June 2018


Updates to the Public Health Law Website. The Public Health Law website has been reorganized. All resources are now organized by topic and can be found from the Publications & Resources page. If you receive an error message or are unable to locate a particular resource, please email the Public Health Law Program (PHLP) for assistance: PHLawProgram@cdc.gov.

Job Opening: Chief Executive Officer, ChangeLab Solutions.external icon Since its founding in 1997, ChangeLab Solutions has worked to change public health practice from primarily focusing on patient education and clinical care delivery to using a dynamic and intersectoral approach to policy, systems, and environmental change. The organization is now seeking a new CEO who can advance national leadership that builds the field of law and policy in addressing the social determinants of health and creating equity. The new CEO will bring 1) a proven record of success in driving law and policy change to promote the social determinants of health, 2) nuanced understanding of health equity and the drivers that determine the health of communities, and 3) strong organizational leadership experience to lead ChangeLab Solutions into its next phase of work. Applications, including a cover letter describing your interest and qualifications, and your resume (in Word format), should be sent to cls-ceo@nonprofitprofessionals.com.

Webinar: Health Justice, Homelessness and Sanitation: Confronting a National Public Health Crisis.external icon The American Society of Law, Medicine & Ethics, Network for Public Health Law, and Public Health Law Research Program will host a webinar examining the population health effects of lack of sanitation and hygiene access on people experiencing homelessness. The webinar will take place on Thursday, June 28, 2018, 1:00–2:30 pm (EDT), and will highlight legal, policy, and community strategies that promote access to essential services.

Job Opening: Public Health Physician/Medical Director, Greensboro, North Carolina.external icon The Guilford County Department of Public Health seeks a physician/medical director to provide medical leadership, direction, and oversight for patient care. The successful candidate would also contribute to medical policy development for all public health programs and services for the Department of Public Health and ensure the clinical services operate efficiently and effectively. He or she would also provide direct patient care, expert medical services, and consultation in the department’s communicable disease program. This position will remain open until filled.

Journal Analyzing US Supreme Court Indian Law Decisions.external icon This article, “The Supreme Court’s Last 30 Years of Federal Indian Law: Looking for Equilibrium or Supremacy?,” by Alexander Tallchief Skibine and published in the Columbia Journal of Race and Law, discusses the Supreme Court’s Indian law record in the last 30 years and the court’s role in integrating American Indian nations as the third sovereign within the US federalist system.

Health Justice: Empowering Public Health and Advancing Health Equity.external icon The 2018 Public Health Law Conference will include more than 40 sessions exploring law and policy pathways to improving access to health care; protecting vulnerable populations against health risks and injury; developing protections against discriminatory practices; and strengthening efforts of local, tribal, and state public health agencies. The conference will be held October 4–6 in Phoenix, Arizona. Registration closes September 3.

Legal Tools

Issue Brief: The Protecting Patient Access to Emergency Medications Act of 2017. This brief provides an overview of the enforcement of the Protecting Patient Access to Emergency Medications Act—in particular, its effect on standing orders for medications.

Preemption Watch Preemption Map.external icon Grassroots Change presents an interactive map that tracks state preemption laws for eight issues, including e-cigarettes, smoke-free zoning, and fire sprinklers. The map indicates whether local authority has been preserved or preempted for each of the eight issues.

Top Stories

Puerto Rico: Puerto Rico’s Hurricane Maria death toll could exceed 4,000, new study estimatesexternal icon
New York Times   (05/29/2018)  Sheri Fink

Story highlights

A new study published in The New England Journal of Medicineby an independent research group from Harvard T.H. Chan School of Public Health found that mortality rates were significantly higher for Puerto Rico residents in the three months following Hurricane Maria than the mortality rates of the same time period in the previous year. The study estimates that about 4,600 people died from the hurricane, a much higher number than the government’s estimate of 64 deaths.

Due to the wind, rain, and resulting landslides of the hurricane, many homes were demolished or without water or power for months. Of the random households the research group interviewed, roughly 15 percent indicated that someone in their home was unable to access medicines for at least a day after the hurricane, and approximately 10 percent of interviewees reported trouble using electricity-reliant breathing equipment. The study indicates that approximately one-third of the deaths caused by the hurricane could be attributed to lack of access to or delays in receiving medical attention. This estimate, the group says, is still inexact and requires further examination.

