Search

Electronic cigarettes (e-cigarettes) are a growing public health concern because of a dramatic increase in use by adolescents and the uncertainty of potential health impacts. These health concerns and lack of an established federal regulatory scheme have led many local and state governments to address the regulatory void for e-cigarettes by incorporating them into the statutory definition of tobacco or by passing laws specific to the use of e-cigarettes. In August 2016, the US Food and Drug Administration issued a final rule deeming e-cigarettes within their authority; providing uniform requirements like premarket approval applications, Harmful and Potentially Harmful Constituents reporting, and warning labels; and establishing 18 years as a minimum age of purchase. Although the impact on the public's health remains uncertain, regulations and laws governing e-cigarettes continue to develop. This review highlights the available data regarding safety and public health impacts of e-cigarettes and details the status of US regulations and policies affecting their sale and use. Cancer 2017;123:3007-14. © 2017 American Cancer Society.

Since its inception in 2010, the Network for Public Health Law (Network) has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation (RWJF) has invited the Network and other partners to consider new ideas and strategies toward building a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations.

Few legal concepts engender more confusion and concern in public health circles than the doctrine of preemption. Simply stated, preemption refers to “how a state or local law may be averted, displaced, or negated by conflicting laws at a higher level of government.” Federal laws may preempt state or local laws because federal law is supreme. State laws can preempt local laws because local governments are controlled by sovereign states. Even some local governments may preempt laws among lesser municipalities. Understanding the concept of preemption is easy. Applying its principles to public health objectives, however, is complex. Preemption can facilitate or hinder public health goals. Federal preemption, for example, may be used to create a national floor for public health policies (e.g., menu labeling provisions). Conversely, preemption can thwart state or local public health legal and policy objectives. In the past several years, state legislatures have preempted local innovations in diverse public health areas including gun control, tobacco use, food policies, employment protections, and the environment. Emerging tactics fueled by industry and organized through advocacy groups evince a deeper realm of preemption policy. Through what we call “preemption plus” strategies, law- and policy-makers seek to control lower levels of government through actions that exceed traditional boundaries or specific targets of preemption and carry increasingly negative impacts. These schemes, including direct threats, fines, loss of funds, and de-authorizations, are gaining traction especially in public health arenas impacting big industries (e.g., tobacco, sugar sweetened beverages (SSBs)) or specific interests (e.g., rights to bear arms, religious freedom). Collectively, they can essentially force states or localities to comply with higher level policies that are antithetical to the public’s health. This manuscript explores these tactics at federal and state levels along with political and judicial arguments to address deleterious impacts on public health policy.

Background: Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs. Objective: To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP. Methods: We conducted a systematic review of laws, regulations, and policies from the 50 U.S. states in effect between February and June 2016 that define or apply to paramedic SOP. We determined whether each state's SOP included 21 potential skills applicable to CP within the following categories: assessment, treatment & intervention, referrals, and prevention & public health. Laws were also queried for mechanisms for expanding SOP, alternate destinations, and community paramedicine for each state. Additionally, we surveyed representatives from U.S. State Emergency Medical Services (EMS) agencies and asked which of these skills were a part of their current SOP. All data was coded into Excel™ and analyzed using descriptive statistics. Results: All 50 U.S. states have laws relating to EMS. Forty-one states have a statewide SOP (82%), and 3 states have statewide protocols from which the SOP has been inferred for purposed of this study, but may not legally constitute SOP in this jurisdiction (6%). 20 states (40%) had a clearly defined mechanism for expanding SOP. Sixteen states (32%) had laws specific to CP. Seven states (14%) allowed for patients to be transported to alternate destinations. Of the 21 skills surveyed, on average there were 8.63 (6.41–10.85) fewer skills for paramedics found in state SOP laws and regulations than were reported as being a part of a state's paramedic SOP. All skills demonstrated variability between the legal review and survey results with 13.04–96.15% concordance. Conclusion: There is a lack of guidance and consistency regarding CP programs and scope of practice. Further studies are needed to understand best practices around regulation and oversight of CP.

Major disasters and public health emergencies constantly test the nation's resolve to rally and recover from tragedy. Public health crises stemming from prolonged threats like the 2009/2010 H1N1 influenza pandemic require sustained preparedness and response over many months. Even shorter-duration events, like tornados, earthquakes, or hurricanes, leave lasting impacts for which full recovery may take years. Telling examples include the displacement of thousands of persons across the Gulf Coast states following Hurricane Katrina in 2005 and difficulties obtaining basic housing and services that persisted in the Northeast months after Hurricane Sandy in 2012. Whether the result of natural disasters, infectious disease outbreaks, bioterrorism, or other causes, these events can change the societal landscape in affected regions.Despite the challenges of recovery across populations stemming from national or regional emergencies, Americans have consistently supported those directly affected.

Protecting the nation from a diverse array of public health threats remains a consummate objective of federal, state, and local governments. Achieving it is no simple task. Threats to the public’s health are multifarious, unpredictable, and downright scary in many cases. Legitimate and irrational fears are stoked by significant levels of distrust of government or industry. Americans’ trepidations of public health threats invariably beget responses among federal, state, and local governments even if the actual risks to domestic populations are infinitesimally low. Still, for decades, national, state, and local government leaders often classify these and other conditions as emergencies through different legal authorities. Recently, federal leaders and agencies have re-conceptualized the nature of public health emergencies in terms of national security, reflecting a shift in national authority and accountability. Multiple Presidents and other federal officials speak in terms of how public health events pose national security threats (NSTs) or national security priorities (NSPs). As discussed in this Commentary, classifying public health concerns as national security threats presents uncertainties with practical and legal implications. Practical implications include the augmentation of federal influence, resources, and powers to coordinate responses internationally and at home. Labeling public health emergencies as national security events can alter how federal, state, and local governments respond legally to public health crises now and in the future.

As conceptualized by the Robert Wood Johnson Foundation and its partners, a culture of health centers on a society in which health flourishes across all populations and sectors. Law, among other tools, is critical to advancing a culture of health across multiple arenas. In this manuscript, Network for Public Health Law colleagues illustrate how legal innovations at all levels of government contribute to societal health. Examples include modern laws that promote healthy and safe low-income housing, telemedicine reimbursement, paid sick and safe time, healthy food and beverages, reduced smoking rates, child vaccinations, universal pre-k, adolescents' healthy sleep, overdose prevention, and medical-legal partnerships.