Category Archives: Public health law
New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse
Prescription drug-related deaths now outnumber deaths from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C.
A new report about prescription drug abuse released today by Trust for America’s Health (TFAH), finds that few states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the U.S. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, shows that only two states – New Mexico and Vermont – have implemented all ten strategies.
According to the National Center for Injury Prevention and Control (NCIPC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.
>>Watch a one-minute video on the scope of the prescription drug abuse epidemic in the United States.
The report also found that the number of drug overdose deaths – a majority of which are from prescription drugs – has doubled in 29 states, tripled in ten states and quadrupled in four states since 1999.
“The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action,” says Levi.
In the new report, TFAH, based on consultations with experts in public and clinical health, injury prevention, law enforcement and community organization, reviewed national recommendations and examined strategies currently in use to help curb the epidemic. Recommendations include expanding access to treatment options; ensuring responsible prescribing practices; and improving Prescription Drug Monitoring Programs.
>> Learn how your state scores on the 10 key steps to curb prescription drug abuse, with a new app from the Robert Wood Johnson Foundation.
Ohio is one of several states that have implemented six of the proven strategies recommended in the report and today, in fact, will introduce new prescriber guidelines.
NewPublicHealth spoke with Ted Wymyslo, MD, director of the Ohio Department of Health about that state’s review of drug abuse and recent efforts to reduce the epidemic through a variety of means, including public and provider education.
Home fires account for 85 percent of fire deaths in the United States, yet the majority of family homes lack fire sprinklers. Since the late 1970s, a grassroots movement has successfully promoted close to 400 local ordinances that mandate fire sprinklers in all new residential construction. In response, the homebuilding industry has sought out state preemption of local authority, a strategy used by other industries as well, in an effort to reduce costs and shield profits. A new study just published in the American Journal of Public Health looks at grassroots public health movements, including the one mobilized to push back against preempting residential fire sprinklers.
To learn more about how preemption can have a negative impact on public health, NewPublicHealth spoke with Marjorie Paloma, MPH, senior policy adviser and senior program officer for the Robert Wood Johnson Foundation’s Health Group, and a co-author of the new AJPH article on preemption, grassroots efforts and public health.
NewPublicHealth: How does the effort to increase installed sprinklers in the U.S. add to the conversation on the grassroots public health movement?
Marjorie Paloma: The residential fire sprinkler story illustrates the power of grassroots movements and the chilling effect preemption can have. I use power very explicitly because when you look at the residential sprinklers movement, over time, you see how much power people have when they come together and act. Families who lost someone to fire, fire officials and others came together first in local communities and then across the nation to advocate sprinklers and save lives. The new article in the American Journal of Public Health shows that over three decades, 34 states passed legislation on this — over 350 local ordinances — and I think that this example shows you the arc of a grassroots movement. This example also shows how powerful preemptive legislation is on a grassroots movement. In those two years between 2009 and 2011, 13 states passed preemptive legislation and that essentially pulled the wind out of the sails of advocates who had been working on this issue. And, it shows you how that tactic, that strategy of preemption can really deflate, thwart, and potentially kill a movement.
NPH: How does the grassroots movement intervene and explain what the impact of preemption is on movements that promote health?
Critical Opportunities: New Journal Article, Videos Offer Proposed Legal and Policy Changes that Can Impact Public Health
Ten new videos released today by Public Health Law Research (PHLR), a national program of the Robert Wood Johnson Foundation, with direction and technical assistance from Temple University, offer suggestions of proposed changes to laws and policies that can impact public health, such as fortifying corn masa flour to prevent neural tube defects and increasing taxes on alcohol to reduce consumption. The five-minute videos offer examples of PHLR’s “Critical Opportunities” initiative—brief presentations which showcase legal approaches to improving public health.
“Laws can be cost-efficient and popular tools for achieving public health goals. This initiative captures specific actionable, evidence-based ideas for creative ways of using law or legal interventions to improve a public health problem,” said Scott Burris, JD, director of the PHLR program.
