Collection of vital statistics has long been a key public health function, and cause of death information contained in death records is fundamental to public health practice. For instance, rates of infant and maternal mortality—obtainable from death records—are “essential indicators of the nation’s health,” revealing important details about access to care and racial or other disparities in health. Accurate and detailed cause of death reports can support the development of effective public health responses to public health problems (such as the ongoing opioid epidemic or high rates of suicide), while inaccurate reports may lead to underreporting of, and insufficient response to, significant public health threats (for example, dementia and the involvement of alcohol in motor vehicle traffic fatalities). Thus, improving the accuracy and timeliness of death certificates, such as through electronic reporting, are key strategies for improving public health policy and practice.
Public access to death records can also yield additional significant public health benefits. For example, researchers may rely on death records to monitor and examine various causes of morbidity and mortality, while investigative reporters may use death records to uncover inappropriate public health, public safety, or physician practices; investigate potential cases of medical malpractice; or draw attention to other public health threats, such as instances of elder abuse occurring in nursing homes. Unfortunately, these activities may be hindered by state laws that restrict access to death records.
Public access to death records varies by state. According to a 2012 law review article by Jeffrey R. Boles, state laws governing public access to death records typically fall into one of three categories—open access, partial access, or no access:
As of 2012, Boles identified approximately ten states that granted open access to death records; three states that provided partial access; and over 30 states that significantly restricted access.
As noted by Boles, restrictive public access laws are often justified by privacy concerns, but some suspect these laws are instead driven by motivation to reduce administrative burdens on the state. The Indiana Supreme Court recognized this driving force in a 2014 case in which it concluded that local health departments must disclose certificates of death requested by any applicant, while the state registrar is authorized to disclose the same records only to specified eligible applicants. The court explained that the legislature “could have intended to distribute the administrative burden of record production among local health departments rather than letting it fall solely upon the State Health Department.” Unfortunately, local health departments in Indiana and across the country face significant budgetary shortfalls as well; thus, a lack of capacity to process death record requests is symptomatic of an overall failure to prioritize funding for public health.
Whether restrictive laws are due to privacy concerns or budgetary constraints, it is important to remember that open access to death records can yield significant public health benefits by expanding the reach and capacity of public health through the involvement of researchers, journalists, public health policy makers and practitioners, and the community at large.
This post was developed by Colleen Healy, Staff Attorney, at the Network for Public Health Law – Mid-States Region at the University of Michigan School of Public Health.
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 does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.