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Contents - JLME - 2011 Volume 39: 1 - Supplemental Issue
Table of Contents
  1. Table Of Contents
Letter From The Editor
  1. Letter From The Editor
Symposium Articles
  1. PREFACE Connecting Public Health Law, Practice, Policy, and Research
  2. Lawyers, Guns, and Money: A Plenary Presentation from the Conference "Using Law, Policy, and Research to Improve the Public's Health"
  3. Making the Case for Laws that Improve Health: The Work of the Public Health Law Research National Program Office
  4. What Gets Measured, Gets Changed: Evaluating Law and Policy for Maximum Impact
  5. Health in All Policies: Addressing the Legal and Policy Foundations of Health Impact Assessment
  6. The Potential of Shared Decision Making to Reduce Health Disparities
  7. Environmental Public Health Law: Three Pillars
  8. State Boards of Health: Governance and Politics
  9. Policy Issues in American Indian Health Governance
  10. Global Public Health Legal Responses to H1N1
  11. Public Health Preparedness Laws and Policies: Where Do We Go after Pandemic 2009 H1N1 Influenza?
  12. Protecting the Mental Health of First Responders: Legal and Ethical Considerations
  13. Five Legal Preparedness Challenges for Responding to Future Public Health Emergencies
  14. National Health Care Reform and the Public's Health
  15. Implementing Health Reform at the State Level: Access and Care for Vulnerable Populations
  16. Rhetorical Federalism: The Role of State Resistance in Health Care Decision-Making
  17. Meaningful Use and Certification of Health Information Technology: What about Safety?
  18. Right to Health Litigation and HIV/AIDS Policy
  19. The Role of Federal Preemption in Injury Prevention Litigation
  20. Regulating Food Retail for Obesity Prevention: How Far Can Cities Go?
  21. Pursuing Health Equity: Zoning Codes and Public Health
  22. The Michigan BioTrust for Health: Using Dried Bloodspots for Research to Benefit the Community While Respecting the Individual
  23. Becoming the Standard: How Innovative Procedures Benefitting Public Health Are Incorporated into the Standard of Care
Calendar
  1. Calendar of Events
Table of Contents
Table Of Contents
ASLME - [PDF] (Free Download)
THE JOURNAL OF LAW, MEDICINE & ETHICS contents - SPECIAL SUPPLEMENT TO VOLUME 39:1 spring 2011 Symposium Articles 5 preface Connecting Public Health Law, Practice, Policy, and Research James G. Hodge, Jr. scoping the field of public health law, policy, and research 9 Lawyers, Guns, and Money: A Plenary Presentation from the Conference "Using Law, Policy, and Research to Improve the Public's Health" James S. Marks, Michelle A. Larkin, and Angela K. McGowan 15 Making the Case for Laws that Improve Health: The Work of the Public Health Law Research National Program Office Scott C. Burris and Evan D. Anderson 21 What Gets Measured, Gets Changed: Evaluating Law and Policy for Maximum Impact Jamie F. Chriqui, Jean C. O'Connor, and Frank J. Chaloupka 27 Health in All Policies: Addressing the Legal and Policy Foundations of Health Impact Assessment Benjamin R. Rajotte, Catherine L. Ross, Chinyere O. Ekechi, and Vladimir N. Cadet 30 The Potential of Shared Decision Making to Reduce Health Disparities Jaime S. King, Mark H. Eckman, and Benjamin W. Moulton
Letter From the Editor
Letter From The Editor
ASLME - [PDF] (Free Download)
In September 2010, ASLME and the Public Health Law Association co-hosted "Using Law, Policy, and Research to Improve the Public's Health: A National Conference." Funded by the Robert Wood Johnson Foundation, this conference brought together current and future leaders in numerous health law fields to examine the role of law in public health and build on existing policy and scholarly content. Over 350 public health lawyers, practitioners, and students from across the country and abroad attended the conference. Between plenary, training, and concurrent sessions, the conference marked the opportunity for attendees to re-connect and share knowledge and ideas for a new course in public health - one that includes more empirical research in its practice.
