Health Equity in Housing Book Club: “Knocking on the Door”

Q&A with Christopher Bonastia, PhD

This is the first in a series of posts we will share during our research for our housing equity project. Have a suggestion for what we should read next? Let us know.

In his 2006 book, Knocking on the Door: The Federal Government’s Attempt to Desegregate the Suburbs, Christopher Bonastia, PhD, reviews the federal government’s role in perpetuating residential segregation in the United States, and its fleeting attempts to desegregate the nation’s neighborhoods.

Dr. Bonastia discusses the active role federal agencies and courts have played in creating and perpetuating residential segregation. He points to the Home Owners’ Loan Corporation, the Federal Housing Administration, the Veterans Administration, and the US Department of Housing and Urban Development as significant players in segregation and desegregation.

Understanding the roots of segregation and policy attempts to desegregate is key to understanding housing as a social determinant of health. Empirical research has shown associations between black-white segregation and an increased black infant mortality rate, elevated rates of black mortality, black homicide rates, and other negative individual and public health outcomes. Addressing racial residential segregation is imperative when attempting to improve any of those health outcomes.

Christopher Bonastia is professor of sociology at Lehman College and the City University of New York Graduate Center, as well as associate director of the Lehman Scholars Program and Macaulay Honors College at Lehman. He is the author of Southern Stalemate: Five Years without Public Education in Prince Edward County, Virginia as well as Knocking on the Door: The Federal Government’s Attempt to Desegregate the Suburbs.

Our team read Knocking on the Door during our initial research period on housing, health equity and legal levers. Continue reading below for our interview with Dr. Bonastia about this book and ongoing research in this area.

Continue reading

Legal Levers for Health Equity through Housing: A New Research Project

Health equity in housing can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health and social services, and quality of health and social services based on a person’s dwelling or neighborhood.

Lack of housing access, poor housing conditions, and income or racial segregation all have been shown empirically to cause negative health outcomes. Law has a pervasive role in housing, and has for a long time. Law was instrumental in creating and maintaining segregation through mechanisms like red-lining, restrictive covenants and zoning. The Civil Rights movement brought an end to explicitly discriminatory policies, and new finance and inclusionary zoning policies helped create millions of units of affordable housing, but we still have a long way to go. As Matthew Desmond’s work shows, drastic improvements are needed in how governments enforce housing codes and balance the rights of landlords and tenants. The bottom line is that too many of our people have trouble affording decent housing in neighborhoods with the amenities for healthy living, and too many of our neighborhoods are still segregated.

Our team at the Center for Public Health Law Research has been selected as a research hub in the Robert Wood Johnson Foundation’s Policies for Action Program. For the next 20 months, we will be using empirical research and legal scholarship to analyze the housing crisis through the lens of law. We know that law shapes environments and behaviors, so we are searching for the links between laws, their intended and unintended effects on the housing market, and the health outcomes that follow. We will be bringing a focus on law and its mechanisms to a field rich in policy research. Our aim is to investigate how law influences health equity in housing, and offer recommendations about how it can be a lever for greater equity. We hope to engage the community of non-profits, advocacy groups, policy think-tanks, and social scientists who are working on identifying problems and finding solutions, as well as the community of legal scholars and litigators working on housing issues. In our recommendations we plan on both identifying steps to incrementally advance housing equity through existing law, and envisioning creative changes to the legal framework itself.

We are excited to engage the housing policy and the law community in a discussion about legal levers for health equity through housing. We also look forward to sharing our work with you as we go, here and on the Policies for Action website. Please stay tuned!

If you are interested in continuing this discussion please reach out to Abraham Gutman at Abraham.gutman@temple.edu

Biosimilars – In The Pipeline or Still a Pipe Dream?

By Jonathan Larsen, JD, MPP and Adrienne R. Ghorashi, Esq.

The US Food and Drug Administration (FDA) approved the first biosimilar for use in the United States in March 2015. The approval came after several years of regulatory process development authorized by the Biologics Price Competition and Innovation (BPCI) Act of 2009, a component of the Affordable Care Act.

