June 2015—Public Health Law News

Webinar Series on the Intersection of Public Health and Health Care—The Role of Law. The American Health Lawyers Association and the Public Health Law Program (PHLP) are co-hosting a six-part free webinar series focused on legal issues at the intersection of public health and health care. The second webinar in the series Health Care Quality: What’s Law Got to Do with It?, will take place Friday, July 17, 2015, 1:00–2:30 pm (EDT). This webinar will provide an overview of federally qualified health centers and rural health clinics and give practical insight into the field.

Webinar on the Relationship Between Student Loan Debt and Health. The Network for Public Health Law is hosting a webinar, Borrowing for College: Exploring the Connection between Student Loan Debt and Health, on Wednesday, June 24, 2015, 1:00–2:30 pm (EDT). The free webinar will review current trends in student borrowing and debt, examine effects of debt on student health, and consider proposed legal and policy reforms for financing higher education.

Survey Describing Public’s Perception of Prescription Drug Abuse Problem [PDF 452KB]. A new study, “Prescription Painkiller Abuse: Attitudes Among Adults in Massachusetts and the United States,” looks at the public’s perception of prescription painkiller abuse. The study is based on surveys conducted by the Boston Globe and the Harvard T. H. Chan School of Public Health in April 2015.

Association of Healthcare Emergency Preparedness Professionals (AHEPP). A new professional association dedicated to advancing the field of disaster preparedness and response, AHEPP is accepting members and announces their first national conference. The conference will take place November 17–18, 2015, in Omaha, Nebraska, and will help guide participants through the most important disaster concerns in various types of healthcare facilitates. See AHEPP’s website for early bird rates, the complete conference agenda, and more information.

NACCHO Annual Conference 2015. The National Association of County and City Health Officials (NACCHO) Annual Conference will take place July 7–9 in Kansas City, Missouri. The conference theme is “Envisioning the Future: Creating Our Path.”

Trends in Indian Health: 2014 Edition. Trends in Indian Health contains tables and charts describing the Indian Health Service (IHS) program and the health status of American Indians and Alaska Natives. This publication includes information about IHS structure, American Indian and Alaska Native demography, patient care, and community health. The publication also depicts historical trends and, when appropriate, compares populations.

Medical Marijuana Laws for Patients Map. The Robert Wood Johnson Foundation’s Public Health Law Research published an interactive LawAtlas map exploring medical marijuana laws for patients, including diseases and symptoms that qualify a patient to use medical marijuana, where medical marijuana can be used, whether non-residents can use medical marijuana, and possession limits for patients.

Human Papilloma Virus (HPV) Resource Guide. NACCHO published the Guide to HPV Resources for Local Health Departments to help local health departments increase HPV vaccination rates.  

Commonwealth Fund Program Officer in Healthcare Delivery System Reform. The Commonwealth Fund is accepting applications for a program officer in healthcare delivery system reform. Candidates must have an advanced degree or strong healthcare delivery, government, or other relevant experience and appropriate degrees. A minimum of five years related work experience and demonstrated senior health care services research or health care delivery experience. This position requires strong coordination and project management abilities.

Commonwealth Fund Senior Program Officer in Cost Control and Medicare. The Commonwealth Fund is accepting applications for a Senior Program Officer in Cost Control and Medicare. The candidate should be an experienced executive with a strong background in health economics and policy, health services financing and delivery, and access to care issues to oversee two programs in areas critical to the overall mission of the Commonwealth Fund: cost control and Medicare.

Yale Clinical Fellowship in Global Health. The Yale Global Health Justice Program seeks applications for the Yale Clinical Fellowship in Global Health Justice. The fellowship is a two-year position for graduates of law and public health schools as well as other health professionals with experience in domestic or international health policy and advocacy who are interested in preparing for a career in global health justice or interdisciplinary clinical teaching. The fellow will supervise the experiential learning component of the Global Health Justice Partnership and help coordinate its activities. Applications are due July 1, 2015.

