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January 2019

Public Health Law News Banner

In This Edition

Announcements

CDC Externships in Public Health Law. CDC’s Public Health Law Program (PHLP) offers externships in public health law, tribal public health, and administration and communications. The externships consist of 9–14 weeks of professional work experience with PHLP in Atlanta, Georgia. With rolling start and completion dates during the academic year, unpaid externships must qualify for academic credit as authorized by law and public health schools. Applications for summer 2019 positions are due by January 31, 2019.


Policy Levers to Promote Access to and Utilization of Children’s Mental Health Services: A Systematic Review. Families’ ability to obtain behavioral healthcare for their children can be affected by healthcare policies, but little is known about the impact of specific policy approaches. CDC reviewed what is known about whether select policy approaches increase families’ use of children’s mental and behavioral health services. The study found that policies concerning the location of mental and behavioral health services (such as offering services in schools and primary care settings) showed higher family satisfaction and increased use of these services. Policies about insurance coverage for mental and behavioral health services showed more affordability for families. Having sets of policies that complement each other and address multiple outcomes simultaneously (such as affordability and availability of effective services) may have a population-level impact on children who need mental health services.


Evaluation of State-Mandated Reporting of Neonatal Abstinence Syndrome—Six States, 2013–2017. In 2014, in the United States, an infant with signs of neonatal abstinence syndrome (NAS) was born every 15 minutes. Historically, NAS surveillance has depended on hospital discharge data, frequently with a time lag, limiting ability to rapidly direct public health resources. This evaluation focuses on six states with state laws implementing required NAS case reporting for public health surveillance during 2013–2017. It also reviews implementation of the laws, state officials’ reports of data quality before and after laws were passed, and advantages and challenges of legally mandating NAS reporting for public health surveillance in the absence of a national case definition.


ChangeLab Solutions Seeks a New Chief Executive Officer. The ideal candidate should be a lawyer with significant experience in social justice, public interest law, or government practice. ChangeLab Solutions works to advance equitable laws and policies that make communities healthier places to live for everyone. This search is being conducted with assistance from Katherine Jacobs and Cara Pearsall of the national search firm Nonprofit Professionals Advisory Group. Candidates are encouraged to apply as soon as possible. The search committee will begin reviewing applications in February 2019 with interviews expected to take place in early April. Applications, including a cover letter describing interest, qualifications, and resume, should be sent to cls-ceo@nonprofitprofessionals.com. To expedite the sorting and reviewing process, type your name (Last, First) as the only contents in the subject line of your email.


Five-Part Webinar Series Exploring Policy Surveillance. The Center for Public Health Law Research will host a five-part monthly webinar series examining policy surveillance and empirical legal research methods and standards, issues in global and local policy surveillance, and challenges and opportunities for the use of policy surveillance in research and policy making. The next webinar in the series will discuss challenges and opportunities in global policy surveillance and will take place February 11, 2019, 11:00 am–12:30 pm (EST).


APHA Annual Meeting Call for Abstracts. The law section of the American Public Health Association (APHA) seeks abstracts that focus on current hot topics in public health law and are relevant to APHA’s 2019 Annual Meeting theme, “Creating the Healthiest Nation: For science. For action. For health.” The law section welcomes outstanding abstracts that address research on the impact of law and policy on public health, legal theory with important implications for public health, or the practice of law to advance health. Abstracts must be submitted by February 19, 2019.


APPE 28th Annual Conference. Registration is now open for the Association for Practical and Professional Ethics’ (APPE’s) 28th Annual Conference. This is an opportunity for individuals across all disciplines to learn about professional and practical ethics. The conference is February 28–March 3, 2019. On-time registration ends February 1, 2019.


