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June 2016—Public Health Law News

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Public Health Law Program
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In This Edition

Announcements: Webinars, Advanced Practice Registered Nursing Report, More

Webinar About Data Sharing. The American Health Lawyers Association and the Public Health Law Program (PHLP) will host a webinar, “The Intersection of Public Health and Healthcare Law: Emerging Trends in Health Information and Data, Part II: Data Sharing: Addressing Provider Reluctance,” June 17, 2016, from 2:00 to 3:30 pm (EDT). This webinar will explore providers’ reluctance to collect and share health data. Speakers will characterize data sharing for public health purposes, explore real versus perceived barriers to data sharing, and highlight best practices for bi-directional data sharing.

Webinar About Health Equity. The Network for Public Health Law and PHLP will host a webinar, “Pursuing Health Equity: Promising Practices in Policy and Law,” Thursday, June 23, 2016, from 1:00 to 2:00 pm (EDT). This webinar will focus on promising practices, based in law, to address health equity issues through drug abuse treatment and overdose prevention, medical-legal partnerships, and interventions in domestic violence and homelessness.    

Prevention Status Reports. CDC's Prevention Status Reports (PSRs) highlight the status of state-level policies and practices to address critical public health problems. Reports are available for all 50 states and the District of Columbia on the following 10 health topics: alcohol-related harms; healthcare-associated infections; heart disease and stroke; HIV; motor vehicle injuries; nutrition, physical activity, and obesity; prescription drug overdose; teen pregnancy; and tobacco use. Because many of the PSR topics are relevant to public health law, the News will be featuring different PSR topics in the announcements during the coming months. Read the reports and check out the teen pregnancy indicator, which focuses on expansion of state eligibility for Medicaid coverage of family planning services.

Report on Advanced Practice Registered Nursing in Georgia. [PDF - 1.13MB] Georgia Watch published “Perspectives on Advanced Practice Registered Nursing in Georgia,” a report that discusses the role of advanced practice registered nurses and the Georgia laws that govern the profession.

2016 Public Health Law Conference. The Public Health Law Conference will take place September 15–17, 2016, in Washington, DC. The conference, hosted by the Network for Public Health Law, is for public health lawyers, practitioners, officials, policy makers, researchers, and advocates. Conference attendees will learn about laws and policies affecting critical public health issues, such as disease prevention, drug overdose, health data sharing, and access to care. Early bird registration ends August 16, 2016. A preliminary agenda is available now.

Legal Tools: Public Health Law Competency Model, ADHD Resources, Healthy People 2020, More

Public Health Competency Model: Version 1.0. [PDF - 733KB] PHLP's competency model provides a framework for the knowledge, skills, and abilities expected of entry-level, supervisory, and executive-level public health practitioners in public health law. The model is for attorneys, public health practitioners, legal educators, and policy makers seeking a benchmark for satisfactory or exemplary public health law understanding and performance.

Attention-Deficit/Hyperactivity Disorder Resources. PHLP, in collaboration with CDC’s National Center for Birth Defects and Developmental Disorders and the Robert Wood Johnson Foundation’s Public Health Law Research Program at Temple University, has released a suite of resources related to attention-deficit/hyperactivity disorder (ADHD), including 

Healthy People 2020 Law and Policy Project Resources. PHLP, in partnership with the Healthy People 2020 Initiative (HP2020) has published four new legal and policy resource anthologies related to HP2020 topic areas, including mental health and mental disorders, older adults, oral health, and substance abuse.  

Electronic Health Record Toolkit. Through a collaboration with CDC’s Division for Healthcare Quality Promotion, the Association for State and Territorial Health Officials, and the Keystone Center, PHLP examined the use of law and legal tools to improve access to electronic health record (EHR) systems in healthcare facilities during outbreaks. This toolkit can help health department professionals work with healthcare facilities during outbreaks (including outbreaks of healthcare-associated infections) to secure access to EHR systems and facilitate outbreak investigations.

Top Stories: Sodium Added to Food, Medicaid and Zika

FDA proposes guidelines for salt added to food

New York Times   (05/01/2016)   Sabrina Tavernise

The Food and Drug Administration (FDA) recently released voluntary guidelines for the food industry about decreasing sodium levels. Thirty-six other countries have already taken this step, with Britain having accomplished a significant decline in both average blood pressure and heart disease deaths in less than 10 years.