Dr. Gilbert Burnham, a professor of international health at Johns Hopkins University who has experience conducting studies to assess deaths but was not involved in this study, says, “There is clearly an excess mortality, and let’s not argue very specific numbers.” He says that despite the study’s limitations, these types of surveys “should become a standard activity in post-disaster situations,” as they expose vulnerabilities that, if properly addressed, could save lives.

According to Dr. Domingo J. Marqués, an associate professor at Albizu University San Juan who helped conduct the study with his students, “The situation is not over. We still have people without power, without running water, and it’s already hurricane season again.” More optimistically, he says, “We hope our data helps the government develop some more specific continuity plans so they can prepare for proper general health and also mental health planning.”

Carlos S. Mercader, executive director of the Puerto Rico Federal Affairs Administration, says this Harvardstudy, as well as a government-commissioned study under way at the George Washington University Milken Institute School of Public Health, will allow Puerto Rico to “better prepare for future natural disasters and prevent lives from being lost.”

World: DRC: experimental Ebola vaccine to be administered in Mbandakaexternal icon
The Guardian   (05/20/2018)   Jason Burke

Story highlights

A new campaign will attempt to “ringfence” the outbreak of Ebola in the Democratic Republic of Congo (DRC) by administering an experimental vaccine by Merck. The vaccine is not yet licensed but proved effective in West Africa from 2014 to 2016 during the largest Ebola outbreak on record. It’s hoped these efforts will keep the outbreak from moving into the populous city of Mbandaka and the nine countries bordering the DRC. The risk of spread throughout the DRC remains high, according to the World Health Organization (WHO). As of May 20, 2018, the death toll of the current outbreak had reached 26, with an additional 46 confirmed infections. According to the DRC’s minister of health, Oly Ilunga, the vaccine will be administered to approximately 600 individuals—“the health staff, the contacts of the sick, and the contacts of the contacts.”

The primary challenge of this campaign will be keeping the 4,000 doses of vaccine at a sufficiently cold temperature. As the DRC is among the poorest of the world’s nations, remote areas such as those primarily affected by the outbreak often have electricity failures and incomplete roads.

Municipalities downstream of affected areas are being surveilled. According to Nahid Bhadelia, Boston University School of Medicine, “The vaccine is a powerful tool but you still need other tools. You still need to find the contacts. This outbreak has multiple epicenters that are some distance apart and include a big city . . .  Then you need some kind of infrastructure to follow up.” In the nine times Ebola has reached the DRC, twice it has made its way to the capital, Kinshasa, but it has been controlled both times. Robert Steffen, chair of the WHO International Health Regulations Emergency Committee regarding the Ebola outbreak in West Africa, indicated that a strong response is necessary or the state of affairs could worsen. He spoke hopefully, however, saying there is “strong reason to believe this situation can be brought under control.”

[Editor’s note: Learn more about the rVSV-ZEBOV vaccineexternal icon and read the World Health Organization’s statement on ethical considerations for use of unregistered interventions for Ebola virus disease, 2014external icon and Ebola vaccines, therapies, and diagnosticsexternal icon (including the “ring vaccination” strategy). Also, learn more about Ebola and use of unapproved drugs in the United Statesexternal icon.]

Briefly Noted

California: Aaron Persky, judge in Brock Turner case, recalledexternal icon
The Huffington Post   (06/06/2018)   Antonia Blumberg
[Editor’s note: Learn more about intimate partner violence. Also, learn more about how judges are selected in Californiaexternal icon and other statesexternal icon.]

California: San Francisco voters uphold ban on flavored vaping products external icon
New York Times   (06/06/2018)   Jan Hoffman
[Editor’s note: Read more on the vaping product ban and Proposition Eexternal icon.]

Georgia: Atlanta gambles on MARTA expansion amid declining transit useexternal icon
The Atlanta Journal Constitution   (06/07/2018)   David Wickert
[Editor’s note: Learn more about how transportation relates to public health and check out CDC’s Transportation Health Impact Assessment Toolkit.]

Illinois: Illinois ratifies Equal Rights Amendment—decades after deadlineexternal icon
The Hill   (05/30/2018)   Jacqueline Thomsen
[Editor’s note: Learn more about the Equal Rights Amendmentexternal icon.]

Minnesota: Girl, 6, died by hanging in foster care. County settles with family for $1.5 million.external icon
The Washington Post   (06/07/18)   Samantha Schmidt

Virginia: Supreme Court to hear Virginia uranium mining caseexternal icon
Route Fifty   (05/21/2018)   Bill Lucia
[Editor’s note: Learn more about uranium mines and millsexternal icon and uranium exposure and toxicity.]