Symposium Articles
PREFACE Connecting Public Health Law, Practice, Policy, and Research
James G. Hodge, Jr. - [PDF] (Free Download)
This symposium issue of the Journal of Law, Medicine & Ethics is devoted to the reconvening of the first national public health law conference since 2006, Using Law, Policy, and Research to Improve the Public's Health, on September 13-15, 2010, in Atlanta, Georgia. This event was conceptualized, organized, and hosted by the American Society of Law, Medicine & Ethics (ASLME) and the Public Health Law Association (PHLA) with generous support provided by the Robert Wood Johnson Foundation (RWJF). The Centers for Disease Control and Prevention (CDC), American Public Health Association (APHA), Association of State and Territorial Health Officers (ASTHO), American Bar Association (ABA), and other collaborators also made significant contributions. The conference brought together premier scholars, leaders, and practitioners in public health law, policy, and research to explore critical topics with over 400 participants from varied backgrounds including law, public health, health care, and nursing, among other fields. Many of these topics, discussed briefly below, are the subject of scholarly and applied manuscripts in this issue.
Lawyers, Guns, and Money: A Plenary Presentation from the Conference "Using Law, Policy, and Research to Improve the Public's Health"
James S. Marks, Michelle A. Larkin, and Angela K. McGowan - [PDF] (Free Download)
On behalf of the Robert Wood Johnson Foundation (RWJF), I want to thank the Public Health Law Association and the American Society of Law, Medicine & Ethics for your leadership and the work that both you and the Centers for Disease Control and Prevention (CDC) have done to grow this field. RWJF is pleased to co-sponsor this conference. The music that opened this talk is a clip from Warren Zevon, who encouraged us musically to "send lawyers, guns and money." Zevon was a singer/songwriter and social critic whose songs often took a jaundiced, somewhat cynical point of view. Even so, I know that I am probably stretching his meaning when I think of this song. I see "lawyers, guns and money" as his take on the major drivers of how change happens in a society.
Making the Case for Laws that Improve Health: The Work of the Public Health Law Research National Program Office
Scott C. Burris and Evan D. Anderson - [PDF] (Free Download)
Introduction - No one who attended the 2010 national public health law conference hosted by the Public Health Law Association (PHLA) and the American Society of Law, Medicine & Ethics (ASLME) could miss the sense of excitement and momentum. The revival of this annual public health law meeting, with the support of the Robert Wood Johnson Foundation (RWJF), the energetic leadership of the PHLA president and board, ASLME's expert guidance, and a rousing address by Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC), symbolize the continued commitment of a wide range of important individuals and institutions to the proposition that law is of substantial importance to public health. But there is more than just symbolism to be excited about. CDC's public health law program continues to champion efforts to promote the use and understanding of law as a public health tool. Academic centers like Georgetown's O'Neill Institute, the Rudd Center for Food Policy at Yale, the Centers for Law and the Publicís Health at Johns Hopkins, and the Center for Health Law Studies at St. Louis University have brought new prominence to public health law within legal academia. A whole generation of talented young scholars (too numerous to name without risk of a painful omission) are now working at schools of law, medicine, and public health.
What Gets Measured, Gets Changed: Evaluating Law and Policy for Maximum Impact
Jamie F. Chriqui, Jean C. O'Connor, and Frank J. Chaloupka - [PDF] (Free Download)
Does law matter regarding public health outcomes? Regardless of what one may think about the answer to this age-old question, in recent years the public health community has increasingly demonstrated and recognized the roles that public health laws and policies play in effectuating long-lasting and broad-based population-wide changes. Public health laws and policies have been instrumental in the following ways: reducing smoking prevalence; reducing underage alcohol-related drinking, driving, crashes, and fatalities; reducing exposure to second-hand smoke; eliminating vaccine-associated paralytic poliomyelitis (VAPP); increasing seat-belt use and reducing traffic fatalities; reducing dental carries; and reducing access to and consumption of unhealthy foods and beverages sold in schools and to reductions in caloric intake and overweight. In fact, in a review of the ten greatest public health achievements in the 20th century, all were influenced by policy change.
Health in All Policies: Addressing the Legal and Policy Foundations of Health Impact Assessment
Benjamin R. Rajotte, Catherine L. Ross, Chinyere O. Ekechi, - [PDF] (Free Download)
Introduction - The concept of Health in All Policies aims to improve the health outcomes associated with policies in an attempt to mitigate health disparities and provide optimal environments for healthier living. This multidisciplinary framework seeks to improve health through effective assessment and reformation of policy for organizations of any level and stature. The importance of integrating health in policy assessment and decision making is a key concept in the growing field of Health Impact Assessment.