Grant Opportunity from OVW. The US Justice Department’s Office on Violence Against Women (OVW) has announced a grant program for Indian tribes concerning domestic violence. The program encourages collaborative efforts among tribal leadership, courts, prosecutors, attorneys, defenders, law enforcement, probation, victim services providers, and other partners to ensure that victims find safety and justice. The program is also intended to ensure that non-Indians who commit crimes of domestic violence, dating violence, and violations of protection orders in tribal territory are held accountable. Application period closes February 14, 2019.

Legal Tools

CDC Releases 2018 Public Health Emergency Preparedness and Response Capabilities. CDC has published the 2018 Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health.CDC began updating the capabilities in 2017 in response to feedback from CDC subject matter experts, state and local health departments, and national partner organizations. The 2018 standards recognize the maturity and experience jurisdictional public health emergency preparedness and response programs have gained since 2011. They also describe the components necessary to advance jurisdictional public health preparedness and response capacity.


Stroke Systems of Care Policy Evidence Assessment Reports. On average, a stroke occurs every 40 seconds in the United States. Stroke systems of care improve patient care and support throughout the patient’s healthcare journey—from the first symptoms of stroke, EMS transport, and hospital care to follow-up with outpatient providers. State law could help scale up evidence-based interventions shown to increase the reach, consistency, and coordination of stroke care. Read recently released assessments of policy evidence to learn which 16 recommended stroke policy interventions are most effective.


NACCHO 2018 Preparedness Profile Assessment [PDF – 611KB]. The National Association of County and City Health Officials (NACCHO) has released the 2018 Preparedness Profile Assessment, which describes the landscape of public health emergency preparedness across the United States. The assessment gathers information about preparedness trends and emerging issues at local health departments to provide an evidentiary foundation for future public health preparedness initiatives.


Journal Article on Health and Human Rights. This article, published in The Lancetand in concurrence with the 70th anniversary of the Declaration of Human Rights, discusses the progress the world has made regarding health and human rights as well as rising challenges to these successes.


Legal and Non-Legal Strategies to Improve Childhood Lead Screening Rates in Illinois and Ohio. The Network for Public Health Law has published an issue brief that examines the lead screening requirements in Illinois and Ohio. This brief includes information on state laws and Medicaid requirements. It also explores strategies to improve lead screening rates.

Top Stories

Tennessee: Cyntoia Brown is granted clemency after serving 15 years in prison for killing a man who bought her for sex
CNN   (01/07/2010)   Mallory Gafas and Tina Burnside

Story highlights

Cyntoia Brown was 16 when she was sentenced to life in prison for the murder and robbery of Johnny Mitchell Allen, a man who brought her to his home after soliciting her for sex. After serving 15 years in prison, Brown was granted clemency by Tennessee Governor Bill Haslam, who deemed the original punishment too harsh for a juvenile. She will be released on August 7, 2019, on parole.

Brown was tried in 2004 after she shot Allen and took money and guns from his home. While the prosecution claimed Brown killed Allen as part of a robbery, Brown claims she stole the money and guns because she was afraid of returning to her pimp, a man known as “Cut Throat,” empty-handed.

Even though Allen solicited Brown for sex, the murder was deemed an act of robbery instead of self-defense under the law, and she was tried and convicted as an adult.

Community members, celebrities, and advocacy groups voiced outrage and demanded clemency be granted to Brown. And since Brown’s conviction, juvenile sentencing guidelines in Tennessee have been changed. Local CNN affiliate anchor Stacy Case stated, “Our courts today would view her as a child sex slave…she would have been viewed a victim.”

Brown’s case sparked the 2011 documentary “Me Facing Life: Cyntoia’s Story,” which detailed her horrific experience with her pimp and her tumultuous upbringing. Prior to being trafficked for sex, Brown was adopted several times, unable to live with her alcoholic mother. While living with her pimp, Brown knew she faced certain death if she was unable to bring back money.

Despite her difficult journey, Brown works to rebuild her life through mentoring and education.

