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April 2018

Public Health Law News Banner

In This Edition

Announcements

Webinar About Tribal Public Health Emergency Law. American Indian/Alaska Native (AI/AN) tribal governments are sovereign entities with inherent authority to create laws and enact health regulations. Coupled with state and federal laws, tribal laws are an essential tool for ensuring effective public health emergency preparedness and response on tribal lands. This webinar, co-sponsored by CDC’s Public Health Law Program (PHLP) and CDC’s Office for Public Health Preparedness and Response, will explore the legal challenges of working on public health emergencies that affect tribes or cross tribal borders. It will also offer practical tips for addressing those challenges through cooperation with tribes. The webinar will take place on Wednesday, May 9, 2018, 1:00–2:00 pm (EDT). Registration is not required. Participants can log onto https://adobeconnect.cdc.gov/r6ooog3mlz5/ to view the webinar. To listen to the audio portion via a phone line, dial 1-800-475-4962 and enter participant passcode 4330935.


The Case for Streamlining Emergency Declaration Authorities. This article, published in the Emory University Law Journal,argues that a streamlined and adaptable state legal system for emergency response 1) provides a governor with the authority to issue one type of emergency declaration, 2) does not divide vital authorities across various declaration types, and 3) provides a governor with the unilateral power to remove statutory and regulatory barriers to an effective response.


Notice of Funding Opportunity Deadline: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement. Applications are due April 24, 2018, no later than 11:59 pm (EDT) for CDC’s Office for State, Tribal, Local and Territorial Support (OSTLTS) notice of funding opportunity (NOFO), CDC-RFA-OT18-1803: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement. This five-year cooperative agreement will fund up to 25 federally recognized AI/AN tribal nations and regional AI/AN tribally designated organizations to optimize the quality and performance of tribal public health systems, including infrastructure, workforce, data and information systems, programs and services, resources and communication, and partnerships. For more information, please send questions to OSTLTSTribalNOFO@CDC.gov.


Policy Surveillance Summer Institute 2018. Temple University’s Policy Surveillance Program will host the third annual Policy Surveillance Summer Institute June 7–8, 2018, in Philadelphia, Pennsylvania. The institute is open to students and professionals interested in policy surveillance. Attendees will learn introductory and advanced policy surveillance methods and how they may be applied to research and practice.

Legal Tools

Legal Epidemiology Competency Model (LECM). The LECM was created by PHLP to provide uniform standards for public health practitioners conducting legal research. The LECM’s goal is to provide user-friendly minimum competencies in legal epidemiology, including research and translation knowledge and skills required of public health practitioners, lawyers, and policy experts working in state, tribal, local, or territorial health departments. The LECM development was supported by a multidisciplinary expert review workgroup, and the model is designed to help practitioners build their legal epidemiology skills throughout their careers.


Behavioral Health Integration (BHI) Infographic. The Division of Human Development and Disabilities in CDC’s National Center on Birth Defects and Developmental Disabilities has published an infographic describing barriers to and resources for improving access to mental health care for children. The infographic is part of a group of resources created by CDC, including a CDC-sponsored report on BHI published by the Milbank Memorial Fund and a new web page on improving access to children’s mental health care.


Alcohol Taxes Infographic. Alcohol taxes are an evidence-based strategy to reduce excessive alcohol consumption and related harms. ChangeLab Solutions created this infographic to provide an overview of 1) how alcohol taxes work to reduce consumption and 2) the public health effects of that reduced consumption. To learn more about this strategy, see ChangeLab Solutions FAQs for alcohol taxes. In addition, see the organization’s resources on alcohol outlet density and commercial host liability.


City Rights in an Era of Preemption: A State-by-State Analysis. [PDF – 3.2MB] The National League of Cities (NLC) has published the 2018 update to its state-by-state analysis of preemption laws. The report is the third project outcome between NLC and the state municipal leagues. This study of state preemption began with collecting preemption data for each policy area from secondary sources. State municipal leagues then verified the data for their states to ensure timeliness and accuracy. A total of 38 state leagues responded to NLC’s requests for comment. This is the second edition of the report. Data are current as of February 2018.

Top Story

National: When towns lose their newspapers, disease detectives are left flying blind
StatsNews    (03/20/18)  Helen Branswell

Story Highlights

Public health practitioners collect surveillance data from a wide variety of sources—local and state agencies, the Internet, social media, and local news. As local news outlets disappear, however, researchers are concerned that the closures will disproportionately affect tracking of the spread of disease.

The use of informal information sources is essential to public health surveillance because there are limitations to tracking traditional health data. Barriers to surveillance, such as data privacy laws and health departments’ ability to archive surveillance data, support researchers’ claims about the need for alternative information sources.