On average, Americans consume 3,400 milligrams of sodium a day, almost 50 percent more than the recommended level. This continues to put people at risk for high blood pressure, a major risk factor of heart disease. The majority of salt consumed by Americans is found mainly in processed and prepared foods and can be controlled by reducing sodium in food products like bread and salad dressings.

Dr. Thomas Frieden, CDC’s director, said applying these guidelines would not only reduce sodium in the food supply, but would also “make the default option the healthier option.” These guidelines should have a positive effect on not only the American diet, but also on heart disease prevention.

[Editor’s note: Read FDA’s Draft Guidance for Industry: Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged, and Prepared Foods.]

States told they can use Medicaid to fight Zika

The Hill   (06/01/2016)   Sarah Ferris

The Centers for Medicare and Medicaid Services (CMS) recently published a bulletin about the Medicaid benefits now available to states for the prevention, detection, and response to the Zika virus. Medicaid will now cover physician-prescribed insect repellants and the majority of family planning services, like condoms and oral contraceptives. States can use Medicaid funding to cover not only preventive tools, but also diagnosis and treatment services for both the Zika virus and conditions that result from the Zika virus.

In addition to the Medicaid reimbursement now available to states for these services, funding is currently being negotiated in the White House to support the domestic and international efforts against Zika. This national response will help prevent the spread of Zika and ultimately protect the public’s health from this mosquito-borne virus.

[Editor’s note: Read the CMS Bulletin on Medicaid Benefits Available for the Prevention, Detection, and Response to the Zika Virus [PDF - 105KB]]

Briefly Noted: Needle Stealing, Homelessness, Swimming Pools, More

California: California nears letting undocumented immigrants buy healthcare
The Sacramento Bee   (05/31/2016)   Jeremy B. White
[Editor’s note: Read California’s Senate Bill 10 [PDF - 99KB].]

Colorado: Needle stealing case highlights issue with tracking health workers
CBS News   (06/03/2016)  

Hawaii: Aloha and welcome to paradise. Unless you’re homeless.
New York Times   (06/03/2016)   Adam Nagourney

New York: Who should public swimming pools serve?
The Atlantic   (06/03/2016)   Adam Chandler

Vermont: Governor Shumlin makes Vermont first state to require Rx drug price transparency
Vermont Biz   (06/03/2016)  
[Editor’s note: Read Vermont’s S216 [PDF - 185KB], which was signed into law by Vermont Governor Peter Shumlin June 2, 2016.]

National: Fearing drugs’ rare side effects, millions take their chances with osteoporosis
New York Times   (06/01/2016)   Gina Kolata

National: How Zika could infect the municipal bond market
Governing   (05/27/2016)   Liz Farmer

National: Old and on the street: the graying of America's homeless
New York Times   (05/31/2016)   Adam Nagourney

Tribal: Cannabis on tribal land a ‘50/50’ gamble for Native Americans in Washington
The Guardian   (05/29/2016) 

Global Public Health Law: Marijuana, Electric Bikes, Tomato Emergency, More

Canada: Two insurers to stop treating all pot users as smokers as marijuana increasingly accepted
National Post   (05/30/2016)   Tom Blackwell

China: Beijing’s electric bikes, the wheels of e-commerce, face traffic backlash
New York Times (05/30/2016)   Chris Buckley

India: India hospital transfusions infect thousands with HIV
BBC   (05/31/2016)  

Nigeria: Nigeria’s Kaduna state declares ‘tomato emergency’
BBC   (05/24/2016)

United Kingdom: UK doctors told to halve inappropriate antibiotic prescriptions by 2020
The Guardian   (05/26/2016)   Anushka Asthana and Sarah Boseley

Profile in Public Health Law: Linda Quan, MD, Emergency Medicine, Seattle Children’s Hospital

Professor, Pediatrics, University of Washington School of Medicine

BA, Smith College, Northampton, Massachusetts; MD, University of Washington School of Medicine, Seattle, Washington

CDC Public Health Law News (PHLN): Please describe your career path.

Quan: I went into pediatric residency because I loved the developmental (from the embryo!), age-related aspect of pediatric conditions and the supportive environment of pediatrics.

