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February 2018

Public Health Law News Banner

In This Edition

Announcements

Notice of Funding Opportunity: Technical Assistance for Response to Public Health or Healthcare Crises. CDC’s Office for State, Tribal, Local and Territorial Support is pleased to announce that CDC-RFA-OT18-1804, Technical Assistance for Response to Public Health or Healthcare Crises, has been published on Grants.gov. The purposes of this notice of funding opportunity are to 1) establish a pool of organizations capable of rapidly providing essential expertise to various parties involved in an emergency response and 2) fund select awardees to provide that support, when required, based on CDC’s determination of need. Applications are due no later than 11:59 pm (ET) on March 16, 2018.


Job Opening with Healthy People 2020 Law and Health Policy Project. The CDC Foundation is looking for a public health analyst to join the Healthy People 2020 Law and Health Policy Project at the US Department of Health and Human Services Office of Disease Prevention and Health Promotion (ODPHP) in Rockville, Maryland. The project is a collaboration  between ODPHP, CDC, the CDC Foundation, and the Robert Wood Johnson Foundation. Applicants must have a graduate degree in public health, policy, or law and have at least three to five years of relevant work experience. Applications are due by February 24, 2018.


Center for Health Security Emerging Leaders in Biosecurity 2018 Fellows Announced. The Johns Hopkins Center for Health Security has accepted a diverse group of 28 professionals and scholars into the 2018 class of the Emerging Leaders in Biosecurity Fellowship program. The program is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events coordinated by the Center. CDC’s Public Health Law Program (PHLP) congratulates all of the fellows, but particularly Gregory Sunshine, JD, a Cherokee Nation Assurance, LLC contractor with PHLP who oversees PHLP’s emergency legal preparedness portfolio. Congratulations, Greg!

Legal Tools

New! Online Introduction to Legal Epidemiology. Legal epidemiology provides a scientific approach to studying the impact and effectiveness of laws on health. This online training is part of the Public Health Law Academy, created by PHLP and ChangeLab. This training will explain how law affects health, enable participants to define and describe basic legal epidemiology principles, and apply legal epidemiology in practice.


Issue Brief: Fatal Overdose Review Panels—Overview of Laws in Six States. A handful of states have established bodies that specifically review overdose deaths to provide additional data and, typically, make recommendations for policy improvements. This brief explains and contrasts the specifics of panels in the six states that have established them.


Summary of Executive Authority in Flu Season. The Association of State and Territorial Health Officials published “States Leverage Executive Authority to Address Severe Flu Season,” detailing emergency measures and other activities states have undertaken to prevent the spread of flu and respond to the current extreme flu season.

Top Stories

Kenya: She ran from the cut, and helped thousands of other girls escape, too
The New York Times   (01/13/2018)   Jina Moore

Story Highlights

Female genital mutilation or cutting (FGM/C) or female circumcision are procedures that injure female genital organs for non-medical reasons. FGM/C is usually carried out on girls between birth and 15 years old. Not only does FGM/C not have any health benefits, but it often causes serious physical and mental health issues, including severe bleeding, problems urinating, infections, complications during childbirth and increased risk of newborn death.

In Kenya’s Maasai communities FGM/C was traditionally done as a part of coming of age procedures. Nice Leng’ete has been working to stop FGM/C since she ran away from her first FGM/C ceremony when she was just eight years old. Since that time, Ms. Leng’ete, now 27, has helped more than 15,000 girls escape FGM/C in the past seven years.

FGM/C was made illegal in Kenya in 2011 and a special prosecution unit for FGM/C was founded in 2017. The practice, however has continued in spite of the laws because of a variety of lingering beliefs that women who are not subjected to FGM/C are unclean or unsuitable for marriage.

“Every community has their own reason for why they cut their girls,” said Christine Nanjala, who leads the special prosecution unit. “You’re dealing with culture, and when you’re dealing with culture, you’re dealing with the identity of a community.”

Ms. Leng’ete has worked with tribal and community leaders, in largely male-dominated cultures, to better inform communites about cruelty and dangers associated with FGM/C and has worked to help communities create new, positive coming of age traditions that do not involve FGM/C.

As further proof of her success, the Maasai have changed their laws. The 1.5 million Maasai people living in Kenya and Tanzania have their own oral-constitution that is centuries old and rules over them independent of the Kenyan government. Thanks in great part to Ms. Leng’ete, the Maasai constitution was changed in 2014, formally abandoning FGM/C.

