An Introduction to Legal Epidemiology as a Tool to Study Public Health Law A Mini-Course for Public Health Practitioners and Academics
CDC-PHLP Disclaimer These course materials are for instructional use only and are not intended as a substitute for professional legal or other advice. While every effort has been made to verify the accuracy of these materials, legal authorities and requirements may vary from jurisdiction to jurisdiction. Always seek the advice of an attorney or other qualified professional with any questions you may have regarding a legal matter. The contents of this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.
Substantive PHLP’s Mission: Today’s Faculty Due Process To ad advan ance ce the Does the government have an appropriate justification und nders erstanding tanding for depriving someone of life, liberty, or property? an and us use of f la law w as a publ blic ic health th tool
Articulate the importance of legal epidemiology concepts to inform health, fiscal, administrative, legal, social, and political research and discourse Legal Epidemiology Identify opportunities for legal mapping to inform the Competencies process, nature, and impact Addressed Today of policies and laws on public health Identify opportunities for a legal evaluation study to address existing legal, Available at: health, or other issues https://www.cdc.gov/phlp/publications/to pic/resources/legalepimodel/index.html
Education Clinical Interventions Long-lasting Protective Interventions Changing the Context to Make Individuals’ Default Decisions Easier Socioeconomic Factors Source: Friedman T.R. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 100(4), 590-595.
Law that builds and maintains social, economic and physical worlds Law that defines Consider the structures ways that law impacts health Law that is an intervention tool
State School Vaccination Exemption Laws 12 Available at: www.cdc.gov/phlp/publications/topic/ vaccinations.html
Education Policy Change First Surgeon Start General’s Report Nonsmokers Rights Movement Smoking Rates First Great American Federal Smokeout Cigarette Tax Doubles WWII 1900 1930s 1960s 2010 How do we know when laws (and policies) work?
What do we mean by law? 4 Changes in the environments Legal Population Laws on the Lawmaking practices health books Changes in behaviors Law side of the evaluation equation Logic Model of Public Health Law Research (Burris et.al. 2010)
What do we mean by law (part 2)? Logic Model of Public Health Law Program (CDC, 2014)
When do laws impact health? Identify how laws (and policies) can target these complex public health issues Poverty Asthma # of days Poor housing missed school quality Car Crash Pain - Over- Addiction Prescribing Overdose Prescribe Opioids
Informational laws Infrastructural laws What kinds of laws can Interventional laws improve health?
Scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a Legal population. Epidemiology
Scientific Systematic Transparent Replicable Foundational Precise Principles Measurable
Legal practice applies the law; legal epidemiology measures it. Legal Counsel etiology PUBLIC LEGAL HEALTH LAW EPIDEMIOLOGY Legal PRACTICE Representation prevention & control Policy Research surveillance
Health Agencies Use Legal Epidemiology Public Health Emergency Preparedness Tribal Public Health Health Information and Data Healthcare Quality Health Equity Global Public Health Vaccinations/Immunizations Environmental Health Birth Defects Aquatic Health Opioids and more…
Types of Legal Epidemiology Studies LEGAL MAPPING LEGAL EVALUATION Legal Exploratory Explanatory Policy Studies Surveillance Assessments Studies
Legal Mapping A process for capturing important features of laws and policies, and for identifying how they vary across jurisdictions or institutions, and over time.
Legal Policy Assessments Surveillance Collects data at Collects data over one point in time time Creates cross- Creates longitudinal sectional datasets datasets
Meet Wendy! Her task: determine whether distracted driving laws have an effect on health
Wendy plans to measure the law and then measure its impacts on health
Wendy starts with policy surveillance Across space: all US states and DC Over time: 1996 – present day
Wendy assembles a team to tackle the process
8. 1. Tracking and Defining updating the the scope law 2. 7. Conducting Publication background and research dissemination Quality Control 3. Developing 6. coding Coding the law questions 5. 4. Creating the Collecting legal text the law
Fundamental 2 background research Identify key Develop a features of Investigate clear the legal the law and statement landscape any of purpose variations
Each day, more than 9 people … Cull relevant, reliable secondary sources Compile an initial sample of laws
Regulated at state level No preemption Wendy discovers that distracted driving is a significant public health problem that is regulated at the state-level and preemption is not an issue.
Find salient features or variables in the law Wendy learns that in 1996, Arizona became the first state to enact a distracted driving law.
Keep track of progress!
Wendy identifies the study variables Features after Initial features narrowing the observed in the law scope Device Prohibited Device Prohibited Prohibited Behavior Prohibited Behavior Age for Prohibition Type of Driver Driving Record Penalties Type of Driver Penalties To confirm her choices, she must consult an expert.
8. 1. Tracking and Defining updating the the scope law 2. 7. Conducting Publication background and research dissemination Quality Control 3. Developing 6. coding Coding the law questions 5. 4. Creating the Collecting legal text the law
2 4 Collecting the law Collecting the law consists of recording important information about relevant laws for each jurisdiction in the project.
2 Collecting the law 4 Always record: Legal citation Effective date of law The statutory history The body of the law
2 Collecting the law 4 Always record: Legal citation Effective date of law The statutory history The body of the law
Record changes in the legal text over time New Jersey Distracted Driving Law 2010 Version 2014 Version d. A person who violates this d. A person who violates this section shall be fined $100. section shall be fined as follows: (1) for a first offense, not less than $200 or more than $400; 2) for a second offense, not less than $400 or more than $600; and 3) for a third or subsequent offense, not less than $600 or more than $800. N.J. Stat. § 39:4-97.3 Use of hands-free and hand-held wireless communication devices while driving; when permitted; penalty
2 Collecting the law 4 Always record: Legal citation Effective date of law The statutory history The body of the law
2 Collecting the law 4 Always record: Legal citation Effective date of law The statutory history The body of the law
8. 1. Tracking and Defining updating the the scope law 2. 7. Conducting Publication background and research dissemination Quality Control 3. Developing 6. coding Coding the law questions 5. 4. Creating the Collecting legal text the law
2 6 Coding compares laws across jurisdictions and over time
Let’s try it!
Hea ealth Care Worker (H (HCW) Vaccination Leg egal Mapping Activity • You are assisting the National Center for Immunization and Respiratory Diseases (NCIRD) with an ongoing examination of state immunization laws for healthcare workers (HCW) and patients and their impact on public health. You have conducted a preliminary scan of science, laws, and policy related to state immunization laws for HCW and have found some sample laws. • You must examine 4 different provisions related to pertussis vaccinations. Please look over the following laws and assess whether they are relevant to the assessment. If not, please explain your reasoning. For all relevant laws, please code them based on the given criteria.
Coding questions 1. Does state law establish requirements for pertussis vaccinations in the healthcare setting? 2. Does the law apply to patients or HCW? 3. Does the law specify a type of facility? 4. Does the law require a facility to take action? 5. Does the law provide an exemption?
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