After a year of a self-crafted fellowship, I joined the faculty at the University of Washington to help run a clinic. I also joined the Seattle Children’s Hospital Emergency Department, which consisted of only two beds. Believe it or not, there weren’t any true pediatric emergency department (ED) doctors, departments, or staff at that time. We built things from the ground up! I spent a lot of time riding with Seattle Medic One, one of the first emergency medical services (EMS) systems in the country, teaching pediatrics to their paramedic students. In doing so, I really got “into” resuscitation. My fascination with resuscitation led me to conduct research focused on pediatric out-of-hospital resuscitation, an area that no one had really thought about.

Long story short, I ran the Seattle Children’s Hospital ED for 26 years, learning from general EDs about administrating and developing quality measures and risk management, as they were ahead of pediatric EDs, who were academic-based, developing structure (specialty fellowships) and productivity (research). As faculty in the highly research-oriented University of Washington pediatric department, I hired and partnered with people with research backgrounds. Research and geography (representing the Northwest) were the keys to joining national committees. It probably helped being an Asian female those days when women were still rare in pediatrics. Collaboration, of course, and 70- hour work weeks were key to everything in my career.

PHLN: What drew you to emergency pediatrics? 

Quan: I love making diagnoses (Why does this toddler limp? Is this headache a brain tumor?). I love variety (from sniffles to cardiac arrests). I enjoy performing procedures (from ear wax removal to suturing and chest tubes). I also wanted a home life without having to be on-call, the way my dad was. The joke was on me, since I didn’t anticipate cellphones or that anything could be more invasive than phone calls!

PHLN: What are your day-to-day job responsibilities?

Quan: The job description of a good academic is to be a “quadruple threat,” meaning a clinician, teacher, administrator, and researcher. When working full-time, I worked several 10-hour ED shifts a week—treating kids and teaching medical students, residents, and other physicians. Between shifts in the ED, most of my time at the hospital was spent in administrative meetings regarding the ED, the hospital, and the community. I eked out ½-1 day a week in an office away from the hospital to do my research and write grants. I traveled a lot, lecturing and participating in state and national committees. Each day was different—never boring! None of this encompassed the complexity of raising three kids (I bought their soccer shoes) and having a surgeon husband.

PHLN: You’ve spent a great part of your career researching drowning, drowning prevention, and pediatric resuscitation. How did you become interested in pediatric drowning, and how has it shaped your career?

Quan: I initially was intrigued (and I still am) with how cardiac arrest and resuscitation differ in children and adults. It was a very exciting time because EMS cardiac care was in its nascence and the pediatric patient was never considered. When an adult has cardiac arrest, it’s usually because of arteriosclerotic heart disease. When a pediatric patient has cardiac arrest, some kind of respiratory problem usually causes it. At that time, drowning was the most common cause of out-of-hospital pediatric cardiac arrest, mostly involving young children. Thus, it was a perfect model for evaluating the effect of adult treatment protocols on pediatric outcome. I was a resident in our county ED in charge of the care of a three-year-old little girl who’d drowned in an abandoned apartment pool. The child had been in cardiac arrest, was treated successfully after a very long resuscitation poolside by the Medic One paramedics, and was brought to me in the ED. I wondered . . . why did this child drown? Apartment pools in Seattle, really? What worked to bring her back from death? Why was she able to walk out of the hospital weeks later? What predicted that?

After publishing several papers on drowning and building a comprehensive database of drownings, I found myself being referred to as an expert in drowning! I was both excited and humbled to be asked by the American Heart Association to write its drowning resuscitation recommendations. That process led to intensive involvement and learning, as part of the resuscitation community, in how to evaluate the science/evidence and how to work with groups to achieve consensus recommendations on care.

Thanks to funding, mostly from national and federal sources, I was able to conduct more drowning research. Attending international meetings with other drowning experts provided the high of any career—exchanging, bantering, and contesting with others who share a common interest and desire to make things better. 

PHLN: Your interest in drowning prevention has expanded the scope of your interests and activities beyond what many might consider “medical practice.” In what other kinds of activities, related to drowning prevention and water safety, are you engaged?

Quan: Taking care of a drowning patient in the ED is too late in the game. How many times have I walked a mom to the intensive care unit, knowing she is going to watch her child complete the death process over the next 48 hours? To save the patient is to prevent them from drowning in the first place.

