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 Emergency, as well as two practical resources for jurisdictions seeking to avoid similar crises, Public Health Handbook for Communities Under Emergency Management and Emergency Manager Law Primer.
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 email@example.com.
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.