December 2014—Public Health Law News

Public Health Associate Program application period open in January. CDC’s Public Health Associate Program (PHAP) will be recruiting recent graduates for the 2015 PHAP class. Applications will be accepted from January 12–16, 2015. Visit the PHAP webpage for more information about qualifications and how to apply.

NASHP names new executive director. The National Academy for State Health Policy (NASHP) named Trish Riley as its next executive director. In her new role, Riley will work with state health policy officials and NASHP leadership and staff to identify and address emerging issues and lead NASHP’s research and policy analysis agenda to support and strengthen state health policy and practice.

NACCHO Annual Conference 2015 and call for abstracts. The National Association of County and City Health Officials’ (NACCHO) Annual Conference Workgroup seeks sharing session abstracts for the 2015 NACCHO Annual Conference, set for July 7–9, in Kansas City. The conference theme is “Envisioning the Future: Creating Our Path.” The call for sharing session abstracts is now open and the deadline to submit abstracts is Sunday, December 21, 2014, 11:59 pm (PST).

Journal article on Ebola, WHO, and the United Nations, peace and security. Gian Luca Burci, Legal Counsel, World Health Organization (WHO) and Jakob Quirin, WHO, have posted Ebola, WHO, and the United Nations: Convergence of Global Public Health and International Peace and Security, Am. Soc’y of Int’l L. Insight, vol. 18, issue no. 25, November 14, 2014.

Journal article on location’s effect on consumer shopping habits in food deserts. Bonnie Ghosh-Dastidar, Deborah A. Cohen, Gerald Hunter, Shannon N. Zenk, Christina Y. Huang, Robin Beckman, Tamara Dubowitz, Distance to Store, Food Prices, and Obesity in Urban Food Deserts, 47 Am. J. of Preventive Med. 5, 587–95 (Nov. 2014).

State Ebola Protocols. CDC/OSTLTS Public Health Law Program and Office of the Associate Director for Policy compiled a table of state-by-state Ebola protocols to help law and policy makers prepare for and respond to Ebola-related situations.

State medical waste laws and regulations.  Medical waste disposal is regulated primarily at the state level. Medical waste disposal laws also apply to disposal of medical waste from treating diseases such as Ebola. The US Environmental Protection Agency (EPA) released a compilation of state medical waste laws and regulations. The EPA page includes model guidelines for state medical waste management.

Tribal Infectious Disease Control Menu [PDF 294KB]. This inventory from CDC’s Public Health Law Program informs tribal public health practitioners, policy makers, and attorneys about tribes’ use of law as a tool to address infectious disease control.

Health reform FAQs. The Kaiser Family Foundation’s interactive tool responds to frequently asked questions about health reform. Notable sections of the tool include marketplace eligibility, individual mandate, cost-sharing reductions, and renewing marketplace coverage for 2015.

Massachusetts: Gov. Patrick announces ‘pay for success’ plan to aid homeless
CBS Boston   (12/8/2014)  

On December 8, 2014, Massachusetts Governor Deval Patrick unveiled a plan to create 500 housing units for up to 800 people without homes over the next six years. The program is a “pay for success” initiative, also known as a social impact bond (SIB) program. Under the SIB program, investors provide upfront funding for the project but will only be repaid if an outside evaluator finds that the program has reached the goals elucidated at the beginning of the program. The maximum return on investment under Governor Patrick’s plan would be just under 5.3% and should save taxpayers money.

The SIB initiative aimed at reducing homelessness is not the first in Massachusetts; in January 2014, the state announced a $27 million juvenile justice program aimed at reducing the rate of incarceration among young men. Massachusetts state law allows up to $50 million to be authorized for SIBs.

“It is critical that we reduce the reliance on emergency services and provide individuals safe and stable housing that will help strengthen our communities and last for generations to come,” said Governor Patrick of the program.

[Editor’s note: Learn more about social impact bonds, Massachusetts’s SIB initiatives, and Massachusetts’s state law on SIBs: Social Innovation Financing Trust Fund – Mass. Gen. Laws ch. 10, § 35VV(c).]