Ms. Leng’ete continues to promote non FGM/C coming of age ceremonies within Maasai communities. “It’s just the cut that’s wrong,” she said. “All the other things — the blessings, putting on the traditional clothes, dancing, all that — that’s beautiful. But whatever is harmful, whatever brings pain, whatever takes away the dreams of our girls — let’s just do away with that.”

[Editor’s note: Learn more about FGM/C laws in the United States and FGM/C internationally.]


California: After a debacle, how California became a role model on measles
The New York Times (01/16/2018) Emily Oster and Geoffrey Kocks

Story highlights

In December 2014, 159 people contracted measles during an outbreak at Disneyland. Researchers theorized that a tourist visiting the country introduced the epidemic, but the duration of the epidemic was a result of the state’s relaxed vaccination policy. The outbreak attracted national media attention, and by 2016 the state passed Senate Bill 277(SB), which removed the personal belief exemption and increased school’s regulation of the conditionally enrolled students by requiring them to have a plan for vaccination that didn’t last longer than six months.

Before 2016, students in California were able to exempt being vaccinated through limited enrollment in which they may not have been entirely vaccinated but could attend school based on the understanding that they would be getting the rest of the shots soon. Another way to exempt being vaccinated was through personal belief exemptions that included religious and parental fears of vaccinations, allowing parents not to vaccinate their children at all.

The passage of stricter vaccination laws in California in 2016 allowed public health researchers to study the effects of the laws on the distribution of vaccination level. In 2014, the vaccination rate calculated from counties throughout the state was 60%. By 2016, there was a 25% increase; the vaccination rate rose to 90%.

Opponents of the new vaccination law worried that students would be excluded from schools or parents would fake medical records to qualify for the medical exemption. In reality, school enrollment was not affected, and attempts to counterfeit medical history were minimal and did not affect the overall increase in vaccination rates statewide.

[Editor’s note: Read California’s 2015 Senate Bill 277.]

Briefly Noted

California: El Cajon ends ban on feeding homeless
The San Diego Union-Tribune   (01/23/2018)   Karen Pearlman
[Editor’s note: Learn more about the hepatitis A outbreak in El Cajon, California, El Cajon’s temporary urgency ordinance that prohibited food sharing on city property, and how the ordinance related to curbing the spread of disease. Also, learn more about hepatitis A.]


Indiana: Indiana wins federal permission to adopt Medicaid work requirements
The Washington Post   (02/02/2018)    Amy Goldstein
[Editor’s note: Read HHS Approves New Healthy Indiana Medicaid Demonstration.]


Pennsylvania: A bitter legal fight over Philadelphia soda tax could decide the future of sugar taxes in the US
Route Fifty   (02/05/2018)   Chase Purdy
[Editor’s note: Learn more about Philadelphia, Pennsylvania’s Beverage Tax.]


Vermont: Rep. Sullivan introduces bill to curb opiate prescriptions
Manchester Journal   (01/31/2018)   Cherise Madigan
[Editor’s note: Read about Vermont’s H.723.]


Vermont: Vermont is the first state to legalize marijuana through legislature
The Washington Post   (01/24/2017) Katie Zezima
[Editor’s note: Read Vermont’s H. 511, An act relating to eliminating penalties for possession of limited amounts of marijuana by adults 21 years of age or older.]


National: EPA eases path for new chemicals, raising fears of health hazards
NBC News   (01/17/2018)   Suzy Khimm
[Editor’s note: Read about US Environmental Protection Agency’s process for reviewing new chemicals under the Toxic Substances Control Act.]


National: New evidence that access to health care reduces crime
Brookings   (01/03/2018)   Jennifer L. Doleac
[Editor’s note: Read Substance Abuse Treatment Centers and Local Crime. Bondurant, Samuel, et al. National Bureau of Economic Research, 2016, doi:10.3386/w22610.]


National: Panera is calling for a federal crackdown on the eggs in its competitors’ breakfast sandwiches
The Washington Post   (01/25/2018)   Caitlin Dewey
[Editor’s note: Learn more about egg products.]


National: Report measures states on adoption of traffic safety laws
Public Health News Wire   (02/02/2018)   Tiggi Jalloh
[Editor’s note: Read the Advocates for Highway and Auto Safety’s 2018 Roadmap of State Highway Safety Laws, 15th Annual Edition [PDF – 5,96MB].]


National: Walmart distributing first-of-its-kind opioid disposal product
ABC News   (01/17/2018)   Cortney Han
[Editor’s note: Learn more about proper drug disposal.]

