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.

>>Read the full blog post on paid sick leave preemption laws.
>>Read more on preemption.

Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government. 

This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.

>>View the original posting of this interview over at GrassrootsChange.net.
>>Read more on preemption and grassroots movement building.

Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?

Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention]. 

Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science. 

Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.

GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies. 

Cynthia Hallett, executive director of Americans for Nonsmokers’ Rights, will speak today about tobacco policies at a Public Health Law Conference session on innovative community policy. The other presenters include Aaron Wernham of the Health Impact Project and Marion Standish, director of community health at the California Endowment. NewPublicHealth caught up with Ms. Hallett before the session.

NewPublicHealth: What is the focus of the panel discussion you’re a part of?

Cynthia Hallett: We will be sharing some of our collective experiences on successful health policy efforts and some of the resources that would be available for others as they’re thinking about what kind of health policies they want to try to pursue at the community level.

NPH: What will you be presenting about tobacco?

“All public health is local—it’s got to start and be sustained at the local level.” – Howard Koh, Assistant Secretary, U.S. Department of Health and Human Services

Public health is not just about programs—it’s about a ground swell of people getting together to create healthier communities. Grassroots movement building is essential to meaningful, long-term change for any public health initiative. Recent research has even uncovered a link between local policy campaigns and healthy social norms. In other words, when public health movements build from the ground up and lead to local policy, the community is more likely to experience a shift in thinking around the issue at hand, whether it’s tobacco control or obesity prevention.

However, policy-makers may not always understand the full range of policy options at all levels of government, and some federal legislation can actually pose a significant barrier to grassroots movement building. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs, such as a state smoke-free law on office workplaces preempting communities who may want to pass a stronger ordinance to cover all workplaces including restaurants and bars. Preemption can also undermine grassroots public health movements.

Mark Pertschuk, project director of Grassroots Public Health: Preemption and Movement Building in Public Health, Phase 2, a new program supported by the Robert Wood Johnson Foundation (RWJF), says nurturing grassroots movements, and avoiding barriers to movement building such as preemption, are strategic policy decisions with long-term consequences.

In a new article in the Journal of Public Health Management and Practice, Mark Pertschuk and his co-authors look at the consequences that preemption can have for grassroots public health efforts. NewPublicHealth recently spoke with Pertschuk about the new initiative and the article.

NewPublicHealth: Tell us about the origin, scope and purpose of the Grassroots Public Health project.

On Thursday June 21 from 1 to 2 p.m. (EST) the Network for Public Health Law will be holding a free webinar to preview the Network’s upcoming 2012 Public Health Law Conference: Practical Approaches to Critical Challenges to be held in Atlanta, October 10 through 12. Register for the webinar by 1 p.m. EST on Tuesday, June 19.

The webinar offers a "sneak preview into three of the topics to be covered in depth during the conference: toxic exposures, emergency planning for vulnerable populations and electronic health records." Kathleen Dachille, JD, director of the Network for Public Health Law – Eastern Region and faculty member of the University of Maryland Francis King Carey School of Law, will discuss policy changes and efforts to reduce toxic exposures, including exposure to secondhand smoke and pesticides in multiunit housing, and children’s lead exposure in homes.

Rebecca Polinsky, JD, research and practice fellow in the Public Health Law Program at the Centers for Disease Control and Prevention will discuss characteristics of older adults that make them more vulnerable in an emergency and the legal options to help protect them and other vulnerable populations, and Sharona Hoffman, JD, LL.M., professor of law and bioethics and co-director of the Law-Medicine Center at Case Western Reserve University School of Law, will review the use of electronic health records for public health purposes, as well as the legal and ethical implications of EHR and state and federal perspectives on electronic health information exchange.

NewPublicHealth spoke with Dan Stier, director of the Network for Public Health Law, about the upcoming webinar and the conference in October.

NewPublicHealth: What’s the goal of the webinar?

Dan Stier: We want to whet peoples’ appetites for the upcoming conference, where the theme is “Practical Approaches to Critical Challenges.” The planning committee was made up of a couple of dozen people engaged in public health law, including people working on the local, state and federal level, academics and attorneys and advocates. The conference will have six tracks:

• Prevention and promotion at the community level, such as toxic exposures in the home, which is a webinar topic, and injury prevention laws
• Changes and challenges to public health infrastructure, such as accreditation and shared service delivery
• Challenges to public health authority such as preemption and first amendment issues
• Protection and security, such as emergency preparedness issues and food safety
• Skills building and competencies such as interaction between attorneys and public health practitioners
• Data collection and storage

NPH: Who do you expect to be at the conference in the Fall?

Dan Stier: We are trying to get a very nice mix of public health officials, attorneys, advocates and academics. With tight budgets, we will be challenged to draw all the participants we might otherwise, but there is strong interest in the conference. For that reason, one my main tasks is to identify funding sources to provide the opportunity to bring many people to the conference.

We’ve chosen speakers with very deep knowledge, background and experience.

NPH: Can you tell us about the response to the expertise provided by the Network since its launch almost two years ago?

Dan Stier: We’ve had hundreds and hundreds of requests for one on one technical assistance on a wide variety of public health issues. And we’ve led over 100 lectures and presentations as a result of relationship building activities. I’m not surprised at the level of interest, but I am gratified and satisfied.

NPH: Have you been able to help policy-makers better understand the intersection of health and law?

Dan Stier: Yes, we’re helping to connect the dots. We’re working to build the field of public health law, and we’ve had a fantastic start, such as pulling together people in policy who may not have had a handle on what law can do for them.

NPH: What expertise have you added since the launch of the Network?

Dan Stier: We had a strong set of issues when we began, but topics we’ve added expertise on, and information on our website, in response to requests, include maternal and child health issues. Specific issued in that area include breastfeeding in the workplace, newborn screening issues, mandatory reporting of child abuse and technical assistance for courts on early childhood brain development, an issue that often comes up for juvenile and family court judges and guardians.

A new report finds that some existing laws on the books across the nation offer critical opportunities to improve Americans’ health through the use of health impact assessments.

>>Read more on the new report.

>>Follow our coverage from the National HIA Meeting.

NewPublicHealth spoke with Professor James G. Hodge, Jr., JD, LLM, principal investigator and director of the Western Region of the Network for Public Health Law, about the report.

NewPublicHealth: What’s the background on the report?

James Hodge: This project that we’ve done in conjunction with The Pew Charitable Trusts and the Robert Wood Johnson Foundation has taken a very interesting and important look at the role of law in relation to support for the use and implementation of health impact assessments nationally. This was really uncovered material prior to our research in this arena. We were aware of specific instances where federal, state, tribal or local governments had suggestively made HIAs an important component of particular reviews for public safety or public health through laws, but we had not done any national, systematic study to really assess how extensive that is, particularly in non-health sectors. So, for example, in areas like transportation and environment and waste management, to what extent did law support the use of HIAs? The report has provided some initial answers that really are quite profound in this attempt to illustrate just how extensively law can be supportive of these particular initiatives.

NPH: Based on your review of the laws, is it still a novel concept to consider health impacts in projects in sectors as varied as the environment and transportation?