative business when it is written as a bill.
A bill is a draft, or tentative version, of what might become part of the
written law. A bill that is endorsed is called an act or statute.
Ideas for legislation can come from legislators who have experience in a
particular field, or legislators can copy legislation because an idea that
works well in one jurisdiction can be useful to its neighbors. Legislators also
receive proposals from the National Conference of Commissioners on
Uniform State Laws; a conference of 250 lawyers appointed by governors
to represent the states. The Council of State Governments, the American
Law Institute, the American Bar Association, and numerous other
organizations all produce model acts for legislatures. Protection and
promotion of social and economic interests of particular groups also
motivate legislation. Interests groups usually become involved in the
legislative process through lobbyists. The general procedure of enactment
of legislation is governed by the constitution.
When a bill is first introduced it is referred to a relevant committee. to
accommodate and to eliminate technical defects a bill can then be
rewritten. If the committee recommends that the bill be passed, the bill is
placed on the agenda for action by the full legislative body. After a lengthy
and complex procedure, legislators vote on the final passage of the bill.
Once the bill is approved by both houses and is put into final form, it must
be signed by the executive. An executive can refuse to sign a bill and can
return it to the legislature with a veto message explaining why. If the
executive signs the bill, it is filed and becomes law.

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Policy Formulation Process
Policy process involve a „descriptive’ stage, in which attempts to simplify
complexities by identifying key elements of a problem or threat occur; and
„prescriptive’ stage which translates demands into specific actions. One
may also consider the policy process as a continuous process that
involves then following stages:
* Agenda setting. Identifying problems that require government attention,
deciding which issues deserve the most attention and defining the nature of
the problem.
* Policy formulation. Setting objectives, identifying the cost and estimating
the effect of solutions, choosing from a list of solutions and selecting policy
instruments.
* Legitimation. Ensuring that the chosen policy instruments have support.
It can involve one or a combination of: legislative approval, executive
approval, seeking consent through consultation with interest groups, and
referenda.
*Implementation. Establishing or employing an organization to take
responsibility for implementation, ensuring that the organization has the
resources (such as staffing, money and legal authority) to do so, and
making sure that policy decisions are carried out as planned.
* Evaluation. Assessing the extent to which the policy was successful or
the policy decision was the correct one; if it was implemented correctly and,
if so, had the desired effect.
* Policy maintenance, succession or termination. Considering if the policy
should be continued, modified or discontinued.

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Health Laws in
the 10 Essential Public Health Services
The 10 Essential Public Health Services provide a framework for public
health to protect and promote the health of all people in all communities. To
achieve equity, the Essential Public Health Services actively promote
policies, systems, and overall community conditions that enable optimal
health for all and seek to remove systemic and structural barriers that have
resulted in health inequities
The Ten Essential Public Health Services fall into three categories that
define the core functions of public health:
A. Assessment
B. Policy Development
C. Assurance
A.
B.

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A. Assessment:
___1. Monitor health status to identify community health problems.
___2. Diagnose and investigate health problems and health hazards in the
community.
B. Policy Development:
___3. Inform, educate, and empower people about health issues.
___4. Mobilize community partnerships to identify and solve health
problems.
___5. Develop policies and plans that support individual and
community health efforts.
C. Assurance:
___6. Enforce laws and regulations that protect health and ensure
safety.
___7. Link people to needed personal health services and assure the
provision of health care when otherwise unavailable.
___8. Assure a competent public health and personal health care
workforce.
___9. Evaluate effectiveness, accessibility, and quality of personal and
population-based health services.
___10. Research for new insights and innovative solutions to health
problems
EPHS-5
Develop policies and plans that support individual and community
health efforts.
___Leadership development at all levels of public health.
___Systematic community-level and state-level planning for health
improvement in all jurisdictions.
___Development and tracking of measurable health objectives as a part of
continuous quality improvement strategies.

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___Joint evaluation with the medical health care system to define
consistent policy regarding prevention and treatment services.
___Development of codes, regulations, and legislation to guide the practice
of public health.
EPHS-6
Enforce laws and regulations that protect health and ensure safety.
Enforce Laws
This is the first portion of the assurance component. This calls for agencies
to make sure that the community is following safety guidelines in order to
protect the public from potentially being effected in a way that will
negatively affect their health . Agencies or health departments are to
execute the laws in which regard proper sanitation and safe drinking water.
By making sure these laws are being executed it can prevent an outbreak
that will negatively affect the health of a community .
 Full enforcement of sanitary codes, especially in the food industry.
 Full protection of drinking water supplies.
 Enforcement of clean air standards.
 Timely follow-up of hazards, preventable injuries, and exposure-
related diseases identified in occupational and community settings.
 Monitoring quality of medical services (e.g., laboratory, nursing
homes, and home health care).
 Timely review of new drug, biologic, and medical device application.
 Advocacy for needed new health and safety laws and regulations
https://www.cdc.gov/nceh/ehs/images/graphics/essential-services-wheel.png
https://www.cdc.gov/publichealthgateway/publichealthservices/essen
tialhealthservices.html

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Health in All Policies HiAP.
Health in All Policies is an approach to public policies across sectors that
systematically takes into account the health implications of decisions,
seeks synergies, and avoids harmful health impacts in order to improve
population health and health equity.
The following points highlight a health in all policies approach:
 Health in All Policies is a collaborative approach to improving the
health of all people by incorporating health considerations into
decision-making across sectors and policy areas.
 Health is influenced by the social, physical, and economic
environments, collectively referred to as the “social determinants of
health.”
 Health in All Policies, at its core, is an approach to addressing the
social determinants of health that are the key drivers of health
outcomes and health inequities.
 Health in All Policies supports improved health outcomes and health
equity through collaboration between public health practitioners and
those nontraditional partners who have influence over the social
determinants of health.
 Health in All Policies approaches include five key elements:
promoting health and equity, supporting intersectoral collaboration,
creating cobenefits for multiple partners, engaging stakeholders, and
creating structural or process change.
 Health in All Policies encompasses a wide spectrum of activities and
can be implemented in many different ways.
 Health in All Policies initiatives build on an international and historical
body of collaborative work

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Some Egyptians Public Health
Regulations in the field of Public
Health Issues
Unit
Two

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Some Relevant Public Health
Egyptians Regulations in the field of
Public Health Issues
Egypt's Constitution of 2014
https://www.sis.gov.eg/Newvr/Dustor-en001.pdf
Some articles related to public health
Article (13) The State shall protect workers' rights and strive to build
balanced work relationships between both parties to the production
process. It shall ensure means for collective negotiations, protect workers
against work risks, guarantee the fulfillment of the requirements of security,
safety and occupational health, and prohibit unfair dismissal, all as
regulated by Law
Article (18) Every citizen has the right to health and to comprehensive
health care which complies with quality standards. The State shall maintain
and support public health facilities that provide health services to the
people, and shall enhance their efficiency and their equitable geographical
distribution. The State shall allocate a percentage of government spending
to health equivalent to at least 3% of Gross National Product (GNP), which
shall gradually increase to comply with international standards. The State
shall establish a comprehensive health insurance system covering all
diseases for all Egyptians; and the Law shall regulate citizens' contribution
to or exemption from its subscriptions based on their income rates.
Refusing to provide any form of medical treatment to any human in
emergency or lifethreatening situations is a crime. The State shall improve