Two people have guided me into prevention. One was a colleague of mine and the other a county pool inspector from the health department. One day, the county health department told me they’d passed a law requiring abandoned pools be filled in or fenced. Shortly after the law was passed, a county pool inspector called me, saying he wanted to work with me on drowning prevention in our county. I realized quickly that the health department and prevention would save more lives than any EMS treatment protocol. The other guide is my colleague, Elizabeth “Tizzy” Bennett, who comes from a background in hospital marketing and community health. She takes a social marketing approach to injury prevention and has taught me more than any professor how to partner with agencies and the community to engage parents and families to “sell” injury prevention. She’s made it all happen.

As I reflect on the activities I’ve been involved in related to drowning prevention and water safety, a few things come to mind. One is research. I’ve conducted and collaborated on research to prove what works in drowning prevention, and I have shared what I’ve learned with others in the injury and drowning prevention world. Being a member of the American Red Cross (ARC) Scientific Advisory Council Aquatics Subcouncil, which evaluates the science to drive the ARC’s swim programs, has been a particularly dynamic and engaging group to be a part of. It is doing a lot of good research and evaluation to help inform prevention work.

I’ve used what I’ve learned from doing research to write guidelines to improve lifeguard performance/training/standards for the national and international organizations (American Red Cross, International Life Saving Federation), and developed training programs for pediatric resuscitation (American Heart Association Pediatric Advanced Life Support).

Sharing and collaborating has been key to getting buy-in from conscious stakeholders. I also have taken the show on the road to engage other groups—medical professionals, coroner groups, aquatic industry members, law enforcement, etc.—to educate them about drowning and their role in prevention.

Sharing what I’ve learned about drowning prevention with my colleagues isn’t enough, so I have spent a lot of time crafting water safety messages and serving as a media spokesperson on various water safety campaigns. Much of that work was done in partnership with Water Safety USA, the Seattle Children’s Hospital, the American Academy of Pediatrics, and the American Red Cross.

Amazing collaboration and partnerships have developed out of this work. A highlight for me was developing an international open water drowning prevention task force that brought together drowning prevention enthusiasts from across the world to share and collaborate on all things related to water safety. What a thrill!

Policy is also a “biggie” when it comes to making a splash and a real impact on preventing drowning deaths. At the local, regional, and state levels, I’ve been very involved in promoting policy to prevent drowning, including child life jacket requirements and surveillance systems needed to develop prevention strategies.

PHLN: What are “drowning prevention networks,” and how do they relate to your work?

Quan: Prevention, like just about everything, is a team sport.

We started the Washington State Drowning Prevention Network (DPN) in 1994, to provide a forum for organizations and individuals to work together on preventing drowning. Now, almost 25 years later, we have a mix of inspired members—from the older couple who went to public schools to show kids how they couldn’t pick up a quarter at the bottom of a bucket of cold water after five minutes; families of drowning victims; pool managers; dive rescue teams; public health and state government agency staff; US Coast Guard; and marine patrol officers, who when attending, have to sit in designated back-row seats that accommodate their Kevlar and pistols. This group convenes twice a year and sends out a compilation of information and resources monthly.

The network is led by the Washington State Department of Health Injury Prevention Program, SAFE KIDS Washington, Public Health–Seattle and King County, Washington State Parks Boating Program, and Seattle Children’s Hospital. The network’s activities and results are impressive and include April Pools Day and Summer Splash-tacular, life jacket loan programs, training and networking for injury prevention, water safety and boating safety professionals and access to educational information through the website. Network goals include educating families, youth, and adults; increasing access to and use of life jackets; increasing the number of children who learn to swim; providing policy promotion and technical assistance; disseminating and coordinating drowning data; building partnerships for water safety; and developing consistent messaging.

Network activities and results, to date, include

  • Policy advocacy, including a stronger boating under the influence law, which passed in 2013, mandatory boater education, which passed in about 2006, and mandatory child life jacket legislation, which passed in 1999.
  • Fostering development of the first life jacket loan program in the US-Washington State now has more than 175 life jacket programs, many of which are coordinated by Network members. There is a centralized list of sites, Google map of locations, loan program guide and standardized signage.
  • More than 20 years of sponsoring April Pools Day—a water safety event that promotes swimming, boating and water safety for families reaching 2,000—5,000 a year.
  • Training programs for anyone interested in drowning prevention and water safety reaching more than 100 people a year. Evaluations assess satisfaction, usefulness, and changes planned as a result of attendance.
  • Monthly Drowning Prevention Update with links to local and national resources.
  • Tracking and reporting on drownings reported in news clippings as a way to get timely information and specifics on risk factors and drowning settings.
  • Sponsorship of the Tom Warren Water Safety Award to recognize outstanding programs and leaders.
  • Development of media and educational outreach such as the Know Your Limits, Know the Water, Wear a Life Jacket campaign. A coordinated one-day annual media tour, led by Washington State Parks Boating Program, has focused on cold water, life jackets and boating under the influence, resulting in numerous interviews. The model is being expanded to add Portland, Oregon, and Spokane, Washington.

