Category Archives: Public health law
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.
Aiding in the response and recovery effort in Oklahoma following last week’s tornadoes are several state disaster medical assistance teams (DMATs), requested by Oklahoma governor Mary Fallin. The New Mexico DMAT includes a member, Cliff Rees, who is experienced in law as it pertains to public health emergencies. Rees is the practice director of the Network for Public Health Law’s Western Region.
NewPublicHealth spoke with James G. Hodge, Jr., JD, LLM, Principal Investigator/Director of the Network for Public Health Law’s Western Region, about how knowledge of law during an emergency can help speed assistance to victims.
NewPublicHealth: What is Cliff Rees’ role on the ground?
James Hodge: As a member of the DMAT team, he is well trained in many areas of response and is working with his team to provide needed assistance on multiple fronts. However, Cliff is also capable of assessing legal concerns on the ground if they come up.
NPH: What are some of those concerns?
As school winds down and camps and sports prepare for the summer season, a new study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health on sports-related traumatic brain injuries in youth sports, is generating deserved attention.
The study, by Hosea Harvey, JD, PhD, Assistant Professor of Law at the Temple University Beasley School of Law, found that while forty four states and Washington, D.C., passed youth sport TBI laws between 2009 and 2012, none of the laws focus on preventing the injuries in the first place. The laws on the books deal primarily with increasing coaches’ and parents’ ability to identify and respond to traumatic brain injuries and reducing the immediate risk of multiple brain injuries.
>>Read more in a Q&A with the Babe Ruth League Inc. about how youth sports leagues are making strides to prevent injuries.
Harvey’s conclusion is that continued research and evaluation is needed to develop a more comprehensive reduction in youth sport traumatic brain injuries.
NewPublicHealth: What did your study address?
Hosea Harvey: I looked at traumatic brain injury (TBI) laws that were passed at the state level that purported to deal with the problem of youth TBIs in sports statewide. I looked at every related state law passed between 2009 through the end of 2012, though most states only had one law that they passed that dealt with youth sports TBIs during that period.
NPH: And your study found that no state that right now has a law that says this is what you have to do in order to prevent these concussions in the first place?
While a growing number of major league sports teams have policies on concussion assessment and return to play, many youth and school sports leagues and teams do not have similar rules, despite thousands of sports-related traumatic brain injuries (TBIs) reported in children and adolescents every year.
Hosea H. Harvey, PhD, JD, Assistant Professor of Law in Temple University’s Beasley School of Law, has just published an article in the American Journal of Public Health analyzing how this health issue is being addressed across the country. He found that there are laws dealing with concussions in youth sports in 44 states and D.C.—but none are focused on preventing the injuries. The laws only address detecting the injuries or preventing an additional injury after one has already occurred.
The study also revealed that many laws don’t draw on evidence around what works. For example, most state laws establish a minimum 24-hour period of youth athlete removal, but there is no scientific agreement about the optimal minimal time someone who has suffered a sports-related TBI should be removed from play. The study utilized an open source dataset from Robert Wood Johnson Foundation grantee Public Health Law Research called LawAtlas.
>>Read the full study.
NewPublicHealth previously spoke with Harvey and Kerri McGowan Lowrey, JD, MPH, Senior Staff Attorney with the Network for Public Health Law — Eastern Region, about legal and legislative approaches to addressing concussions in youth sports. The previous interview is included below:
Crime and violence in U.S. inner cities has a profound impact on public health. The question is how best to combat it. According to recent studies, one answer could be as simple as assigning more police officers to foot patrols in crime hotspots.
With funding in part from the Robert Wood Johnson Foundation’s Public Health Law Research program, researchers from Temple University worked with the Philadelphia Police Department to conduct a study on the impact of police foot patrols on inner city crime. Findings published in Criminology in 2011 found foot patrols helped reduce violent crime — at least temporarily — by 23 percent in high-crime areas of the city. A recent follow-up study in Policing and Society revealed a qualitative look at how the participating officers developed extensive local knowledge and formed community relationships — both of which contributed to the cuts in crime.
These and other results demonstrate the need to involve officers on foot patrol in the development of violence prevention strategies, according to researchers.
>> Read more about the study.
While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.
In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.
“This problem requires a public health solution since [preventing childhood] lead exposure…involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.
NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.
NewPublicHealth: What did your study find?
Nearly 40 percent of private-sector employees in the United States do not have access to paid sick days, making it difficult for them to miss work when they are ill or have a doctor’s appointment. Those who do stay home often suffer lost wages and risk being fired from their jobs. To avoid financial insecurity, employees often go to work while sick, according to the Network for Public Health Law.
Paid sick days, on the other hand, allow employees to stay home or seek preventive care without risking a family’s income or endangering the health of co-workers, customers and others. In fact, one study found that 7 million workers were infected with H1N1 in 2009 because their co-workers came to work sick. To combat this trend, some U.S. cities and one state (Connecticut) have enacted laws requiring employers to provide paid sick days, which was a topic explored in a webinar earlier this year from the Network for Public Health Law.
But as some cities are making moves toward paid sick leave, some state-level legislation is cropping up that could prevent cities and counties from passing their own paid sick days standards and enacting other workplace protections. Such preemption laws are being considered in at least six states, according to a post by Vicki Shabo, Director of Work and Family Programs, for the National Partnership for Women and Families.
"No matter where you live or work, no one should have to choose between job and family because he or she cannot earn paid sick days," said Shabo in the post.
While laws to help make it easier for everyone to get their veggies are cropping up all over, some would-be planters get stopped in their carrot tracks by regulations that prohibit use of public spaces for planting, or even limit what can be grown on private property, according to a recent article in the Wall Street Journal [note: subscription required]. In some jurisdictions, according to the article, sidewalk gardeners have been fined and may lack the clout to advocate for changing the laws.
>>Bonus Link: Read about Urban Farming, a nonprofit group with high-profile corporate sponsors that supports gardens on unused land.