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the conditions of physicians, nursing staff, and health sector workers. All
health facilities as well as health-related products, materials and means of
advertisement shall be subject to State control. The State shall encourage
the participation of private and nongovernmental sectors in providing health
care services according to the Law.
. Article (46) Every person has the right to a sound healthy environment.
Environment protection is a national duty. The State shall take necessary
measures to protect and ensure not to harm the environment; ensure a
rational use of natural resources so as to achieve sustainable development;
and guarantee the right of future generations thereto.
Article (78) The State shall ensure the citizens' right to adequate, safe and
healthy housing in a manner which preserves human dignity and achieves
social justice
Article (79) Each citizen has the right to healthy and sufficient food and
clean water. The State shall ensure food resources to all citizens. The
State shall also ensure sustainable food sovereignty and maintain
agricultural biological diversity and types of local plants in order to
safeguard the rights of future generations.
Article (83) The State shall guarantee the health, economic, social, cultural
and entertainment rights of the elderly people, provide them with
appropriate pensions which ensure a decent life for them, and enable them
to participate in public life. In its planning of public facilities, the State shall
take into account the needs of the elderly. The State shall encourage civil
society organizations to participate in taking care of the elderly people.
https://www.egypt.gov.eg/english/laws/constitution/chp_one/part_one.aspx

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Presidential Decree No. 268 of 1975
defines the mission and objectives of
the Egyptian Ministry of Health
(MOH)
Article 1 of the decree provides that the Ministry‟s main mission is to protect
the health of all Egyptian citizens through preventive and curative services
at a centralized level.
The MOH has an array of objectives, which include the following: (1)
shaping national health care policies;
(2) recording health care data and conducting economic health studies;
(3) providing centralized health services, including central laboratories,
pharmaceutical services, and manpower training;
(4) monitoring the quality of medicine;
(5) offering effective management during public health crises;
(6) administrating health services and units; and
(7) coordinating with domestic medical units on the local level in all
governorates.

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Law No. 137/1958, Amended by Law
No. 55/1979: CombatingContagious
Diseases
Object and Scope of the Law: Regulating prevention of the contagious
diseases and actions for combating any of them.
Regulation of the Law:
Chapter (1) has set a definition for the contagious disease as set out
in the attached table; and has invested the Minister of Health with the
powers to effect / insert any amendments in such table when necessary.
Chapter (2) : Articles ( 2 -3- 4 ) have indicated the protective vaccination,
antidotes, and serums, and restrictions to be observed , and duties of the
those in charge of vaccinations.
The legislation has for the first time innovated the periodical vaccination
against the contagious diseases. Article (6) has stressed the right of the
Health Authority in vaccinating people in certain areas and the right of the
Minister of Health in issuing the decrees necessary for regulating the
vaccination process against the contagious diseases.
Chapter (3): has tackled prevention of epidemic leakage ; Article (10) has
stipulated that the Minister of Health shall have the right to issue the
decrees necessary for quarantining / isolating , monitoring ,and putting
under observation persons and animals coming from abroad ; and
indicated the health / hygienic conditions required for the imported goods

28
and materials; and has demanded vaccination to all pilgrims prior to their
departure.
Chapter (4) is related to the preventive measure to be taken when
contagious diseases loomed. Article (12) has indicated the steps to be
taken when person is infected ( or suspected to be infected ) with any
contagious disease, and demanded reporting such case within 24
hours. Article (14) has identified the person in charge of reporting such
cases and has granted the competent authority the right to take any action
necessary to avoid spread of the diseases.
Article (15) has identified the power of the law officers in applying the
provisions of this law and has granted them the right to inspect houses and
suspected places to prevent spread of the diseases, to quarantine / isolate
patients and those mingling with them, vaccinating them, and disinfecting
their houses and household materials. The law has also granted the law
officers to destroy objects deemed contaminated and difficult to disinfect.
Law officers may seek assistance of the policemen to carry out their tasks.
Article (16) has stipulated that it is compulsory to quarantine/ isolate any
person suspected to be infected with any of the contagious diseases set
out in the section(1) of the table; Article (20) has entitled the Minister of
Health to issue a decree declaring that certain area is deemed epidemic /
infectious area and authorized him to take all measures necessary to
prevent spread of the disease through the administrative channels. Such
measures include banning the gathering of people at public meetings or in
religious festivals, destroying contaminated food and drinks, removing
water pots, backfilling wells, closing cafes and markets, cinemas, schools,
work places or any other place the running of which deemed hazardous to
the public health.
Authorities Responsible to Execute Law No. 137/1958: Ministry of
Health- Ministry of Interior.

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‫أحكام‬ ‫بعض‬ ‫بتعديل‬ ٠٢٠٢ ‫لسنة‬ ٢٤٠ ‫رقم‬ ‫القانون‬
‫االحتياطات‬ ‫شأن‬ ‫في‬ ٢٥٥١ ‫لسنة‬ ٢٣١ ‫رقم‬ ‫القانون‬
‫المعدية‬ ‫األمراض‬ ‫من‬ ‫للوقاية‬ ‫الصحية‬.
‫ينص‬
‫القانون‬
‫على‬
‫انه‬
‫يجوز‬
‫لوزير‬
‫الصحة‬
‫لمنع‬
‫انتشار‬
‫األمراض‬
،
‫ان‬
‫يلزم‬
‫األفراد‬
‫أو‬
‫الفئات‬
‫التي‬
‫يحددها‬
‫باستخدام‬
‫الكمامات‬
‫الواقية‬
‫او‬
‫األقنعة‬
‫الطبية‬
‫أو‬
‫األوشحة‬
‫وغيرها‬
‫من‬
‫مستلزمات‬
‫الوقاية‬
‫األخرى‬
‫خارج‬
‫اماكن‬
‫السكن‬
.
‫كما‬
‫يضع‬
‫وزير‬
‫الصحة‬
‫القواعد‬
‫واإلجراءات‬
‫الصحية‬
‫الواجب‬
‫اتباعها‬
‫في‬
‫شأن‬
‫التعامل‬
‫مع‬
‫جثامين‬
‫الموتى‬
‫باألمراض‬
‫المعدية‬
‫المنصوص‬
‫عليها‬
‫في‬
‫القانون‬
.
‫ويعاقب‬
‫بالحبس‬
‫وبغرامة‬
‫ال‬
‫تقل‬
‫عن‬
‫خمسة‬
‫آالف‬
‫جنيه‬
‫وال‬
‫تجاوز‬
‫عشرة‬
‫أالف‬
‫جنيه‬
‫او‬
‫بإحدى‬
‫العقوبتين‬
‫كل‬
‫من‬
‫أعاق‬
‫أو‬
‫عطل‬
‫أو‬
‫منع‬
‫دفن‬
‫ميت‬
‫أو‬
‫أيا‬
‫من‬
‫الشعائر‬
‫والطقوس‬
‫الدينية‬
‫المتبعة‬
‫للدفن‬
‫أو‬
‫خالف‬
‫القواعد‬
‫واإلجراءات‬
‫التي‬
‫يحددها‬
‫وزير‬
‫الصحة‬
.
Classification of COVID-19 by the Egyptian Government:
According to the Minister of Health and Population‟s Decree no. 145/2020,
COVID-19 is listed under Section One of the Contagious Diseases list
annexed to the Health Measures to Prevent Contagious Diseases Law no.
137/1958 (the “Health Measures to Prevent Contagious Diseases Law”).
Obligation to Report:
Articles no. 12 and 13 of the Health Measures to Prevent Contagious
Diseases Law puts an obligation on any of the below individuals to report
any infected or suspicious cases of COVID-19 to the authorities (practically,
this can be the Ministry of Health on its dedicated hotline):
• any doctor witnessing the infected or suspicious case;