PHLN: How has the diversity of professional and personal expertise and experience made the drowning prevention network successful?

Quan: Each of us lives and works and, worst of all, thinks in a silo. I found out when I rode in the EMS rigs with the paramedics, that being at the “scene” with a patient and seeing the constraints of providing care in the “field” is so enlightening, shocking, and challenging! I get humbled and schooled by the sheriff in a big Stetson, who has pulled bodies out of the river, and, the lifeguard, who’s working to get older African-Americans or Somali women into the pool to learn to swim. We share our realities.

Public health officials can promote equity and social justice, but when one swim manager says she’ll let life jackets be worn in the pool or that she’ll allow women to wear clothing in the pool for modesty reasons, others throughout the state follow suit. When they hear marine patrol describe costly and dangerous rescues and body retrievals, swimming lessons become more than learning strokes. We’ve moved mindsets and helped shaped policies that address diversity, equity, access, and water safety in multiple settings.

At one DPN meeting we discussed whether or not it is reliable information when kids or parents say they can swim. Pool managers said, “Hey! We can study that at our pools when we swim test. We submitted a grant; CDC helped us conduct the study (the first of its kind), and the findings helped inform surveillance of swimming ability among kids and families.  

Prevention is so multifaceted. You are safe in your car because you’ve learned to drive, but you also wear a seat belt, drive in safety tested vehicles on engineered roads, over constructed bridges, obey enforced speed limits and minimal impediments (fencing, crosswalks, lights, etc.).  In other words, safety happens through attacking a problem continuously from many directions. The Haddon Matrix helps us approach it pre-event through post-event. It’s necessary to involve those who teach swimming; those who design the swim programs; those who write the boating laws and county health rules; those who run the pools and the beaches; and those who patrol the waters. This is what the DPN is doing—getting everyone’s prevention arms around the problem! You can feel the collective energy in the room. It’s why participants drive three hours to come to the DPN meetings; it’s not for the donuts!

PHLN: How are your program and the drowning prevention network working to address water safety and to prevent drowning in Washington?

Quan: We address water safety by looking at all seven aspects of the Spectrum of Prevention, educating each other, and being data driven (we review our state’s data every six months). We look at the “who, what, and where” involved in drowning incidences; identify new trends (canoe and kayak deaths; deaths by those trying to rescue someone else); establish common goals, such as our focus on open water drowning prevention, which is where most of our drownings occur, life jacket loaner programs, and increasing access to swim lessons. We work together on projects, such as the April Pools Day event, where pools across the state open their doors to the public for two free hours of fun and hands-on water safety activities.

As a network, we also have worked extensively on policy. For example, we pulled together to get a boating life jacket law for kids. Mandatory boater education passed. We supported policy efforts to limit access to dangerous rivers, and promoted open water drowning prevention policy, which included developing policy briefs on life jackets and boating under the influence.

Mostly, the DPN has created longstanding, trusting working partnerships among its members. When our state health department received a CDC grant to look at drowning prevention policy and system-change opportunities, we already had many stakeholders in place, and we were able to immediately put together specific task forces to develop policy strategies, such as guidelines around safer swim sites at the community level.

Keys to the network’s success are shared leadership, a collaborative approach that respects and builds on all members’ strengths, and a commitment to work on goals together—even pools and spas promote boating safety! All members have a voice and the leadership team plays an active role in all aspects of the network. We believe this is the longest standing and largest drowning prevention collaboration in the United States.

PHLN: You and other members of the American Red Cross Scientific Advisory Council’s Aquatic Subcouncil identified five layers of drowning prevention. Are these interventions related to law? If so, can you please give an example?