National: House passes ‘right-to-try’ bill for experimental drugsexternal icon
NPR   (05/22/18)   Alison Kodjak
[Editor’s note: Learn more about the newly passed Right to Try Actexternal icon.]

National: House passes bipartisan water infrastructure billexternal icon
The Hill   (06/06/2018) Mallory Shelborne
[Editor’s note: Learn more about the Water Resources Development Act of 2018external icon.]

National: They shared drugs. Someone died. Does that make them killers?external icon
New York Times   (05/25/18)   Rosa Goldensohn

National: Sweet talk: FDA’s ‘added sugar’ label hits sour note with maple syrup makersexternal icon
NPR   (06/06/18)   John Dillon
[Editor’s note: Read about FDA’s proposed “added sugars” declaration ruleexternal icon.]

Global Public Health Law

India: As Nipah virus spread is suspected, government to compensate victimsexternal icon
CNN   (05/24/2018)   Manveena Suri
[Editor’s note: Learn more about Nipah virus.]

Pakistan: Why it’s so hard to wipe out polio in Pakistanexternal icon
NPR   (05/26/2018)   Diaa Hadid

Mexico: Disappearance of 43 Mexican students must be investigated anewexternal icon
The New York Times   (06/05/2018)   Azam Ahmed

World: Looters steal from aid groups, including Doctors Without Bordersexternal icon
NPR   (06/06/2018)   Cassandra Vinograd

Profile in Public Health Law: Peter D. Jacobson, JD, MPH
Photo: Peter D. Jacobson, JD, MPH

Title: Professor Emeritus of Health Law and Policy, Department of Health Management and Policy, University of Michigan School of Public Health; Director, Center for Law, Ethics, and Health

Education: University of Pittsburgh, JD; University of California at Los Angeles, MPH; Dickinson College, AB

Public Health Law News (PHLN):You and your colleagues recently published a suite of resources related to the Flint, Michigan, water crisis. These dynamic and insightful resources include a final report on the crisis, titled Learning from the Flint Water Crisis: Protecting the Public’s Health During a Financial Emergencypdf icon[PDF – 683KB]external icon, as well as two practical resources for jurisdictions seeking to avoid similar crises, Public Health Handbook for Communities Under Emergency Managementpdf icon[PDF – 265KB]external icon and Emergency Manager Law Primerpdf icon[PDF – 955KB]external icon.

Will you please describe why you wanted to work on the Flint, Michigan, crisis?

Jacobson:The most obvious reasons are the scope of the crisis, what it portends for the Flint community, and our geographic proximity to the tragedy. As a university dedicated to serving the public, especially in Michigan, we felt an obligation to contribute our expertise in assisting the Flint community. At the time, I chaired the School of Public Health’s Flint Water Crisis Task Force, and this project fit nicely within what the task force was designed to achieve.

PHLN:What was the main research question you and your colleagues were pursuing?

Jacobson:Here’s how we framed the core legal questions:  Given the appointment of an emergency manager, what legal authority could state, local, and federal public health and environmental agencies use to avert or mitigate the crisis? What legal changes are needed to prevent a similar public health crisis from occurring elsewhere, in Michigan or across the country?

In submitting the proposed research to the de Beaumont Foundation, we argued that a major factor explaining the crisis was the sheer complexity of the legal structure regarding the roles and responsibilities of the governmental agencies involved in maintaining and monitoring safe drinking water. A core tenet of the proposal was that inadequate legal preparedness contributed significantly to how and why the crisis unfolded as it did.

Observing that there had been a breakdown in trust between the community and the local health department, we also proposed conducting a qualitative study of how to restore trust.  But de Beaumont decided that it only wanted to fund the legal analysis.

PHLN:How did you organize and carry out your research?

Jacobson:Colleen Healy Boufides took the lead in analyzing the public health statute, and Jennifer Bernstein led the effort to examine both Michigan’s emergency manager law and similar laws in other states. Denise Chrysler managed the day-to-day work, while I provided general oversight and guidance when needed. For the final products, everyone contributed to the comprehensive report. Colleen then produced the public health handbook, while Jennifer simultaneously developed the emergency manager primer.

PHLN:Could any attorney have carried out the research you and your colleagues have undertaken to create these resources?

Jacobson:Certainly. But two things distinguish our work from what a generic attorney could accomplish. First, any interpretation of the legal structure involves nuance and choices. Having the public health law expertise along with understanding the context of how these laws might be applied gives our work an advantage. Second, this was a substantial investment of time for several Network for Public Health Law attorneys. That alone would make it a difficult investment for most attorneys.

