Search

Objectives. To identify and categorize US state legislation introduced between January 1, 2021, and May 20, 2022, that addresses emergency health authority. Methods. We adapted standard policy surveillance methods to collect and code state bills and enacted laws limiting or expanding the emergency public health authority of state and local officials and agencies. Results. State legislators introduced 1531 bills addressing public health authority; 191 of those were enacted in 43 states and the District of Columbia, including 17 expanding and 65 contracting emergency authority, 163 regulating use, and 30 preempting local use of specific measures such as mask mandates. Conclusions. State laws setting the scope and limits of emergency authority are crucial to effective public health response. These laws are changing in ways that threaten to reduce response capacity. Tracking changes in health law infrastructure is important for evaluating changes in health authority and ensuring that stakeholders recognize these changes. Public Health Implications. The COVID-19 pandemic called for quick, decisive action to limit infections, and when the next outbreak hits, new laws limiting health authority will make such action even more difficult. (Am J Public Health. 2023;113(3):288–296. https://doi.org/10.2105/10.2105/AJPH.2022.307214 )

This chapter explores the public health system, including the organizations, activities, and people who promote public health in the United States. It describes the agencies at the federal, state, tribal, local, and territorial levels that have been granted legal authority to act on behalf of public health, including the functions of each agency in promoting public health. The chapter examines the role of the healthcare system within public health and concludes with a short discussion of the evolving effort to improve the public health system through accreditation, governance, and evaluation.

This chapter explores the basic components of the many ways that individuals and organizations introduce their policy preferences into law and practice. The chapter describes the basic steps in developing and implementing a program of advocacy, specifically comparing the Collective Impact Model and the Collaborating for Equity and Justice Framework. It also explores the fundamental debate about the public health advocacy process and reviews legal limitations on political advocacy by public employees and tax-exempt organizations, limitations that have important effects on how advocacy works in public health practice.

This chapter explores how public health law has evolved over time and introduces important legal processes. The chapter first describes evaluation of laws and policies through legal epidemiological principles. Then the chapter explores how to best evaluate laws and policies in order to test their effects, how they impact behavior, and whether or not they serve their purpose; the ultimate goal is to determine if the law is effectuating its purpose. Next, the chapter discusses legal mapping and policy surveillance: the process of mapping public health laws in an ongoing, systematic, scientific manner so that policymakers can catalogue laws between jurisdictions. The chapter closes with a summary of the five essential public health law services.

This chapter introduces the transdisciplinary model of public health law, which rests on the recognition that public health law is not just the work of lawyers. The chapter explains key terms in the model, including public health law practice, legal epidemiology, and policy surveillance. It also discusses the concept of “mechanisms of legal effect,” which is central to conceptualizing and evaluating the impact of law on health.

This chapter reviews legal approaches that can be used to promote public health and address specific health problems. Legal approaches include prohibiting or mandating conduct; creating and enforcing licensing and permitting schemes; and increasing the costs of unhealthy conduct through taxes or litigation and incentivizing healthy conduct through loans, grants, and tax credits. Legal approaches can also address public health challenges by changing the informational environment with labeling requirements or reporting mandates or modifying the built environment through zoning or complete streets policies. The chapter identifies potential constitutional and practical limitations to each approach.

Chapter 15 reviews the importance of strategy and research in the formation and drafting of a proposed public health law, including assessing potential support and opposition. The chapter dictates an iterative process whereby the proposal’s drafter should first seek to understand their own proposal and its goals, explore the values- and practical-based interests behind why anyone would care about the legal proposal, identify groups of people and individuals who sympathize with or oppose the interests or burdens underlying all aspects of the proposal, research the history and positions of these groups, and anticipate challenges to the proposed enactment and implementation.

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

This chapter introduces and defines basic concepts used throughout the book and within the fields of public health and law. The chapter explores the focus on population-level data, rather than individual-level information, as public health’s primary lens. It defines health disparities, the social determinants of health, and the three levels of prevention to exemplify public health’s broad perspective, which looks beyond healthcare to more systemic causes of illness and disease. It also defines law and its role in shaping behaviors and environments at all levels—federal, state, local, tribal, and international—and introduces examples of how law may be used to impact the public’s health.

This chapter explores the authority of state and local governments to regulate public health at their respective levels. First, the chapter explains the states’ broad “police powers” and the related Jacobson v. Massachusetts Supreme Court decision. It then details local public health powers and how those interact with state powers. The chapter contrasts two rules that set the scope of local public health authority in different states: Dillon’s Rule and home rule. The chapter also discusses the doctrine of state preemption, which varies in its specifics from state to state, and it concludes by explaining how state legislatures can create administrative agencies and delegate authority to them.