30
• any family member or care provider;
• the employer or the manager of an entity;
• driver of a transportation vehicle; or
• an administrative authority representative
The report shall include the case‟s name, address of residence and the
profession.
Other Obligation(s) Listed Under the Health Measures to Prevent
Contagious Diseases Law:
• According to article no. 19 of the Health Measures to Prevent
Contagious Diseases Law, the competent medical authorities (e.g. the
Ministry of Health and Population and the law enforcement officers) shall
have the right to monitor any person who came in contact with an infected
individual for a period decided by the competent medical authorities. If a
person refuses to be monitored, the authorities may order putting this
person in quarantine.
• Additionally, the Minister of Health and Population is authorized to
overtake any means of transportation, real estate, pharmaceutical
products, chemical products, medical devices or supplies necessary for the
prevention of diseases listed under Section One (which now includes
COVID-19). Also, the Minister of Health and Population is authorized to
assign any person to perform any works related to theprevention and
control of the epidemic against compensation provided by to the provisions
of the Supply Affairs Law no. 95/1945.
Moreover, according to article no. 20 bis of the Health Measures to Prevent
Contagious Diseases Law, the Minister of Health shall have authorities to
impose obligations to wear masks or other preventive gear and issue
regulations in relation to handling corpse of those deceased due to a
Contagious Disease

31
Comprehensive Social Insurance
Law
Law no. 148/2019
What’s new in the Law?
1.The Law unified the dispersed social insurance laws under one
umbrella and made all categories of persons subject to the same
legislation.
 The Law replaced Law 179/1975 on Social Insurance (the “Old Social
Insurance Law”), Law 108/1976 on Social Insurance for Employers
and the like, Law 50/1978 on Social Insurance for Egyptians working
abroad, as well as various other regulations and decrees. This means
that all categories of insured persons will be subject to the new Law
instead of these old scattered laws.
2. The Law extended social insurance protection to new groups of
employees
 These are primarily non-regular and seasonal employees or further
categories of employers. Examples include fishermen, overland
transportation employees, domestic workers, owners of small shares
of real estate and owners of environmental, rural and familial
industries, as well as owners of sole- person companies. These new
categories would not affect most corporations.
3. Subscription amounts have changed:
 The contribution rates / percentages to be deducted from the salaries
of the insured persons (employers and employees) have changed.
The amounts of income on which the rates are assessed have not
been addressed by the Law but will be subject to the executive

32
regulation to be issued soon. These may change then. Accordingly,
the effect as to the increase or decrease of social insurance
obligations on the concerned parties cannot be entirely assessed at
this stage.
Below are snapshots of the key provisions of the New Law.
SCOPE OF APPLICATION
Now, under the New Law the following categories will be covered and
benefit from its schemes:
 Public sector employees.
 Employees of state owned companies.
 Private sector employees.
 Employers, business owners and directors.
 Egyptians outside Egypt (optional).
 Expats inside Egypt.
 Employees with irregular employment relationship (i.e. seasonal
employees, street vendors, house-keepers/servants...etc). The
minimum age of the insured persons shall be (18) years (except to
the insurance of employers and business owners whose age shall not
be less than 21 years).
INSURANCE TYPES UNDER THE NEW LAW
Pursuant to the New Law, the covered persons shall benefit from the
following insurance schemes:
 Old age, disability and death.
 Work injuries.
 Illness/sickness.
 Unemployment.
https://nosi.gov.eg/ar/Pages/HomePage/Home.aspx

33
Law No. (10) of 2018
Rights of Persons with Disabilities
Law number 10 of 2018 in its second article states that : persons with
disabilities includes those who have long-term physical, mental, intellectual
or sensory impairments which in interaction with various barriers may
hinder their full and effective participation in society on an equal basis with
others;...
Law No. (10) of 2018 , article 4 includes the general principles established
in the Convention on the Rights of Persons with Disabilities, as follows:
1- Non-discrimination on the basis of disability, type of disability or gender
of the person with disabilities, and to ensure de facto equality in all human
rights and fundamental freedoms.
2- Create conditions and respect differences to accept persons with
disabilities as part of human diversity.
3- Respect for the evolving capacities of children with disabilities, respect
for their right to preserve their identity and to express their views freely.
4- The right of persons with disabilities to express their views freely and to
give due weight to these views when making the decisions in all matters
affecting them to ensure their full and effective participation in society.
5- The right of persons with disabilities and their families to obtain all
information that concerns them from all entities.
6- To enable persons with disabilities to participate in the conduct of public

34
affairs on an equal basis with others, to provide a safe environment for
persons with disabilities and protect them from all forms of exploitation.
7- Integrating in all policies and programs what protects and promotes the
rights of persons with disabilities.
Law number 10 of 2018 embodied all the requirements of article (4) of the
Convention and the most important general obligations as it included all the
legislative, administrative and procedural aspects for the enforcement of
the rights of persons with disabilities; civil, political, economic, social and
cultural. Article (28) of the law imposes on the State an obligation to include
the rights and needs of persons with disabilities fairly and in a balanced
manner in programs and policies to combat and reduce poverty.
Law No. 10 of 2018 on Persons with Disabilities also provides a solid
foundation for the protection of children with disabilities. Article (4) includes
the State's obligation to protect the rights of persons with disabilities, to
respect the evolving capacities of children with disabilities, to preserve their
identity and to express their views freely on all matters affecting them, with
due regard to their views according to their age and maturity, on an equal
basis with other children, and to provide information and assistance in the
exercise of that right in proportion to their disability and age. The Act also
gives particular attention to the education of children with disabilities in the
third chapter in articles 10 to 17..

35
Law on the National Food Safety
Authority (NFSA) enacted by
Law No. 1 of the year 2017,
NFSA is established to be the central regulatory authority responsible for
food monitoring and safety in Egypt. It is an independent authority reporting
directly to the President.
The Executive Regulation of the Law (“Executive Regulations”) was issued
on 18 February 2019. It sets out NFSA‟s authorities as well as the licensing
and compliance requirements that should be observed and followed by
food facilitates.
NFSA’S AUTHORITIES
NFSA will be exclusively competent to inspect and monitor food to ensure
that it is produced, distributed, marketed, consumed, imported from, or
exported to Egypt according to the standards of food safety and
hygiene. NFSA has been granted several authorities, including among
others the following:
1. Licensing, inspecting and supervising the handling of food.
2. Granting compliance certificates necessary for the exportation of
locally produced food.
3. Issuing the mandatory rules for food safety and hygiene.
4. Controlling and inspecting the imported food.
5. Issuing the rules and regulations relating to advertising and labeling
food products.
6. Regulating the use of food additives and substances.

36
Important terms in the law
6. "Food" means any product or substance, whether raw, processed,
partially processed, semi-processed or unprocessed, which is intended for
human consumption, including beverages, bottled water or water added to
food, any substance containing water and chewing gum, except for feed,
plants and crops before harvesting; live animals and birds before entering
slaughterhouses; sea creatures and farm-raised fish before fishing;
pharmaceutical products and cosmetics; tobacco and tobacco products;
and narcotic substances or psychotropic substances.
7. "Food Handling" means one or more operations of food production,
manufacture, offering and displaying for sale, storage, preserving,
wrapping, transportation, delivery, importation, exportation, or the licensing
or approval for any of these activities.
8. "Food Safety" means that food and the environment of food handling
are free from any hazard in accordance with the rules specified in the
present law, food safety-related laws and executive decrees related
thereto.
9. “Foods for Special Dietary Uses (FSDU)” means food products that
are specially processed, prepared or formulated to satisfy particular dietary
requirements, or requirements that exist because of specific diseases,
including foods intended for feeding infants and children, diets for use in
weight gain or reduction and stimulant, fortified and appetizing foods, as
established by the Codex Alimentarius Commission (CAC).
10. "Irradiated Foods" means food products that are treated by ionizing
radiation, especially in order to control foodborne pathogens, reduce
microbial load and insect infestation, inhibit the germination of root crops or
extend the durable life of perishable fresh produce.
11. "Genetically Modified Foods (GMFs)" means foods that include,
consist of or produced from the so-called genetically modified organisms
"GMOs" that have had changes introduced into their DNA so as to allow for
the introduction of new genetic traits.

