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October 2016—Public Health Law News

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Public Health Law Program
Office for State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention

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In This Edition

Announcements: Enabling Authorities Article, Lipitz Awards, Tribal Public Health Law Externship

Journal Article About State Public Health Enabling Authorities. The Journal of Public Health Management and Practice published “State Public Health Enabling Authorities: Results of a Fundamental Activities Assessment Examining Core and Essential Services,” by Aila Hoss, Akshara Menon, and Liza Corso (Vol. 22, Issue 6, 529–36, November/December 2016). The article summarizes an assessment of public health fundamental activities laws—including laws that reference the essential public health services and the core public health functions—for public health practitioners, policy makers, and attorneys interested in the legal foundation for the financing, organizing, and delivering of public health services.  (Subscription required.)

Lipitz Public Health Policy Faculty Awards. The Institute for Health and Social Policy at Johns Hopkins School of Public Health announced its 2016‒2017 Awards Cycle. One of the award recipients is Professor Lainie Rutkow, JD, PhD, MPH, associate professor in the Department of Health Policy and Management and Health, Behavior and Society for her proposal, “An Analysis of Litigation Arising Out of Emergency Preparedness and Response Activities: Creating and Translating an Evidence Base for Policy-Makers.” Dr. Rutkow will collaborate with CDC’s Public Health Law Program (PHLP) using standard legal epidemiology research methods to 1) create a data set of federal and state-level litigation in which substantive issues concerning emergency preparedness arose; 2) conduct a content analysis of all identified litigation; and 3) translate and disseminate findings to state and local policy-makers who are PHLP’s constituents.

Tribal Public Health Law Externship. PHLP now offers externships in tribal public health law for rising second- or third-year law students. The externship consists of 9–14 weeks of professional work experience with PHLP in Atlanta, Georgia. With rolling start and completion dates during the academic year, unpaid externships must qualify for academic credit as authorized by law schools. Applications for the spring 2017 externships are due by November 1, 2016.

Blog Post About Sugar Consumption and Obesity.

The Network for Public Health Law published “The Truth, Unsweetened: Informing Consumers on Sugar Consumption and Obesity,” a blog post by Sarah Wetter. The post discusses the relationship between sugar advocates and research related to obesity and other activities and developments that could signal a change in the public’s understanding of and feelings about sugar.

Legal Tools: Guide for Cross-Jurisdictional Sharing, LawAtlas

Guide for Cross-Jurisdictional Sharing Agreements. The Center for Sharing Public Health Services, in partnership with the Network for Public Health Law, has released a new publication, “Guide for Developing Legal Documents Governing Cross-Jurisdictional Sharing Arrangements.” The guide was developed after reviewing the work of many teams involved in cross-jurisdictional sharing initiatives.          

Redesigned LawAtlas. The Center for Public Health Law Research at the Beasley School of Law, Temple University has launched the newly redesigned LawAtlas website. The design includes new and updated maps and data and a series of training modules and resources that teach policy surveillance and legal mapping methods. The training models were created in part with funding from CDC’s Office for State, Tribal, Local and Territorial Support through cooperative agreement CDC-RFA-OT13-1302.

Top Stories: Dakota Access Pipeline, Bike Lanes

National: Controversial Dakota Access Pipeline Case Back in Court
ABC News (10/5/2016)   Catherine Thorbecke

The Standing Rock Sioux continue their battle to halt construction of an oil pipeline planned to stretch from North Dakota to Illinois. The pipeline is planned to border Sioux lands and run under the Missouri River—the primary water source for the tribe. The tribe is suing to halt construction of the pipeline, claiming that they were not consulted adequately before construction began, the construction will desecrate sacred ancestral lands, and the pipeline represents a threat to their water supply. A lower court denied an injunction sought by the tribe on the basis of protecting culturally important land. The case has now landed before the US Court of Appeals for the DC Circuit. In the meantime, the Department of Justice, Department of the Army, and Department of the Interior issued an unprecedented joint statement halting construction underway on lands controlled by the US Army Corps of Engineers. They are seeking more tribal consultation and reviewing previous decisions. 

The case is bringing international attention to issues that indigenous peoples face around the world, as hundreds of Native Americans of many tribes gather near the construction to protest the apparent disregard for treaties and tribal sovereignty. 

