Recent State Legislative Attempts to Restructure Public Health Authority: The Good, The Bad, and The Way Forward.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.

Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures.

INTRODUCTION: California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015-2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. METHODS: Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012-2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February-June 2019. RESULTS: Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions' adult smoking prevalence. State law changes in 2015-2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). CONCLUSIONS: Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.

State Preemption of Food and Nutrition Policies and Litigation: Undermining Government's Role in Public Health.

INTRODUCTION: In the U.S., federal, state, and local governments have various legal tools to support public health and prevent diet-related disease, including enacting policy and bringing lawsuits against businesses that produce harm-causing products. Yet, states preempt, or limit, government's authority to enact public health policies or initiate litigation. METHODS: In 2018, research was conducted to find state laws enacted through March 16, 2018, using state legislatures' websites, LexisNexis, UConn Rudd Center's Legislative Database, Centers for Disease Control and Prevention Chronic Disease State Policy Tracking System, and the Internet, that preempt local food and nutrition policies including their legislative histories; and preempt lawsuits related to food consumption and chronic disease (e.g., Commonsense Consumption Acts), including explicitly preempting government activity. RESULTS: Between 2008 and March 16, 2018, 12 states enacted 13 preemptive laws on nutrition labeling, content or "criteria"; consumer incentive items; "food-based health disparities"; sale, distribution, or serving of food and beverages; portion size; food safety; menus; taxes; and "marketing." Between 2003 and 2013, 26 states enacted laws preempting lawsuits claiming long-term food consumption causes obesity and diet-related disease; of these, ten states explicitly preempt such litigation by the government and five explicitly preempt laws providing litigation as a remedy. CONCLUSIONS: State preemption may hinder public health progress by impeding local food and nutrition policies and government-initiated litigation. Local governments are in a prime position to address fundamental concerns, such as reduction of health disparities, the provision of nutrition information, access to healthy food, and the cost of unhealthy food. Government-initiated litigation could potentially support broader policy changes.

Legal risks to employers who allow smoking in the workplace.

There is mounting evidence that documents the dangers of exposure to secondhand smoke, including in the workplace. In states that permit workplace smoking, employers face significant legal risks from employees who are exposed to secondhand smoke on the job. Employers have been held liable for employee exposure to secondhand smoke in numerous cases, including those based on workers' compensation, state and federal disability law, and the duty to provide a safe workplace. Given this liability risk, employers should voluntarily adopt smoke-free workplace policies. Such policies do more than fulfill an employer's legal obligation to provide a safe workplace; they also reduce the risk of litigation, potentially reduce workers' compensation premiums, and protect employees from harm.

Local venues for change: legal strategies for healthy environments.

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. In response to America's growing obesity problem, local policymakers have been looking for legal strategies that can be adopted in their communities to encourage healthful behaviors. In order to provide practical tools to policymakers, this article examines four possible venues for local policy change to improve the health of a community: (1) the school environment (2) the built environment (3) community facilities and (4) the point of sale environment. Finally, the article examines the use of taxes or fees as a means of paying for nutrition policy work as well as potentially reducing the consumption of unhealthy products. This article illustrates that local laws and policies can be a valuable tool in changing a community's environment in order to improve nutritional options and increase opportunities for physical activity.