Public health and the power of law

Public health workers would be more likely to respond in emergencies if the law guaranteed they would receive personal protective equipment and recovery services, according to preliminary data presented today at an Annual Meeting session on law and the public health workforce.

For instance, more than 75 percent of public health workers said they would be more willing to respond to incidents of anthrax or bioterrorism, a dirty bomb or pandemic flu if they knew they’d have the proper equipment. For a weather-related event specifically, 83 percent said they would be more willing to respond if equipment was guaranteed.

Rutkow

Researchers questioned 1,100 urban and rural public health workers in Florida, Minnesota and Missouri. They examined public health workers’ willingness to respond to disasters if state laws guaranteed them things like family priority access to health care for any condition related to the emergency as well as individual access to mental health services during and after the response.

But what are the implications to policy and practice, asked presenter Lainie Rutkow, a public health lawyer at Johns Hopkins Bloomberg School of Public Health. Is it ethical to give certain people priority access to health care? Would guaranteeing personal protective equipment be an unfunded mandate?

“And for something like provision of mental health services during an actual disaster response, how would something like that be operationalized?” Rutkow asked.

Mark Pertschuk, director of Grassroots Change in Oakland, Calif., also examined how law affects public health locally. He noted that grassroots movement building is much more effective than the use of “pre-emption,” which can get in the way of strong local efforts. Pre-emption is when state laws supersede local ordinances that communities have already enacted.

Pertschuk

For example, Pertschuk took session attendees through the history of legal requirements for fire sprinklers in homes. While an effective sprinkler head was patented in 1874, the safety tool is still mostly used in commercial buildings.

However, 85 percent of all fire deaths occur in one- to two-family homes. In 2010, there were 3,120 fire deaths (excluding fire fighters) and 17,720 injuries, according to Pertschuk.

“While the numbers of those who are impacted directly by this are smaller than, for example, alcohol-related problems or tobacco, the nature of these deaths and injuries resulting from fires are often very expensive and very horrific,” he said. 

As of 2011, there were 368 local ordinances requiring fire sprinkler system installation in all new residential buildings, while only two states have statewide requirements. The numbers show the power of grassroots movements, Pertschuk said, and represent a diversity of political leanings.

“These are not blue states or red states,” he said.

As a result of the movement for better fire safety, California and Maryland passed statewide codes. But it was not until 31 communities in Maryland and 146 in California had passed local ordinances.

“That illustrates the innovative power of local public health policy advocacy,” Pertschuk said.

— M.P.

Photos by Melanie Padgett Powers