Public Health Law Blog

Over the past several months, in the lead-up to our 2018 Public Health Law Conference, we asked Network members and friends what health justice means to you. Your insights, along with a survey of the legal and policy issues impacting health equity, informed the strong and diverse programming for the more than 40 sessions organized for the conference.

With 21,315 reported cases and 35 deaths from measles in 2017, Europe is experiencing a surge in this highly contagious, but preventable disease. The World Health Organization points to low immunization coverage as a major factor for the outbreak, with over 41,000 additional cases so far in 2018. Given that most of the measles cases in the U.S. result from unvaccinated individuals who contract the disease in other countries, this outbreak is concerning in light of declining U.S. vaccination rates.

Differences in implementation and enforcement of certain laws, like housing codes and immigration laws, can lead to poor and sometimes disparate health outcomes among different communities and populations. Medical-Legal Partnerships are uniquely positioned to identify legal failures and gaps and are important partners for public health. Often, patterns in individual health-harming legal challenges reflect a need for population-level intervention.  

States have expanded legal gambling significantly over the last decade and continue to do so as they grapple with budget shortfalls, desperate to raise revenue without raising taxes. All but two states collect revenue through one or more types of gambling. The nature of gambling has changed in recent years, however, with the proliferation of Daily Fantasy Sports (DFS). The major DFS companies offer services in 39 states as many regulators have determined that DFS is a permissible skill-based game rather than impermissible gambling (or games of chance). In 2017, the DFS industry collected over $3 billion in user entry fees and generated $335 million in revenues. And now states have the opportunity to further expand permissible gambling—and state revenue—by permitting sports betting, such as wagers on the Super Bowl and brackets for March Madness following the decision in Murphy v. NCAA (May 14, 2018).

In states that have passed mandatory flu immunization for children between six months and five years of age, deaths and hospitalization due to flu have declined. In June, the New York Court of Appeals upheld a New York City Health Code requiring annual flu vaccination for children (ages of six – 59 months) who attend city-regulated child care or school-based programs. The ruling is a significant victory for public health in light of the ongoing legal challenges to mandatory vaccination requirements and childhood vaccination rates.

Access to broadband is increasingly being recognized as an important social determinant of health. However, despite progress in expanding connectivity, approximately 34 million people in the United States still lack broadband access. The “digital divide” is particularly acute in rural communities, where 23 million residents lack broadband access. Law and policy directly affect the availability and cost of broadband services. Federal and state policies, including the funding of broadband infrastructure in rural areas, can facilitate expansion of broadband access.

More women in the United States die from pregnancy complications than in any other developed country, and the rate of maternal deaths continues to rise. Recent legislation passed by Congress establishes a shared responsibility between States and the Federal Government to identify opportunities to improve maternal health. The legislation supports the development of a model for States to operate maternal mortality reviews, assess the various factors that may have contributed to maternal mortality, and develop appropriate interventions to reduce and prevent such deaths.

Some of the public health law and policy stories that made headlines recently include a Justice Department declaration that key provisions of the Affordable Care Act are unconstitutional; a proposed change to a Medicaid rule to address the opioid crisis; rising suicide rates in the U.S.; the multi-state hepatitis A virus outbreak; studies showing the effectiveness of certain gun laws; and Virginia’s decision to expand its Medicaid programs.

The U.S. is experiencing its worst outbreak of hepatitis A in over 20 years. The outbreak has primarily affected people experiencing homelessness (PEH) due to their lack of access to sanitation and hygiene facilities. In Los Angeles alone, one study found only nine public toilets for every 1,777 PEH. As a result, the city has initiated community and local government interventions designed to address this shortfall.

Extension programs connect land grant universities and the larger public, bringing academic research to communities that can apply it. Programming at the recently held National Health Outreach Conference, sponsored by the Cooperative Extension System, focused on engaging in a culture of health and highlighted ways in which Extension programs are collaborating with others to advance community health.