37
12. "Processing Aid" means a substance or material not consumed as a
food ingredient by itself, intentionally used in the treatment or production of
food or its ingredients, which results in the unavoidable presence of
residues or derivatives in the food.
13. "Food Additive" means any substance added to food during
manufacture, processing, treatment, packaging, wrapping or transportation
for technological purposes or functions or for producing actual or possible
effects on food. This substance is not normally consumed as a food by
itself and not normally used as a typical ingredient of the food, whether or
not it has nutritive value. The term does not include contaminants or
substances added to food for maintaining or improving nutritional qualities.
14. "Food-Contact Material" means any substance that come into contact
with food or produced for the purpose of coming into contact with food,
including containers, wrappings and packages.
15. "Hazard" means any physical, biological, chemical or radiological
agent in food.
16. "Risk" means potential hazards in food.
17. "Traceability" means the ability to trace and follow food through all
stages of production, processing and distribution.
18. "Food Withdrawal" means an action taken to remove a food product
from the supply chain except for the product possessed by a consumer.
19. "Food Recall" means an action taken to retrieve a food product after
being sold, where the consumer is advised to take a proper procedure such
as returning or destroying the product.
20. "CAC" means Codex Alimentarius Commission which is one of the UN
bodies established by way of agreement between the Food and Agriculture
Organization (FAO) and World Health Organization (WHO) in 1963. CAC
issues food standards and is the

38
Decree of the Prime Minister No. 412 of the year 2019
"Contamination" means the introduction or occurrence of a contaminant in
food.
"Fraud" means the act of falsification, counterfeiting and mingling of a
particular product intended for sale or possessed for the purpose of
handling, by substantially altering, modifying and misrepresenting the
essence, normal composition, weight or expiration date of the product with
a view to changing the main characteristics of such product or hiding any
defects in a fake or counterfeit product in order to appear identical to a
genuine product in terms of shape and appearance, while in fact such
product is different from a genuine product, without being declared on
labels so as to get the price difference between genuine and fake or
counterfeit products and to realize the maximum financial gain rapidly and
easily. It also means an intentional fraudulent marketing practice.
 "Deception" means the act of causing someone to accept as true or
valid what is false or invalid.
 "Processing" means any action that substantially alters the main
characteristics of food in particular, cooking, baking, heating, smoking,
curing, maturing, drying, mixing, milling, parting, severing, packaging,
canning, chilling, freezing, pickling, extraction, extrusion, irradiation,
ozone treatment, thawing or a combination of those processes.
 "Manufacture" means all activities performed in a food business from
the stage of receipt of raw materials until the distribution of food.
 "Food Business" means any undertaking, whether for profit or not and
whether public or private, permanent or temporary, performing any of the
activities related to any stage of
 "Audit " means a systematic and independent examination to determine
whether activities and the related results thereof comply with planned
arrangements and whether such arrangements are applied effectively so
as to attain the objectives.
 "Inspection" means the examination of any aspect of food so as to
verify that such aspects comply with the legal requirements set forth in
the law and food safety related legislation.

39
 "Monitoring" means conducting a planned sequence of observations or
measurements with a view to obtaining an overview of the state of
compliance with the law and food safety related legislation.
 "Surveillance" means a careful observation of one or more food
businesses, FBOs or the activities performed by such businesses with a
view to verifying the compliance thereof with the law and food safety
related legislation.
Snapshots of the key provisions of the Law
Risk Analysis
Article (4)
NFSA shall establish the procedures necessary for the implementation of
risk analysis system in order to provide a high level of protection for the
safety and health of consumers.
NFSA shall make science-based risk assessment, where scientific
evidence exists in an independent, impartial and transparent manner.
The results of risk assessments shall be taken into consideration in risk
management, and the results of the studies made by competent
international organizations and bodies may be taken into account.
Consumption patterns, consumer behavior in Egypt and other legitimate
requirements related to the subject under consideration shall also be taken
into account provided that health and safety requirements are fulfilled.
Traceability
Article (5)
NFSA shall develop a food traceability system that clarifies the obligations
on all parties at all stages of production, processing, manufacture,
packaging and other food handling operations until a product reaches a
consumer.
Labelling of Foodstuffs Article (6)
NFSA shall establish rules and procedures for the labelling of foodstuff

40
Work Law 12/ 2003
Book 4 Occup .Safety and Health
Part - I Definitions And Range or Application
Article: 202 In applying the provisions of this Book, the following
expressions shall denote the meanings indicated next to each of them:
1. Work injury, vocational diseases and chronic diseases:
The definitions prescribed in the Social Insurance Law and its executive
decrees.
2. Establishment: Any project or utility owned or managed by a public or
private law person.
3. Establishment in applying the provisions of Part (IV) of this book:
Any project or utility owned or managed by a private law person.
Article: 203
The provisions of this Book shall apply to all work sites, establishments and
their branches whatever their kind or attachment, whether they are inland
or offshore.
They shall also apply to water surfaces of all kinds, and the different means
of transport.
Part - II Work Sites, Installations and Licenses
Part - III Ensuring Labour Environment Security

41
Article: 208 The establishment and its branches shall provide the means
of vocational safety and health and ensuring labour environment security in
places of work by which to, ensure protection from physical, risks resulting
in particular from the following:
(A) Severity and intensity of heat and chilliness;
(B) Noise and vibrations;
(C) Lighting;
(D) Harmful and dangerous radiation;
(E) Atmospheric pressure changes;
(F) Static and dynamic elasticity; and
(G) Explosion risks.
Article: 209
The establishment and its branches shall take all precautions arid
measures as necessary to provide the means of vocational safety and
health and ensuring labour environment security for protection from
mechanical dangers resulting from colliding the worker's body with a solid
body, particularly the following:
(A) All danger arising, from work tools, and machines comprising tagging
and lifting equipment, articles, apparatuses, and means of transport
handling and power transmission.
(B) All danger arising from construction, building, and digging works, and
risks of collapse and downfall.
Article: 210
The establishment and its branches shall take all protection means for its
workers from the danger of infection with bacteria, viruses, fungi, parasites

42
and the rest of biological risks, once the nature of work exposes the
workers to the conditions of infection therewith, particularly the following:
(A) Dealing with infected animals, their products and their wastes….
Part - IV Social and Health Services
Subject to the provisions of the Social Insurance Law, the establishment
and its branches shall carry out the following:
(A) Medically examining the worker before joining the work to ascertain his
safety and health fitness pursuant to the type of work to be assigned to
him.
(B) Examining his abilities, to ascertain the worker's fitness from the point
of view of his physical, mental and psychological abilities to ensure his
fitness to work demands.
These examinations shall be carried out according to the health insurance
regulating provisions. The concerned minister, in agreement with the
Minister of Health, shall issue a decree determining the levels of fitness
and health safety, as well as the mental and psychological
abilities on the basis of which these examinations are carried out.
Part - V Inspection In The Field Of Vocational Safety And
Health And Labour Environment
Part - VI Regulating the Agencies for Vocational Safety And
Health and Ensuring Labour Environment Security in the
Establishments
Part - VII Research and Studies Agencies and Consultative
Agencies

43
Law for Environment,
Law No. 4 of 1994.
Prime Minister's Decree No. 338 promulgating the Executive
Regulations of the Law for Environment, Law No. 4 of 1994.
The objectives of these regulations represented by, but not limited to, the
following:
- To specify the establishments that should undertake an assessment of
the environmental impact.
- To specify the assignments of the Appeal Committee and its operating
procedures as well as the complaint procedures.
- To define the specifications and norms which must be compiled with by
industrial establishments allowed discharging treated degradable polluted
substances.
- To specify the non-degradable polluting substances which are prohibited
from discharge into the water environment.
- To specify the permissible limits of air pollutants in emissions.
- To specify the permissible limits of sound intensity and safe exposure
period
Main parts of this law
PART ONE: PROTECTION OF LAND ENVIRONMENT FROM POLLUTION
CHAPTER ONE: Development and Environment (ARTICLES 19 to 28) .
CHAPTER TWO: Hazardous Material and Waste (ARTICLES 29 to 33)..