The Potential of Shared Decision Making to Reduce Health Disparities
Jaime S. King, Mark H. Eckman, and Benjamin W. Moulton - [PDF] (Free Download)
Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making (SDM) to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities.
Environmental Public Health Law: Three Pillars
Richard J. Jackson and Timothy F. Malloy - [PDF] (Free Download)
Most people dread being the subject of interest for doctors, scientists, regulators, and lawyers. While we may joke about the arrogance of the medical profession and the aggressiveness of the legal field, both lie at the core of environmental public health (EPH). They are inseparable, sometimes complementary and other times in tension. The role of medicine and science in EPH is clear, but their relationship with law is often opaque. Yet in no other area of public health, from infectious and chronic disease prevention to providing health care in underserved communities, is law so central as an instrument and partner. In this article we explore the relationship of law and science in the broader context of EPH, beginning with an overview of potential goals and challenges. We then offer three organizing principles that inform and guide the integration of law, science and policy in EPH.
State Boards of Health: Governance and Politics
Richard Hughes, IV, Korisha Ramdhanie, - [PDF] (Free Download)
Introduction: The governance structures of state public health systems vary as much as the states themselves, including the existence and role of state boards of health. Understanding these differences is essential to a complete understanding of the governmental public health enterprise. State boards of health are obvious vehicles for public health policy development in some states, where they work closely with or oversee state health agencies. In other states they do not exist or serve only in a non-binding advisory capacity.
Policy Issues in American Indian Health Governance
Donald Warne - [PDF] (Free Download)
Perhaps the most significant law affecting the provision of health services to the American Indian and Alaska Native (AI/AN) population is the Indian Self-Determination and Education Assistance Act of 1975 (ISDEAA, PL 93-638). This Act allows tribes to assume the management and control of health care programs from Indian Health Service (IHS) and to increase flexibility in health care program development. Under ISDEAA, tribes have the option to contract or compact with IHS to deliver health services using pre-existing IHS resources (formula-based shares tables determine funding for various IHS sites), third party reimbursements, grants, and other sources. Typically, tribes develop their own non-profit health care corporations to provide services to their community, and as a result are eligible for grants and other types of funding not available to federal agencies like IHS.
Global Public Health Legal Responses to H1N1
Lance Gable, Brooke Courtney, Robert Gatter, and Eleanor D. Kinney - [PDF] (Free Download)
Introduction: Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A (H1N1) virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all levels, from global to local. Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization (WHO) reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher
Public Health Preparedness Laws and Policies: Where Do We Go after Pandemic 2009 H1N1 Influenza?
Jean O'Connor, Paul Jarris, Richard Vogt, and Heather Horton - [PDF] (Free Download)
The detection and spread of pandemic 2009 H1N1 influenza in the United States led to a complex and multi-faceted response by the public health system that lasted more than a year. When the first domestic case of the virus was detected in California on April 15, 2009, and a second, unrelated case was identified more than 130 miles away in the same state on April 17, 2009, the unique combination of influenza virus genes in addition to its emergence and rapid spread at the end of the typical Northern Hemisphere influenza season suggested the potential for a high morbidity, high mortality event. In response, federal, state, and local public health officials conducted epidemiologic investigations with federal and state laboratory support to help to determine the scope of the H1N1 pandemic.2 On April 26, the Secretary of the U.S. Department of Health and Human Services (HHS) declared a public health emergency that was renewed through June 23, 2010. The pandemic that ensued tested virtually every aspect of U.S. public health preparedness and response systems, from laboratory capabilities and capacities to social distancing plans.
Protecting the Mental Health of First Responders: Legal and Ethical Considerations
Lainie Rutkow, Lance Gable, and Jonathan M. Links - [PDF] (Free Download)
Introduction: The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.
Five Legal Preparedness Challenges for Responding to Future Public Health Emergencies
Brooke Courtney - [PDF] (Free Download)
Since the anthrax attacks of 2001 and the severe acute respiratory syndrome (SARS) outbreak of 2003, significant efforts have been made to develop and revise a range of legal tools designed to strengthen public health emergency responses. The 2009 H1N1 pandemic provided an unprecedented opportunity to implement and exercise many of these mechanisms. At the global level, the World Health Organization (WHO) declared a public health emergency of international concern (PHEIC) pursuant to the revised International Health Regulations [IHR (2005)], and many governments declared national or regional emergencies. At the U.S. federal level, the Secretary of Health and Human Services (HHS) made public health emergency and Public Readiness and Emergency Preparedness (PREP) Act declarations. In addition, the Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) (to allow the emergency use of certain antiviral medications, diagnostic tests, and respirators during the pandemic), and President Obama declared a National Emergency (to authorize the use of temporary waivers or modifications of certain federal requirements related to health care facility responses). Select state and local governments also declared emergencies.