This chapter describes “due process,” a constitutional restriction on governmental actions, in the context of public health. It outlines the doctrines of procedural and substantive due process, including the legal tests that courts apply to decide whether individuals’ due process rights have been violated. It uses examples from Supreme Court cases that have defined due process in the context of public health, including those that struggle to define the scope of reproductive rights. It also examines two cases where public health principles were raised as a justification for governmental action: one about involuntary sterilization and one about Ebola. The chapter concludes with a brief discussion of the “state action doctrine” that defines which public health actors may be challenged on due process grounds.

This chapter examines the role of the Constitution in federal government, defines federalism, and explains the types of federal preemption at play in public health policy. The chapter begins with an exploration of the U.S. Constitution; it explains the Constitution’s history and the role that the Constitution plays in public health policy formation. The chapter next defines the concept of federalism and details the Supremacy Clause and the Tenth Amendment. It briefly discusses the division of labor and authority between state/local governments and the federal government regarding public health laws. Last, the chapter delves into the concept of federal preemption. It applies the concepts of preemption to an in-depth example involving tobacco regulation; this example explores both express and implied preemption.

Chapter 20 explores the strategic reasons why entities may challenge public health laws, and uses the R.J. Reynolds Tobacco Company v. FDA case to walk through the steps of a legal challenge to a public health law. The chapter also identifies the attorneys involved in defending public health laws on behalf of local, state, and federal government entities and explains how legal technical assistance from public health organizations can support their efforts. Finally, the chapter defines the role of amicus curiae briefs and how they may effectively contribute to the defense of public health laws and regulations.

This chapter starts with the recognition that policymaking usually precedes evidence of what laws are effective in solving the problem at hand. That does not mean that policymaking cannot be guided by evidence. Policymakers can usually draw on extensive evidence defining the problem and evidence of analogous policies. This chapter identifies sources of policy recommendations and direct evidence of policy impact, including systematic reviews, narrative reviews, models, cost–benefit analysis, and individual studies. It reviews strategies for identifying bias and source credibility and tools for “educated guessing” about policy options in matters where evidence is scarce or incomplete, including causal mapping and the Haddon matrix. Finally, it introduces the Health in All Policies approach and the use of health impact assessments as tools to consider broader impact and cross-sectoral cooperation.

The public’s faith in the field of public health and the competency of public health agencies has been shaken by COVID-19. From our transdisciplinary perspective, we were keenly disappointed in the degree to which federal, state, and local health officials seemed to have forgotten the value of diversity of expertise and experience in developing and implementing public health laws. This Afterword considers how COVID-19 has brought changes to policy development, advocacy, implementation, and evaluation. It reaffirms the core premises of transdisciplinary public health law: that no single profession or scientific approach provides sufficient guidance for good policy decisions; that effectively using law for public health requires designing rules that can be enacted and enforced so that they render large-scale public compliance; and that practicing public health law requires good judgment under conditions of uncertainty.

The Introduction presents the purpose of the book, explains its transdisciplinary focus, and describes how it can be used to teach public health law to students in law schools, public health programs, social work programs, and other graduate and advanced undergraduate programs. It then provides an overview of the book’s chapters, which follow the general outline of the 5 Essential Public Health Law Services. Finally, it provides some commentary, continued in the book’s Afterword, on the impact of COVID-19 on the field of public health law. Although the second edition of the book integrates lessons from the COVID-19 pandemic and describes changes in the law that were influenced by COVID-19, the book also keeps its focus on basic skills and enduring legal principles of public health law.

This chapter defines regulation and identifies its three generic elements: a standard of behavior, means of monitoring whether the standard is being practiced, and means of incentivizing those who have not adopted the behavior to do so. The chapter introduces the various actors within and outside government who may practice the elements of regulation and reviews the theory of responsive regulation and enforcement. The chapter ends with an exploration of the challenges to effective regulation.

This chapter defines the three basic meanings of ethics: as a way of defining the “Good,” as a set of basic principles that emerge from ethical deliberation, and as a way of establishing standards to interact with professionals outside a given field. The chapter explores professional ethical codes from law, medicine, and public health and identifies ways in which ethics are supported or enforced through law.

This chapter defines the process of drafting a law, beginning with understanding the goal of the law; then moving through the steps of incorporating the existing science and law; capturing the goal, the rules of conduct, and the intervention in organized language and structure, which differs depending on whether the law is a regulation or a statute; and soliciting expert and stakeholder feedback. The chapter also covers technical drafting issues, such as legal definitions, cross-references, use of consistent terminology, and the use and placement of modifiers.

