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Public Health Law Series Webinar Exploring Social Determinants of Health through a Public Health Law Lens Thursday, July 14, 2016
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Page 1: Final exploring social determinants of health through ... · Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens How to Use Webex

Public Health Law Series Webinar

Exploring Social Determinants of Health through a Public Health Law Lens

Thursday, July 14, 2016

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Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens

How to Use Webex

Audio: If you can hear us through your computer, you do not need to use your phone. Just adjust your computer speakers as needed.

Support: If you need technical assistance, call Webex Technical Support at 1-866-863-3904.

Submitting Questions: All participants are muted. Type a question into the Q & A panel for our panelists to answer. Submit your questions at any time during webinar.

Recording: This webinar is being recorded. If you arrive late, miss details or would like to share it, we will post link to the recording at www.networkforphl.org/webinars after the session has ended.

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Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens

How to Use Webex

Accessing Network webinars from your mobile device: You can now access and fully participate in Network webinars on the go using the WebEx app for Apple or Android. 

o Download the app.

o Register for a webinar on the Network website, then use the event number provided in your attendee email to connect via the mobile app.

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Public Health Law Series Webinar: 4Shared-Use Agreements to Support Public Health

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Public Health Law Series Webinar

Exploring Social Determinants of Health through a Public Health Law Lens

Thursday, July 14, 2016

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Public Health Law Series Webinar:Taking on Tobacco RegulationPublic Health Law Series:

Moderator

Exploring Social Determinants of Health through Public Health Law Lens

Donna Levin, National Director, Network for Public Health Law

J.D., Northeastern University School of Law

Areas of expertise:  Social determinants of health Health equity Newborn screening Health insurance consumer protections Emergency public health response Medical marijuana

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Public Health Law Series Webinar:Taking on Tobacco RegulationPublic Health Law Series:

Presenter Introduction

Scott Burris, Professor of Law and Public Health, Temple University; Director, Center for Health, Law, Policy, and Practice; Director, Public Health Law Research

J.D., Yale Law School

Research interests/areas of expertise:  Social determinants of health HIV/AIDS Global health governance Health effects of criminal law and drug policy

Exploring Social Determinants of Health through Public Health Law Lens

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Public Health Law Series Webinar:Taking on Tobacco RegulationPublic Health Law Series:

Presenter Introduction

Dawn Pepin, Public Health Analyst, Carter Consulting, Inc., Public Health Law Program, Centers for Disease Control and Prevention

J.D., Seton Hall University School of Law M.P.H., Johns Hopkins University

Research interests/areas of expertise:  Health equity Health crisis and humanitarian assistance Vulnerable populations

Exploring Social Determinants of Health through Public Health Law Lens

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Public Health Law Series Webinar:Taking on Tobacco RegulationPublic Health Law Series:

Presenter Introduction

Ellie Gladstone, Senior Staff Attorney, ChangeLab Solutions

J.D., University of California, Davis M.P.H., University of California, Berkeley

Areas of expertise:  Social determinants of health Inequities in access to recreational space Engaging faith‐based organizations in community health 

and wellness efforts

Exploring Social Determinants of Health through Public Health Law Lens

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Click to edit Master title style

Social Determinants and LawyersWorking our Way Upstream

Scott BurrisProfessor of Law and Public Health, Temple UniversityDirector, Public Health Law Research Program

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Bad News: Mortality

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Bad News: Inequality

Piketty T, Saez E. Inequality in the long run. Science. 2014 May 23, 2014;344(6186):838‐43.

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Social Determinants

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Social Determinants

Social determinantsof health(e.g., inequality)

Particular pathologies(e.g., HIV)

Individual interventions: Helping people cope with current environment

Structural interventions: Changing the environment

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Social Determinants

Social determinantsof health

Particular killers

Individual interventions

Changing the environment

CVD meds

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Social Determinants

Social determinantsof health

Particular killers

Individual interventions

Changing the environment

CVD medsStress‐reduction counseling

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Social Determinants

Social determinantsof health

Particular killers

Individual interventions

Changing the environment

CVD meds

No smoking laws

Stress‐reduction counseling

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Social Determinants

Social determinantsof health

Particular killers

Individual interventions

Changing the environment

CVD meds

No smoking laws

Greater equality at work and in the community

Stress‐reduction counseling

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Social Determinants

Social determinantsof health(e.g., inequality)

