The shutdown is just one of two government stories making headlines today. The other, of course, is the opening of consumer health insurance marketplaces, also known as exchanges, in every state that will let consumers purchase coverage that takes effect as early as January 1, 2014. (Sign up after December 15, 2013 and coverage could begin after January 1.) The marketplaces are the cornerstones of the Patient Protection and Affordable Care Act (ACA) signed into law three years ago.

The exchanges will not only sell insurance, but also serve as electronic sign-up centers for public health coverage. For example, under the ACA, Medicaid has been expanded to cover many low-income adults; previously in order to qualify for Medicaid, most adults had to have children under 18 years of age as dependents. Information on the exchange websites will let people comparison shop for health insurance by price and other options, as well as find out whether they qualify for subsidies and tax breaks to help cover the cost of the insurance. In a statement released to announce the opening of the marketplaces, the American Public Health Association (APHA) underscored the fact that all Americans using the marketplace will be guaranteed access to health care and a range of preventive services, including cancer screenings; vaccinations; care for managing chronic diseases; and mental health and substance use services.

“This is a defining moment in the transformation of our U.S. health system,” said Georges Benjamin, MD, APHA’s executive director. “Thanks to the Affordable Care Act, Americans will finally have greater access to affordable, quality care and preventive health services. The marketplace gives preventive care to Americans who never had it before, especially the 44,000 who die prematurely every year because they lack health insurance.”

According to the APHA, under marketplace and Medicaid expansion provisions 25 million uninsured Americans will gain health coverage within 10 years and even more will lower their health costs. Other provisions of the ACA include the Prevention and Public Health Fund already in place to improve the health of Americans through proven community-based preventive health services and strengthening of the public health work force and infrastructure.

Experts at the Robert Wood Johnson Foundation have created and compiled resources to help individuals and health experts navigate the exchanges in their states.

>>Bonus Links: Read previous posts about the Affordable Care Act on NewPublicHealth:

• Do You Speak Affordable Care Act? — Sept. 4, 2013
• What’s the Role of Local Health Departments in Implementing the Affordable Care Act? — July 24, 2013
• Health Departments Begin Implementing the Affordable Care Act: NACCHO Annual — July 11, 2013
• How Will the Affordable Care Act Impact Public Health? — Dec. 3, 2012
• RWJF Statement on the Supreme Court's Affordable Care Act Ruling — July 28, 2012

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.

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.”

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.

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.

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.