Global Public Health Law

India: One woman’s crusade to address India’s child sexual abuse epidemic
The Sydney Morning Herald   (02/05/2018)   Amrit Dhillon


South Africa: Cape Town pushes possible tap closure on ‘day zero’ to May
US News and World Report   (02/05/2018)   Bram Janssen


United Kingdom: Illegal teeth whitening caused ‘excruciating pain’
BBC News   (02/05/2018)   Guy Lynn

Profile in Public Health Law: Mark Biagioni, MPA

Mark Biagioni, MPH, Acting Deputy Director, Division of Community Health Investigations, Agency for Toxic Substances and Diseases Registry (ATSDR)/CDC

Title: Acting Deputy Director, Division of Community Health Investigations, Agency for Toxic Substances and Diseases Registry (ATSDR)

Education: University of Georgia, MPA


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

Biagioni:I’ve always been interested in public service and about how I can make a positive impact in other people’s lives. I started as a program evaluator for the US Department of Health and Human Services and was drawn to CDC because there is so much potential to improve health through implementation of effective programs and policies. Often, policy—broadly defined as a law, regulation, procedure, incentive, or even voluntary practice—can be a cost-effective way to create sustainable improvements. So, I really have the best of both worlds here at ATSDR.

PHLN:What is the Division of Community Health Investigations, and what is your role within the division?

Biagioni:The Division of Community Health Investigations (DCHI) is part of ATSDR that works to reduce people’s exposures to toxic substances in the environment. DCHI evaluates environmental exposures, recommends ways to protect people’s health, and prepares environmental reports based on our findings. In addition, DCHI collaborates with communities in public health activities, supplies health education materials to those communities, and provides technical help to communities, states, tribes, and other agencies.

PHLN:What are brownfields and how do they threaten public health?

Biagioni:The term “brownfield site” was defined under the 2002 Brownfields Amendments to the  Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA). These are sites where there are concerns about the presence of hazardous substances, pollutants, or contaminants; these concerns may limit or complicate the redevelopment, expansion, or reuse of the sites. There are some exclusions to the definition of “brownfield site,” such as facilities that may be placed or are listed on the National Priorities List (e.g., Superfund sites). ATSDR includes brownfields as a type of land reuse site.

Land reuse sites are sites that are slated for redevelopment but may have contamination with hazardous substances. In other words, land reuse sites include brownfields plus those sites that are exempted from the 2002 CERCLA amendment, such as Superfund sites.

Brownfields and other land reuse sites can affect a community’s health in a number of ways. Protecting people from harmful exposures that may be associated with these sites is of particular concern to ATSDR. But, ATSDR also encourages people to think broadly about how land reuse sites can affect the community’s physical and mental health, infrastructure, and environment.

PHLN:What kind of industries and contaminants are associated with brownfields?

Biagioni:Lead, asbestos, trichloroethylene, petroleum products, and a variety of metals are some of the most commonly found contaminants at land reuse sites. These contaminants come from many sources, such as industrial legacy, former gas stations, dry cleaning businesses, and older housing stock. Many, but not all, land reuse sites are contaminated.

PHLN:What is your division doing to reduce the harm caused by brownfields and other land reuse sites?

Biagioni:ATSDR addresses brownfields through our core work to protect people from environmental hazards by directly providing assistance to states to detect, respond, and prevent exposures to toxic substances in the environment. We also have created special resources focused around land reuse, including

  • An action model to help communities identify priorities and plan for land reuse
  • A site tool to help public health and municipal staff inventory potential land reuse sites and identify levels of contamination that warrant further evaluation
  • Land reuse and redevelopment toolkits, which are tailored to community members, developers, local planners, public health experts, and municipal agencies

Finally, we are working in partnership with the National Environmental Health Association to develop specialized training for public health staff.

PHLN:What is ATSDR’s Partnership to Promote Local Efforts to Reduce Environmental Exposure (APPLETREE)?

Biagioni:APPLETREE is ATSDR’s cooperative agreement program with 25 state health departments. Through APPLETREE, ATSDR provides technical and financial assistance to states to identify exposure pathways at specific sites; educate affected communities and local health professionals about site contamination and potential health effects; and review health outcome data to evaluate potential links between site contaminants and community health outcomes.

PHLN:How is the latest funding opportunity through project APPLETREE different from previous funding opportunities under your cooperative agreement?