Particular pathologies(e.g., HIV)

Individual interventions: Helping people cope with current environment

Structural interventions: Changing the environment

Dignity – Equality ‐‐Cooperation – Security ‐‐Morality – Opportunity ‐‐ Care

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Social Determinants

Social determinantsof health(e.g., inequality)

Particular pathologies(e.g., HIV)

Individual interventions: Helping people cope with current environment

Structural interventions: Changing the environment

Dignity – Equality ‐‐Cooperation – Security ‐‐Morality – Opportunity ‐‐ Care

gReduce smoking

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Social Determinants

Social determinantsof health(e.g., inequality)

Particular pathologies(e.g., HIV)

Individual interventions: Helping people cope with current environment

Structural interventions: Changing the environment

Dignity – Equality ‐‐Cooperation – Security ‐‐Morality – Opportunity ‐‐ Care

gReduce smoking

ppSocial support

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Social Determinants

Social determinantsof health(e.g., inequality)

Particular pathologies(e.g., HIV)

Individual interventions: Helping people cope with current environment

Structural interventions: Changing the environment

Dignity – Equality ‐‐Cooperation – Security ‐‐Morality – Opportunity ‐‐ Care

gReduce smoking

Health care

ppSocial support

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Ways law matters

Social determinantsof  health

Health

Criminal justice

School disciplineOSH and work lawHousingPublic safetyDrug policy

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Ways law matters

Social determinantsof  health

Health

1. Laws shape contexts

Criminal justice

School disciplineOSH and work lawHousingPublic safetyDrug policy

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Ways law matters

Social determinantsof  health

Health

1. Laws shape contexts

2. Laws influence behavior

Criminal justice

School disciplineOSH and work lawHousingPublic safetyDrug policy

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Law: Missing in Action?

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Law: Missing in Action?

Deaths attributable to:Racial segregation: 176,000Low education: 245,000

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Kingdon Streams

Politics

Policy

Problem

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Kingdon Streams

Politics

Policy

Problem

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Kingdon Streams

Politics

Policy

Problem

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A Long‐Term Perspective

Impact

Arguments that work now

Arguments that  work in 20 years

Arguments that  work in 10 years

Legal Scholarship

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Transdisciplinary Health Law

Help Engaging Communities and Building Political Will

Help Engaging Communities and Building Political Will

Expertise in Designing Legal 

Solutions 

Expertise in Designing Legal 

Solutions 

Support for Enforcing and Defending Legal 

Solutions

Support for Enforcing and Defending Legal 

Solutions

Policy Surveillance 

and Evaluation

Policy Surveillance 

and Evaluation

Access to Evidence and Expertise

Access to Evidence and Expertise

Better Health Faster

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Summary

ENGAGETIME

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Summary

ENGAGETIME

ENGAGE

SCIENCE

PRACTICE

ADVOCACY

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Centers for Disease Control and Prevention

New Tools to Achieve Health Equity: Section 1557 of the Affordable Care Act 

Dawn Pepin, JD, MPHPublic Health AnalystCarter Consulting, Inc.Public Health Law ProgramOffice for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention

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CDC Public Health Law Program DisclaimerThe contents of this presentation have not been formally disseminated by the Centers for Disease Control and Prevention (CDC) and should not be construed to represent any agency determination or policy. 

These course materials are for instructional use only and are not intended as a substitute for professional legal or other advice. Always seek the advice of an attorney or other qualified professional with any questions you may have regarding a legal matter.

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Health Disparities in the United States

Healthcare disparity – “Differences in group in access to care, quality, and coverage”

Health disparity– “Higher burden of illness, injury, disability, or mortality experienced by 

one population group relative to another group.” Disparities in Health and Health Care: Five Key Questions and Answers, Kaiser Family Foundation, last accessed May 9, 2016.Image: Equity and social justice, Kingcounty.gov, Last Updated October 27, 2015 

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Health Disparities and Discrimination in the United States

Proposed 45 CFR Part 92 

“Discrimination in the healthcare context can often lead to poor andinadequate health care or health insurance or other coverage forindividuals and exacerbate existing health disparities in underservedcommunities.”