Biosimilars are highly similar, but not identical, copies of FDA-approved biologics, known as “reference” products. Biologics are used to treat a variety of diseases and medical conditions, including cancer. For many years, biosimilar development was thought to be too complex and too costly to advance, and exclusivity patents for reference biologics prohibited developers from marketing competing biosimilars. Now that those patents have started to expire, biosimilar development can finally begin, at a potentially huge benefit to patients.

Continue reading

Updated Nurse Practitioner Scope of Practice Map

The Policy Surveillance Program staff has recently updated the Nurse Practitioner Scope of Practice Dataset on LawAtlas.org to include laws through May 2016.

Fifty jurisdictions and the District of Columbia have laws pertaining to nurse practitioners’ scope of practice. In general, scope of practice laws regulate the autonomy nurse practitioners are given within their practice to treat patients. State laws fall into two main categories: limited practice and full practice. In limited practice states, the law limits autonomy for nurse practitioners by requiring them to collaborate with, or work under, the supervision of another health care provider. By contrast, full practice states allow nurse practitioners to practice independently.

In total, there are 29 limited practice states. In those states, collaboration, supervision, or a combination of the two are required in performing activities such as prescribing medication, ordering tests, performing examinations, and counseling or educating patients, among other activities.

1map

– States with limited practice authority

Continue reading

California the latest to pass a Death with Dignity law, 5th in US

Medical personnel are trained to “first do no harm.” In end-of-life treatment, that simple directive can be difficult to interpret, and the legal landscape has evolved in the United States over the past 25 years. In 1990, the US Supreme Court ruled that physicians and other health care providers could withhold medical treatment at the direction of a patient or the patient’s directed agent.

Most recently, a movement to provide patients’ help in dying has been termed “death with dignity” and “assisted suicide.” Federal law does not currently address euthanasia or “mercy killings” in terminal patients who seek a physician’s aid to end their own suffering. Rather, the patient’s right to obtain a physician’s or other health care provider’s help to end their life is established by state law. Continue reading

Prior Authorization Policies for Pediatric ADHD Medication Prescriptions

According to the Centers for Disease Control and Prevention, more than 6.4 million US children 4-17 years old have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). The percentage of US children diagnosed with ADHD has increased by 3-5 percent per year since the 1990s. Relatedly, the percentage of children in this age group taking ADHD medication also has increased by about 7 percent per year from 2007-2008 to 2011-2012.

In response, some state Medicaid programs have implemented policies to manage the use of ADHD medications and guide physicians toward best practices for ADHD treatment in children. These policies include prescription medication prior authorization requirements that restrict approvals to patients above a certain age, or require additional provider involvement before approval for payment is granted.

In a new article published this afternoon in MMWR, CDC researchers compared Medicaid and employer-sponsored insurance (ESI) claims for “psychological services” (the procedure code category that includes behavior therapy) and ADHD medication among children aged 2–5 years receiving clinical care for ADHD.

The article references a newly released LawAtlas map that examines features of state Medicaid prior authorization policies that pertain to pediatric ADHD medication treatment, including applicable ages, medication types, and criteria for approval.

States with Medicaid programs that have a policy that requires prior authorization for ADHD medications prescribed to children younger than 28 years old.

States with Medicaid programs that have a policy that requires prior authorization for ADHD medications prescribed to children younger than 28 years old.

Continue reading

Variability of US State Workplace Wellness Program Laws

A team of researchers led by Jennifer Pomeranz, JD, MPH, Clinical Assistant Professor of the College of Global Public Health at New York University, have released a new set of resources that detail characteristics of laws related to workplace wellness programs and identify trends in these laws across the United States: interactive maps for public and private employers at LawAtlas.org and a paper published in the American Journal of Public Health.

Workplace Wellness Program Laws in US

A few key findings:

  • Thirty-three states and the District of Columbia have laws related to workplace wellness programs.
  • Four states (Georgia, Indiana, Maine and Massachusetts) provide tax incentives for work place wellness programs.
  • State laws addressed public and private employers differently, for example, five states permit rewards (e.g., discounts, rebates and waivers) by public employers, whereas 16 states expressly permit positive rewards for participation in programs by private employers.

The research was funded by the Robert Wood Johnson Foundation’s Public Health Law Research Program.

