Public Health in the Crosshairs of Culture Wars.

This JAMA Forum discusses the topics of reproductive rights, transgender care, firearm safety, and COVID-19 vaccines in the context of public health and the political climate in the US.

One Year After Dobbs-Vast Changes to the Abortion Legal Landscape.

This JAMA Forum discusses state-level abortion restrictions and protections, emergency care, abortion medication, and abortion counseling 1 year after the Dobbs decision that overturned Roe v Wade.

The global health and care worker compact: evidence base and policy considerations.

BACKGROUND: During the COVID-19 pandemic, and recognising the sacrifice of health and care workers alongside discrimination, violence, poor working conditions and other violations of their rights, health and safety, in 2021 the World Health Assembly requested WHO to develop a global health and care worker compact, building on existing normative documentation, to provide guidance to 'protect health and care workers and safeguard their rights'. METHODS: A review of existing international law and other normative documents was conducted. We manually searched five main sets of international instruments: (1) International Labour Organization conventions and recommendations; (2) WHO documents; (3) United Nations (UN) human rights treaties and related documents; (4) UN Security Council and General Assembly resolutions and (5) the Geneva Conventions and Additional Protocols. We included only legal or other normative documents with a global or regional focus directly addressing or relevant to health and care workers or workers overall. RESULTS: More than 70 documents met our search criteria. Collectively, they fell into four domains, within which we identified 10 distinct areas: (1) preventing harm, encompassing (A) occupational hazards, (B) violence and harassment and (C) attacks in situations of fragility, conflict and violence; (2) inclusivity, encompassing (A) non-discrimination and equality; (3) providing support, encompassing (A) fair and equitable remuneration, (B) social protection and (C) enabling work environments and (4) safeguarding rights, encompassing (A) freedom of association and collective bargaining and (B) whistle-blower protections and freedom from retaliation. DISCUSSION: A robust legal and policy framework exists for supporting health and care workers and safeguarding their rights. Specific human rights, the right to health overall, and other binding and non-binding legal documents provide firm grounding for the compact.However, these existing commitments are not being fully met. Implementing the compact will require more effective governance mechanisms and new policies, in partnership with health and care workers themselves.

The Supreme Court Is Harming Public Health and the Environment.

This Viewpoint looks back at the US Supreme Court's 2021 and 2022 terms and forward to the 2023 term and beyond with a focus on decisions that affect health care, public health and safety, environmental policy, and social equity.

Fix the backlash against public health.

Societies generally have reacted to deadly epidemics by strengthening health systems, including laws. Under American federalism (the constitutional division of power between states and the federal government), individual states hold primary public health powers. State legislatures have historically granted health officials wide-ranging authority. After the anthrax attacks in the United States in 2001, the US Centers for Disease Control and Prevention (CDC) supported the Model State Emergency Health Powers Act, which granted public health officials even more expansive powers to declare a health emergency and respond swiftly. But all that ended with COVID-19, as state legislatures and courts gutted this authority. The next pandemic could be far deadlier than COVID-19, but when the public looks to federal and state governments to protect them, they may find that health officials have their hands tied behind their backs.

Risk Trade-Offs and Equitable Decision-Making in the Covid-19 Pandemic.

Since the start of the Covid-19 pandemic, societies have faced agonizing decisions about whether to close schools, shutter businesses, delay nonemergency health care, restrict travel, and authorize the use of emergency Covid-19 countermeasures under limited scientific understanding. When both action and inaction can result in significant harm and irreversible damage, decisions surrounding infection control measures become complicated. Yet ethics can help us think about hard trade-offs that weigh competing values and have deep consequences for society and particularly the most disadvantaged. This essay discusses the challenges of making policy trade-offs amid scientific uncertainty. While there may be no perfect formula for deciding what to do and when, we propose four key considerations for assessing risk-risk trade-offs and apply those considerations to the areas of education, economies, health care, travel and migration, social engagement, and medical countermeasures.

Ethical Allocation of Scarce Food Resources During Public Health Emergencies.

Escalating demands for limited food supplies at America's food banks and pantries during the COVID-19 pandemic have raised ethical concerns underlying "first-come, first-served" distributions strategies. A series of model ethical principles are designed to guide ethical allocations of these resources to assure greater access among persons facing food insecurity.