National Health Care Reform and the Public's Health
Corey S. Davis and Sarah Somers - [PDF] (Free Download)
On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA or the Act) into law. ACA aims to improve access to care and health outcomes through a number of mechanisms, including requiring most individuals to carry health insurance, prohibiting insurers from denying health insurance coverage based on pre-existing conditions, and creating exchanges through which individuals and families not eligible for employer- or government-sponsored health insurance may purchase coverage. While the Act is aimed primarily at improving individual health by increasing access to health insurance, it also contains a number of provisions targeted directly at improving health at the population level. Most of these provisions, which encompass a variety of disease prevention and access-to-care initiatives, are found in ACA Title IV.
Implementing Health Reform at the State Level: Access and Care for Vulnerable Populations
John V. Jacobi, Sidney D. Watson, and Robert Restuccia - [PDF] (Free Download)
Introduction: The Affordable Care Act1 (ACA) promises to improve access to coverage and care for two vulnerable groups: low-income persons who are excluded by a lack of resources and chronically ill and disabled people who are excluded by the dysfunction of our existing insurance and care delivery systems. ACA's sprawling provisions raise a wealth of implementation challenges that are exacerbated by the compromises required to move reform through Congress. In particular, the compromise between regulatory/public program advocates and advocates for private, market-driven programs requires thoughtful regulatory coordination between public and private health systems.
Rhetorical Federalism: The Role of State Resistance in Health Care Decision-Making
Elizabeth Weeks Leonard - [PDF] (Free Download)
Introduction: The Patient Protection and Affordable Care Act (ACA)1 represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and continues to be, resistance from states. The rhetoric of federalism - states' rights, reserved powers, state sovereignty, limited government, and local diversity - resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties.
Meaningful Use and Certification of Health Information Technology: What about Safety?
Sharona Hoffman and Andy Podgurski - [PDF] (Free Download)
Introduction: Health information technology (HIT) is becoming increasingly prevalent in medical offices and facilities. Like President George W. Bush before him, President Obama announced a plan to computerize all Americans' medical records by 2014. Computerization is certain to transform American health care, but to ensure that its benefits outweigh its risks, the federal government must provide appropriate oversight. President Obama's stimulus legislation, the American Recovery and Reinvestment Act of 2009 (ARRA), dedicated $27 billion to the promotion of health information technology.1 It provides payments of up to $44,000 per clinician under the Medicare incentive program and $63,750 per clinician under the Medicaid program.
Right to Health Litigation and HIV/AIDS Policy
Benjamin Mason Meier and Alicia Ely Yamin - [PDF] (Free Download)
Domestic litigation has become a principal strategy for realizing international treaty obligations for the human right to health, providing causes of action for the publicís health and empowering individuals to raise human rights claims for HIV prevention, treatment, and care. In the past 15 years, advocates have laid the groundwork on which a rapidly expanding enforcement paradigm has arisen at the intersection of human rights litigation and HIV/AIDS policy. As this enforcement develops across multiple countries, human rights are translated from principle to practice in the global response to HIV/AIDS, transforming aspirational declarations into justiciable obligations and implementing human rights through national policies and programs.
The Role of Federal Preemption in Injury Prevention Litigation
Jon S. Vernick - [PDF] (Free Download)
Introduction: In 2007, there were 182,479 injury-related deaths in the United States - including homicides, suicides, and unintentional injuries - making injuries the leading cause of death for persons under age 45.1 Also in 2007, nearly 30 million Americans suffered a non-fatal injury serious enough to warrant hospital treatment.2 The lifetime cost of fatal and non-fatal injuries occurring in 2000 is estimated to exceed $400 billion.3 Efforts to prevent injuries have often focused on changes to the built environment or potentially dangerous products to reduce risks. Building safety into a product or environment - especially in ways that require little or no user action to confer protection - is often more effective than trying to change consumer behavior. For example, improving the crashworthiness of cars through design changes such as air bags, fire-resistant fuel systems, or electronic stability programs, is more effective than simply trying to teach operators to become safer drivers.