– Why?• Postponing or not seeking care• Being denied the opportunity to get care to begin with

– What is the result?• Care is not getting to those who need it most• Higher costs from more complicated care, lost wages, lost productivity 

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What Section 1557 of the ACA does Prohibits discrimination on the basis of 

– Race, color, and national origin– Sex – Age – Disability 

Prohibits discrimination by– Any health program or activity that received federal

• Credits • Subsidies• Contracts of insurance• Executive agency programs• Programs under this title 1 (or amendments) 

42 U.S.C.A. § 18116; Proposed 45 CFR 92

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What Section 1557 of the ACA does Prohibits discrimination on the basis of 

– Race, color, and national origin – Sex – Age – Disability 

Prohibits discrimination by– Any health program or activity that received federal

• Credits • Subsidies• Contracts of insurance• Executive agency programs• Programs under this title 1 (or amendments) 

42 U.S.C.A. § 18116; Proposed 45 CFR 92

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Enforcement

• Federal• HHS Office for Civil Rights 

• Federal courts

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What is missing? 

Sexual Orientation Chronic Disease  Etc. 

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States

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For more information, contact CDC1‐800‐CDC‐INFO (232‐4636)TTY:  1‐888‐232‐6348    www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Dawn [email protected]

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• Presented by• Ellie Gladstone, Senior Staff Attorney

Beyond Statutes & Regulations:Increasing Recreational Access with

Shared Use Agreements & Policies

July 14, 2016

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• Healthier communities for all through better laws and policies.

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Disclaimer

The information provided in this discussion is for informational purposes only, and does not constitute legal advice. ChangeLab Solutions does not enter into attorney-client relationships.

ChangeLab Solutions is a non-partisan, nonprofit organization that educates and informs the public through objective, non-partisan analysis, study, and/or research. The primary purpose of this discussion is to address legal and/or policy options to improve public health. There is no intent to reflect a view on specific legislation.

© 2016 ChangeLab Solutions

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Public Health Law and Policyare more than just

legislation

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Hospital policyLocal ordinances Zoning language Resolutions

School/agency policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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How do you build ahealthy community?

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Shared Use Occurs When…

• government entities or nonprofit organizations

• agree to open or broaden access

• to facilities • for community use

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Increase opportunities for physical activity

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Getting from here…

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…to here

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Low-income communities and communities of color are more likely to lack safe, well-maintained parks and other recreational spaces

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Hospital policyLocal ordinances Zoning language Resolutions

School district policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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Hospital policyLocal ordinances Zoning language Resolutions

School district policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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Hospital policyLocal ordinances Zoning language Resolutions

School district policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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Formalizing Shared Use

Creative Commons Flickr: jk5854

1) Shared Use Agreements

2) School District Policies

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Shared Use Agreements

• Formal contract• Between > 2 parties• With terms and

conditions • For use of the

property

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Shared Use Agreement: Lemon Grove, CA

Photo credit: Lemon Grove HEAL Zone

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School District Policies

• Community Use of Facilities

• Open Use

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Community Use of Facilities

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Open Use Policies

• Community access• For individual play

and recreation• For free• Without formal

partnership or agreement

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Open Use Policy: Hamilton County, TN

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Hospital policyLocal ordinances Zoning language Resolutions

School district policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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Hospital policyLocal ordinances Zoning language Resolutions

School/agency policy language

Contracts/agreements State/federal laws

University policy Organization policy Hospital policy

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can depend on state law

Feasibility and success

AuthorityLiabilityFunding

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Shared Use Resources

www.ChangeLabSolutions.org/shared-use

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ChangeLabSolutions.org

Thank [email protected]

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Public Health Law Series Webinar:

Q&A

Please type your questions in the Q&A panel.

Shared-Use Agreements to Support Public HealthExploring Social Determinants of Health through Public Health Law Lens

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Public Health Law Series Webinar:

Thank you for attending

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Exploring Social Determinants of Health through Public Health Law Lens