‘It’s not garbage anymore:’ Seattle sees uptick in organic waste collections under new rules

Route 50   (06/07/2015) Bill Lucia

Seattle Washington’s City Council passed and the mayor signed an ordinance prohibiting food waste and compostable paper from being disposed as garbage in September 2014. The new rules went into effect in January. Penalties—which were to take effect in July and would be $1 for residential customers and $50 for businesses and multi-family properties—were suspended because of the program’s success so far and the need for additional education about the requirements.

Under the new rules, no more than 10 percent trash content may be recyclable or food waste. Drivers will not catalogue all trash but will look inside bags.

“It’s based on what you can see. You can’t have drivers opening bags,” said James Feore, a supervisor at one of Seattle’s waste pickup contracting companies, Recology Cleanscapes.

Since the ordinance took effect and until the penalties are reinstated, the city’s two contracted waste removal services are giving warning tags to customers who are in violation of the ordinance. About 10,000 warnings were issued from January through May 2015—less than one percent of the garbage pickups during that timeframe. 

[Editor’s note: Read Seattle Washington’s Ordinance Number 124582.]

California: California lawmakers pass vaccine bill amid emotional debate NewsOK   (06/09/2015) 
[Editor’s note: Read California’s SB277 [PDF 256KB].]

Oklahoma: Following Texas, Oklahoma leaders look to ban fracking bans, too
Route 50   (05/26/2015)   Bill Lucia
[Editor’s note: This bill was signed by the governor on May 29, 2015. Read Oklahoma’s Senate Bill No. 809 [PDF 68KB]]

Vermont: Shumlin signs bill removing vaccine exemption
Burlington Free Press   (05/28/2015)   April Burbank
[Editor’s note: Read Vermont’s H.98 [PDF 128KB]]

National: Appalachia’s hepatitis C infection rates soar
CNN   (06/06/2015)   Ray Sanchez

National: CMS releases proposed health insurance rates
CQ Roll Call   (06/02/2015)   Rebecca Adams
[Editor’s note: Read Public Review of Proposed Health Insurance Rate Increases for the 2016 Coverage Year.]

National: FDA removes artificial trans fat from nation’s food supply
Public Health Newswire   (06/16/2015)   David
[Editor’s note: Read the FDA’s news release about the new rules for artificial trans fat in food.]

National: ‘Viagra for women’ is backed by an FDA panel
New York Times   (06/04/2015)   Andrew Pollack
[Editor’s note: Read the advisory committee’s report [PDF 14.6MB] to the FDA.]

National: 50 hospitals charge uninsured more than 10 times cost of care, study finds
Washington Post   (06/08/2015)
[Editor’s note: Read Bai, Ge, and Gerard F. Anderson. Extreme Markup: The Fifty US Hospitals with the Highest Charge-to-Cost Ratios. 34 Health Aff. 6, 922–28 (2015) (last visited June 15, 2015). doi:10.1377/hlthaff.2014.1414.

International: Sexual violence against children is a global problem
NPR   (06/04/2015)   Marc Silver
[Editor’s note: Read the full report, Prevalence of Sexual Violence Against Children and Use of Social Services—Seven Countries, 2007–2013, MMWR June 5, 2015.

Interview with Benjamin D. Winig, JD, MPA

Title:
Senior Staff Attorney and Program Director, ChangeLab Solutions

Education:
Bachelor of Arts, with distinction, social anthropology, University of Michigan
Master of Public Affairs, La Follette School of Public Affairs, University of Wisconsin–Madison
Juris Doctor, University of Wisconsin Law School

Public Health Law News (PHLN): What motivated you to become an attorney?

Winig: I always saw the law as a means to effect social change. I believe we’re all in this thing together, and that it’s incumbent upon each of us not only to heal the world, but also to transform it into a more just and equitable place. To be fair, I never actually wanted to practice law. I always saw myself as a bit of a policy wonk but realized rather quickly that I needed a law degree to make the greatest impact. Turns out that I actually loved law school—I know, I’m one of the rare ones—so I ended up practicing for several years.