“Cyntoia Brown committed, by her own admission, a horrific crime at the age of 16. Yet, imposing a life sentence on a juvenile that would require her to serve at least 51 years before even being eligible for parole consideration is too harsh, especially in light of the extraordinary steps Ms. Brown has taken to rebuild her life. Transformation should be accompanied by hope,” said Governor Haslam.

[Editor’s note: Learn more about Tennessee’s efforts to combat sex trafficking [PDF 260KB] and sex trafficking risks and impact.]


Texas: Blindsided by scooter drop, Austin races to make riding safer
KUT News   (01/07/19)   Dalyah Jones

Story highlights

CDC and the City of Austin are conducting a study on the safety of dockless scooters to present to the Austin City Council. CDC researchers are examining data related to scooter injuries recorded by Austin hospitals between September and November 2018. The city will use the findings to improve a current dockless mobility ordinance. The study is collecting information on the severity of the injury, as well as whether the injury required hospital admission or follow-up medical care.

Since the emergence of dockless scooters in Austin about a year ago, 160 scooter-related accidents have been recorded. The rise in rides has put pressure on the city to pass more safety standards for scooters. Currently, the city has seven dockless mobility companies, whose users have taken 2.3 million rides, most of them on scooters. While the city had plans to launch its own dockless bike and scooter program, these companies have rolled out scooters much faster than the city was able to introduce its own program.

The city requires companies to have permits and has restricted scooters in some areas, but these requirements do not fully address safety. CDC will evaluate injuries and the context in which the injuries happened. The city will then use this data to develop and enforce clear ordinances. Ordinances contemplated by the city could include the requirement of a helmet and no texting and driving.

Once CDC presents its injury findings to the Austin City Council sometime around March 2019, the city will likely discuss and potentially pass ordinances to address the safety concerns associated with dockless scooters.

[Editor’s note: Learn more about Austin’s dockless mobility systems.]

Briefly Noted

Alaska: Officials push to keep dozens of earthquake sensors slated for removal across Alaska
Anchorage Daily News   (01/05/2019)   Alex DeMarban
[Editor’s note: Learn more about Alaska’s earthquake and tsunami preparedness program.]


California: Want to reduce opioid use? Nudge the doctors who prescribe them
Los Angeles Times   (01/01/2019)   Atul Nakhasi


Georgia: Georgia sues drug companies for allegedly causing opioid deaths
Atlanta Journal Constitution   (01/03/2019)   Mark Niesse


New York: Judge blocks New York City law aimed at curbing Airbnb rentals
New York Times   (01/03/2019)   Benjamin Weiser and J. David Goodman
[Editor’s note: Read the opinion in Airbnb, Inc. v. City of New York, United States District Court, Southern District of New York, Case No. 1:18-cv-07712-PAE, filed 01/03/2019.]


New York: New York now requires changing tables in public men’s bathrooms
CNN   (01/06/2019)   Gisela Crespo
[Editor’s note: Learn more about the new law and similar measures.]


Pennsylvania: What Pennsylvania & federal records say about Zika in 2018
Lancaster Online   (01/03/2019)   Heather Stauffer
[Editor’s note: Learn more about law and polices related to Zika.]


West Virginia: WV, surrounding states working to improve foster care laws
Charleston Gazette-Mail   (01/05/2019)   Taylor Stuck
[Editor’s note: Learn more about adverse childhood experiences and public health.]


National: As wildfire risk increases, home insurance is harder to find
Stateline   (01/03/2019)   Sophie Quinton


National: How to stop teen vaping? Make e-cigarettes harder to get
NBC News   (12/07/2019)   Maggie Fox
[Editor’s note: Read about tobacco retail licensing and youth product use.]