Navajo Nation: Navajo Nation president approves junk-food tax 
KRQE.com   (11/23/2014)  

On Friday, November 21, 2014, Navajo Nation President Ben Shelly signed legislation to increase the sales tax on food with little to no nutritional value by two percent. The tax, which will take effect in 2015, is the first in the Navajo Nation specifically addressing consumer spending habits.

The law cites statistics from the Navajo-area Indian Health Service reporting that the obesity rate for some Navajo age groups is as high as 60%, and about one-third of Navajos are diabetic or pre-diabetic. Advocates of the bill hope the law will encourage more thoughtful food choices.

“We want them to think twice about buying healthy foods instead of soda pop, potato chips, and the junk food. The effort is really much more in the message of Navajo people making better choices for quality foods,” said Gloria Begay, a supporter of the tax.

Annually, the tax is expected to generate an additional $1 million. Though the disbursement plan has not been finalized, the additional tax revenue will fund farmer’s markets, vegetable gardens, and wellness and exercise equipment across the tribe’s 110 communities.

[Editor’s note: Learn more about Navajo Nation’s Health Dine’ Nation Act of 2014 and read the Act [PDF 5.15MB].]

National: FDA requires calorie counts for cocktails, theater popcorn, vended food
Los Angeles Times   (11/25/2014)   Jenn Harris

In November 2014, the United Stated Food and Drug Administration (FDA) announced two new rules requiring movie theaters, vending machines, and chain restaurants to clearly display the calories in food and drink products. The new rules, which are additions to the menu labeling law passed as part of the Affordable Care Act in 2010, require calorie counts for cocktails on drink menus and concession stand items, such as popcorn and nachos.

The rules apply to establishments with 20 or more locations under the same name. Vending machines will have to post the calorie information on the product packages or on the front of the vending machine itself. Restaurants and vending machine operations will have one and two years respectively to comply with the new rules.

The new rules are supported by the National Restaurant Association, which represents nearly one million food establishments and more than 13 million restaurant industry employees. “The National Restaurant Association strongly believes in the importance of providing nutrition information to consumers to empower them to make the best choices for their dietary needs. We believe the Food and Drug Administration has positively addressed the areas of greatest concern with the proposed regulation and is providing the industry with the ability to implement the law in a way that will most benefit consumers,” the association said in a statement.

[Editor’s note: Read the FDA’s new calorie labeling rules.]

Arizona: Vote on rejecting applicants who smoke and fee for current smokers
Arizona county to vote on whether to refuse to hire smokers
Mashable.com   (12/08/2014)   Kristina Bravo

Kansas: Highest military court to hear HIV-related aggravated assault appeal
Military appeals court to hear HIV case involving former McConnell airman
The Wichita Eagle   (12/08/2014)   Roxana Hegeman

Massachusetts: SCOTUS might consider begging law that could violate free speech
Justices may review begging law (and ex-colleagues’ opinion)
New York Times
[Editor’s note: Read Worcester, Massachusetts’s City Ordinance, Aggressive Begging, Soliciting, and Panhandling, Chapter 9, section 16 [PDF 1.87MB].]

National: New guidance breaks warnings into “pregnancy, lactation and fertility”
FDA revamps system explaining the risks of medicines during pregnancy
New York times   (12/3/2014)   Sabrina Tavernise
[Editor’s note: Read about the FDA’s new medication guidance for pregnant women.]

National: Juvenile justice system, jurisdictional gaps fail Native American juvenile offenders
From broken homes to a broken system
Washington Post   (11/28/2014)   Sari Horwitz

National: HPV vaccine not associated with increase in risky sexual behavior
No increase in risky sexual activity with HPV vaccine and read
Reuters   (12/8/2014)   Kathryn Doyle
[Editor’s note: Learn more about human papillomavirus (HPV), and read the study, Effect of human papillomavirus (HPV) vaccination on clinical indicators of sexual behaviour among adolescent girls: the Ontario Grade 8 HPV Vaccine Cohort Study, by Leah M. Smith, Jay S. Kaufman, Erin C. Strumpf & Linda E. Lévesque published in Canadian Medical Association Journal.]