“The US Army Corps of Engineers approved the pipeline without consulting with our tribe. The approval of this pipeline by the US Army Corps of Engineers is a violation of our treaty rights and we will not stop fighting until our lands, people, water and sacred places are permanently protected.” —Chairman Dave Archambault II of the Standing Rock Sioux Tribe
[Editor’s note: Read the Joint Statement from the Department of Justice, the Department of the Army, and the Department of the Interior regarding Standing Rock Sioux Tribe v. US Army Corps of Engineers.]

New York: Bike lanes are a sound public health investment, says NY study
GMA News   (10/02/2016)   Katheryn Doyle

According to a study by Dr. Babak Mohit of the Mailman School of Public Health at Columbia University, investing in bike lanes creates benefits equivalent to one additional year of life at full health over the lifetime of all New York City residents (or quality-adjusted life year (QALY) per $1,300 the city invested in bike lanes in 2015.

This means that bike lanes in New York have a higher rate of return on investment than many direct health treatments. For example, one QALY from dialysis costs around $129,000. Currently the best QALY score is for vaccines, which add one QALY per $100 spent on vaccines.

Including bike lanes in motor vehicle roads raises the probability that people will ride bikes (an estimated 9% according to the study) and reduces the risk of bicycle-automobile-related injuries. Adding bike lanes also increases physical activity while decreasing pollution.

In 2015, New York build 45.5 miles of bike lanes, which cost about $8 million. The cost per each of New York’s 8.5 million inhabitants was about $2.70 and the gain in QALY is .00022.
“For bike lanes, the cost per QALY is $1,300, a little bit higher than vaccines but way lower than most medical interventions that we have in healthcare. We’re finding more and more of these social interventions are not directly medically related but have an extremely positive effect on giving us more life years,” said Mohit.

[Editor’s note: Read The Cost Effectiveness of Bike Lanes in New York City, Injury Prevention, by Jing Gu, Babak Mohit, Peter Alexander Muennig. Published September 9, 2016, epub ahead of print.]

Briefly Noted: Paramedicine, Native Hawaiian Government, Heroin Epidemic, More

California: Calif. community paramedicine program aims to ease ER overcrowding
EMS1   (10/03/2016)  

California: LA County plans to make hospitals report superbug infections
Los Angeles Times   (10/06/2016)   Melody Petersen

Florida: President Obama Declares State of Emergency in Florida
NBC News   (10/06/2016)  
[Editor’s note: Read the emergency declarations for Georgia and South Carolina.]

Hawaii: Native Hawaiians now have a pathway to form a government
NPR   (09/23/2016)   Merrit Kennedy
[Editor’s note: Learn more about the US Department of Interior’s finalization of a pathway to reestablish a formal government-to-government relationship with the Native Hawaiian community [PDF - 39KB].]

Indiana: Public health emergency declared in Allen County, Indiana   (10/06/2016)   Staff Reporter
[Editor’s note: Learn more about the Indiana State Department of Health’s public health emergency declaration for Allen County, Indiana, approving syringe services program in an effort to reduce the spread of HIV and hepatitis C.]

Kentucky: US Attorney’s office releases video campaign on heroin epidemic
LEX18   (10/07/2016)  
[Editor’s note: Learn more about the US Attorney’s fight against Kentucky’s heroin epidemic and watch the videos.]

Washington: Seattle Councilmember: Garbage from homeless campers creating public health problem
KOMO News   (10/05/2016)   Matt Markovich

National: National: Voters contemplate options on health ballot issues
National Conference of State Legislatures   (10/13/2016)   Emily Heller

National: Four more states likely to legalize pot
The Hill   (10/06/2016)   Reid Wilson

National: Public health groups sue FDA on graphic cigarette warning labels
Winston-Salem Journal   (10/05/2016)   Richard Craver
[Editor’s note: Read the complaint [PDF - 69KB] and learn more about the US Food and Drug Administration’s graphic cigarette warning labels.]

National: The shackling of the American city
Slate   (09/09/2016)   Henry Grabar

Global Public Health Law: Columbia Peace Negotiations, Migrants, Sugar Tax, More

Columbia: Nobel peace prize revives hopes of Columbia’s peace process with Farc
The Guardian   (10/07/2016)   Sibylla Brodzinsky

Europe: Finding Europe untenable, more migrants return to their home countries
NPR   (09/23/2016)   Rebecca Hersher

South Africa: South Africa’s bittersweet sugar tax
BBC   (09/23/2016)

World: Global pledge to stamp out drug-resistant infections
BBC   (09/21/2016)  

Profile in Public Health Law: Sarah Martin-Anderson, Local Public Health Department Policy

Division Manager of Community Engagement, Policy and Accountability, Kansas City Health Department , Kansas City, Missouri; Adjunct Professor of Public Administration, Kenry W. Bloch School of Management, University of Missouri-Kansas City

BA— political science and art history (California State University, Bakersfield); master of public policy, master of public health in epidemiology and PhD in public policy (University of California, Berkeley)

Public Health Law News (PHLN): Please describe your education and what drew you to public health.

