Civil Rights Law and the Determinants of Health: How Some States Have Utilized Civil Rights Laws to Increase Protections against Discrimination
September 10, 2019
The recently released Journal of Law, Medicine & Ethics supplemental issue features articles authored by presenters at the 2018 Public Health Law Conference in Phoenix, Arizona. Dawn Pepin, Public Health Analyst, Cherokee Nation Assurance contractor for the Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention; Samantha Bent Weber, JD, Doctoral Candidate, Joint Program in Public Policy at the Georgia Institute of Technology School of Public Policy and the Georgia State University Andrew Young School of Policy Studies co-authored the article, “Civil Rights Law and the Determinants of Health: How Some States Have Utilized Civil Rights Laws to Increase Protections against Discrimination.”
In the following Q&A, Dawn and Samantha discuss their article and how it addresses a critical public health concern.
Q: Why is this topic so critical right now?
While health remains a critical issue in our country, our public conversation about it can often be both complicated and complex. As a result, one critical related problem, disparities in health, merits highlighting. As the country continues to become more diverse, it is increasingly important for society to take steps to improve the health outcomes of people who are disproportionately affected by various forms of inequity and discrimination. Structural forces embedded in the laws and other institutions, as well as conscious and unconscious biases, still exist in healthcare and public health. For example, a recent JAMA article highlights data demonstrating that black individuals were significantly less likely than white individuals to receive stroke prophylaxis. The article says, “after adjusting for clinical variables, socioeconomic characteristics, and acknowledging patient-level factors, what potentially remains is the subtle but pernicious influence of subconscious bias.”
This article and many others point to the reality that social, economic, legal, and other aspects beyond medical treatment have a large impact on population health. Discrimination in the social and structural determinants of health, such as housing, education, credit, and public accommodation, worsens public health outcomes. Thus, to address the impact of discrimination on health outcomes, society would need to consider measures to reduce or eliminate discrimination.
Q: How does your article address this issue and its challenges?
Civil rights law is one tool that can be used to address health disparities. Federal civil rights law establishes a floor or a set of minimum requirements for civil rights, meaning that states can enact protections that go beyond federal law. Our initial look at the literature encouraged us to examine what states have done to protect civil rights—the kinds of civil rights laws states have passed and institutions they have created, such as civil and human rights commissions. We conducted a legal mapping study, which is a type of legal epidemiological study that identifies “the key provisions of law on a particular issue, identifies patterns in the nature and distribution of laws, and defines important questions for evaluation research, legal analysis and policy development.” We found that state laws vary widely in the additional protections they extend to particular classes of people, as well as in the types of settings where discrimination is considered illegal. A better understanding of both the historical role of law prohibiting discrimination and the current uses of civil rights laws in preventing discrimination will better inform future research surrounding health inequities.
Q: How do current policy solutions address this issue?
From a policy standpoint, this is a great time for experimentation and creative thinking. Developments in communities around the country suggest that states and localities can drive successful efforts to promote health equity and achieve health justice. Further, new research on such topics as unconscious bias has spurred new thinking about training and prevention of discrimination in healthcare and other determinants of health. While civil rights law has its basis in the US Constitution, this research shows that law is not static but changing and evolving.
Q: Is there anything else you would like to note?
Identifying and mapping variations in laws across the states is a first step in understanding the relationship between civil rights and health. Moving forward, as a field, we need to better understand the connections between legal data and public health data in order to evaluate the impact of state-level civil rights laws and policies on health outcomes.
This document was authored by researchers in the Public Health Law Program (PHLP) in the Center for State, Tribal, Local, and Territorial Support at the US Centers for Disease Control and Prevention (CDC). The findings and conclusions in this article are those of the authors and do not necessarily represent the official views of CDC. For further information, please contact PHLP at email@example.com.
This guest post was prepared by Dawn Pepin, Cherokee Nation Assurance contractor for the Public Health Law Program, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention; and Samantha Bent Weber, Joint Program in Public Policy at the Georgia Institute of Technology School of Public Policy and the Georgia State University Andrew Young School of Policy Studies
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
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