National: Laws intended to protect firefighters who get cancer often lack teeth
NPR   (01/04/2019)   Lauren Bavis

Global Public Health Law

Australia: Australian beaches closed after ‘epidemic’ of bluebottle jellyfish stings
The Weather Channel   (01/07/2019)   Ron Brackett


Canada: ‘Safe supply’ program will distribute free opioids to entrenched users
CBC   (01/04/2019)   Rafferty Baker


Saudi Arabia: Young woman who fled Saudi Arabia arrives in Canada as refugee
NPR   (01/13/2019)   Francesca Paris


Poland: Poland cracks down on escape rooms after deadly fire
New York Times   (01/07/2019)   Joanna Berendt and Marc Santora


Global: : CDC warns international travelers of rabies risk
U.S. News   (01/03/2019)   Alexa Lardieri

Profile in Public Health Law: Jordan Greenbaum, MD

Photo: Jordan Greenbaum, MD

Title:
Medical Director, Global Health and Well-Being Initiative, International Centre for Missing and Exploited Children; Adjunct Assistant Professor, Department of Pediatrics, Emory School of Medicine; Staff Physician, Institute on Healthcare and Human Trafficking, Stephanie V. Blank Center for Safe and Healthy Children, Children’s Healthcare of Atlanta

Education: MD, Yale School of Medicine; BA, Smith College


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

Greenbaum:I am trained as a forensic pathologist. I worked as an assistant medical examiner for a few years before deciding that I wanted to shift my career focus. I wanted to use my forensic training and was fortunate to meet a child abuse pediatrician, who mentored me in the medical evaluation of child maltreatment. Eventually, I became medical director of a child advocacy center, and for the last several years, I have been focusing more and more heavily on human trafficking and exploitation.

PHLN:What is human trafficking?

Greenbaum:Broadly speaking, human trafficking involves the exploitation of another person, typically for sex or labor, using force, fraud, or coercion—or in the case of a person less than 18 years of age, involving that person in a commercial sex act. The latter refers to any sex act in which there is the exchange of something of perceived value, such as food, clothing, or money.

PHLN:Who is vulnerable to human trafficking?

Greenbaum:While human trafficking may involve persons of any age and socioeconomic, religious, racial, ethnic, or cultural background, most trafficked persons have one or more vulnerabilities. These can occur at the individual level (e.g., homelessness, substance misuse, untreated mental health disorder), relationship level (e.g., intimate partner violence, family dysfunction), community level (marginalized population, limited community awareness of trafficking) or societal level (homophobia, gender bias/discrimination, ethnocentricity). For example, a transgender female runs away from home due to physical abuse and parental intolerance of her gender identity. She lives in a community where there is considerable violence, as well as many adult sex venues. She is befriended by a man on the street who offers to “take care of her.” He gives her a place to stay, and in exchange, she is expected to have sex with men he brings to the apartment.

PHLN:Is human trafficking, and child sex trafficking in particular, a public health issue? If so, why?

Greenbaum:I am so glad you asked! Yes, it is a major public health issue. That is, it is a preventable condition that significantly impacts the health of individuals and communities, and it can be addressed through public health measures such as systematic risk assessment, evidence-based primary prevention efforts, and early intervention programs that are subjected to rigorous scientific evaluation. Adequately addressing human trafficking will require us to address vulnerabilities at all of the levels mentioned above. Public health strategies do just that: they aim to positively impact individual, relationship, community, and societal factors that can make persons vulnerable to trafficking and exploitation.

PHLN:What role does law play in child sex trafficking prevention?

Greenbaum:Alongside a public health approach, our efforts to combat human trafficking require a strong legal intervention, including comprehensive laws that clearly define human trafficking, hold offenders accountable, and protect and serve all trafficked persons. We need training of law enforcement officers, attorneys, and the judiciary. Our legal response needs to strongly address not only sex trafficking, but labor trafficking and exploitation, as well.

PHLN:What barriers are there to enforcing human trafficking laws and identifying victims?