New Federal Employee Drug Screening Guidelines to Include Opioid Testing

By Jonathan K. Larsen, JD, MPP

There is no denying that the United States is experiencing an opioid overdose epidemic. Drug overdose deaths generally in the United States have been associated, at least in part, with increasing mortality rates among white non-Hispanics, which is counter to trends in other wealthy nations. The Urban Institute’s Laudan Aron recently posted about the underlying causes of our current epidemic, paying special attention to aggressive marketing of painkillers, the related spike in opioid prescriptions, and the closely correlated increase in opioid abuse. The issue has even made it into the current Presidential campaign, however briefly. President Obama has sought increased funding to address the issue, as well as a focused private, state, and local effort to tackle prescription drug abuse. While opioid abuse has been on the rise, it is not typically part of employee drug testing, when employers choose or are required to test. This may be changing.

The Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency responsible for drug testing standards for federal agencies, is poised to release drug screening guidelines (see page 4 (28104 in the Federal Register) that would expand drug screening for opioid abuse to federal employees, and could influence employee drug testing policies across the nation. The US Department of Defense has been testing for hydrocodone and benzodiazepines (used to treat anxiety and seizures among other things) since May 1, 2012. SAMHSA cites sobering statistics about opioid-related deaths now outnumbering deaths from illicit drugs, as it prepares to test for oxycodone, oxymorphone, hydrocodone, and hydromorphone, all classified as Schedule II drugs, or drugs with high risk of abuse, by the United States Food and Drug Administration (FDA). The proposed guidelines were released May 15, 2015, so the final rules should be coming soon. Continue reading

Involuntary Outpatient Commitment in the US

Civil commitment laws in the United States variably give authority to mental health providers, law enforcement, and others to compel someone to receive treatment if they may be a danger to themselves or others because of mental illness. These laws have long been a topic of discussion, but there has been limited research on their impact to patients and their communities, largely because the laws have not been effectively or reliably catalogued. The Policy Surveillance Program has been actively collecting and coding state civil commitment laws and regulations to create an index.

The research breaks down civil commitment into three categories: short-term, long-term, and involuntary outpatient commitment.

Under involuntary outpatient commitment laws, individuals with mental illness who meet certain criteria, such as danger to self or others, are required to receive mandatory treatment in an outpatient setting. An individual may be placed directly into outpatient treatment with a court order or after the patient has already been placed in an inpatient treatment facility (more commonly referred to as conditional release). Continue reading

Is our legal commitment process an evidence-based model?

By Bryan Kozusko

The research methods used by the Policy Surveillance Program to develop datasets mapping health laws and policies include secondary research that provides context to the law, identifies the legal strategy it embodies, and uncovers any evidence to suggest whether it is improving health and well-being. While policy surveillance is meant to facilitate an evidence-building process by producing robust data for analysis, researchers attempt to uncover some indication that existing policies are evidence-based.

The Policy Surveillance Program has been mapping involuntary civil commitment laws at various levels: short-term inpatient commitment, long-term inpatient commitment, and outpatient civil commitment. So far, a literature review is inconclusive on the effectiveness of involuntary outpatient civil commitment.

Domestically, a handful of studies appear to exist. To date, only two systematic studies have been performed, both of which yield inconclusive or inconsistent results (see Kisely & Campbell, 2014, and Ridgely, Borum & Petrila, 2001). The Kisely and Campbell review shows an overall improvement in areas such as social functioning and quality of life; however, researchers acknowledge the sample size is very small and the quality of the trials range from low to medium. The Ridgely et al. review gathered similar unreliable data, inconsistent or conflicting results on quality of life after commitment. Continue reading

Changing How We Think (and Talk) About Public Health Law

By Scott Burris, JD

Marice Ashe, Donna Levin, Matthew Penn, Michelle Larkin and I have a new piece in the Annual Review of Public Health (also available on SSRN). We set out a “transdisciplinary model of public health law” that encompasses within the core of the field both the traditional public health law practice of lawyers and what we call “legal epidemiology” — all the important public health law functions (from policy design to evaluation) that are typically carried out by people without legal training. I hope you will take a look.

