Improving Public Health Through Legally Sustainable Change
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This document outlines various public health issues addressed by state attorneys general, including obesity, gun violence, end-of-life care, infectious disease, prescription drug abuse, environmental toxins, food safety, mental health, and injury. For each issue, it provides data on scope, causes, and examples of how specific state attorneys general have taken action to effect change through legislation, regulations, enforcement, and coordinating stakeholders. The attorneys general employ a variety of legal strategies but also recognize the need for multidisciplinary solutions and navigation of constitutional issues.
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Improving Public Health Through Legally Sustainable Change
- 1. Improving the Public Health Despite Constitutional Impediments How State A=orneys General Can and Do Effect Legally Sustainable Change in Public Health Policy June, 2013 Kate Whelley McCabe Assistant A3orney General Office of the Vermont A3orney General Caitlin Stanton Vermont Law School JD Expected May, 2014 Soraya Ghebleh Geisel School of Medicine, The Dartmouth Institute MPH, June 2013 AJ Van-‐‑Tassel Investigator Office of the Vermont A=orney General
- 2. Table of Contents Obesity Gun Violence End-‐‑of-‐‑Life Care Infectious Disease Prescription Drug Abuse Environmental Toxins Food Safety Mental Health Injury Hospital Price Se?ing Made Possible by the Generosity of the Robert Wood Johnson Foundation and the National Association of A3orneys General
- 3. Obesity Scope -‐‑ 33% of adults are overweight -‐‑ 1 in 3 children are overweight -‐‑ Cost estimated to be over $100 billion dollars annually Causes -‐‑ Improper diet, lack of physical activity -‐‑ Socioeconomic factors -‐‑ Poor nutrition, limited access to healthy foods 2010: Vermont A6orney General Convenes Stakeholders, Invites Legislature to Combat Obesity “With current trends, our kids’ generation will be less healthy than our own. Shame on us, if we let this happen.” –AG Sorrell Coast is Clear -‐‑ Regulate foods available in public schools -‐‑ Incentivize healthy behaviors/dis-‐‑ incentivize unhealthy behaviors Navigation Required -‐‑ Restrict marketing to children -‐‑ 1st Amendment -‐‑ Dormant Commerce Clause -‐‑ NLEA Preemption
- 4. Gun Violence Scope -‐‑ 30,000 deaths and 300,000 injuries annually -‐‑ Cost burden estimates range from $10 billion to $100 billion -‐‑ Crimes with guns are 44x more likely to be fatal Causes -‐‑ Gun ownership coupled with certain educational, behavioral, and socioeconomic factors -‐‑ Substance abuse and crime -‐‑ Mental health coupled with other factors 2013: New Jersey A6orney General Uses Criminal Forfeiture Monies To Buy Back Guns “To date approximately 5,000 guns . . . have been taken out of circulation as a result of these buybacks. . . . We recognize that these buybacks aren’t a singular, one-‐‑stop solution to the gun violence problem. However, they are important because, as we all recognize, there are just too many firearms circulating out there and too many innocent people dying or being critically wounded as a result.” –AG Chiesa Coast is Clear -‐‑ Planning for crises -‐‑ Reduce circulation Navigation Required -‐‑ Nearly everything else -‐‑ 2nd Amendment
- 5. End-‐‑of-‐‑Life Care Scope -‐‑ 10-‐‑12% of overall healthcare spending (30 billion) on end-‐‑of-‐‑life care per year -‐‑ 80% of deaths occur in hospital Nature of Problem -‐‑ Patient involvement in choices limited -‐‑ Mechanisms through which choices made inadequate -‐‑ Expense -‐‑ Quality of care 2006: Montana A6orney General Coordinates The Montana End-‐‑Of-‐‑ Life Registry “Decisions about end-‐‑of-‐‑life medical care are deeply personal, and it’s important that they are made and documented well in advance of a terminal illness or medical emergency. . . . The registry is an extremely effective way to ensure that your wishes are known and respected.” –AG McGrath Coast is Clear -‐‑ Improve documentation of choices -‐‑ Establish compassionate care benefit -‐‑ Improve provider curriculum Navigation Required -‐‑ Requiring morally sensitive provider conversations, actions -‐‑ 1st Amendment -‐‑ UHCDA Preemption
- 6. Infectious Disease Scope -‐‑ Universal -‐‑ CDC estimates 21,000 new cases of Hep. A, 2.5 -‐‑ 4 million Hep. C, and over 1 million new STDs annually -‐‑ HIV/AIDS, lyme disease, pneumonia, influenza all have high cost burden Causes -‐‑ Host of factors varying in appearance, prevalence, transmission, and severity 2012-‐‑2013: Michigan A6orney General Takes Administrative Legal Actions Against Compound Pharmacy “Michigan citizens demand that drug manufacturers follow the laws designed to keep consumers safe. In this case, mistakes resulted in tragedy for Michigan families. We will take every step necessary to restore public safety and welfare.” –AG Schue=e Coast is Clear -‐‑ Reduce drug resistance -‐‑ Encourage vaccination Navigation Required -‐‑ Mandate vaccinations, testing, quarantine -‐‑ 4th Amendment -‐‑ Equal Protection -‐‑ Due Process