Greenbaum:I think some of the challenges to enforcing laws and identifying victims involve variations in state laws on human trafficking, inadequate training of professionals encountering trafficked persons (e.g., workers in law enforcement, social services, medical and mental health, public health, other child-serving professions), bias/discrimination, and a lack of adequate resources to respond to suspected trafficking. People may be very reluctant to screen for trafficking if they know there is little they can do to help a person who is being exploited. In addition, many trafficked persons may be very hesitant to disclose their exploitation to others, due to fear of retaliation from traffickers, fear of arrest and/or deportation, shame, guilt, or simply an inability to recognize their exploited status.

PHLN:Are any local or state jurisdictions taking innovative legal approaches to combat child sex trafficking?

Greenbaum:Yes. A good example involves the state of New York, which passed a law in November 2017 requiring healthcare facilities to train clinical and security staff and develop protocols for responding to suspected human trafficking. The law resulted in proposed rules that were released in December 2018. We know that many trafficked persons seek medical or mental healthcare at some point during or around the time of their exploitation. If we can train health professionals to recognize persons at risk and respond in a trauma-informed, culturally sensitive manner, we will be able to offer these persons critical resources and referrals.

PHLN:What kind of trainings should be conducted to prevent child sex trafficking?

Greenbaum:I think we need to educate parents and the lay public about human trafficking dynamics, possible indicators, an appropriate response to possible trafficking, and prevention strategies (e.g., online safety, common recruitment techniques, risk factors). We need to work with children so they understand the differences between healthy and unhealthy relationships, how to respect others, how to say “no,” and how to recognize situations that present a high risk for exploitation. Training should also be provided to healthcare professionals, law enforcement, social service workers, legal professionals, teachers, and other child-serving professionals. We need to address prevention at all levels. And this training needs to include information about labor trafficking, as well as sex trafficking, since the two types of exploitation often coexist, and labor trafficking is associated with many of the same adverse health consequences as sexual exploitation.

PHLN:What should be included in trainings about labor trafficking?

Greenbaum:The same things included in trainings about sex trafficking. With professionals, training should include the trauma-informed, rights-based, culturally sensitive approach to interacting with trafficked persons, common trauma-related stress responses and behaviors, reasons why trafficked persons may be hesitant to disclose their situation or accept help, and short/long-term needs of trafficked persons.

PHLN:How is identifying and treating adult sex trafficking victims different from child sex trafficking victims?

Greenbaum:Many adult trafficked persons were exploited as minors so both age groups may share many of the same risk factors. However, there are clear developmental differences between adolescents and adults, so sex-trafficked minors may present differently, may perceive offers to assist in a different way, and may behave differently with those around them.  Because of their stage of brain development, they may have particular difficulty developing insight into their exploitation and exercising caution in high-risk situations. Their emotional needs may differ from adults, as may their ability to express those needs.

PHLN:Where can healthcare workers seek training for recognizing and treating child sex trafficking victims?

Greenbaum: Fortunately, there are a number of good resources, including—

PHLN: Where can people learn more about child sex trafficking prevention?

Greenbaum: Here are some resources:

PHLN:What other projects are you currently working on?

Greenbaum:The Institute on Healthcare and Human Trafficking is a partnership between Emory University School of Medicine, Georgia State University School of Public Health, and Children’s Healthcare of Atlanta, and provides training and technical assistance to medical and mental health professionals regarding all types of adult and child trafficking. We help write guidelines/protocols for health facilities, train staff, and offer numerous resources on our website, including research articles, templates, fact sheets, sample protocols, and prevention materials. In addition, we are continuing to validate a short screening tool designed to identify youth at high risk for child sex trafficking when they present for healthcare. The six-item tool has been evaluated in several health settings and been found to be helpful in identifying trafficked persons and those at risk for exploitation. We are continuing to evaluate it, and we are also working with an adult hospital to pilot a different screening tool for vulnerable adults who present to the emergency department.

PHLN:Do you have any hobbies?

Greenbaum:I like spending time with our dogs, walking, hiking, and goofing around.