Biagioni:For FY 2017, the program added a new activity asking states to implement programs to prevent hazardous exposures among those who are most vulnerable—young children. ATSDR is providing funding and assistance to states to ensure early care and education (ECE) programs are free from environmental hazards. To accomplish this, states will review former uses of the property proposed to become an early care and education facility to determine if harmful substances were left on the property (both building and land). They will also determine possible migration of harmful substances onto the property from nearby properties or activities or if any naturally-occurring harmful substances, such as asbestos or radon, are on the property. Finally, they’ll determine the property has access to safe drinking water source.

ATSDR envisions continuing to incorporate what it has learned investigating hazardous exposures to guide states in developing practices to prevent exposures in the first place.

PHLN: What kind of innovations have jurisdictions funded through APPLETREE created so far?

Biagioni:Connecticut has created a policy framework called SAFER to ensure that ECE programs are safely sited. SAFER is one of the models that we’ve highlighted in our guidance for states. It is a low-cost, non-regulatory approach to safe siting. Other models included in our guidance are from New York and New Jersey.

PHLN:How can individuals and policy makers become more informed about brownfields and make their homes and communities safer?

Biagioni:ATSDR has a wealth of resources on our website that can be a starting point for interested individuals. Our Land Reuse Toolkits have resources for community members, developers, planners, public health experts, and other local agencies. We encourage planners and community groups to work with their state and local health and environmental agencies because those agencies have expertise and information that is useful in safe redevelopment, including information about past uses of a site, nearby contaminants, and how to judge whether a contaminant is harmful to health. If people have specific questions about these issues in their areas, they can contact their closest ATSDR regional staff.

PHLN:Have you read any good books lately?

Biagioni: The Last Days of Night, by Graham Moore. It is the story of the lightbulb patent wars between Thomas Edison and George Westinghouse, told through the lens of a young attorney hired by Westinghouse. I enjoyed how the concepts of technology, business, and law were intertwined and how there were countless lessons for modern-day management, business, and government practices—it was a real page-turner!

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

Biagioni:I could see myself as a city planner working in the Atlanta area to help re-vision neighborhoods and communities, given all the growth and redevelopment that has been taking place. Atlanta has really changed over the last decade, but there’s still a lot of work to do to make it a model live, work, and play community.

PHLN:Do you have any hobbies?

Biagioni:My hobbies lately have been raising three vibrant boys (ages 7, 4, and 1), staying connected to my wife of 12 years, and enjoying the north Georgia mountains when we can. We are also a soccer family, so I enjoy playing with friends, coaching my kids, and watching Atlanta United.

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 February 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 February 2018

When are applications due for the CDC Notice of Funding Opportunity: Technical Assistance for Response to Public Health or Healthcare Crises?

Winning Response to the January 2018 Public Health Law NewsQuiz

Question: Which administration within the US Department of Health and Human Services released its final rule, Confidentiality of Substance Use Disorder Patient Records, in January 2018?

Answer: The Substance Abuse and Mental Health Services Administration (SAMHSA)

Court Opinions

Maryland: “Cost of the premium” is an actuarial estimate made before claims are paid; employee are not entitled to reimbursement for premium payments withheld from paychecks when actual costs were lower.
Huber v. Montgomery County
Court of Special Appeals of Maryland
Case No. 1228, September Term, 2016
Filed 01/26/2018
Opinion by Judge Dan Friedman


Michigan: Fraudulent concealment exception may allow tolling of statutory limitations for two years in Flint contaminated water case.
Mays v. Snyder
Court of Appeals of Michigan
Case Nos. 335555, 335725, 335726
Filed 01/25/2018
Opinion by Judge Kathleen Jansen


New York: Discovery request limited to all information related to infected cord blood during a discrete period of time when salmonella infection was present in neonatal intensive care unit is not overly broad under HIPAA.
CM v. NYU Hosp. Ctr.
Supreme Court, New York County
Case No. 805292/14
Filed 01/18/2018
Opinion by Judge Joan A. Madden

Quote of the Month

Morgan Alan, CEO of the National Rural Health Association

“We cannot continue to defer entirely to decisions made by individual physicians without some level of accountability within the healthcare industry as a whole,” said Vermont Representative Linda Joy Sullivan of a bill that would increase physician accountability for opiate prescriptions.

[Editor’s note: This quote is from Rep. Sullivan introduces bill to curb opiate prescriptions, Manchester Journal, 01/31/2018, by Cherise Madigan]

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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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, or persons quoted therein, 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 Web sites 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.

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