The release of the videos is accompanied by an article published this week in the American Journal of Public Health, “Critical Opportunities for Public Health Law: A Call to Action.” It outlines five high-priority areas where evidence suggests legal interventions can have big impacts on health, and calls for a national conversation to continue to identify and prioritize opportunities for legal and policy action.
“The Centers for Disease Control and Prevention, the Institute of Medicine, and others have called for better, smarter use of legal interventions to advance public health,” said Michelle Mello, JD, PhD, the lead author of the article and professor of law and public health at Harvard University. “That’s no small task, but there’s a treasure trove of great ideas to draw on and evidence to back them up.”
PHLR has also developed a toolkit for use by organizations or instructors to host Critical Opportunities sessions at their meetings or in classrooms. The toolkit offers a how-to guide for using the format to identify ways laws can be used to address public health issues.
All ten of the new Critical Opportunities videos are available here. To highlight just one of the presentations, NewPublicHealth recently spoke with Adam Finkel, ScD, of the University of Pennsylvania Law School, about his Critical Opportunity presentation on the benefit and limitations of “smart disclosures,” an alternative to regulations and laws for improving public health.
Public Health Presentations Cap First Class of Network for Public Health Law Mentorship Program for Young Attorneys
Laws and policies that impact public health can create healthier conditions for entire communities—a more cost-effective approach than treating one person at a time, and then only after they’re sick. Last week, five inaugural Visiting Attorneys in Public Health Law presented on their efforts over the past year as part of a program hosted by the Network for Public Health Law and the Robert Wood Johnson Foundation (RWJF). The attorneys focused on public health law around:
- The legality of tobacco “power walls” that put colored cigarettes boxes directly in the line of vision of children
- The impact of environmental noise on heart disease
- Displacement of residents through gentrification
- The challenges and promise of “health in all policies”
- Legal avenues toward reducing sodium intake by the public
The post-JD program is designed to help develop exceptional skills in practice-based public health law than can help lawyers to advance their public health law careers. During the program, the five attorneys were each located at a host site under the mentorship of a renowned public health legal expert. This year’s mentors included Doug Blanke, founder and director of the Public Health Law Center at the William Mitchell College of Law in Minnesota, and Clifford Rees, practice director of the western region of the Network for Public Health Law.
“This fellowship is one that we developed in conjunction with the Network for Public Health Law to help to build the field of public health law and to allow bright, new attorneys with an interest in public health, to be able to experience working in [that] setting while being mentored and coached by leaders in the field,” says Angela McGowan, JD, MPH, RWJF’s senior program officer.
McGowan says RWJF hopes this type of experience will highlight that public health law is an exciting career option, as well as show the value of engaging new professionals in this practice as a way of making meaningful impacts at the local, state and federal levels of public health. McGowan added that the Visiting Attorneys were able to really be engaged with the real work that public health and law practitioners face daily, and to apply their legal knowledge to solving public health problems.
NewPublicHealth is partnering with Grassroots Change: Connecting for Better Health to share interviews, tools, and other resources on grassroots public health. The project of the Robert Wood Johnson Foundation Health Group supports grassroots leaders as they build and sustain public health movements at the local, state and national levels.
In this excerpted Q&A, conducted by Grassroots Change, California State Fire Marshal Tonya Hoover shared her thoughts on a quiet but highly successful public health movement: fire sprinkler requirements as a cost-effective measure to reduce civilian deaths, injuries, and property damage while protecting fire fighters and the natural environment. Tonya Hoover is a 20-year veteran of the fire service and an experienced advocate for fire prevention. She has promoted residential fire sprinkler ordinances as a local fire marshal in California and a statewide requirement that went into effect on January 1, 2011.
>>Read the full Q&A on GrassrootsChange.net.
Grassroots Change: Tell us about the grassroots movement for residential fire sprinklers.
Tonya Hoover: California has seen the passage of residential sprinkler laws since the first local adoption in San Clemente in 1978. Since that time, over 160 local ordinances have passed [fire sprinkler requirements for all new construction, including 1- and 2-family homes].