Quan: Five evidence-based protections are four-sided pool fencing, supervision, life guards, life jackets, and learning swimming and water safety.Indeed,laws can prevent drowning deaths! For example, mandated pool fencing decreases deaths by 50%, but laws need to be enforced. Mandated life jacket wear by boaters decreases boating deaths. Laws work by increasing wear: water-skiers, those being towed behind a boat and personal water craft users have 95% or more life jacket wear rates because laws require life jackets are worn. These groups don’t drown; they die of major trauma if they crash into something, but they don’t drown! 

PHLN: Why isn’t education about life jackets alone enough to ensure that people will use personal flotation devices appropriately?

Quan: The injury prevention world first learned that education wasn’t all it is cracked up to be with driver education. In fact, driver’s education increased risk by putting more young people behind the wheel. Education didn’t work to get everyone to wear a seat belt in cars. Less than 25% of boaters wear life jackets although everyone knows that a life jacket floats you. The US Coast Guard has spent millions [of dollars] trying to convince boaters to wear life jackets, but the percentage of boaters who do wear them has not budged in more than 10 years.

Boaters have told us, in focus groups, they believe that people who wear life jackets are inexperienced swimmers, children, or that life jackets are only needed in bad weather. However, data tells us that most drowning deaths happen in good boating conditions. Behavior change is most likely when a multifaceted approach—one that includes education and policy—is taken. 

PHLN: What laws apply to personal flotation devices in Washington?

Quan: Washington State’s first life jacket policies applied to personal watercraft users and people towed behind boats. Then, it took four years to pass a law requiring children 12 years and younger to wear a life jacket. And we were able to get that passed only because we share the Columbia River with neighboring Oregon, which already had a law in place for that age group. Although national laws mandate jackets that fit for everyone onboard, these laws do not mandate that older boaters actually wear the jackets.

What we need is a national law for all ages, not individual state laws for varying age groups. As a pediatrician, I say that saving kids is important, but kids also needs their dad, uncle, brother, mom, friends, etc. Through conducting life jacket observations, we know that kids and teens are more likely to wear life jackets if the adults in the boat wear them too.

PHLN: Seattle-King County, Washington, is one of the few local jurisdictions in the United States with a law that requires health equity in all government policies. How has this law been leveraged with regard to swimming?

Quan: Our prior Seattle mayor addressed a public policy that no other city had tackled: To allow its parks and recreation department to provide free women- and men-only swim sessions as part of regular swim programming at public pools. With the goal of providing water-related exercise opportunities, we worked with Harborview Injury Prevention and Research Center and Seattle Parks to get a neighborhood matching grant to offer women-only swimming at a city pool in a highly diverse area. It was wildly successful!

When grant funding stopped, the program shut down because Seattle Parks couldn’t provide their settings for free because of a policy that precluded exclusivity. We couldn’t find other cities that had solved the problem, with the exception of Portland, Oregon, which had a small, limited program. With funding from a CDC Communities Putting Prevention to Work grant, we worked with pools, community health clinics, and a number of community organizations to promote policies that allowed single-gender swim program to increase access to water recreation for all. When the mayor heard about the programs, the health and diversity needs made sense to him and were also aligned with the city’s race and social justice goals. Now, there are single-gender swim programs regularly offered in four different areas of the city.

PHLN: How do swim scholarship guidelines and promotion relate to equity and swim safety?

Quan: In our area, swim lessons cost about $50–80 per session. Most kids need several sessions—acquiring that skill and feeling comfortable in the water require time. Low-income families often find themselves in a position of having to choose between basic needs and school materials; they don’t have the means to pay for swim lessons. That’s not to mention cost of a bathing suit, goggles, and transportation to and from the site.

In the United States, learning to swim is a luxury. In many European countries, learning to swim is mandatory. Through a policy-and-system-change strategy called Everyone Swims, pools learn how to create scholarship offerings that work for all families. For example, providing information in multiple languages, applying easy-reader approaches to content, and offering pre-existing financial screening, such as Head Start or Medicaid as proof of eligibility.

PHLN: How do equity and access to swim areas relate to open-water swimming? 

Quan: If you have money, you can join a swim club, or go to a beach where a lifeguard is present. Lower-income families or those unfamiliar with water activities will opt for free, open water swim sites—at lakes, along rivers, or in the ocean. These sites may have underwater hazards, such as   drop-offs or currents. They may be unmaintained, undeveloped, and without lifeguards. Thus, the perfect storm: A higher-risk population in a higher-risk environment incurs higher drowning risk!