Martin-Anderson: I honestly had no intentions of going into public health when I started graduate school in public policy. I had plans to go into civil rights law, political campaigns, and strategy—but a few things happened that changed my path. First, I was assigned Tracy Kidder’s book Mountains Beyond Mountains in a course with Robert Reich, and that basically just knocked me down. It made me recall some things that happened in my life that I had really never confronted—especially issues around my first child, who was for a brief time uninsured after he was born, requiring me to wait for hours in free clinics to try to get him medical care. So there was a personal connection there to the work that I had to learn to integrate. Growing up working class and then ending up at Berkeley meant my first instinct was to pretend I knew what I was doing there! But when I started really digging in to the things that I was passionate about, I lost that inferiority complex. Second—I met some amazing people at Berkeley and around the country who were developing the identity of “ social epidemiology” and also folks working on epigenetics. So I was beginning to understand how the social environment could get under the skin. I fell in love with the intersection of public policy and the study of disease, so I added my MPH.

Public Health Law News (PHLN): What is a PhD in public policy and how is it different from other degrees traditionally thought of as policy degrees, such as a degree in public administration?

Martin-Anderson:A PhD in public policy is a unique thing—most students get the MPP (a professional master’s degree)and leave to go do amazing things. A PhD was not part of the plan, but I had some pretty phenomenal advisers in my MPP who made me feel like a PhD was necessary to really combine this love of policy and health outcomes, so I stuck around. Policy degrees are different from other degrees (in my opinion) because a higher emphasis is placed on quantitative skills and analysis—it’s very economics heavy. I always affectionately call my PhD in public policy “e con lite.” The best part of my MPP work was doing projects for real life clients three times in the course of two years. The first of those clients was the City of Oakland, and we focused on the relationship between l and use and health outcomes. That was my first professional entry into the field I’m in now and how I met the folks who would eventually hire me  as a policy analyst (Alameda County Public Health) and the group who would teach me everything there is to know about health impact assessments (Human Impact Partners).

Public Health Law News (PHLN): Please describe how you built your program of study and the strategic reasoning behind it.

Martin-Anderson:A PhD in public policy at Berkeley is highly customized, so once again, I got to combine things I love into something cohesive (in fact, I did that in my undergrad too when I petitioned for a double major in political science and art history!). I took my methods classes in agricultural and resource economics because I knew I needed stronger quantitative skills but I wasn’t at the level of the traditional PhD economics classes. Then I took my field exam courses in economic demography— a good companion for public health courses—and added some epigenetic seminars and more biostats. At some point I think I took a seminar in Renaissance art, but that was just for fun!

Public Health Law News (PHLN): Please describe how you ended up in your current position.

Martin-Anderson: I came to Kansas City for a tenure-track position in public administration at the University of Missouri-Kansas City. Shortly after I arrived, I was part of the Women’s Foundation’s first class of “The Appointments Project,” which connects women to boards and commissions to rectify the gender imbalance. I was a mayoral appointee to the Health Commission and then, later, a gubernatorial appointee to the State Board of Healing Arts. My time with the Health Commission introduced me to Dr. Archer and the rest of the team at Kansas City Health Department (KCHD). It took a little bit of wooing on their part, and a whole lot of discerning on my part, to get me to leave the tenure track to return to local government. But after we were able to design a job description that was aligned with my passion and skills, it was a no brainer. Academia is great for some, but not for all. Anytime you get to have a say in your own job description, take it.

PHLN: Please describe your health department’s jurisdiction and your day-to-day job responsibilities.

Martin-Anderson: KCHD serves the city of Kansas City, Missouri—a city of roughly half a million people stretched over four counties. The metro area straddles two states and has about 2 million people. However, we are the largest health department in the region, so we are also a regional hub for a large area of Missouri when it comes to reporting of communicable diseases and other programs and services.

My day -to -day job is just so fun. That’s the only way I can describe it. It’s also constantly evolving. In short, I do a lot of partner engagement, which means I hang out with other awesome organizations to collaborate on projects. Because we are deeply rooted in social determinants of health, we obviously can’t do that alone. I’m also heavy in public policy most of the day, overseeing the Health Commission, getting policy created, sponsored and through the process, advocating for budget allocations, keeping up strong relations with the council and mayor and watching a whole lot of committee meetings on our council public access channel. On top of all that, I work on performance management for the department—working with the city manager’s office to implement evidence -based decision -making and stronger program evaluation techniques. Oh, and I adjunct teach one class a semester because even though I left the tenure track, I still love teaching my MPA students.