PHLN:How do you hope these resources might help other jurisdictions?

Jacobson:My hope is that other jurisdictions will examine their current legal structure using our templates and take appropriate action to prevent similar safe drinking water disasters. Remember, the Flint water crisis was almost entirely preventable. Our materials alone won’t avoid a similar crisis, but other states and municipalities can adapt them and at least mitigate looming drinking water problems.

PHLN:As the legal issues in Flint continue to be adjudicated and remediated, what are the next steps in order for the community to heal?

Jacobson:I wish I knew the answer. As noted earlier, a core issue remains the lack of trust between Flint residents and governing officials and agencies who failed to protect them. As far as I’m concerned, restoring trust is an essential component to healing. A second component is for the state to accept accountability and fix the pipes. No excuses. Third, the state needs to compensate financially the Flint community for the harms it suffered. So far, the state has not met its moral obligation to help the community heal.

PHLN:What is the Michigan School of Public Health Flint Water Crisis Task Force?

Jacobson:The charter of the task force states: “Our goal will be to partner with the Flint community, local, state, and federal agencies, and other UM faculty, to investigate the best, sustainable set of solutions to protect the health of Flint residents. The Task Force will seek robust solutions that are durable rather than quick solutions that may gain immediate media attention but might not be the right approach for protecting the community’s health. While the Task Force will consider short-term options, its focus will be on devising longer-term strategies to prevent similar tragedies from occurring.”

PHLN:How do you hope the task force will help protect the community?

Jacobson:The task force hopes to help build the community’s capacity to address the harms already experienced, mitigate any further damage, and facilitate future economic development. Here are a few recent examples of task force activity: regularly participating in Flint Area Coordination Team meetings, bringing Michigan School of Public Health expertise to the evolving needs of the ongoing water crisis response, developing a white paper on the proposed 2018 Michigan Lead and Copper Rule reform, and monitoring implementation of the Governor’s Flint Water Task Force recommendations. The task force is optimistic that these actions will help the community make informed decisions.

PHLN:How can we prevent crises like the lead contamination in Flint from happening again?

Jacobson:Our study suggests several ways of averting or mitigating similar tragedies. First, fiscal distress laws need to incorporate mandatory public health considerations and mandatory input from citizens. Second, improved legal preparedness is essential. Third, governmental agencies need to improve their coordination and communication capacities. Fourth, governmental agencies need to build cultures of openness so that agency staff will be encouraged to report information that administrators and elected officials might prefer to bury.

PHLN:How can individuals learn more about your work?

Jacobson:Probably the easiest way is for people to contact me directly at pdj@umich.edu.

PHLN:What projects are you currently pursuing?

Jacobson:I’m completing a project examining the development and implementation of health in all policies programs funded by the Robert Wood Johnson Foundation. I’m also working on a health law text for health administration students (though progress is slow). My colleagues and I are considering possible extensions of our work on the Flint water crisis.

PHLN:Have you read any good books lately?

Jacobson:Yes—one of the benefits of retirement is the opportunity to read more. Most of my reading is nonfiction, especially history. Two books of note are David White’s The Republic for Which it Stands (a study of American history from 1865–1900, with significant parallels to our current era) and Ronen Bergman’s Rise and Kill First (a study of Israel’s secret targeted assassinations, which is by turns inspiring and terrifying, and raises serious moral and ethical concerns).

PHLN:What would you be doing if you weren’t working in public health law and ethics?

Jacobson:That’s hard to answer because I’ve been doing this for about 40 years.  In all likelihood, I would have pursued a PhD in history.

PHLN:Do you have any hobbies?

Jacobson:My primary hobbies are playing the piano and bicycling. Now that I’m retired, I have much more time to pursue both. I’m also able to start reading the pile of books that I haven’t been able to dent until now.

Public Health Law NewsQuiz

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the July 2018 edition of the News.Email your entry to PHLawProgram@cdc.gov with “PHL Quiz” as the subject heading; entries without the heading will not be considered. Good luck!

Public Health Law News Quiz Question June 2018

What upcoming event is dedicated to the following: improving access to health care; protecting vulnerable populations against health risks and injury; developing protections against discriminatory practices; and strengthening efforts of local, tribal, and state public health agencies?