44
PART TWO: PROTECTION OF AIR ENVIRONMENT FROM POLLUTION
(ARTICLES 34 to 47)
PART THREE: PROTECTION OF WATER ENVIRONMENT FROM
POLLUTION
CHAPTER ONE: POLLUTION FROM SHIPS (ARTICLES 48 to 68)
SECTION ONE: Oil Pollution (ARTICLES 48 to 59
SECTION TWO: Pollution By Harmful Substances (ARTICLES 60 to 65)
SECTION THREE: Pollution from Sewage and Garbage (ARTICLES 66 to 68)
CHAPTER TWO: POLLUTION FROM LAND BASED SOURCES (ARTICLES 69
to 75)
CHAPTER THREE: INTERNATIONAL CERTIFICATES (ARTICLES 76 to 77)
CHAPTER FOUR: ADMINISTRATIVE AND JUDICIAL PROCEDURES
(ARTICLES 78 to 83)
PART FOUR: PENALTIES (ARTICLES 84 to 101)
FINAL PROVISIONS (ARTICLES 102 to 104)
Some definitions in the law
4. Public Place:
A place equipped to receive people or a specific category of people for any purpose.
5. Closed Public Place:
A public place which is in the form of an integrated building that receives no
incoming air except from designated inlets. Vehicles for public transport are
considered closed public places.
6. Semi-closed Public Place:
A public place which is in the form of a non-integrated building with direct access to
the ambient air and which cannot be completely closed.
7. Environmental Pollution:
Any change in environmental properties which may result directly or indirectly in
harming living organisms or establishments or in affecting the ability of people to
lead a normal life.
8. Environmental Degradation:

45
Effect on the environment that reduces its value, or changes its nature, depletes its
resources or harms living organisms or monuments.
9. Environmental Protection:
Protecting and promoting the components of the environment and preventing or
reducing their degradation or pollution. These components encompass air, seas,
internal waters, including the river Nile, lakes and subterranean water, land, natural
protectorates, and other natural resources.
10. Air Pollution:
Any change in the properties or specifications of the natural air which causes
hazards to human health or to the environment, whether resulting from natural
factors or human activities, including noise.
18. Hazardous Substances:
Substances having dangerous properties which are hazardous to human health, or
which adversely affect the environment, such as contagious, toxic, explosive or
flammable substances or those with ionizing radiation.
19. Hazardous Waste:
Waste of activities and processes or its ashes which retain the properties of
hazardous substances and have no subsequent original or alternative uses, like
clinical waste from medical treatments or the waste resulting
from the manufacture of any pharmaceutical products, drugs, organic solvents,
printing fluid, dyes and painting materials.
20. Substance Handling:Anything that leads to the displacement of substances for the
purpose of assembling, transporting, storing, treating, or using them.
21. Waste Management:
Collecting, transporting, recycling and disposing of waste.
22. Waste Disposal:
Processes which do not extract or recycle waste such as composting, deep
subterranean injection, discharge to surface water, biological treatment, physio-
chemical treatment, permanent storage or incineration.
23. Waste Recycling:
Processes which allow the extraction or recycling of waste, such as using it as fuel, or
extracting metals and organic materials or soil treatment or oil re-refining.
35. Environmental Monitoring Networks:
Agencies which undertake, within their spheres of competence and through their stations
and work units, to monitor the components and pollutants of the environment and relay their
results and data to the competent authorities periodically.
36. Environmental Impact Assessment:
Studying and analyzing the environmental feasibility of proposed projects, whose
construction or activities might affect the safety of the environment in order to protect it.
37. Environmental Disaster:
An accident resulting from natural factors or human action which causes severe
damage to the environment and requires resources beyond the local means.

46
Waste Management
Law no. 202 of 2020
The Law addresses waste generation and processing with the intent to
promote waste recycling and reuse. It focuses on the integrated
management of municipal, industrial, agricultural, demolition and
construction waste as well as their safe disposal. In this regard, it classifies
waste as hazardous or non-hazardous. The requirements for the
management of each are as follows:
Hazardous Waste: it is defined under the Law as waste that contains
organic or non-organic components or compounds that have a harmful
effect on human health or the environment as a result of their physical,
chemical or biological characteristics or that contain any dangerous
qualities such as contagious, flammable, explosive or toxic substances.
The requirements pertaining to the management of this type of waste
include, but are not limited to: (a) obtaining a special license for the
integrated management of hazardous waste and substances, (b) obtaining
an approval from the above-mentioned authority for its circulation, (c)
maintaining a register of such waste and the methods of disposal, and (d)
sterilizing and disinfecting the place where the facility producing such waste
was established in case it was moved or its activities suspended.
Non-Hazardous Waste: it is defined as waste that, by its nature, is not
dangerous, whether municipal, industrial, agricultural, demolition,
construction waste or their equivalent.
The requirements pertaining to the management of this type of waste
include but are not limited to: (a) obtaining a license for the integrated
management of non-hazardous waste, and (b) taking all precautions
required to avoid causing any harm to the environment.

47
The Law also provides for the establishment of a Waste Management
Authority (the “Authority”). The roles of the Authority include but are not
limited to:
Regulating, tracking, auditing, evaluating and developing everything related
to Integrated Waste Management activities,
Attracting and encouraging investments in the field of Integrated Waste
Management activities in a manner that guarantees achieving sustainable
development and tracking the implementation of the plans required to
regulate waste management in cooperation with governmental institutions,
municipal governments, the private sector, NGOs and international
organizations, and Issuing the licenses needed to undertake waste
management activities.
In order to curb the use of single-use plastic bags, the Law provides that
the manufacturing, import and export of Single-Use Plastic Bags shall take
place in accordance with the conditions, parameters and technical
specifications stipulated by a decree of the Minister of Trade and Industries
as agreed with the Competent Minister. Said decree may prohibit the
manufacturing, import, or export of Single-Use Plastic Bags if they include
any input or substances that could cause severe harm to the environment.
Further, the Law prohibits the sale, circulation, storage, free distribution or
disposal of Single-Use Plastic Bags unless they are done in compliance
with the conditions, parameters and technical specifications stipulated by
the executive regulations of this law.