Regulating Food Retail for Obesity Prevention: How Far Can Cities Go?
Paul A. Diller and Samantha Graff - [PDF] (Free Download)
A growing number of cities and counties have emerged as leaders in the fight against obesity in the United States and have enacted innovative policies to address this epidemic. Much of this local strategy focuses on how retail food establishments - namely, chain restaurants, corner stores, supermarkets, farmers markets, and mobile vendors - affect public health. Recognizing the enormous influence a communityís food environment has on the quality and quantity of what people eat, cities and counties have sought to encourage food retail establishments to promote healthier options through regulations and incentives.
Pursuing Health Equity: Zoning Codes and Public Health
Montrece McNeill Ransom, Amelia Greiner, Chris Kochtitzky, - [PDF] (Free Download)
Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of oneís race, gender, nationality, age, ethnicity, religion, and socioeconomic status. Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions. Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues. For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness. While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. African-American men, for example, are more than twice as likely as their white counterparts to die of prostate cancer. In addition, 36% of adults with a disability are obese compared to 23% of adults without a disability, and smoking prevalence for people with disabilities is approximately 50% higher than for people without disabilities. Among the 10 leading causes of mortality in the U.S., minority populations experience the highest rate of death. The reported reasons for these disparities vary, including individual factors such as limited access to health care and differences in cultural beliefs, social norms, and socioeconomic status.
The Michigan BioTrust for Health: Using Dried Bloodspots for Research to Benefit the Community While Respecting the Individual
Denise Chrysler, Harry McGee, Janice Bach, Ed Goldman, and - [PDF] (Free Download)
The Michigan Department of Community Health (MDCH) stores almost 4 million dried blood spot specimens (DBS) in the Michigan Neonatal Biobank. DBS are collected from newborns under a mandatory public health program to screen for serious conditions. At 24 to 36 hours of age, a few drops of blood are taken from the baby's heel and placed on a filter paper card. The card is sent to the state public health laboratory for testing. After testing, MDCH retains the spots indefinitely for the personal use of the patient and also, pursuant to a 2000 law, for possible research.
Becoming the Standard: How Innovative Procedures Benefitting Public Health Are Incorporated into the Standard of Care
Jalayne J. Arias - [PDF] (Free Download)
Physicians' resistance to implementing innovative medical procedures due to a perceived risk of liability can adversely affect the public's health. This resistance prevents public access to procedures that could better treat communicable or chronic diseases. Innovative procedures, for the purpose of this article, are medical practices that require physicians to modify current clinical approaches to treating or diagnosing a patient's condition and incorporate: (1) newly developed tests, treatments, drugs or devices (e.g., genetic screening to identify drug sensitivities to reduce adverse drug reactions); or (2) novel methods not commonly used by a majority of physicians (e.g., partner delivered therapy to treat an intimate partner for a communicable disease or advanced prescription of naloxone to patients prone to an opioid overdose3). Innovative procedures do not include treatments provided during clinical research or those beyond a physician's scope of practice.
Calendar
Calendar of Events
ASLME - [PDF] (Free Download)
U.S. Holocaust Museum and ASLME present Deadly Medicine: Creating the Master Race Countway Library Boston, MA April 21, 2011 6:30 P.M. ASLME is proud to announce that it will be partnering with the U.S. Holocaust Memorial Museum of Washington, D.C., in presenting the historical exhibition entitled Deadly Medicine: Creating the Master Race. The exhibit, as described by the staff of the holocaust museum, explores how from 1933 to 1945, Nazi Germany carried out a campaign to cleanse German society of individuals viewed as biological threats to the nation's health. Enlisting the help of physicians and medically trained geneticists, psychiatrists, and anthropologists, the Nazis developed racial health policies that began with the mass sterilization of genetically diseased persons and ended with the near annihilation of European Jewry. ASLME members and other interested parties will be invited to the reception following the exhibition. 34th Annual Health Law Professors Conference Loyola University School of Law Chicago, IL June 9-11, 2011 This conference is intended for professionals who teach law or bioethics in schools of law, medicine, public health, health care administration, pharmacy, nursing, and dentistry. ASLME's Annual Health Law Professors Conference combines presentations by experienced health law teachers with the opportunity for discussion among conference participants. The program is designed to provide participants with updates on issues at the forefront of law and medicine and to provide them with the opportunity to share strategies, ideas, and materials.