My team includes all the statisticians in the department, so often we are also the go-to analysts for the department, the council, and the mayor.

PHLN: Your health department was recently named the 2016 Health Department of the Year by the National Association of County and City Health Officials. How is your health department unique, and how might winning the award help support some of your health department’s initiatives?

Martin-Anderson: KCHD is unique and not unique at the same time. We are unique in that we pay a lot of attention to non-medical sources of health outcomes—we partner incessantly with community organizations and, increasingly, other departments in the city. Something people wouldn’t know about KCHD is that we also pay a lot of attention to what makes a great team—we are devotees of the Strengths Finder book series and “Death by Meeting.” Our leadership team often sits with placards in front of us in meetings that shows our Myers-Briggs profile, so we remember that how we perceive something someone says might be a function of our conflicting communication styles.

We are not unique in that we struggle with the same issues every local health department does across this country: not enough funding, increasing responsibilities (clinical care for the uninsured, communicable disease monitoring, environmental health), often working in siloes, and a lack of awareness of the relative importance of public health vs. clinical care. So we are trying to push the boundaries of public health while at the same time delivering the same services we’ve always been relied on to provide.

PHLN: Do you consider yourself a public health law practitioner? If so, in what ways?

Martin-Anderson: Yes. I’m not a lawyer (that was the plan . . . but LSAT scores got in the way!), but I’m a policy analyst. My job is to protect the public’s health with effective laws and make sure the laws we currently have on the books are working the way they are intended to. But my job also includes a lot of relationship- building and lobbying for the importance of public health, which combines my love of good research and my extrovert nature.

PHLN: What are some of the public health law and policy topics you are currently working on and what strategies you’re applying?

Martin-Anderson: It changes so rapidly, but I have three favorite things we are working on right now. First, establishing a regional prescription drug monitoring program (PDMP), since Missouri Legislators have failed to respond adequately to the 600% rise in opioid deaths, and we are the only state in the country (including Puerto Rico, Guam, and DC) not to have a PDMP. So we are taking it on ourselves, partnering with our counties. Second, working with the mayor’s office and other partners to investigate sound discipline policies in schools so that our kids are on grade level and we can work together to prevent missed school days. Discipline severity is predicted by gender and race, so it’s the beginning of the school to prison pipeline we need to intervene in. And third, working with a local nonprofit to evaluate Radio Novelas (Spanish language soap operas) to increase the number of Latinas using SNAP benefits at farmers markets.

PHLN: What are the challenges to these strategies?

Martin-Anderson: By far the biggest challenge of this work is that it is often political and sensitive. It’s sensitive because Kansas City has a very long, dark history of legislated segregation and exclusion. We are working every day to right those wrongs, but sometimes it feels overwhelming. It also requires substantive collaboration, and that’s a challenge in itself—managing multiple partners, each with their own work style and perspective.

PHLN: What is your favorite part of your job?

Martin-Anderson: I feel like I get paid to make friends. I get to meet smart, interesting, devoted people throughout the region and the state. I get to work hard at something I believe in. I get to balance policymaking and politics, and my personal beliefs align with my professional duties, which is something my parents and grandparents never got to do. So it feels like such a blessing.

PHLN: What are the greatest challenges you face in your position ?

Martin-Anderson: Easy. Getting people to understand that health is more than health care. Getting people to stop thinking “what are you doing here?” every time I’m at a meeting for a project or legislation that doesn’t have the word “health” in it—that could be related to education, criminal justice, or even urban planning.

PHLN: Your position is relatively new, so how do you hope it and your work will evolve?

Martin-Anderson:I hope that having a “policy person” becomes the norm in local health departments. I have a little sticky note on my screen that says “Be indispensable.” I hope that our team becomes the primary respected resource for analysis of the impacts of laws on our residents and visitors.

PHLN: What would you be doing if you weren’t in public health policy?

Martin-Anderson: Three things: I always say if I could sing better, I wouldn’t be here. I’d be on Broadway, starring as Evita Peron. I’m two-thirds of a triple threat. I went to college on a theater scholarship, but those skills come in handy in my job now. I would also like to be a museum curator or a professional hip hop dancer (I spend some of my free time dancing for a competitive street dance studio, but most people aren’t hiring 35- year- old mothers as backup dancers).