48
Comprehensive Health Insurance
Scheme
‫الشامل‬ ‫الصحى‬ ‫التأمين‬ ‫نظام‬ ‫قانون‬
Egypt has identified Universal Health Insurance (UHI)1 as its way to
achieve Universal Health Coverage (UHC). The new UHI Law established
the legislative structure for an overall health system overhaul that fulfills the
constitutional mandate2 set forth in the country‟s new Constitution of 2014
and will be an important instrument to make UHC a reality. Properly
implemented, as envisioned, it will provide the means to ensuring that
everyone will have access to quality health services, they need, without
suffering financial hardship. As indicated in the UHI Law and Bylaw, the
implementation on process will be phased on a period of maximum 15
years. The first phase will start with Portsaid governorate by mid-2019 and
then gradual geographic expansion will follow until full implementation by
2032.
Three new bodies
The new health insurance law will be imposed through the creation of three
bodies aimed to fund, build, and supervise the scheme.
The first of these bodies is the General Authority for Comprehensive
Health Insurance. This authority is to have its own legal personality, acting
under the supervision of the Prime Minister. Its headquarters will be in
Cairo, with different offices around Egypt. The main aim of this body is the

49
collection of the premiums from citizens, and to invest this money safely,
using returns to finance the two other bodies.
The second body is the General Authority for Health Care. This authority
is predicted to bring a tangible change to health care in Egypt, by providing
three levels of health care through health units, hospitals, and hospitals
specialized in heart diseases and tumors. The health units will provide eight
services: family health, dentistry, pharmacy, pediatrics, obstetrics,
gynecology, emergency, laboratory, and radiology. It will be responsible for
building new hospitals, establishing bodies to manage existing health care
providers, and providing the medicines and medical tools necessary. In
fact, an electronic file for every family, with a sub-file for each member, will
be created and kept with the doctor and health unit assigned to them. The
file will include their medical history, their doctors‟ visits, and any
medication they are using.
Finally, the third body, The General Authority for Accreditation and
Supervision, will be responsible for setting the standards for the quality of
health units and hospitals, as well as accrediting the establishments that
abide to these standards. This will include carrying out routine inspections
of the establishments. The body will also be responsible for cooperating
and coordinating with similar bodies abroad.
Funding
As mentioned above, the new system will be financed in a number of ways.
Employees will pay a percentage of their income towards their insurance
and that of their spouse and children. This is explained in the annex to the
law, and will depend on the number of children the working father has.
Business owners will now have to add an additional 4 percent to their social
insurance subscription.
Again, the General Authority for Comprehensive Health Insurance will
invest money in order to use the returns for the benefit of the system. Other

50
contributions will come from higher taxes on cigarettes, extra charges on
birth, death, marriage, and divorce certificates, higher car licensing fees,
and higher tolls when passing through different governorates
Moreover, all companies and establishments are to contribute 0.25 percent
of their gross yearly revenue, non-deductible from their taxes.

51
Profession Ethics Regulations
Issued By the Resolution of the
Minister of Health & Population No.
238/2003
The Egyptian Profession Ethics Regulations contains 61 articles in
four sections as follows:
 Part One- : the oath
 Part Two- Duties of the Physician
 Part Three- Medical Interventions of Special Nature
 Part Four- Conducting Medical Research & Experiments On
Human Beings

52
Some international
laws and
regulations
Unit
Three

53
Family of International
classifications
International classifications are used to standardize health data, and lay the
foundation for evidence-based healthcare.
Classifications are some of the most important, yet least-known products
produced by WHO. They are used by:
 Governments to allocate resources.
 Researchers to collaborate across borders.
 Doctors to document their cases.
 Hospitals to count the frequency of health problems.
 Laboratories to exchange investigative data.
 Insurance companies for billing purposes.
 International organizations to assess trends in public health.


54
Family of Classifications and Terminologies
The WHO Family of International Classifications (FIC) is a set of integrated
classifications that provide a common language for health information
across the world. WHO is responsible for three primary reference
classifications:
1. International Statistical Classification of Diseases and Related
Health Problems (ICD)
2. International Classification of Functioning, Disability and Health
(ICF)
3. International Classification of Health Interventions (ICHI)

55
ICD purpose and uses
ICD is the foundation for the identification of health trends and statistics
globally, and the international standard for reporting diseases and health
conditions. It is the diagnostic classification standard for all clinical and
research purposes. ICD defines the universe of diseases, disorders,
injuries and other related health conditions, listed in a comprehensive,
hierarchical fashion that allows for:
 Easy storage, retrieval and analysis of health information for
evidenced-based decision-making
 Sharing and comparing health information between hospitals,
regions, settings and countries
 Data comparisons in the same location across different time periods
Based on clinical input, research and epidemiology, ICD has become a tool
that is suiable for many uses in health, as:
 Monitoring of the incidence and prevalence of diseases,
 Causes of death
 External causes of illess
 Codes for antimicrobial resistance, in line with GLASS
 Primary care and family medicine concepts have been incorporated
into ICD-11
 Medicaments (INN - ATC), allergens and chemicals, histopathology
(ICD-O 3.2), are embedded in ICD-11
 Codes for full documentation of patient safety, in line with the WHO
patient safety framework
 Dual coding for traditional medicine diagnoses
 Primary care settings Recording of rare diseases
 Casemix or Diagnosis Related Groupings (DRG), resource allocation
 Embedding of guidelines

56
International Classification of Functioning, Disability
and Health (ICF)

 The International Classification of Functioning, Disability and Health,
known more commonly as ICF, is a classification of health and
health-related domains. As the functioning and disability of an
individual occurs in a context, ICF also includes a list of
environmental factors.
 ICF is the WHO framework for measuring health and disability at both
individual and population levels. ICF was officially endorsed by all
191 WHO Member States in the Fifty-fourth World Health Assembly
on 22 May 2001(resolution WHA 54.21) as the international standard
to describe and measure health and disability.

57
International Classification of Health Interventions
(ICHI)
The International Classification of Health Interventions (ICHI) is being
developed to provide a common tool for reporting and analysing health
interventions for statistical purposes.

58
International Health Regulations
IHR 2005
In response to the exponential increase in international travel and trade,
and emergence and reemergence of international disease threats and
other health risks, 194 countries across the globe have agreed to
implement the International Health Regulations (2005) (IHR). This
binding instrument of international law entered into force on 15 June 2007.
The stated purpose and scope of the IHR are "to prevent, protect against,
control and provide a public health response to the international spread of
disease in ways that are commensurate with and restricted to public health
risks, and which avoid unnecessary interference with international traffic
and trade."
Because the IHR are not limited to specific diseases, but are applicable to
health risks, irrespective of their origin or source, they will follow the
evolution of diseases and the factors affecting their emergence and
transmission.
The IHR also require States to strengthen core surveillance and response
capacities at the primary, intermediate and national level, as well as at
designated international ports, airports and ground crossings. They further
introduce a series of health documents, including ship sanitation certificates
and an international certificate of vaccination or prophylaxis for travelers.
The IHR are an instrument of international law that is legally-binding on
196, the WHO Member States.. They create rights and obligations for
countries, including the requirement to report public health events. The
Regulations also outline the criteria to determine whether or not a
particular event constitutes a “public health emergency of international
concern”.

59
At the same time, the IHR require countries to designate a National IHR
Focal Point for communications with WHO, to establish and maintain core
capacities for surveillance and response, including at designated points
of entry. Additional provisions address the areas of international travel and
transport such as the health documents required for international traffic.
Finally, the IHR introduce important safeguards to protect the rights of
travellers and other persons in relation to the treatment of personal data,
informed consent and non-discrimination in the application of health
measures under the Regulations.
The Regulations aim to provide a legal frame work for the prevention,
detection and containment of public health risks at source, before they
spread across borders, through the collaborative actions of States Parties
and WHO.
Notification is required under IHR for all "events that may constitute a public
health emergency of international concern". In this regard, the broad new
definitions of "event", "disease" and "public health risk" in the IHR are the
building blocks of the surveillance obligations for States Parties and WHO.
 "Disease" means "an illness or medical condition, irrespective of origin
or source, that presents or could present significant harm to humans".
 The term "event" is broadly defined as "a manifestation of disease or an
occurrence that creates a potential for disease".
 "Public health risk" refers to "a likelihood of an event that may affect
adversely the health of human populations, with an emphasis on one
which may spread internationally or may present a serious and direct
danger".
 A public health emergency of international concern (PHEIC) is
defined as "an extraordinary event which is determined to constitute a
public health risk to other States through the international spread of
disease and to potentially require a coordinated international response".
Consequently, events of potential international concern, which require
States Parties to notify WHO, can extend beyond communicable
diseases and arise from any origin or source.

