‘Scholars in Residence’: A Q&A with Mary Crossley
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.
NPH: What will be your role?
Crossley: I will be doing a number of things. I will be working with the health officer for the city and county of San Francisco, Dr. Tomas Aragon, to identify innovative ways public health officers in California can use their legal authority to addres the growing burdens of chronic disease and some of the social and economic factors leading to poor health. As part of that, I will really be talking with folks in the San Francisco Department of Public Health about the kinds of things that they would like to be able to do in those areas, but they really don’t know whether they can legally. I think that’s a question that public health officers don’t always have a good sense of the answer to in terms of the scope of their legal authority. So I’ll be learning a lot about what they’re doing and what they want to do. Then I’ll be able to work on developing resources for them that give them guidance about what they clearly can do, things perhaps that they clearly can’t do legally and things that fall into the gray area of, well, the law’s not really clear whether you can do this—and working with them to maximize the likelihood that they’d be successful if any of their actions encountered legal challenge.
NPH: What are some of the issues that come up about public health law?
Crossley: The history of public health has focused not only on addressing issues such as sanitation and broad-based areas that try to provide a higher level of health for the community, and a lot of the legal questions have focused on the extent of authority in responding to infectious disease. So there’s a fairly well-developed body of law in that area, but what’s less well developed is the law with respect to what public health agencies can do to address things such as cancer, obesity, diabetes, hypertension and some of the more chronic diseases where quarantine doesn’t do anything. So, to what extent can public health agencies engage in surveillance, in regulation, and in other kinds of interventions?
Particularly as public health agencies look at those kind of questions and look at them in a landscape where increasingly modes of communication involve electronic communications—and those electronic communications can be about risk behaviors and offer opportunities for public health agencies to intervene—public health agencies need to have a sense, for example, of the First Amendment limits on what they can do. How do the laws regulating the internet apply to what public health agencies might want to do?
Another area where I think that there is a lot of room for thinking and trying to figure out some strategies and the legal limits of those strategies has to do with public health agencies trying to intervene in ways that address some of the social determinants of health, which requires them to partner with other government agencies or nonprofits working in other sectors.
And so that seems to be an area where legal issues relating to privacy laws come into play. Under the privacy laws relating to healthcare and medical care, to what extent can information about individuals be shared? To what extent can information about individuals be shared by school boards or school nurses, for example, with public health agencies? So there are just a lot of questions about if public health agencies want to collaborate with other sectors, what’s the scope of their ability to do that? What kind of legal obstacles might they face?
NPH: Are there some public health departments that would have looked at these issues previously and some that haven’t? Why is there a need for the program?
Crossley: Coming in as certainly something of a novice, I don’t think that I’m going to identify these questions that no one has ever thought about before. But some issues have been addressed by legal scholar in a way that’s not very accessible to public health officers or they may have been addressed by someone in a public health agency who perhaps didn’t have access to a higher level of legal expertise. So I think my real goal is to find the public health law questions the department is most interested in, and then survey to see to what extent these questions have been addressed before. I’ll be able to pull together the existing wisdom out there and try to boil it down in a way that it really provides a sophisticated level of useful guidance for health officers, not only in San Francisco, but throughout California as a whole, to use in their daily practice.
NPH: What do you expect to learn that you will take back into your academic field?
Crossley: As someone who was already interested in expanding the scope of my teaching and scholarly inquiry into public health law, I think it’s a great way for me to immerse myself in kind of “on the ground” public health practice and get a good sense as to the legal issues that public health agencies face. So I think it will be an excellent, rapid learning experience for me. I hope I’ll be able to provide a useful product to them in terms of the guidance I will put together as my project paper.
But in terms of what I will bring back with me, it will certainly be an experience that informs my own scholarly work as I continue to write about inequality in health and health care and the ways that the law can respond or may want to work with public health. It will also provide I think an excellent basis for including some of what I learned in my teaching. I developed, a number of years ago, a seminar for law students on health care and civil rights, but I really am looking at expanding that in the future to include more coverage of public health and public health responses to inequity in the distribution of health.
Ultimately I’d like to be able to use what I learned to put together a project base for law students and graduate students of public health to work with a local public health agency here in Allegheny County, Pennsylvania, on issues that require both public health and legal expertise. So I think it will help me develop some exciting learning opportunities for my students here.