This chapter introduces the basic elements of administrative law and some key related legal doctrines. It covers administrative procedure acts that govern how agencies make or promulgate regulations and the rights of the public to have input. It then addresses the law governing legal challenges to the validity of the rules that agencies succeed in issuing, such as the ultra vires doctrine, and how agencies defend their decisions through legal doctrines such as Chevron deference. Finally, the chapter discusses how people establish standing to challenge agency actions, through both administrative channels and the writ of habeas corpus.

A decline in response rates was found for agricultural education research studies using survey research methods. The use of incentives and various response modes can affect survey response rates and were the focus of this experiment. The purpose of this study was to determine the effects of survey response mode and incentives on response rates when surveying SBAE teachers. Findings revealed a significant increase in response rates for groups receiving an incentive. No significant differences were found between groups using different survey response modes. When examining summated scale scores for each construct in the questionnaire, participants answering on paper scored more positively in four of the six constructs compared to web responses. Recommendations for practice included using mixed response modes when financially feasible and oversampling to achieve the desired sample size to represent a population. Further research on the effects of communication mode on response rates is needed. An examination of why differences in scale scores occur with different response modes is recommended.

Metacognition is an important skill required for improving students’ reading comprehension ability. Studies have reported effectiveness of metacognitive reading strategies to increase reading comprehension and information retention. However, there is limited research utilizing eye-tracking technology to explore the effectiveness of metacognitive reading strategies. This experimental study utilized eye-tracking technology on 40 undergraduate students to investigate the effectiveness of a metacognitive strategy on reading comprehension outcomes. The Survey, Question, Read, Respond, Recite, Record, and Review (SQ5R) strategy was used as the metacognitive reading strategy intervention. Participants’ eye movements were recorded during the reading process. Reading comprehension was assessed before and after watching the SQ5R intervention. This study revealed that participants adopted the SQ5R when reading scientific text, which enabled the students to better comprehend and retain more information. Results suggests that agricultural educators should incorporate the SQ5R metacognitive reading strategy into the design of agriscience reading materials to improve students’ reading skills and their ability to comprehensively understand complex and controversial issues in agriculture.

Summary Governance is an important factor in urban health, and law is an important element of healthy governance. Law can be an intervention local government wields to influence behavior and shape environments. Law can also be an important target of health promotion efforts: Law and the enforcement and implementation behaviors it fosters can promote unhealthy behaviors and environmental conditions, and can act as a barrier to healthy interventions or practices. Finally, law is a design and construction tool for the organization of governance. Law is the means through which cities are formally established. Their powers and duties, organizational structure, boundaries and decision-making procedures are all set by law. Regardless of the form of government, cities have legal levers they can manipulate for health promotion. Cities can use tax authority to influence the price of unhealthy products, or to encourage consumption of healthy foods. Cities can use their legal powers to address incidental legal effects of policies that they themselves cannot control. Cities may also have the authority to use law to address deeper determinants of health. The overall level of income or wealth inequality in a country reflects factors well-beyond a local government’s control, but city government nonetheless has levers to directly and indirectly reduce economic and social inequality and their effects. A renewed focus on law and urban governance is the key to assuring health and well-being and closing the health equity gap.

Using a “transdisciplinary approach” to public health law, this book follows the core competencies for both law and public health programs. It reviews the basic background of the field of public health law, then introduces tools, concepts, and skills needed for effective development of public health laws and policies. The book also introduces the core legal doctrine of public health law and outlines the process for turning a public health law idea into an actionable, codified law or policy. It then turns to the challenges and key issues regulators and authorities face in implementation, enforcement, and legal and political defense against challenges. The book concludes with evaluation—explaining how legal monitoring and evaluation are integral to the cause of using law in public health and helping spread laws that work across jurisdictions, from the city level and beyond.

Throughout the world, laws play an important role in shaping population health. Law making is an intervention with measurable effects yet often unfolds without evaluation or monitoring. Policy surveillance—the systematic, scientific collection and analysis of laws of public health significance—can help bridge this gap by capturing important features of law in numeric form in structured longitudinal data sets. Currently deployed primarily in high-income countries, methods for cross-national policy surveillance hold significant promise, particularly given the growing quality and accessibility of global health data. Global policy surveillance can enable comparative research on the implementation and health impact of laws, their spread, and their political determinants. Greater transparency of status and trends in law supports health policy advocacy and promotes public accountability. Collecting, coding, and analyzing laws across countries presents numerous challenges—especially in low-resource settings. With insights from comparative politics and law, we suggest methods to address those challenges. We describe how longitudinal legal data have been used in limited, but important, ways for cross-national analysis and propose incorporating global policy surveillance into core global public health practice.