60
Some related international laws
International Trade Law
International trade agreements that liberalize trade between countries
typically recognize that states may restrict trade to protect human health.
Under the General Agreement on Tariffs and Trade
International Humanitarian Law
Health is also embedded in international humanitarian law, otherwise
known as the laws of war. In fact, health has been a core value of
international humanitarian law since it began to develop in the
midnineteenth century. Contemporary international humanitarian law
contains detailed rules protecting the health of combatants, prisoners of
war, and non-combatants in international and civil armed conflicts.
4. International Human Rights Law
Health also appears as a significant feature in international human rights
law. While the purported "human right to health" seems the most relevant
aspect of human rights law, health protection is an objective in other areas
of such law
. 5. International Labor Law
The International Labor Organization (ILO) has proved active in developing
international legal rules that protect workers around the world.'56 As part of

61
this activity, the ILO has established international rules governing
ccupational health and safety. The ILO Convention Concerning
Occupational Safety and Health and the Working Environment applies to all
workers in all economic activities and requires states parties to formulate,
implement, and review a national policy on occupational
6. International Environmental Law
Much of the enormous body of international environmental law seeks to
protect human health from various threats caused by pollution and
environmental degradation. International legal rules on transboundary air
pollution; 161 transboundary water pollution;'marine pollution;
transboundary shipment of hazardous wastes, chemicals, and pesticides;'"
The New Delhi Declaration on Global Health Law states that "global health
law" includes: (1) "strengthening institutional and human capacity for law";
(2) developing regulatory and legislative approaches to support "Health for
All"; and (3) ensuring monitoring and implementation of health

62
Guidelines on occupational safety
and health management systems
(ILO-OSH 2001)
The guidelines have been developed according to internationally agreed
principles defined by the ILO‟s tripartite constituents. The practical
recommendations of these guidelines are intended for use by all those who
have responsibility for OSH management.
The OSH management systems in the organization has five main sections
which follow the internationally accepted Demming cycle of Plan-Do-
Check-Act, which is the basis to the “system” approach to management.
These sections are namely Policy, Organizing, Planning and
implementation, Evaluation and Action for improvement
Policy contains the elements of OSH policy and worker participation. It is
the basis of the OSH management system as it sets the direction for the
organization to follow.
Policy
3.1. Occupational safety and health policy
3.1.1. The employer, in consultation with workers and their
representatives,
should set out in writing an OSH policy, which should be:
(a) specific to the organization and appropriate to its size and the nature of
its activities;

63
(b) concise, clearly written, dated and made effective by the signature or
endorsement of the employer or the most senior accountable person in the
organization;
(c) communicated and readily accessible to all persons at their place of
work;
(d) reviewed for continuing suitability; and
(e) made available to relevant external interested parties, as appropriate.
3.1.2. The OSH policy should include, as a minimum, the following key
principles and objectives to which the organization is committed:
(a) protecting the safety and health of all members of the organization by
preventing
work-related injuries, ill health, diseases and incidents;
(b) complying with relevant OSH national laws and regulations, voluntary
programmes, collective agreements on OSH and other requirements to
which the organization subscribes;
(c) ensuring that workers and their representatives are consulted and
encouraged to
participate actively in all elements of the OSH management system; and
(d) continually improving the performance of the OSH management
system.
3.1.3. The OSH management system should be compatible with or
integrated in other management systems in the organization.

64
MODELS OF LEGAL
INTERVENTION
LegalEpidemiology
Unit
Four

65
MODELS OF LEGAL INTERVENTION
Government has its tools to improve population health . Legal and public
policy tools for the public‟s health include:
 taxation, incentives, and spending (e.g., cigarette and other “sin”
taxes and allocation of the tax to combat the problem, may include
pricing policies and financial incentives);
 altering the informational environment (e.g., food or drug labeling,
and disclosure of health information);
 altering the built/physical environment (e.g., zoning, toxic waste);
 altering the natural environment (e.g., clean water, air,
environmental justice);
 direct regulation (e.g., seat belts, helmets, drinking water
fluoridation, folate fortification of grain-based products, iodized salt;
licensure of medical care providers and facilities);
 indirect regulation (e.g., tort litigation in tobacco); and
 deregulation (e.g., distribution of sterile injection equipment or
criminalization of HIV risk behaviors).

66
Actual and Hypothetical Examples of the Legal Models
of Intervention Applied to Food and Nutrition
a. Tax ad spend: Subsidies for healthy school lunches
b. Informnational environment: Laws requiring disclosure of calories on
restaurant menus
c. Built/physical environment: Laws on fast-food or liquor store density
d. Natural environment: Food safety laws that order changes to the
disposal of animal waste contamination of water sources
e. Direct regulation (of persons, professionals,
businesses): Requiring fortification of cereal grains with folate to prevent
birth defects
f. Indirect regulation: Tort liability lawsuit brought by overweight adults or
children against fast-food chaina
g. Deregulation: End subsidies of agricultural products that contribute to
unhealthy eating, including corn used to produce inexpensive sweeteners,
and corn and soy used for feed, meat, and dairy

67
Legal Epidemiology
“Legal epidemiology” is
“ the scientific study and deployment of law as a factor in the
cause, distribution, and prevention of disease and injury in a
population. Legal epidemiology is a transdisciplinary field that
relies on the collaborative efforts to develop, implement, and
evaluate the effects of law. Historically, public health law has
focused on “what law says,” and legal epidemiology focuses on
“what law does” . Legal epidemiology supports the idea that laws
and legal practices can be studied using theory and robust
scientific methods, similar to other social phenomenon that are
important to population health.
LEGAL EPIDEMIOLOGY IN PRACTICE: SIX STEPS
1. Engage
Identify a public health problem or a policy of interest through through
feedback from the community, subject matter experts, and policymakers.
2. Identify research needs
Review existing research and identify gaps to inform new research on laws
and policies.

68
3. Create legal data
Conduct a legal mapping study to create empirical legal data that can be
compared across jurisdictions and over time.
4. Analyze
Complete a legal evaluation study to analyze the relationship between law
and health using empirical legal data linked to outcome data.
5. Translate
Publish and communicate findings to inform public health practice,
decision-making, and public knowledge via agencies, academia,
decisionmakers, advocates, media, and the public.
6. Monitor and repeat
Continue monitoring and measuring legal changes and engaging with the
community and stakeholders about the impact of laws, repeating previous
steps as legal changes arise.