Maia Majumeder, a research fellow at Boston Children’s Hospital, is dismayed by the decrease in local newspapers. She works with HealthMap, a disease detection project that uses nontraditional information sources, such as local news and social media, to track the prevalence of global infectious disease. The information gathered by the organization is used worldwide by public health authorities and researchers interested in studying the dynamic distribution of infectious diseases. She and other researchers are alarmed that the reduction in the number of local news outlets will affect their data sources for tracking outbreaks.

For example, during the 2009 H1N1 epidemic, the Centers for Disease Control and Prevention used local news media to search for trends in reporting of flu-like illness in Mexico, where there were reports of a new disease affecting the population. Local reporting helped researchers monitor the origin point for the outbreak.

These concerns are not limited to the United States. The World Health Organization encourages countries to include “event-based surveillance” with more traditional surveillance methods, such as reports from doctors and labs. Event-based surveillance tracks disease prevalence using media reports, rumors on social media, and word of mouth. The limitations of event-based surveillance are significant, however, and include accurate journalism reporting and inaccurate (either accidentally or by design) reporting from social media.

Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases, says, “It is well-known that event-based surveillance depends on healthy, local journalism. So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”

Majumeder says she’s concerned that the nationwide decrease in media outlets coincides with areas where voters report being uninformed. In these cases, Majumeder says, “What that means is they lose access to news which is very, very vital for knowing what’s going on in your town. But also from the public health surveillance point of view, we’re losing access to knowing what they need.”

Mauricio Santillana, an assistant professor at Harvard Medical School, specializes in using informal data to track and report disease outbreaks. He says, “When you combine data from multiple data sources . . . including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country.”

Briefly Noted

Kentucky: Ky. Lawmakers didn’t consult federal experts about limiting black lung claims reviews
NPR   (04/09/2018)   Howard Berkes
[Editor’s note: Read Kentucky’s HB2 18RS.]


Utah: Utah becomes first state to pass ‘free-range parenting’ law
The Hill   (03/27/2018)   Morgan Gstalter
[Editor’s note: Read Utah’s “Free-range Parenting” Law and learn more about safe routes to school approaches from ChangeLab Solutions.]


National: Birth control apps find a big market in ‘contraception deserts’
NPR   (03/26/2018)   Lesley McClurg and Ashley Lopex


National: Craigslist removes personal ads after sex trafficking act passes
Rolling Stone   (03/23/2018)   Daniel Kreps
[Editor’s note: Read HR 1865—Allow States and Victims to Fight Online Sex Trafficking Act of 2017.]


National: EPA to roll back car emissions standards, handing automakers a big win
The Washington Post   (04/02/2018)   Juliet Eilperin and Brady Dennis
[Editor’s note: Read about EPA’s regulations for emissions from vehicles and engines.]


National: FDA to consider what ‘healthy’ means and other claims food companies can make
CNBC   (03/29/2018)   Angelica LaVito


National: FDA sued for delaying e-cigarette, cigar regulations
The Washington Post   (03/27/2018)   Laura McGinley
[Editor’s note: Learn more about FDA’s regulation for e-cigarettes, cigars and all other tobacco products and read the complaint filed in the United States District Court for the District of Maryland on March 27, 2018 [PDF – 1.3MB].]


National: Federal ban on methadone vans seen as barrier to treatment
Stateline   (03/23/2018)   Christine Vestal


National: Medicare is cracking down on opioids. Doctors fear pain patients will suffer.
New York Times   (03/27/2018)   Jan Hoffman
[Editor’s note: Read Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 draft Call Letter.

Global Public Health Law

Brazil: Plea for action on shipping emissions
BBC News   (04/09/2018)   David Shukman


United Kingdom: Soft drink sugar tax starts, but will it work?
BBC News   (04/06/2018)   Nick Triggle


World: Meet the man leading the charge against the global HIV/AIDS epidemic
The Washington Post   (03/27/2018)   Tom Fox
[Editor’s note: Learn more about HIV/AIDS and PEPFAR.]

Profile in Public Health Law: Geoffrey Mwaungulu, Jr, JD, MPH

Title: Senior Program Analyst; Public Health Preparedness, Law, and Ethics; National Association of County and City Health Officials (NACCHO)

Education: JD, University of Pittsburgh School of Law; MPH, Health Policy and Management, University of Pittsburgh Graduate School of Public Health


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

Mwaungulu:Sure! When I started working after undergrad, I knew I wanted to be in the world of health; however, my professional experiences following my education led me to realize that I wanted to be in public health law. I started out working for a company that created conferences for professionals in the healthcare world. My role was to identify conference topics and the subject matter experts who would be speaking at these events. After putting on conferences on topics such as claims processing, hospital supply tracking, and sleep centers, I was able to find a healthcare-related position with a different company focused on providing industry research to hospitals. While I was in that position, I started to think about the impacts of law and policy on various industries and decided to move on to an association focused on creating industry-developed standards for telecommunications. It was while I was in that position that things clicked, and my vision for a career path became clearer as I realized the many ways that law affects population health. From there I decided to go back to graduate school and pursue a dual degree in law and public health, thus allowing me to find a position here at NACCHO, where I’ve been able to focus my efforts on addressing the connection between law and public health from the local perspective.

