Law and public health: beyond emergency preparedness

This Article examines three questions: What is public health? What is public health law? What roles can lawyers play in public health? It first describes the breadth of public health, highlighting six trends shaping its future: social determinants of health; synergy between medicine and public health; shifts in focus from external (e.g., environmental and social) to internal (behavioral) risks to health; federalization of public health law; globalization of health risks and responses; and bioterrorism. Because the domains of law that apply to public health are equally broad, the Article next offers a conceptual framework for identifying the types of laws most suitable to different public health problems. Finally, the role of lawyers in the applied field of public health law is examined, first to encourage attention to law's effect on health, even laws having little apparent relationship to health; and second, to recognize that laws intended to achieve specific health outcomes may affect broader legal principles. Lawyers have a unique role to play in ensuring that the legal principles used to promote health also preserve justice.     

Why public opinion changes: the implications for health and health policy

Research on stasis or change in public opinion toward health, health policy, and medical care tends to focus on short-term dynamics and to emphasize the impact of discrete messages communicated by individual speakers in particular situations. This focus on what we term "situational framing," though valuable in some respects, is poorly equipped to assess changes that may occur over the longer term. We focus, instead, on "structural framing" to understand how institutionalized public health and health care policies impact public opinion and behavior over time. Understanding the dynamics of public opinion over time is especially helpful in tracking the political effects of the Patient Protection and Affordable Care Act of 2010 as it moves from the debate over its passage to its implementation and operation.     

Xenotransplantation: consent, public health and charter issues

There is a growing body of literature and commentary analyzing the ethical and public policy concerns associated with xenotransplantation. While this technology holds great promise to provide an almost limitless supply of organs for transplantation, there remains grave concern about possible public health ramifications. As a result, it has been recommended that patients who undergo xenotransplantations will need to agree, inter alia, to a lifetime of close health monitoring, participation in an international database and autopsy upon death. It has been suggested that this agreement would transform the nature of informed consent into a "binding contract." Though such draconian measures are understandable given the magnitude of the risks involved, would existing common law and legislation allow their implementation? This paper analyzes relevant Canadian consent and public health law in the context of the xenotransplantation. Canada is a country with a particularly rich body of informed consent jurisprudence--jurisprudence firmly rooted (rightly or not) in the ethical principle of autonomy. In this climate, many of the suggested monitoring strategies would find little support from Canadian law. Before xenotransplantations proceed, policy makers must be sensitive to the legal barriers which exist to the implementation [of] effective public health measures. Effective surveillance programs will require novel approaches to consent and the enactment of specific public health laws.     

Concussions and youth football: using a public health law framework to head off a potential public health crisis

Concussion from sport is increasingly recognized as a public health priority. In response, all states and the District of Columbia have enacted youth concussion legislation. This paper first examines key developments in concussion-related policy and legislation and then uses the findings from recent scientific studies to highlight the need to incorporate evolving scientific evidence into concussion legislation in order to better protect youth and adolescent athletes. Next, the paper discusses the framework of empirical health law research and why it should be applied in the case of concussion legislation. Finally, this paper argues that empirical health law research should be considered in any decision about whether legislation can help improve the health and safety of young players, a particularly vulnerable population whose unique needs have not yet been adequately addressed.     

Immigrant workers: health, law, and public policy

Immigrant workers are a large segment of the lower echelon of the U.S. labor force, and as many as 3.6 to 6 million of these workers and their families are living in the U.S. illegally. This paper examines who the recent immigrants are: explains why their current situation in the U.S. is an important public health matter; discusses the ethical and policy issues stemming from their health needs and from illegal status; and concludes with a brief look at some implications of the Simpson-Mazzoli Immigration and Reform Act, currently before Congress. The paper suggests that the illegal status of undocumented workers intensifies their health risks; that the immigrants' responsibility for budget short-falls in public services is not as clearcut as frequently assumed; and that legislation aimed at regulating the status of immigrant workers in the U.S. is unlikely to solve many of the central problems.     

Cluster munitions: public health and international humanitarian law perspectives

As a result of civilian deaths in Vietnam, Cambodia, Laos, Chechnya, Kosovo, Afghanistan, Iraq and Lebanon, cluster munitions have been recognised to pose a grave threat to civilian populations because of their limited precision and problematically high rate of initial failure to explode. Efforts are intensifying to ban cluster munitions and to mandate those who have discharged them to defuse them effectively so as to reduce the risks to civilians. This editorial reviews these efforts and identifies a need for them to be actively supported by both the legal and medical communities.     

Harry and Louise and health care reform: romancing public opinion

The question whether the "Harry and Louise" campaign ads, sponsored by the Health Insurance Association of America (HIAA) during the 1993-1994 health care reform debate, influenced public opinion has particular relevance today since interest groups are increasingly choosing commercial-style mass media campaigns to sway public opinion about health policy issues. Our study revisits the issue of the Harry and Louise campaign's influence on public opinion, comparing the ad campaign's messages to changes in opinion about health care reform over a twenty-six-month period in Oklahoma. Looking at the overall trends just prior to the introduction of the Harry and Louise campaign, public opinion was going in the "wrong" direction, from the HIAA perspective. Moreover, public opinion continued in the wrong direction until the mid-point of the campaign. However, in either the turning point of the campaign in terms of message content and tone or in the lag period following it, public opinion reversed on each health reform issue and returned to pre-campaign levels. It appears from these findings that the campaign captured public opinion when support for issues that were unfavorable to HIAA members was increasing and turned public opinion back to pre-campaign levels. The campaign may result in many more such marriages of political interest groups and commercial advertisers for the purpose of demobilizing public support for health policy initiatives that are unfavorable to special interests.