PHLN: Please describe your career path.

Winig: I always tried hard not to let the classroom get in the way of my education, so I traveled a lot in my late teens, twenties, and early thirties. Those experiences really shaped my worldview and helped me focus my career interests. They led to a variety of jobs and internships—both here and abroad—which, despite their differences, all had a social justice bent. After graduation, I had a brief stint as an immigration attorney, and then decided to focus my energies locally and pursued a career as a municipal lawyer. I practiced for almost seven years before joining the team at ChangeLab Solutions.

PHLN: What encouraged you to move from practicing law as a municipal attorney to working for ChangeLab Solutions?

Winig: I really enjoyed providing advice and counsel to local elected officials, but I missed working for a mission-oriented organization. ChangeLab Solutions’ unique approach to using law and policy to improve health outcomes intrigued me. There isn’t a day that goes by that I don’t feel very grateful for my job.

PHLN: Can you please tell us about ChangeLab Solutions—what is it and what is its mission?

Winig: ChangeLab Solutions is a national, nonprofit organization based in Oakland, California. Our mission is to create healthier communities for all through better laws and policies. We aim to achieve our mission through, what I believe to be, an innovative approach. We’ve intentionally built an interdisciplinary team of attorneys, policy analysts, urban planners, and public health experts, all under one roof, which enables us to utilize each other’s expertise. Together we develop cutting edge, and legally sound, policy solutions to address our chronic disease epidemic.

PHLN: Are all of ChangeLab Solutions projects related to public health?

Winig: Yes, but not necessarily as directly as people might think. We try to focus our resources on affecting the social determinants of health—those conditions in the environments in which people are born, live, learn, work, play, worship, and age—because they have such a profound impact on health. So we work upstream, researching and developing laws and policies that link all aspects of community life, including housing, education, jobs, the economy, and the environment, to healthy outcomes. We recognize that when communities are healthier and cities more livable, the people in those places can be healthier, too.

PHLN: Please describe your day-to-day job responsibilities and the areas you focus on as a senior staff attorney at ChangeLab Solutions.

Winig: I work primarily at the intersection of the built environment and health, spending much of my time advising elected officials, public agency staff, community-based organizations, and public health advocates on a variety of active living and healthy planning strategies. I also oversee the legal side of our land use work, which includes shared use, among other things.

PHLN: What is shared use?

Winig: Shared use, which is sometimes called “joint use” or “community use,” occurs when government entities, or sometimes private, nonprofit organizations, agree to open or broaden access to their facilities for community use. It can take place on a formal basis (based on a written, legal document) or on an informal basis (based on historical practice, for example).

PHLN: What are shared use agreements or joint use agreements? Is there a difference between the two?

Winig: Over the last few years, the field has been moving away from the term “joint use” and toward “shared use.” A shared use (joint use) agreement is a formal, written agreement between two separate entities—often a school district and a city or county—setting forth the terms and conditions for the shared use of property. These agreements allow school districts to share the costs and responsibilities with local governments or nonprofits incurred from opening their facilities. Subject to overriding state and local laws, the agreements can allocate some or all of the responsibility for costs, security, supervi­sion, maintenance, repairs, and potential liability. It’s true that in some jurisdictions, a “joint use agreement” might mean something different than a “shared use agreement,” but that’s a technical, legal distinction that has little, if any, practical difference.

The key is not to get hung up on the mechanism through which shared use might occur. One size definitely does not fit all. For some communities, a shared use agreement might be the appropriate legal tool to formalize a partnership; in others, a lease, a license, or some other type of legal arrangement may be a better fit. And in those communities that do not have or need a partnering entity, an open use policy may be the best course of action to create more opportunities for physical activity. What’s most important is that shared use is a worthwhile strategy, and it can be tailored to the specific needs of a community. Not only is the evidence base growing, but in an era of budget shortfalls, maximizing access to existing facilities—rather than developing new ones—is an efficient and economical use of public resources.