PHLN:What is NACCHO?

Mwaungulu:NACCHO stands for the National Association of County and City Health Officials. It’s a member organization focused on serving the needs of the nearly 3,000 local health departments spread across the United States. NACCHO helps lead local health departments through the complex issues that confront them, partners with local health departments and other organizations to address public health concerns, and acts as the unified voice of local health departments when interacting with outside organizations and governmental entities.

PHLN:How does public health law relate to NACCHO’s work? Why is public health law of particular importance to local governments?

Mwaungulu:NACCHO frequently considers how the law and legal interventions can be incorporated into its wide array of programmatic activities. As the law plays a role in almost every aspect of the work done by government agencies, including local health departments, improving the legal knowledge of a public health practitioner at the local level can have a large impact on his or her ability to effectively work for the community. Incorporating legal considerations and strategies into the work we do can make our tools that much more effective for our members.

PHLN:Please describe your role at NACCHO.

Mwaungulu:As a senior program analyst, I manage a variety of programs and projects that support local health departments seeking to improve their capabilities in public health practice and increase their capacity to serve their communities. My work typically falls within the categories of public health preparedness, law, and ethics.

PHLN:It sounds as if you and your team provide a lot of infrastructure, research, and project support for local jurisdictions. What kinds of public health law projects are you working on currently?

Mwaungulu:Recently, a great deal of my time has been focused on administrative preparedness at the local level. I have also been focused on issues related to opioids, legalized cannabis, the intersection between law and ethics, and more.

PHLN:What is the NACCHO Legal Workgroup, and how does it support local public health entities?

Mwaungulu:The NACCHO Legal Workgroup is a forum that gives local health officials and attorneys from local health departments the opportunity to discuss the legal and policy issues they face on a day-to-day basis. Through these conversations, participants can work with their peers to identify potential policy and legal strategies for addressing their concerns and recognize potential legal problems that could impact their communities. We are looking for opportunities to expand this group’s scope of activities to allow for an increased ability to provide on-demand peer-to-peer technical assistance to the public health community.

PHLN:How does having a network of local public health department attorneys improve public health outcomes?

Mwaungulu:Since the law plays such an important role in the practice of public health at the local level, having a network of local public health attorneys allows NACCHO and its members to be better able to anticipate and react to public health issues that might arise at the local level, anticipate new issues that might arise across the country, and identify potentially useful solutions and legal interventions that are informed by some of the foremost minds in local public health practice. Each one of these outputs can positively influence local activities and make a real impact on community health.

PHLN:You mentioned that you are working on NACCHO’s opioid response activities. What challenges are local jurisdictions facing with regard to the opioid crisis? How are the challenges different from those faced at the national or state levels?

Mwaungulu:As the boots on the ground, local health departments have the most experience working with the people most affected by the ongoing opioid abuse crisis. In the normal course of their work, local health departments need to be able to conduct activities such as containing opioid-abuse outbreaks, addressing rises in bloodborne infectious disease associated with injection drug use in communities, and monitoring opioid use data—all while still serving other aspects of their community’s health. Additionally, local health departments are in the unique position to bring partners, such as emergency management and law enforcement, together across the spectrum to find solutions to this multifaceted and complex crisis.

PHLN:What is administrative preparedness, and how does it relate to local public health practice?

Mwaungulu:Administrative preparedness is the process of ensuring that the fiscal, legal, and administrative authorities and practices that govern funding, procurement, contracting, and hiring are appropriately integrated into all stages of emergency preparedness and response. The goal of administrative preparedness is to remove administrative barriers that can prevent timely response activities. A deficiency in administrative preparedness can delay acquisition of goods and services, hiring or assignment of response personnel, disposition of emergency funds, and legal determinations needed to implement protective health measures.

PHLN:What can local health entities do to improve their administrative preparedness?

Mwaungulu:Local health departments can take on a number of activities to improve their administrative preparedness. We’ve found that incorporating administrative staff in preparedness planning activities, including exercises, is one of the most impactful strategies that locals can use to improve their administrative preparedness. By taking this course of action, local health departments can increase the familiarity and cohesion between preparedness staffs and their non-preparedness colleagues who could be involved in a public health response. It can also help them improve the general knowledge about changes in law or policy that occur following the declaration of an emergency.

Individuals can also improve their administrative preparedness capabilities by reviewing tools created by NACCHO and its partners, which are in the administrative preparedness toolkit in the NACCHO Toolbox. This toolkit contains items developed by NACCHO, our partners, and local health departments that offer guidance on how to address areas of administrative preparedness, including incorporating administrative preparedness into exercises, workforce mobilization, personnel and procurement, reporting practices, and more.