National: Proposed new ozone rules expected to significantly reduce smog
Obama to introduce sweeping new controls aimed at ozone
New York Times   (11/25/2014)   Coral Davenport
[Editor’s note: Learn more about the Environmental Protection Agency’s stance on ozone and about air pollution and respiratory health.]

National: Panel votes against contraindication warning for steroid injections
Panel rejects sternest FDA warning for steroid shots
New York Times   (11/25/2014)   Sabrina Tavernise

National: Some Canadian poultry imports grounded due to avian influenza
US suspends some Canadian poultry imports due to bird flu
FoxNews   (12/08/2014)  
[Editor’s note: Learn more about avian flu.]

Interview with Jonathan Mermin

Title:
Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at CDC

Education: 
MD, Stanford University; MPH, Emory University; BA, Harvard University

PHLN: Please describe your career path. 

Mermin: When I was in college in the 1980s, the AIDS epidemic had just started. I took a year out of school to work on HIV policy issues, helping establish and run a group of academic faculty and community members focused on AIDS and public policy, jointly organized by Harvard’s schools of public health, government, and medicine. It was a time when people were writing in the newspaper that people with AIDS should be quarantined on an island off the coast of Massachusetts and given permanent tattoos identifying them as having HIV. I became interested in using policy as a tool for decreasing illness and improving health. 

I went to medical school and completed a residency in internal medicine at the county hospital in San Francisco. It was deeply meaningful to care for people at a time of need, when small efforts mattered. But, I could not escape from the idea that preventing illness mattered, and the science of solving epidemics grabbed hold of a part of my brain and wouldn’t let go. I ended up interning at CDC, volunteering briefly in Cameroon and India and joined the Epidemic Intelligence Service—the training program at CDC for disease detectives.

It took me to Tajikistan to work on a 20,000-person outbreak of multi-drug resistant typhoid fever during a civil war (the take home message was chlorine is good and water conservation prevents negative pressure and sewage from flowing into drinking water pipes) and to study the association of pet reptiles and amphibians with human Salmonella infection (the take home message was that reptile poop is bad for you—and eating it is really bad for you); to Japan during a 9,000-person outbreak of E. coli O157:H7, a potentially deadly bacteria that in this case was associated with eating radish sprouts (the take home message was don’t always believe what your mother told you about healthful food); and ultimately to Africa to work on HIV for CDC for 10 years. Six years ago I returned to the United States to work on HIV domestically, and now I work on a broader range of infectious diseases, as well as school health.

PHLN:  What drew you to public health?

Mermin: In the 1990s I was providing care to patients in San Francisco at a public primary care clinic and hospital, in the emergency department, and once a week through a van providing services to the homeless. I often met the same people having difficulty or being hospitalized for reasons beyond their immediate illness. A man might have had an abscess that needed debriding or a woman a heart infection that needed antibiotics, but in an underlying sense, they were hospitalized because they injected drugs or lived on the street. I wanted to prevent illness and change the social determinants that resulted in being sick. At that point I was also committed to HIV, and there was so much to do in the midst of tragedy.

PHLN: Please describe your day-to-day job responsibilities.

Mermin: I oversee CDC’s response to infections that are quintessential examples of stigmatized disease of inequity. The center has about 2,000 staff and contractors and an annual budget of $1.1 billion. My day-to-day work varies from participating in meetings and reading documents to planning new programs and helping to writing guidelines and policies—from meeting with health departments and community-based organizations to talking with people who have HIV, hepatitis, TB, and STDs or care about those who do. We often have the opportunity to prioritize new science or program findings and incorporate them into formal guidelines, such as pre-exposure prophylaxis for HIV prevention, STD treatment, birth cohort screening for hepatitis C, new treatments for latent tuberculosis infection, or school health policies.

PHLN: Do you perceive yourself as working in public health law?     

Mermin: Public health is inherently political because social, environmental, and behavioral factors influence the occurrence of illness and health. I don’t think it would be possible to effectively work in US domestic public health and not appreciate the tools that policy, practice, and law offer for enhancing public health. I see many untapped opportunities to examine the effects of laws on public health and individual wellbeing.