PHLN:Do you have anything you’d like to add?

Greenbaum:I just want to thank you for taking an interest in this topic and helping to build awareness on human trafficking. I truly appreciate it.

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 2019 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 NewsQuiz Question January 2019

Which state now requires changing stations in men’s public restrooms?

Public Health Law NewsQuiz Question December 2018 Winner!

Photo: Anthony J. Kondracki, MD, MPH, CPH, Doctoral Candidate

Anthony J. Kondracki, MD, MPH, CPH, Doctoral Candidate

December Question:
Which state recently launched an initiative that treats incidents of violence as a public health issue?

Winning Answer: Wisconsin

A brief explanation of your job:
Doctoral candidate in maternal and child health, University of Maryland School of Public Health, College Park, Maryland

Education:
Jagiellonian University School of Medicine (MD), Tulane University School of Public Health and Tropical Medicine (MPH), University of Maryland School of Public Health (PhD candidate)

Favorite section of the Public Health Law News:
“Top Stories” and “Briefly Noted” for a quick overview of emerging health issues and news from around the nation.

Why are you interested in public health law?
Linking both scientific research and translation knowledge with legal components is the best evidence-based approach to policies and programs aiming at health promotion, eradicating barriers and improving healthcare accessibility, eliminating health disparities, and addressing burden of disease from a population perspective. My interest is in methodology and epidemiology to identify gaps in existing evidence using knowledge of legal mechanisms which can inform, encourage, and compel health-related behaviors. Last May, shortly before I visited China, the country launched several campaigns to fight outdoor and indoor air pollution focusing on adverse health effects of secondhand cigarette smoke, in support for existing smoke-free laws and to encourage smokers to quit.

What is your favorite hobby?
Traveling, learning foreign languages, and meeting people.

Court Opinions

Federal: “Reprehensibility” of conduct of tobacco company-defendant entitles plaintiff to $8 million in punitive damages.
Izzarelli v. RJ Reynolds Tobacco Co.
United States District Court, District of Connecticut
Case No. 3:99-cv-2338 (SRU)
Filed 12/13/2018
Opinion by District Judge Stefan R. Underhill


Federal: Plaintiffs’ motion for preliminary injunctive relief denied in case alleging gender discrimination in town’s ordinance prohibiting only women from exposing their breasts in public. Plaintiffs’ motion was denied because the plaintiffs were unable to show they were likely to succeed on the merits of their case—namely by producing evidence that the ordinance in question did not reflect the sensibilities of the town.
Eline v. Town of Ocean City
United States District Court, District of Maryland
Case No. JKB-18-0145
Filed 12/20/2018
Opinion by Chief District Judge James K. Bredar


Federal: The Clean Air Act’s use of “under this chapter” waives the EPA’s sovereign immunity in claims arising from the agency’s failure to perform nondiscretionary duties mandated by the act. Sovereign immunity is a legal doctrine that prohibits lawsuits against the government, unless the government consents. When sovereign immunity is waived, the government can be sued. Waiver of sovereign immunity and ability to be sued does not, however, automatically mean suits filed against the government will be successful. Defendant’s motion to dismiss and motion to stay are both denied.
California v. United States Environmental Protection Agency
Case No. 18-cv-03237-HSG
Filed 12/21/2018
Opinion by District Judge Gilliam S. Haywood, Jr.

Quote of the Month

“If you have good laws and you enforce those laws to keep tobacco out of the hands of kids, fewer kids will get hold of tobacco.” Dr. Harold Farber, physician at Texas Children’s Hospital, who specializes in pediatric lung illnesses.

[Editor’s note: This quote is from How to stop teen vaping? Make e-cigarettes harder to get. NBC News, (01/07/2019), by Maggie Fox

About Public Health Law News

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.

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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 Newsis in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the Public Health Law Newsshould be cited as sources. Readers should contact the cited news sources for the full text of the articles.

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