Other states have also adopted residential sprinkler ordinances for many years. Residential sprinklers aren’t new. What is new is they’re getting their time in the sun with the public because we already sprinkler apartments and larger buildings. People are used to seeing sprinklers in commercial buildings and office spaces. Most apartments in California – the complexes that have been going up in the past 20-25 years – have sprinklers. We hope to get people to look up and say: “Why isn’t my house sprinklered? This is supposed to be my safe haven.”
Public Health Law Research’s (PHLR) LawAtlas is a comprehensive content management tool that enables users to track and analyze key laws aimed at improving health and access to health care. From interactive law maps to policy surveillance reports to “reams” of digital data, it offers an expansive view of how health and the law are intersecting throughout the country. In fact, LawAtlas just today released two new data sets, one on Child Restraint Systems and one on Dental Hygienist Scope of Practice Laws.
NewPublicHealth spoke with Scott Burris, Director of PHLR’s National Program Office, and Damika Barr, Legal Analyst and LawAtlas Manager, about what LawAtlas means for the public health community—and their hopes for its future.
NewPublicHealth: What are you learning about the value of LawAtlas to the public health and law communities?
Scott Burris: I think there are two things that people really like about this. One is getting law as data. So, we take law and it’s a bunch of words that people in health often don’t want to cope with or don’t really appreciate. It’s not what they do. We turn it into data that they understand, that they can use, that fits right into their broader lifestyle, as it were. Meeting the needs of people doing epidemiology and science, that’s one part of it. The other part is just a great demand to see law laid out in this geographical way so that everyone can see what states have what laws and how any particular policy is progressing across the states.
Damika Barr: We’re finding that this is eye opening because you can finally see the dimensions of the law across jurisdictions over time with your own eyes, and it’s really easier for our researchers or the public health law communities and providers to see the dimensions as compared to looking at a long table with many columns. Researchers can start to ask more detailed questions or about more dimensions of the law than they would have if they were just limited to a table.
NPH: We’ve seen a couple of the ways that LawAtlas is being used already, including the study by Hosea Harvey that looked at youth sports concussion laws. What are some other innovative ways you’re seeing LawAtlas being used in research?
Burris: I think it’s not so much “innovative ways" as what important things can LawAtlas show us? LawAtlas in itself was an innovation in that it allows people to more efficiently code the characteristics of the law and more easily publicize it, but what we’ve learned in recent research is how you can answer important questions with it.
The recently launched Scholars in Residence fellowship program was created to place legal experts in public health agencies across the country—where together they can find new solutions to public health problems. The program, from Network for Public Health Law and the Robert Wood Johnson Foundation, has chosen six scholars to work with local and state health agencies.
NewPublicHealth spoke with Mary Crossley, Professor of Law and former Dean at the University of Pittsburgh School of Law, who will help California health officials identify new ways to address the growing issue of chronic diseases.
NewPublicHealth: Tell me about your career path, and how you came to be interested in public health.
Mary Crossley: I have a career in law teaching and scholarship, but my focus has been—in both my teaching and my scholarship—on health law. Particularly in my scholarship I’m focusing on issues of inequality in healthcare; finance and delivery; and how the law responds to those inequalities—and in many cases fails to respond. So, it’s really been through an interest in thinking about other ways to approach inequity in health and healthcare that I have become more interested in public health and public health law as a mechanism to address it. I also started doing some lecturing and writing that looks at the intersection between the civil rights to inequality in health and a public health approach.
NPH: Did you apply for this or did they come and find you and ask you to take on the position?
Crossley: I applied for it. They put out requests for applications back in the fall, and it was targeted specifically to tenured law professors. And in fact what I learned in talking to the folks involved in the program was that they were particularly interested in getting folks who didn’t necessarily have a long history of involvement in public health, but instead saw this as a way of bringing new people into the discussion and engaging larger numbers of legal academics in teaching and thinking and writing about the intersection of public health and law.
NPH: Where are you going to be working?
Crossley: Part of the application process was finding a public health agency with which I would like to work and which was willing to work with me to support my application, and I ended up partnering with the San Francisco Department of Public Health.