We are working to develop “safer” local, open water swim sites in each community. We need the kind of planning and oversight for open water sites that have been given to pools for decades. This includes the availability of lifeguarded open water areas.

PHLN: How is your team working to make open water swimming safer and more accessible? 

Quan: While developing Everyone Swims, we learned from focus groups consisting of diverse, low-income families that these families want to learn to swim at free, open water sites at our local parks. Classes had been offered mid-day only, typically the slowest time for the lifeguards. Seattle Parks worked on staffing and programming to offer free swim lessons in the evening at several beaches. Enrollment skyrocketed, particularly among kids of color. Now, more children are learning to swim in open water and families experience the benefits of being in a lifeguarded area.

We’ve also worked to have life jacket loaner programs at swim areas, developing the first one nationally in 1992. Just because you don’t own a life jacket doesn’t mean you can’t access one. There are now at least 175 loaner programs in the state of Washington.

PHLN: Do you have any hobbies?

Quan: I’m an avid backpacker/hiker and, yes, I will swim in mountain lakes in the summer. I also love museums.

PHLN: What’s your favorite swim stroke?

Quan: I was lucky: My Chinese parents—neither of whom I ever saw go in the water above their knees during summers at Cape Cod—made me learn to swim. I do the crawl for a half mile, which got me through my pregnancies.

Public Health Law News Quiz June 2016

The first reader to correctly answer the quiz question will be given a mini public health law profile in the July 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: June 2016

When and where will the 2016 Public Health Law Conference take place?

Public Health Law News Quiz Question May 2016 Winner!

Candice Gilliland

Question: What new content section was launched in the May 2016 edition of the Public Health Law News?

Answer: Global Public Health Law

Employment organization and job title: I’m a contractor with Eagle Medical Services working with the preparedness team of the Quarantine Border Health Services Branch of Division of Global Migration and Quarantine. Within the preparedness team, I’m the Region 1 preparedness coordinator, and I’m also assisting with the Global Migration Task Force for the Zika response.

A brief explanation of your job: 
As a preparedness coordinator, I help create response plans and exercises for quarantine stations, sub-ports, and maritime ports within my Region. Region 1 consists of the following quarantine stations and their jurisdictions: Dulles, Atlanta, Miami, San Juan, Houston, and Dallas-Fort Worth. On the task force, I assist with operations and task tracking.

I have a BS in biology from Wingate University, an MS in forensic science from University of Alabama at Birmingham, and am currently enrolled in Law School at the Birmingham School of Law in their weekend program.

Favorite section of the News:  
Probably the Legal Tools because it gives interesting information and provides resources I can use both at work and in school.

Why are you interested in public health law?  
It’s an area that few lawyers are familiar with—nor are many people who work within public health. I think it is an area that is full of history (especially the quarantine section) and is still evolving.

What is your favorite hobby?  
I like to play video and board games with my kids and go hiking. 

Court Report: Commercial Composting, ACA, Ambulatory Surgical Center, More

Michigan: Commercial composting amounts to a “public health hazard”
Charter Township of White Lake v. Ciurlik Enterprises
Court of Appeals of Michigan
Case No. 326514
Filed 05/12/2016
Opinion per curiam

Missouri: Revocation of PPKM’s ambulatory surgical center license would pose a public health threat
Planned Parenthood of Kansas and Mid-Missouri, Inc. v. Lyskowski
Case No. 2:15-cv-04273-NKL
Filed 05/11/2016
Opinion by Judge Nanette K. Laughrey

National: Religious non-profit organizations are to resolve their ACA issues with the lower courts
Zubik v. Burwell
Supreme Court of the United States
Case Nos. 14-1418, 14-1453, 14-1505, 15-35, 15-105, 15-119, 15-191
Filed 05/16/2016
Opinion per curiam

Ohio: Mandatory pooling application requires consideration beyond financial factors
Simmers v. City of North Royalton
Court of Appeals of Ohio
Case No. 15AP-900
Filed 05/16/2016

Quotation of the Month: Professor Ma Guilong

Quotation of the Month: Professor Ma Guilong

“The motor vehicles have occupied all the lanes for electric bikes, so they have no place to go. Many times I’ve been obediently riding in the bike lane and suddenly hit by a car. I’ve take quite a few tumbles like that,” said Professor Ma Guilong, one of China’s experts on electric vehicles and a retired professor at Tsinghua University in Beijing, China.  

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