Public security and law enforcement have a crucial but often largely unacknowledged role in protecting and promoting public health. Although the security sector is a key partner in many specific public health programmes, its identity as an important part of the public health endeavour is rarely recognised. This absence of recognition has resulted in a generally inadequate approach to research and investigation of ways in which law enforcement, especially police at both operational and strategic levels, can be effectively engaged to actively promote and protect public health as part of a broader multisectoral public health effort. However, the challenge remains to engage police to consider their role as one that serves a public health function. The challenge consists of overcoming the continuous and competitive demand for police to do so-called policing, rather than serve a broader public health function-often derogatively referred to as social work. This Series paper explores the intersect between law enforcement and public health at the global and local levels and argues that public health is an integral aspect of public safety and security. Recognition of this role of public health is the first step towards encouraging a joined-up approach to dealing with entrenched social, security, and health issues.

The centrality of law as a public health intervention has been undeniable during the Covid-19 pandemic. In just the first half of 2020, more than 1000 laws and orders were issued by federal, state, and local authorities in the United States in an effort to reduce disease transmission. Legal interventions include stay-at-home orders, mask mandates, and travel restrictions, as well as more particular rules for business operations, alcohol sales, curfews, and health care. Given their heavy use, importance, and obvious socioeconomic side effects, and the social and behavioral complexities of their implementation, one might have expected the National Institutes of Health (NIH), other research funders, and the research community to jump to the work of determining the right mix, intensity, and enforcement approaches of legal restrictions to control transmission with the least and most equitably distributed harms. No organized research program emerged. This commentary calls for increased investment in research and funding to better understand the mechanisms of effect and impacts of law and policy on health and well-being.

Reproductive rights have been the focus of United Nations consensus documents, a priority for agencies like the World Health Organization (WHO), and the subject of judgments issued by national and international courts. Human rights approaches have galvanized abortion law reform across numerous countries, but human rights analysis is not designed to empirically assess how legal provisions regulating abortion shape the actual delivery of abortion services and outcomes. Reliable empirical measurement of the health and social effects of abortion regulation is vital input for policymakers and public health guidance for abortion policy and practice, but research focused explicitly on assessing the health effects of abortion law and policy is limited at the global level. This paper describes a method for Identifying Data for the Empirical Assessment of Law (IDEAL), to assess potential health effects of abortion regulations. The approach was applied to six critical legal interventions: mandatory waiting periods, third-party authorization, gestational limits, criminalization, provider restrictions, and conscientious objection. The IDEAL process allowed researchers to link legal interventions and processes that have not been investigated fully in empirical research to processes and outcomes that have been more thoroughly studied. To the extent these links are both transparent and plausible, using IDEAL to make them explicit allows both researchers and policy stakeholders to make better informed assessments and guidance related to abortion law. The IDEAL method also identifies gaps in scientific research. Given the importance of law to public health generally, the utility of IDEAL is not limited to abortion law.

Objective Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. Methods Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. Results Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. Conclusion Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.

This is the sixth and final report in a series of reports exploring the role of law in housing equity and innovative uses of law to improve health equity through housing. The reports are based on extensive literature scans and semi-structured interviews with people who are taking action in housing policy and practice. The full series includes: Report I: A Vision of Health Equity in Housing; Report II: Legal Levers for Health Equity in Housing: A Systems Approach; Report III: Health Equity in Housing: Evidence and Evidence Gaps; Report IV: Creative People and Places Building Health Equity in Housing; Report V: Governing Health Equity in Housing; and Report VI: Health Equity through Housing: A Blueprint for Systematic Legal Action. This report offers guidance for action based on our research. We propose one overarching recommendation, the adoption of a systematic policy experimentation approach to achieving health equity in housing. We explore this approach through a case study of lead poisoning prevention efforts in Rochester, NY. We then present six areas of housing law that are ideal for experimentation. They range in topics, including strengthening fair housing enforcement to reduce discrimination, and supporting residential stability. The report also contains an appendix with additional ideas for experiments that emerged through our research and interviews.

Toward Healthy Drug Policy in the United States A recent ruling on a proposed overdose-prevention site in Philadelphia means that one initial hurdle to the creation of this facility has been cleare...

Study abroad experiences serve to enrich students’ educational experiences, granted these programs must be evaluated to assess educational effectiveness. The purpose of this qualitative study was to examine Nicaraguan students’ perceptions of agriculture and future aspirations, before and after engaging in a four-day agricultural -based program. Graphic elicitation and arts-based projective techniques served as metrics to assess students’ perceptions. Four major themes, with six sub-themes emerged from the data: a) perceptions of agriculture (i.e., previous agriculture); b) strength through unity (i.e., unity; and ripple effect); c) aspirations (i.e., importance of education); d) value of experience (i.e., learning new things; and thankfulness). Overall, the Nicaraguan students indicated the study abroad experience broadened their perspective of agriculture, having a direct impact on their career aspirations.