Why this article and a transdisciplinary model? The idea comes out of the experience that the authors have all had trying to promote public health law practice and research. We realized that in spite of the success of the field and its importance to public health, a lot of non-lawyers in public health training, practice and research were uncomfortable with law — even when their work had to do with enforcing it or evaluating its impact.

We realized that we as lawyers were making things worse, by adhering to a traditional view of public health law as purely a practice of lawyers. We found that acknowledging the work of non-lawyers in public health law, conceptualizing key public health law activities in scientific terms, and even borrowing some scientific practices for legal work, were effective ways to change attitudes and improve our impact. Many of us have articles in the pipeline on legal epidemiology, policy surveillance and “the five essential public health law services” that will show the model in action.

I don’t have to tell readers of this blog that public health law is a great field. I hope the concept of transdisciplinary model will help make it a truly integral part of public health.

Read the full article here.

Job Opportunity: Legal Research Associate

Come join our team!

The Public Health Law Research program is hiring legal research associates to work on our policy surveillance project. The legal research associate will conduct legal research using Lexis and Westlaw, build historical law using HeinOnline, and conceptualize legal domains for empirical research. The associate will also code law for the creation of quantitative legal datasets at LawAtlas.org, and write legal briefs and other materials for LawAtlas.org.

Learn more and apply today!

Tennessee: The Next State to Require Involuntary Outpatient Commitment?

By Bryan Kozusko, JD (Expected graduation: May 2016)

How will Tennessee address involuntary outpatient commitment hereon out? Currently, Tennessee is one of seven states that does not provide for direct involuntary outpatient commitment, pending a final disposition by a court with jurisdiction. According to general involuntary outpatient commitment law, whenever an individual is believed to require such commitment, a final hearing must be held allowing an adjudication on the merits and the establishment of grounds by clear and convincing evidence. The other states that do not allow for this process are Alaska, Connecticut, Kentucky, Maryland, Massachusetts, and New Mexico.

For six years Tennessee legislators have tried, but failed, to successfully implement a permanent statute authorizing direct involuntary outpatient commitment following the disposition of a final commitment hearing. In 2009, Bill H.R. 0297 of the 106th General Assembly passed through the Senate unanimously. Once received by the House, no further action was taken and the bill was never voted on. In 2012, the 107th General Assembly authorized the creation of an involuntary outpatient pilot program to operate two years in Knox County, Tennessee. In 2014, the 108th General Assembly amended their law to terminate the pilot program on June 30, 2015, citing the public welfare of their citizens.

Continue reading

Second Amendment Rights and Mental Illness

By Mariam Ahmed, JD/MSPP (2016)

In recent years, there have been a multitude of state- and federal-level discussions about how to use law to minimize gun violence as active shooter events increase. During these deliberations, one point that has repeatedly been debated is whether people with mental illness should have their gun possession rights limited.

Here’s how the legal landscape currently looks.

Continue reading

A needle in a haystack – finding the elusive solution to Indiana’s HIV Outbreak

By Nicolas Wilhelm, JD

Scott County, Indiana, which only has a few thousand residents, has historically had an average of five HIV cases per year. Since December 2014, however, the county has seen an outbreak, with more than 140 newly diagnosed cases. Dr. Jonathan Mermin, the director of the National Center for HIV/AIDs, Viral Hepatitis, STD and TB Prevention at the Center for Disease Control (CDC) calls this “one of the worst documented outbreaks of HIV among IV users in the past two decades.” Dr. Joan Duwve, the chief medical consultant with the Indiana State Department of Health, explained that the abuse of the prescription drug Opana was one of the catalysts for the increase in HIV cases, with some residents injecting it as frequently as 10 times a day, and sharing syringes with other members of their community.

HIV is mainly spread either by sexual contact with another person with HIV, or by sharing needles or syringes with someone who has HIV. One way to reduce the spread of the disease is to implement syringe exchange programs (SEPs) that reduce the transmission of blood-borne pathogens like HIV by providing free sterile syringes and collecting used syringes from injection-drug users (IDUs).