- 7. Prescription Drug Abuse Scope -‐‑ Approximately 19 million Americans currently abuse Rx Drugs -‐‑ Estimated 6,600 new abusers daily Causes -‐‑ Incorrect prescribing practices, aggressive marketing strategies, drug diversion -‐‑ Introduction of highly addictive drugs, increase in drug availability 2011-‐‑2013: Florida A6orney General Asks Legislature, Task Force, Feds to Join Her Fight Against Prescription Drug Abuse “Our state needs a unified effort at every level. . . . We are working with state and local law enforcement, as well as our federal partners, to curtail the dangerous dispensing and abuse of prescription drugs.” – AG Bondi Coast is Clear -‐‑ Establish limits on prescribers -‐‑ Reduce illicit access -‐‑ Improve treatment for addiction Navigation Required -‐‑ Mandatory employee drug testing -‐‑ 4th Amendment
- 8. Environmental Toxins Scope -‐‑ 25% of diseases worldwide are a3ributed to environmental factors -‐‑ Cost burden of over $54 billion dollars annually Causes -‐‑ Secondhand smoke -‐‑ Pesticides, lead, polluted water, particulates, unsafe sanitation 2013: New Mexico A6orney General Uses Bully Pulpit To Fight Copper Mine Rule “The environment is not Democrat or Republican. The environment is for us all. My office will fight for the present and future generations of New Mexicans to protect our water resources.” –AG King
- 9. Food Safety Scope -‐‑ 1 in 6 Americans get sick from contaminated food -‐‑ Estimated cost burden of over $77.7 billion each year -‐‑ Foodborne outbreaks upwards of 1,000 Causes -‐‑ Raw foods, pathogens -‐‑ Insufficient food safety regulations, contaminated meat, pesticides, unsafe agricultural biotechnology 2012: New York A6orney General Enforces Criminal Laws To Ensure Food Safety “We will continue to pursue cases where individuals advance their own greed above the law and the health of the public.” –AG Schneiderman
- 10. Mental Health Scope -‐‑ Only 17% of adults in the US are at “optimal mental health” -‐‑ Estimated annual cost burden of $57.5 billion Causes: -‐‑ Fragmented care -‐‑ Limited access to services -‐‑ Stigma associated with mental illness 2011: Rhode Island A6orney General Uses Courts To Bring Mental Health Services To Veterans “Each year, hundreds of Rhode Islanders serve in our nation’s military in combat zones. Post-‐‑traumatic stress disorder is a real issue for veterans. For many, the transition back to home is difficult and can result in bad choices that put them in conflict with the law. It is incumbent upon us to provide a legal system that does not penalize our veterans, but rather provides access to treatment necessary to transition back to their families, their jobs, and their community.” – AG Kilmartin
- 11. Injury Scope -‐‑ Cost burden of more than $465 billion annually -‐‑ 180,000+ deaths occur from injury every year Causes -‐‑ Traumatic Brain Injury (TBI) -‐‑ Falls and accidents -‐‑ Motor vehicle accidents -‐‑ Sports-‐‑related injury -‐‑ Work-‐‑related injury 2012: Kansas A6orney General Takes Position That Doctor Must Clear Student Athletes For Post-‐‑Concussive Play “Although the legislative history of the School Sports Head Injury Prevention Act is ambiguous,” its text is clear. Given [its] plain language, we opine that the examination and clearance required by the Act must be provided by a . . . person licensed to practice medicine and surgery, not a person delegated by such a heath care provider.” -‐‑AG Schmidt
- 12. Hospital Price Se?ing Scope -‐‑ Extreme variations in prices with widespread lack of transparency -‐‑ Variations estimated to cost $36 billion annually in wasted resources Causes -‐‑ No requirement to share hospital prices -‐‑ Variations in prices on identical procedures -‐‑ Lack of consensus on actual cost of different procedures 2011: Massachuse6s A6orney General Continues Fight Against Rising Health Care Costs “The continued increase in health care costs is one of the most important issues confronting families and businesses. Our investigation shows that a move to global payments is not the panacea to controlling costs without first addressing provider price disparities that are not related to the quality or complexity of the services being provided.” -‐‑ AG Coakley
- 13. Contact Information Kate Whelley McCabe Assistant A=orney General Public Protection Division Vermont Office of the A=orney General 109 State Street Montpelier, VT 05609 P: 802.828.5621 kwhelleymccabe@atg.state.vt.us