Public Health Law NewsQuiz Question May 2018 Winner!
Photo: Lia M. Anderson, MSN, APRN-BC, CNS

Lia M. Anderson, MSN, APRN-BC, CNS

May Question:
Which resource in the May 2018 edition of the Public Health Law Newswas established to assist tribal nations interested in expanding their legal preparedness capacity?

Winning Quiz Answer: The Tribal Legal Preparedness Project

Employment organization and job title: Fort Belvoir Community Hospital, Public Health Clinical Nurse Specialist

A brief explanation of your job: Currently, I lead Public Health Nursing’s Community Health Promotions Program. My job includes performing community assessment and utilizing results to design, develop, promote, and implement population-based wellness programs to help active duty military, their family members, retirees, and federal workers at Fort Belvoir, Virginia, make healthier lifestyle choices. I also serve as the Seasonal Influenza Vaccination Program manager for the hospital and its satellite clinics.

Education: BA, law enforcement; BS, nursing; MS, nursing with a focus in public health nursing administration

Favorite section of CDC’s Public Health Law News:“Briefly Noted”— a great way to get a quick recap of newsworthy information for myself and to share with colleagues.

Why are you interested in public health law? Having both a public health nursing and law enforcement background, I enjoy discovering how they work together in practice. Most people think public health law only deals with the aspect of “powers of enforcement.”  I try to incorporate legal findings or decisions in my community outreach to show the broader application of public health law for social justice and advocacy.

What is your favorite hobby?  Summertime hobby—kayaking and fishing!

Court Opinions

Michigan: Tax-exempt retirement community must use property for purposes set out in articles of incorporation to maintain tax status.

United Methodist Retirement Communities, Inc. v. City of Chelsea, Michiganexternal icon
Court of Appeals of Michigan
Case No. 337998
Filed 05/22/2018
Opinion Per Curiam

Federal: Service providers do not have a right of action to enforce federal statutes against an insurance company.
Air Evac EMS Inc. v. Arkansas Blue Cross and Blue Shieldexternal icon
United States District Court, Eastern District of Arkansas, Western Division
Case No. 4:16-CV-00266 BSM
Filed 05/29/2018
Opinion by Chief District Judge Brian S. Miller

Federal: FDA connected a new rule, which extends tobacco warnings to cigars, pipe tobacco, and e-cigarettes, to the public health standard. Decision of FDA to extend warning upheld.
Cigar Assoc. of America, et al. v. US Food and Drug Administrationexternal icon
United States District Court, District of Columbia
Case No. 1:16-cv-01460 (APM)
Filed 05/15/2018
Opinion by District Judge Amit P. Mehta

Federal: Plaintiff had a due process right to be notified by the city that his property had been found to be blighted, but plaintiff did not have a right to be informed that he had thirty days to challenge the determination because “citizens are presumptively charged with knowledge of the law.”

MAK Investment Group, LLC v. City of Glendale, Colorado, and Glendale Urban Renewal Authorityexternal icon
United States Court of Appeals, Tenth Circuit
Case No. 16-1492
Filed 05/14/2018
Opinion by Chief Judge Timothy M. Tymkovich

Quote of the Month

Lee Biola, President of Citizens for Progressive Transit

“Transportation systems just can’t be structured so that all five million of us can get from Point A to Point B in our preferred way (cars). It’s physically impossible,” said Lee Biola, president of Citizens for Progressive Transit, in response to criticism of transit expansion in Atlanta, Georgia.

[Editor’s note: This quote is from Atlanta gambles on MARTA expansion amid declining transit useexternal icon. The Atlanta Journal Constitution, 06/07/2018.]

The Public Health Law Newsis 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 Newsis published by the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support.


Subscribe to Public Health Law News or access past issues. To make comments or suggestions, send an email message to PHLawProgram@cdc.gov.


Public Health Law News (the News) content is selected solely on the basis of newsworthiness and potential interest to readers. CDC and HHS assume no responsibility for the factual accuracy of the items presented from other sources. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or HHS. Opinions expressed by the original authors of items included in the News, persons quoted therein, or persons interviewed for the News are strictly their own and are in no way meant to represent the opinion or views of CDC or HHS. References to products, trade names, publications, news sources, and non-CDC websites are provided solely for informational purposes and do not imply endorsement by CDC or HHS. Legal cases are presented for educational purposes only, and are not meant to represent the current state of the law. The findings and conclusions reported in this document are those of the author(s) and do not necessarily represent the views of CDC or HHS. The News is in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the Public Health Law News should be cited as sources. Readers should contact the cited news sources for the full text of the articles.

Page last reviewed: June 21, 2018