PHLN: How are shared use agreements related to public health?

Winig: Providing access to existing recreational facilities is one of the most promising strategies for creating more opportunities for children and their families to engage in physical activity. Although shared use is most often used as a strategy to increase opportunities for physical activity on school grounds, other government agencies and community- and faith-based organizations are successfully implementing shared use arrangements in both the active living and healthy eating contexts. For example, some entities have shared use agreements for growing food, opening kitchen facilities for cooking classes, and creating recreational opportunities outside the traditional school setting.

PHLN: What kind of communities might benefit from shared use agreements?

Winig: All kinds. We’ve seen successful partnerships in rural, urban, and suburban communities. And in communities of all sizes, too—the biggest cities to the smallest villages. Shared use can also be a critical tool for under-resourced communities. We know that not everyone has the same opportunities to be active because recreational space is not equitably distributed. This is a major problem. Low-income communities and communities of color have fewer recreational facilities than other neighborhoods, and shared use can play a role in helping to address this inequality and the resulting health disparities.

PHLN: Who are typically the parties to a shared use agreement—is it always a school district and a city or county?

Winig: No, not always. The traditional arrangement was between a school district and city or county, but these days we’re seeing all types of public and private entities find successful partnerships through shared use. Public utilities, community-based organizations, and even the faith community have embraced shared use as a strategy to improve health outcomes. 

PHLN: What are some of the hurdles communities must cross when implementing a shared use agreement?

Winig: The barrier we encounter most frequently is liability. But, communities are also understandably concerned about other issues, such as maintenance, vandalism, or added expenses. All of these issues can create real barriers, but all of them can be overcome with the right tools.

PHLN: Are any of these challenges necessarily fatal to a proposed shared use agreement?

Winig:Absolutely not, or at least they shouldn’t be. We know school and city administrators are often overwhelmed with their current responsibilities, and it’s a lot easier, for example, to raise the issue of liability and use it as a fancy nine-letter word for “no.” That’s an understandable position, particularly if one is unfamiliar with the strong protections afforded to public entities under state law. But our years of experience in the field show that if parties engage in prudent risk management strategies, carry the proper insurance, and distribute legal risk through shared use agreements, they can often overcome any liability concerns that may stand in the way of achieving a successful shared use partnership. 

PHLN: ChangeLab Solutions has helped several communities create shared use agreements. Can you tell us about them and whether they’ve been successful?

Winig: Over the years, ChangeLab Solutions has provided technical assistance to hundreds of communities across the country on how to create successful shared use partnerships. Some communities have embraced shared use agreements, while others have opted for memoranda of understanding or open use policies. As I mentioned earlier, context matters. One recent example that comes to mind is our work with the National Tongan American Society (NTAS) in Salt Lake City. NTAS was working with both churches and schools to open up their facilities to the Tongan American and Pacific Islander communities so they could have more opportunities for exercise and play. Liability was a real concern for everyone involved. Through a series of phone conferences, we demystified the law surrounding liability and subsequently helped craft an agreement that everyone could understand. The result: six churches, five schools, and one community center opened their facilities for public use.

PHLN: How did ChangeLab Solutions and your partner communities negotiate the challenges you described above?

Winig:In real estate, the mantra is “location, location, location.” For shared use, it’s “communication, communication, communication.” Or maybe it’s a mix of communication and education. Once people understand how it works, they can successfully overcome any challenges through open and honest communication. 

PHLN: How can people learn more about shared use agreements?

Winig: ChangeLab Solutions has developed many resources over the years, and more are on the way. Over the next few months, we’ll be releasing a model open use policy, a resource on shared use with faith-based organizations, model school wellness policy language that addresses shared use, and more. Readers should also know that the Safe Routes to School National Partnership maintains the Shared Use Clearinghouse, which contains a lot of good resources from across the country.