US State-Level Preemption Legislation, 2017-2018: Implications for Public Health Policy and Practice.

OBJECTIVES: We sought to systematically identify US state-level proposed legislation focused on preemption and introduced over a 2-year period. We analyzed each bill's objectives and intended impacts on local public health policy making and practice. DESIGN/SETTING: Using standardized search terms, we used the LexisNexis State Capital database to identify state-level bills relating to preemption that were introduced between January 1, 2017, and December 31, 2018. Information was abstracted from relevant bills via an electronic data collection form. Abstracted information was analyzed using descriptive statistics to identify preemption-related patterns and trends. RESULTS: One hundred thirty-four bills were included in our analysis. The bills were introduced in 35 states and 28 received sufficient votes to pass into law. The majority of the 134 bills (89%), and all of the bills that passed into law (100%), removed or restricted local authority to regulate. Of the bills that became law, the most common topic areas in which local regulatory authority was restricted were firearms (14%), business and professions (11%), and employment (11%). CONCLUSIONS: Lawmakers at the state level are introducing and passing legislation that preempts local regulatory authority on a variety of public health topics. To preserve local control, local leaders should anticipate the introduction of state preemption legislation, engage with public health stakeholders, and work to counter bills that would restrict local authority.

Responding to Covid-19: How to Navigate a Public Health Emergency Legally and Ethically.

Few novel or emerging infectious diseases have posed such vital ethical challenges so quickly and dramatically as the novel coronavirus SARS-CoV-2. The World Health Organization declared a public health emergency of international concern and recently classified Covid-19 as a worldwide pandemic. As of this writing, the epidemic has not yet peaked in the United States, but community transmission is widespread. President Trump declared a national emergency as fifty governors declared state emergencies. In the coming weeks, hospitals will become overrun, stretched to their capacities. When the health system becomes stretched beyond capacity, how can we ethically allocate scarce health goods and services? How can we ensure that marginalized populations can access the care they need? What ethical duties do we owe to vulnerable people separated from their families and communities? And how do we ethically and legally balance public health with civil liberties?

Local Public Health Policymakers' Views on State Preemption: Results of a National Survey, 2018.

Objectives. To learn about local health policymakers' experiences and responses to preemption-the ability of a higher level of government to limit policy activity at a lower level. Methods. Between March and June 2018, we conducted an anonymous Web-based survey of mayors and health officials in US cities with populations of 150 000 or more. We used descriptive statistics to analyze multiple-choice responses. We analyzed open text responses qualitatively. Results. Survey response rates were 28% (mayors) and 32% (health officials). Nearly all respondents found preemption to be an obstacle to local policymaking. When faced with preemption, 72% of health officials and 60% of mayors abandoned or delayed local policymaking efforts. Conclusions. Preemption is viewed as an impediment across a range of public health issues and may stifle local policy activity (i.e., have a chilling effect). Those working at the local level should consider the potential for preemption whenever seeking to address public health concerns in their communities. Public Health Implications. Local governments should engage with advocates, practitioners, and public health lawyers to learn about successful and failed efforts to meet public health objectives when faced with preemption.

Falling short: how state laws can address health information exchange barriers and enablers.

Objective: Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers. Materials and Methods: We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature. Results: Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address ≤5 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in >60% of the 53 jurisdictions. Discussion: Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs. Conclusion: The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.

Taxing Sugar-Sweetened Beverages to Lower Childhood Obesity: Public Health and the Law.

Consumption of sugar-sweetened beverages (SSBs) contributes to multiple health problems including obesity, diabetes, and tooth decay, especially among children. Excise taxation has been proven efficacious in changing purchasing behaviors related to tobacco use with resulting improvements in public health outcomes. Similar taxes applied to SSBs are starting to take hold internationally and domestically. SSB taxes have been proposed in over 30 U.S. jurisdictions since 2009, but only Berkeley (CA) has passed and implemented one to date. Given empirical evidence of their effectiveness, governments should consider implementation of SSB excise taxes based on uniform definitions of SSBs and other factors.