Continue reading

Webinar, 5/6: Policy Surveillance and Public Health

May 6, 2015 at 12 p.m. ET

Policy surveillance is the ongoing, systematic collection, analysis, and dissemination of data about laws and policies. There is a long tradition of conducting “50 state surveys” to identify laws of public health significance, but the methods for creating these surveys are largely unscientific. Unlike this traditional legal research, policy surveillance uses systematic quantitative and qualitative coding to create scientific datasets and track policies over time. Throughout the past year the Robert Wood Johnson Foundation’s Public Health Law Research program, the Network for Public Health Law, ChangeLab Solutions and the CDC Public Health Law Program have been exploring policy surveillance through a Delphi process and within their programs. This webinar will present the findings from that Delphi study and will explore the role of policy surveillance in understanding the impact of law on public health.

Presenters include:

  • Jennifer Ibrahim, PhD, MPH, Associate Director, Public Health Law Research program, Associate Professor, College of Public Health at Temple University
  • David Presley, JD, Policy Surveillance Manager, Public Health Law Research program
  • Matthew Penn, JD, MLIS, Director, Centers for Disease Control and Prevention, Public Health Law Program
  • Donna Levin, JD, Director, Network for Public Health Law (Moderator)

Register here.

Building on 20 Years of Success: The Future Role of Law

By Scott Burris, JD

On this, the last day of National Public Health Week 2015, we’re looking forward by looking backward. There is nothing new about using law and policy to promote healthier environments, products and behavior. There is no good future for public health that does not include even more, and more effective, legal interventions.

Evan Anderson and I wrote in 2012 about the legal regulation of health-related behavior over the past half-century. The story we told offered several reasons for unabashed optimism about what law can do for health. The record is clear that law works, and works across a wide range of different health threats. We pointed to CDC lists of Great Public Health Achievements from the last century and the first decade of the 21st.   Every one of them — from high levels of vaccination, through motor vehicle safety and cancer prevention to maternal and child health – could not have been successful without law and policy. Continue reading

Making Connections & Collaborating for the Future of Public Health

As part of the Public Health Law Research program’s participation in National Public Health Week 2015, we have been sharing materials and resources under the daily themes. Today’s theme, Building Broader Connections, is about expanding partnerships and making connections to benefit public health.

We spoke with Laura Hitchcock, JD, Policy Research & Development Specialist for Public Health – Seattle & King County and the King County Executive/Department of Executive Services Partnerships Initiative Lead. We asked her to offer some insight from her work as a lawyer and researcher in a public health department.

PHLR: What role can researchers play in building partnerships with health departments and contributing to the policy-making discussion?

Laura Hitchcock, JD

Laura Hitchcock, JD

LH: Public health researchers can help to support development and refinement of evidence-based policies. Because policies are created in a political process, it is important for public health departments to continue to offer their scientific knowledge to support creation of effective policies, including repeal of ineffective policies or refinement of existing policies to better result in a healthy population by 2030. Health departments may need help to define local or state-focused areas for policy evaluation by working together with researchers, and should contribute to development of research agendas by identifying areas where policy makers, communities, medical professionals and others have concerns about the public’s health, and are likely to need support from researchers to know how to ‘plug in’ to research agenda development. Continue reading

Short-Term Emergency Commitment Laws Require Police to Assess Symptoms of Mental Illness

By Leslie Allen, JD

On November 20, 2014, the Public Health Law Research program released a new 50-state dataset analyzing state law governing the short-term emergency commitment process. These laws give law enforcement officers and others the right to involuntarily admit someone into a mental health care facility if they are in danger of harming themselves or others because of a mental illness.

In 47 states, police may take a person into custody without a warrant, and may initiate an emergency psychiatric hold – essentially committing them to a mental health institution without their consent. Recently, the media has increasingly examined how the police interact with the mentally ill (for example, “Police Taught to Spot Signs of Psychiatric Crisis” from FoxNews, republishing from the  Associated Press, “Police Confront Rising Number of Mentally Ill Suspects” from The New YorkTimes, and see “Where the Police are Part of Mental-Health Care” from The Atlantic). Much of the police forces’ relationship with the mentally ill is established by the laws governing civil commitment.

Police officers serve as first responders for mental health crisis treatment by legislation in nearly every state. Continue reading