PHLN: Have you read any good books lately?

Martin-Anderson: Since my job can get very serious, I spend my reading time with books that either make me laugh or cry. The last book I read was Amy Schumer’s book— The Girl with the Lower Back Tattoo. I also really liked The Girl on the Train. And I’ve never turned down a good weepy Nicholas Sparks novel—those things are like cotton candy to me.

PHLN: If you could travel anywhere in the world, where would you go and what would you do?

Martin-Anderson: I’m planning a trip with my three best friends to Cuba this year. We went to Haiti last year, so you can see that tropical locales are my go-to. My favorite US city is Miami—so there’s a theme there. All I need is sand, water, and high-quality rum, and I’m good.

PHLN: Do you have any hobbies?

Martin-Anderson: Dancing, hanging out with my three awesome kids and my husband, swimming, bourbon, hanging out on a porch with hilarious women making crude jokes.

PHLN: Is there anything you would like to add?

Martin-Anderson: Nope! I’ve gone on long enough!

Public Health Law News Quiz October 2016

The first reader to correctly answer the quiz question will be given a mini public health law profile in the November 2016 edition of the News. Email your entry to with “PHL Quiz” as the subject heading; entries without the heading will not be considered. Good luck!

Public Health Law News Quiz Question: October 2016

What award did Kansas City, Missouri’s health department recently receive from the National Association of County and City Health Officials?

Public Health Law News Quiz Question September 2016 Winner!

Michelle Wozniak-Hicks

Question: When are applications for PHLP’s spring 2017 tribal externship due?

Answer: November 1, 2016

Employment organization and job title: Valley View Medical Center, Mohave, Arizona. Interim Infection Prevention Coordinator

A brief explanation of your job: Oversee all aspects of infection prevention throughout the hospital. My primary goal is to keep patients, visitors, and employees safe, as well as gather surveillance data for reporting new and ongoing diseases and conditions.  

Education: Bachelor of science in public health, with minors in sociology and anthropology.

Favorite section of the News: Global Public Health Law—WHO Zika guidance, precautions, and preventing the spread of Zika primarily through sexual contact. This information is helpful because many questions arise about Zika and its spread.

Why are you interested in public health law? Besides it being extremely interesting, I enjoy educating the public, promoting healthy behaviors, implementing educational programs, and conducting research that might prevent problems from happening or recurring. I continue to educate myself about infectious diseases and how they spread so I can educate the public about better health practices.

What is your favorite hobby? I enjoy outdoor recreational activities, such as hiking, fishing, and boating. The next best thing is curling up on the couch with a Stephen King novel.

Court Opinions: Revised Drug Labels, African-Style Hair Braiding, Reused Needle Guides, More

Federal: Plaintiffs unable to show a sufficient basis for expedited processing on the grounds of imminent threat to the life or safety of an individual in revised medication warning labels case
Treatment Action Group v. FDA
United States District Court, Division of Connecticut
Case No. 15-cv-976 (VAB)
Filed 09/20/2016
Opinion by District Judge Victor A. Bolden

Federal: African-style hair braiding implicates traditional public health concerns; state may require cosmetology or barbering licenses and stylists’ constitutional rights not violated
Niang v. Carroll
United States District Court, Eastern District of Missouri, Eastern Division
Case No. 4:14 CV 1100 JMB
Decided 09/20/2016
Opinion by District Judge John M. Bodenhausen

Federal: Court holds sufficient evidence to support conviction that doctor conspired to commit adulteration in violation of the Federal Food, Drug, and Cosmetic Act by reusing plastic needle guides in prostate biopsy exams
United States v. Kaplan
United States Court of Appeals, Ninth Circuit
Case No 15-10241
Filed 09/09/2016
Opinion by Judge Richard C. Tallman

Quotation of the Month: Dr. Margaret Chan, WHO Director-General

“Antimicrobial resistance poses a fundamental threat to human health, development, and security. The commitments made today must now be translated into swift, effective, lifesaving actions across the human, animal and environmental health sectors. We are running out of time.” —Dr. Margaret Chan, WHO Director-General

[Editor’s note: This quote is from Global pledge to stamp out drug-resistant infections, published by BBC, 09/21/2016.]

About Public Health Law News

The Public Health Law News is published the third Thursday of each month except holidays, plus special issues when warranted. It is distributed only in electronic form and is free of charge.

The News is published by the Public Health Law Program in the Office for State, Tribal, Local and Territorial Support.


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