69
Five models of public health regulation:
(1) economic incentives and disincentives (taxing and spending powers);
A high tax on cigarettes, for example,
(2) the informational environment (education, labeling, and commercial
speech regulation);
When public health authorities counsel individuals or educate groups or
populations about the government's view concerning unsafe sex, abortion,
smoking, a high-fat diet, or a sedentary life-style, there is no formal
coercion. Yet education conveys more than information; it is also a process
of inculcation and acculturation intended to change behavior
(3) direct regulation (penalties for engaging in risk behavior);
Public health authorities have the power to set health and safety standards
as well as to monitor compliance and punish noncompliance. Monitoring
activities include injury and disease surveillance, screening individuals for
disease and reporting positive cases to health authorities, and inspecting
commercial premises. Government can directly prohibit behavior (e.g.,
exceeding highway speed limits) or require individual behavior (e.g.,
wearing seatbelts); mandate businesses to alter product designs to
promote safety (e.g., air bags in automobiles, trigger locks on firearms,
safety caps on medicines); or modify sales practices (e.g., sale of
cigarettes or alcoholic beverages to children). In the area of infectious
diseases, government can compel vaccination, treatment, or isolation.
(4) indirect regulation (the tort system);
actions taken by legislatures and administrative agencies to prevent injury
or disease or to promote public health. The creation of private rights of
action in the courts can also be an effective means of public health
regulation.
A tort is a civil, noncontractual wrong for which an injured person or group
of persons seeks a remedy in the form of monetary damages.

70
(5) deregulation (dismantling legal barriers to desired public health
behaviors). Regulations may actually impede the achievement of public
health objectives, and the necessary social response is to deregulate.
Sometimes policy makers enact laws that criminalize or otherwise penalize
provision of, or access to, the means for achieving behavior change.
Consider government regulation designed to impede access to sterile
syringes and needles even though public health authorities recommend
their use to reduce transmission of blood-borne diseases such as HIV and
HBV
Policy as a “Critical Content of the Core for a 21st Century Master of
Public Health Degree.”
Developing and engaging in policy is imperative to successfully addressing
the complex health challenges within today‟s society. In order to do so,
knowledge of the basic dynamics of the policy process, political theories,
key terms, and policy analysis skills is needed.
Recognizing the importance of policy as a public health strategy, The
Association of Schools and Programs of Public Health (ASPPH) outlines
the significance of policy within its “Critical Content of the Core for a 21st
Century Master of Public Health Degree.” They describe one of the
foundational areas as: legal, ethical, economic, and regulatory dimensions
of health care and public health policy, the roles, influences, and
responsibilities of the different agencies and branches of government, and
approaches to developing, evaluating, and advocating for public health
policies.

71
Cited References and Helpful Resources
1. Prevention, Policy, and Public Health Edited by Amy A. Eyler, Jamie F.
Chriqui, Sarah Moreland-Russell, and Ross C. Brownson. Oxford University
Press Jan 2016 .
2. Legal and Public Policy Interventions to Advance the Population's Health.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK222835/
3. https://www.ncbi.nlm.nih.gov/books/NBK222839/pdf/Bookshelf_NBK222839.pdf
4. https://www.law.cornell.edu/wex/
5. https://www.taylorfrancis.com/books/routledge-handbook-socio-legal-theory-
methods-naomi-creutzfeldt-marc-mason-kirsten-
mcconnachie/e/10.4324/9780429952814?refId=351dee07-c5d1-4080-97c3-
f8cd53b21359
6. https://read.dukeupress.edu/jhppl/article/41/6/1151/40084/Policy-Surveillance-A-
Vital-Public-Health-Practice
7. https://www.youtube.com/watch?v=bpMTsSL6Okk&feature=youtu.be
8. Legal Epidemiology: Studying the Impact of Law on Health
https://www.youtube.com/watch?v=bpMTsSL6Okk&feature=youtu.be
9. Legal Epidemiology: Studying the Impact of Law on Health
10.https://www.semanticscholar.org/paper/Legal-Epidemiology%3A-The-Science-of-
Law-Ramanathan-Hulkower/6f0614aa494492baa83428dc14a5d26060c5d87b
11.https://www.jhsph.edu/research/centers-and-institutes/center-for-law-and-the-
publics-health/education/courses.html
12.• Network for Public Health Law: https://www.networkforphl.org/
13.• CDC Public Health Law Program: http://www.cdc.gov/PHLP/
14.• ChangeLab Solutions: http://changelabsolutions.org/
15.• Public Health Law Center: http://publichealthlawcenter.org/about/staff
16.• ASTHO: http://www.astho.org/Public-Policy/Public-Health-Law/Resources/

72
17.• NACCHO: http://www.naccho.org/topics/infrastructure/PHLaw/index.cfm
Johns Hopkins Center for Law & the Public’s Health:
http://www.jhsph.edu/research/centers-and-institutes/center-for-law-and-the publics-
health/
18.http://site.eastlaws.com/GeneralSearch/Home/ArticlesTDetails?MasterID=41639
19. Public Health Law Map - Beta 5.7 https://biotech.law.lsu.edu/map/index.htm
20. Introduction to Legal Epidemiology
https://www.changelabsolutions.org/product/introduction-legal-epidemiology
https://www.youtube.com/watch?v=18DCoheA0G8&feature=youtu.be
21. introduction-legal-mapping
https://www.changelabsolutions.org/product/introduction-legal-mapping
https://www.youtube.com/watch?v=svDFKAuSKaI&feature=youtu.be
22. Egypt: Legal Responses to Health Emergencies
https://www.loc.gov/law/help/health-emergencies/egypt.php
32
.
‫مصرية‬ ‫تشريعات‬ :‫مصر‬ ‫فى‬ ‫النقض‬ ‫محكمة‬
https://www.cc.gov.eg/legislations
24. Revitalizing Law and Policy to Meet New Challenges
Institute of Medicine. 2011. For the Public's Health: Revitalizing Law and Policy to Meet New
Challenges. Washington, DC: The National Academies Press. https://www.nap.edu/read/13093/
25. LEGISLATION BY COUNTRY: EGYPT TOBACCO CONTROL LAWS
https://www.tobaccocontrollaws.org/legislation/country/egypt/laws
26. WHO health_law-report
https://www.who.int/healthsystems/topics/health-law/health_law-report/en/
٠١
.
‫قانونية‬ ‫منشورات‬ ‫موقع‬
https://manshurat.org/
٠١
.
‫تشريعات‬ : ‫المصرية‬ ‫الحكومة‬ ‫بوابة‬
http://www.egypt.gov.eg/arabic/laws/default.aspx

73
Power Point Presentations )AhmedRefat )
29.policy-framework related terms
https://www.slideshare.net/AhmedRefat/policy-framworkrelatedterms
30.how-to formulate a health policy
https://www.slideshare.net/AhmedRefat/how-toformulateahealthpolicy
31.Medical research ethics
https://www.slideshare.net/AhmedRefat/ss-45273292
32.international-health
https://www.slideshare.net/AhmedRefat/international-health-18182856
33.disability-current-concepts
https://www.slideshare.net/AhmedRefat/disability-current-concepts
34.seven-principles-of-public-life
https://www.slideshare.net/AhmedRefat/seven-principles-of-public-life
35.medical-research-ethics-in-the-egyptian-regulation
https://www.slideshare.net/AhmedRefat/medical-research-ethics-in-the-egyptian-
regulation
36.ethics-of-medical-researches
https://www.slideshare.net/AhmedRefat/ethics-of-medical-researches
37.HiAP concepts and tools
https://www.slideshare.net/AhmedRefat/hi-ap-evolutionconceptsandtools
38.occupational-diseases-international-list
https://www.slideshare.net/AhmedRefat/occupational-diseases-international-list
39.community-based-rehabilitation-cbr
https://www.slideshare.net/AhmedRefat/community-based-rehabilitation-cbr
40.occupational-diseases-and-disability-assessment-tables-egypt
https://www.slideshare.net/AhmedRefat/occupational-diseases-and-disability-
assessment-tables-egypt

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