PHLN: You have a great deal of international public health practice experience. How has that experience changed your perspective?

Mermin: Working in Africa, including last month in Sierra Leone participating in the Ebola response, highlights the difference between knowing what to do and getting it done. Governments know the importance of well thought out guidance and legislation but often don’t have the time or expertise to write, refine, and implement effective policy. When they do, it can greatly benefit their constituents.

PHLN: As center director for CDC/NCHHSTP, how have you observed law and policy used to improve public health outcomes?

Mermin:Legal practice and policy establish enabling environments for increasing health and wellness—or the opposite. One of the responsibilities for all of us working in public health is to think about the obstacles to health that if overcome would have the greatest impact on improving outcomes. Laws and policies can create situations that enhance the health of nations or harm it.

PHLN: Can you give an example of how laws and policies can be harmful to public health?

Mermin: Laws that impede access to health care are some of the most obvious, but there are also subtle areas. For example, laws intended to decrease illicit drug use by criminalizing possession of needles and syringes can potentially increase incidence of hepatitis C and HIV. The effect of some laws might change over time. For example, legislation put into effect in the beginning of the HIV epidemic when discrimination was frequent and strong, prioritized anonymous HIV testing; later it resulted in less diagnosis and follow-up care for people with HIV. Ultimately, all states modified their testing policies to protect confidentiality and support more facile testing.

PHLN: How has the public health system responded to the negative effects of laws and policies?

Mermin: Most often by documenting negative health effects. Ideally, we go further and share findings effectively, provide information to law or policy makers, and adjust or issue policies that benefit the public.

PHLN: How can high-impact policies be used to improve the quality of care for patients with HIV or AIDS?

Mermin: Not all health interventions are effective, and not all effective interventions are equal. It is necessary to consider economics, feasibility, and overall coverage of the populations in need.  Since we have limited resources, maximizing prevention means achieving the lowest cost per infection averted or quality-adjusted life year saved. For example, we have substantial data that antiretroviral therapy—HIV treatment—decreases HIV transmission by over 95% at the same time that it prolongs life. And new federal guidelines recommend treatment for everyone with HIV. A model suggests that implementing CDC’s testing guidelines combined with expanded antiretroviral therapy would prevent a substantial proportion of new HIV infections at a very reasonable cost. A large-scale, multimillion-dollar testing program supported by CDC that emphasized routine HIV screening in healthcare settings was cost-saving; the healthcare system saved $2 for every $1 spent, and it resulted in thousands of people finding out they had HIV, receiving care, and ultimately living a longer and healthier life. 

PHLN: What are HIV CD4 counts and viral loads, and how can measuring them improve public health?

Mermin: In a person with HIV, a CD4 cell count is a measure of the health of the immune system, and HIV viral load is the measure of how much HIV is in a person’s blood. They should be measured regularly in a person with HIV every 3–6 months. If they are reported routinely to the health department, as is currently required by 40 states, then the public health system can help persons with HIV who have fallen out of care or whose response to therapy is not optimal get access to the care they need. It also allows the public health system to see where along the continuum of HIV care people in their jurisdiction are not achieving optimal services and to implement programs that improve outcomes.

PHLN: Your center is also responsible for CDC’s response to sexually transmitted diseases (STD) and has carried out a great deal of research on expedited partner therapy (EPT). What is EPT and is it an effective measure for improving public health?

Mermin: Expedited partner therapy is a practice where medications or prescriptions are provided to the partner of a patient diagnosed with gonorrhea or chlamydia without physical examination of the partner. It prevents reinfection of the index patient, and it treats a partner who is likely have the same STD.

PHLN: Why is EPT a legal issue?

Mermin: Prescribing and dispensing medication to a person who was not examined by a clinician raises liability issues. Yet, it has been shown to work in multiple studies. And, laws matter. In one study where permissible EPT laws for gonorrhea existed, 13% of patients reported receiving EPT compared with 1% of patients where no laws were in place and EPT was only potentially allowable.

PHLN: What other projects are you currently working on?