The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.
For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.
To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.
NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?
Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.
In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.
NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?
Approximately 362,100 residential fires left 2,555 civilians dead and another 13,275 injured in 2010, according to the U.S. Federal Emergency Management Agency (FEMA). They also caused about $6.6 billion in property damage.
According to FEMA, automatic fire sprinklers are the “most effective fire loss prevention and reduction measure with respect to both life and property.” The numbers regarding just home fires are especially impressive: the risk of death drops 80 percent and the cost of property damage drops 71 percent, according to Preemption Watch. And when comparing simple costs to the lives saved, they’re without question cheap. Residential sprinkler systems cost only about $1.61 per square foot to install and typically help lower insurance costs.
When seen through the lens of public health, residential fire sprinklers are an inexpensive and easy tool to prevent injuries and save lives. They’re low in cost, quick to respond, small in size and require little work to install, which makes for a high return on investment.
The successful implementation of more than 300 local ordinances since the 1970’s demonstrates the power of grassroots movements in public health. And, in the reactions by many state governments, it helps illustrate the “preemptive” legislation that can hinder efforts to advance public health.
USDA Issues Rules for Healthy Snacks at School
The U.S. Department of Agriculture has released rules for healthy snacks at school. The program, called Smart Snacks in School and required by the Healthy Hunger-Free Kids Act of 2010, applies to snack food and a la carte foods sold at meal time. The rules take effect for the school year beginning in 2014. The rules do not apply to foods brought from home or to fundraisers held during after-school hours. The rules promote foods with more whole grains, low-fat dairy, fruits, vegetables and leaner protein, as well as foods lower in fat, sugar and sodium that provide more of the nutrients kids need. New rules also apply to beverages sold at school. Only sports drinks and sodas that contain 60 calories or less per 12-ounce serving will be allowed in high schools. In elementary and middle schools, drink choices will be limited to water, carbonated water, 100 percent fruit or vegetable juice, low-fat milk and fat-free milk.
“The updated standards are critical to addressing the nation’s childhood obesity epidemic and helping our most vulnerable children get the foods and drinks they need to grow up strong and healthy,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “Together with recent efforts to improve school meals, these updates will help to create a culture of health in schools and a better future for millions of children…while the standards will not take effect until the 2014-2015 school year, schools can begin implementation and act now. Let’s seize this opportunity. When it comes to keeping our kids healthy, there is no time to waste.” Read more on obesity.
New York Rebuffs Bloomberg’s Veto, Passes Paid Sick Time Law
New York City lawmakers overrode Mayor Michael Bloomberg’s veto yesterday and passed a law requiring businesses to provide more than one million workers with paid sick time. While other large cities have similar regulations—including Portland, Ore., San Francisco, Seattle and Washington, D.C.—supporters believe this vote will help make paid sick time the norm across the entire country. "The catalyst will have been the successful struggle we waged here in New York City," said Dan Cantor, the national executive director of the Working Families Party. Bloomberg vetoed the measure earlier this month on the grounds that the added costs to businesses would ultimately hurt employees. The ordinance was passed after considerable research and advocacy from Community Services Society of New York, a Robert Wood Johnson Foundation Roadmaps to Health Community Grantee, along with other partners. Read more on public health law.
HHS Seeking Private Sector Innovators, Entrepreneurs to Solve Health Challenges
The U.S. Department of Health and Human Services (HHS) is now seeking applicants for its second annual HHSentrepreneurs Program. The program is designed to bring together private sector innovators and entrepreneurs with federal groups working to answer major health, health care and human services challenges. This year’s goal is to place up to eight entrepreneurs into six projects:
- Application of Design Thinking to Grants
- Cloud-Based GIS Maps Displaying Aggregate Data on Medical Malpractice
- Health Information Exchange Accelerators
- Modernizing the National Plan and Provider Enumeration System
- Predictive Analytics: Merging Innovation and Business Operations
- Publication Planning and Clearance Process Improvement Project
Read more on Health and Human Services.