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

Winig: Running a bed and breakfast, somewhere overseas.

PHLN: Have you read any good books lately?

Winig: Ha ha, good one. I have two young kids. But, last night I read Dr. Seuss’s ABC’s about 20 times in a row. The last “real” book that I loved was The Brief Wondrous Life of Oscar Wao—just don’t ask me when I read it.

PHLN: What are your hobbies?

Winig: I love to travel, but that’s on hold until my kids are a bit older. For now, it’s growing food in our garden, hiking, and anything else that gets me outdoors.

PHLN: Is there anything you would like to add?

Winig: Thank you to Public Health Law News for this opportunity.

[Editor’s note: Ben Winig and his colleague Ellie Gladstone will present “Shared Use: New Evidence and New Frontiers” at the 8th Biennial Childhood Obesity Conference in San Diego, California, June 29–July 2, 2015.]

The first reader to correctly answer the quiz question will be given a mini public health law profile in the July 2015 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: June 2015

What would Benjamin D. Winig be doing if he weren’t working in public health law?

Michelle S. Ficken

May Question: According to Mathew Swinburne’s interview, in which states is the sale of raw milk legal?

Winning response: 
Minnesota, New York, Pennsylvania, South Carolina, Utah, and Washington

Employment organization and job title: 
Mental Health Institute in Independence Iowa
Psychiatric Mental Health Nurse and Nurse Educator (MSN, RN-BC)

A brief explanation of your job:  
I’m a psychiatric mental health nurse, specializing in child and adolescent services for 25 years. I’m currently a nurse educator helping to share this knowledge and experience to nursing students who come to this facility. I also help train staff at the institute.

Education: 
Allen College—RN
University of Dubuque—BSN
Mount Mercy University—MSN

Favorite section of the News: 
My favorite section is the Top Story because it keeps me in the loop.

Why are you interested in public health law? 
I’m interested in public health law because its issues affect our local communities, nation, and world.  As a nurse educator, I try to share current events with nursing students.

What is your favorite hobby?
I love to read and be a life-long learner! I want be a role model for our two-year-old granddaughter!

Louisiana: Loss of water for 8 days for potential contamination resulted in economic damage
England v. Fifth Louisiana Levee District
Court of Appeals of Louisiana, Second Circuit
Case No. 49,795-CA
Filed 06/03/2015
Opinoni by Judge J. Jay Caraway

New York: Taxi driver health plan fee-rate was arbitrarily set
Matter of Ahmed v. City of New York
Appellate Division of the Supreme Court of New York, First Department
Case Nos. 101692/13, 15144, 101762/13, 15143
Decided 06/04/2015
Opinion by Justices John Sweeny, Jr., Dianne T. Renwick, Richard T. Andrias, Karla Moskowitz, and Judith J. Gische

Virginia: Child’s allergy-related death, mother’s defamation facts taken as true 
Pendleton v. Newsome
Supreme Court of Virginia
Case No. 141116
Filed 06/04/2015
Opinion by Senior Justice Charles S. Russell

Federal: Cruetzfeldt-Jakob Disease not “communicable disease event” under insurance policy
Catholic Medical Center v. Fireman’s Fund Insurance Co.
United States District Court, District of New Hampshire
Civil No. 14-cv-180-JL
Filed 06/01/2015
Opinion by District Judge Joseph N. Laplante

Quote of the Month: Vermont Governor Peter Shumlin

“Vaccines work, and parents should get their kids vaccinated. I know there are strong feelings on both sides of this issue. I wish the legislation passed three years ago had worked to sufficiently increase vaccination rates. However, we’re not where we need to be to protect our kids from dangerous diseases, and I hope this legislation will have the effect of increasing vaccination rates,” said Vermont Governor Peter Shumlin in a statement as he signed legislation removing the philosophical vaccine exemptions from Vermont’s vaccination law.