PHLN:How can interested individuals and jurisdictions learn more about public health law and policy at NACCHO?

Mwaungulu:Folks interested in learning more about the law and policy work at NACCHO can find additional information at our website, www.naccho.org. The site provides access to our public health law programmatic page, our policy and advocacy pages, and the aforementioned NACCHO Toolbox. Folks may also directly reach out to NACCHO’s public health law program by sending an email to PHLaw@naccho.org.

PHLN:Have you read any good books lately?

Mwaungulu:I’ve been on a nonfiction tear recently, having finished “Deep Work,” by Cal Newport, and soon to start “Peak: Secrets from the New Science of Expertise,” by Anders Ericsson and Robert Pool.

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

Mwaungulu:Good question! I’m not sure, but I’d probably be practicing in health law, though I’ve also been told that I would make a good teacher.

PHLN:Do you have any hobbies?

Mwaungulu:Watching movies, playing trivia games, staying physically active, and catching up on old episodes of Frasier with my wife Carly and our cat Mango.

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 May 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 April 2018

When does the application period close for the notice of funding opportunity, CDC-RFA-OT18-1803: Tribal Public Health Capacity Building and Quality Improvement Umbrella Cooperative Agreement, announced by CDC’s Office for State, Tribal, Local and Territorial Support?

Public Health Law NewsQuiz Question March 2018 Winner!

Alan Trachtenberg, MD, MPH

Alan Trachtenberg, MD, MPH

February Question: What public health law organization is hosting the Policy Surveillance Summer Institute 2018 in Philadelphia, Pennsylvania?

Winning Quiz Answer: Temple University [Editor’s note: Learn more about Temple University’s Policy Surveillance Summer Institute 2018.]

Employment organization and job title:
Medical Officer, Controlled Substance Staff, US Food and Drug Administration/Center for Drug Evaluation and Research

A brief explanation of your job:
I evaluate data on drugs—either during the drug approval process under the Food, Drug and Cosmetic Act, or on illicit drugs—for their potential for abuse and addiction, and recommend scheduling under the Controlled Substances Act (CSA) or other measures to prevent adverse effects on public health.

Education:
Brookline High School (Go public education!)
Rensselaer Polytechnic Institute (RPI, go Tute!)
Tufts University School of Medicine (MD)
UC Berkeley (MPH, General Preventive Medicine and Public Health Residency)
UCSF (Clinical Epidemiology and Health Policy Fellowships)

Favorite section of the news:
Drug advertisements (Not!)

Why are you interested in public health law?
Working in Federal opioid policy for the past 30 years at the intersection of drug law and public health, I was involved in rewriting the federal regulations in the 90s that governed medication-assisted treatment (MAT), also known as narcotic treatment or methadone programs. Following that, I helped create the new national system for office-based opioid treatment, enabled by the Drug Addiction Treatment Act of 2000. This treatment allowed physicians to offer MAT away from special clinics, prescribing C-III opioid medication (buprenorphine, which had previously been prohibited under the CSA). I also worked with state medical boards to make it work at the states’ level under their existing medical practice and controlled substance acts.

What is your favorite hobby?
Medical botany and gardening medicinal herbs.

Court Opinions

Georgia: A vendor under the Food Delivery Methods provisions of the Special Supplemental Nutrition Program for Women, Infants, and Children (“WIC”) can be subject to a three-year disqualification only after 1) a notice of violation and 2) a second violation establishes a pattern of misuse.
Broad Street Supermarket, Inc. v. Georgia Dept. of Public Health
Court of Appeals of Georgia
Case No. A17A1923
Filed 03/06/2018
Opinion by Judge Sara L. Doyle


Federal: The FDA has broad regulatory authority under the Family Smoking Prevention and Tobacco Control Act (“TCA”), including how to fine violators of the act.
Orton Motor, Inc. v. US Department of Health and Human Services
United States Court of Appeals, District of Columbia Circuit
Case No. 16-1299
Filed 03/20/2018
Opinion by Judge Robert L. Wilkins


Federal: Terms of a collective bargaining agreement, including health care benefits, are subject to ordinary principles of contract law.
CNH Indus. N.V. v. Reese
Supreme Court of the United States
Case No. 17-515
Filed 02/20/2018
Opinion Per Curiam
Opinion by Judge Sara L. Doyle

Quote of the Month

Utah Governor Gary Herbert

“[Absent] evidence of clear danger, abuse or neglect, we believe that parents have the best sense of how to teach responsibility to their children,” said Governor Gary Herbert of Utah’s new “free-range parenting” law. [Editor’s note: This quote is from Utah becomes first state to pass ‘free-range parenting’ law, The Hill, 03/27//2018]

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

Disclaimers

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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