Mermin: The center is actively involved in surveillance, program support, policy development, and research in almost all areas of HIV, viral hepatitis, STDs, TB, and school health. We are increasingly using epidemic and economic modeling to inform our work. In addition, we are implementing standard reporting and feedback loops so we know how the nation, states, and grantees are doing to more quickly provide support supervision and learn from success.

PHLN: If you weren’t working in public health at CDC, what would you likely be doing?

Mermin: CDC provides an extraordinary number of different opportunities over one’s career, from working on outbreak investigations and control, to international public health, to policy and guideline development, to research and data analysis, all with dedicated and talented colleagues. I can’t think of a place I would rather work. 

PHLN: Have you read any good books lately?

Mermin: I greatly enjoyed reading an insightful discussion of social communication and humanity written by Jonathan Haidt, “The Righteous Mind: Why Good People Are Divided by Politics and Religion.” I just reread an archetypal management treatise by Marcus Buckingham, “First Break All the Rules.” And my whole family laughed reading out loud Jim Gaffigan’s, “Food,” an irreverent journey into a man’s personal perspectives on food and America that had even hardcore public health professionals amused by our own behavior.

PHLN: Do you have any hobbies?

Mermin: I run (often), play guitar (poorly), and cook (without following directions, which causes much consternation to my family).

The first reader to correctly answer the Quiz question will be given a mini-public health law profile in the January 2015 edition of the News. Entries should be emailed 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: December 2014

Name one of the “take home messages” Dr. Jono Mermin took from his work in the Epidemic Intelligence Service.

Reid Hogan-Yarbro

November Question: According to the November 2014 Profile in Public Health Law, what award did Professor Sarah Deer recently receive?

Winning response: 
2014 McArthur Fellowship Grant

Employment organization and job title:
ICF International, Senior Associate

A brief explanation of your job:
I conduct policy analysis for community health programs to examine the relationship between public health policies, community context, and health outcomes.

Education:
I received a JD from Loyola University Chicago School of Law.

Favorite section of the News:
I really enjoy the Features section and learning about others who have a career interest in public health law.

Why are you interested in public health law?
I have a particular interest in how public health policies shape a community’s local context, from their transportation infrastructure to health curriculum in schools, and how that community context impacts health outcomes for the general population as well as those experiencing health disparities.

Do you have any hobbies?
I work in Atlanta, near an area called Buford Highway, famous for its Asian and Latin American cuisine. I love finding new restaurants and foods to try as I explore that area.

Indiana: Issue of fact in nurse’s scope of practice/wrongful termination suit
Stillson v. St. Joseph County Health Department
Court of Appeals of Indiana
Case No. 20A03-1406-CT-191
Filed 12/02/2014
Opinion by Judge Edward W. Najam, Jr.

New Jersey: Trash pick-up case causes stink, but issues not yet ripe for review
Powder Mill Heights, LLC v. Township of Parsippany-Troy Hills
Superior Court of New Jersey, Appellate Division
Case No. A-2038-13T1
Decided 11/26/2014
Per curium opinion

Federal: Ignition switch case falls within state’s police powers
In re: General Motors LLC ignition switch litigation
United Sates District Court for the Southern District of New York
Case No. 14-MD-2543(JMF)
Filed 11/24/2014
Opinion by District Judge Jesse M. Furman

Federal: Plaintiff’s religious exercise substantially burdened by mandate
Insight for Living Ministries v. Burwell
United States District court for the Eastern Division of Texas, Sherman Division
Case No. 4:14-cv-675
Filed 11/25/2014
Opinion by Magistrate Judge Don D. Bush

Federal: Plasma center not “healthcare provider” under Americans with Disabilities
Act
Levorsen v. Octapharma Plasma, Inc.
United States District Court, Division of Utah, Central Division
Case No. 2:14-cv-325
Filed 12/1/2014
Opinion by Magistrate Judge Dustin B. Pead

Gloria Begay, a supporter of the Navajo Nation’s tax on unhealthful foods.

“We want them to think twice about buying healthy foods instead of soda pop, potato chips, and the junk food. The effort is really much more in the message of Navajo people making better choices for quality foods.” said Gloria Begay, a supporter of the tax.