Montrece McNeill Ransom

Addressing gaps in health care sector legal preparedness for public health emergencies.

Health care providers and their legal counsel play pivotal roles in preparing for and responding to public health emergencies. Lawyers representing hospitals, health systems, and other health care provider components are being called upon to answer complex legal questions regarding public health preparedness issues that most providers have not previously faced. Many of these issues are legal issues with which public health officials should be familiar, and that can serve as a starting point for cross-sector legal preparedness planning involving both the public health and health care communities. This article examines legal issues that health care providers face in preparing for public health emergencies, and steps that providers, their legal counsel, and others can take to address those issues and to strengthen community preparedness.

Pursuing health equity: zoning codes and public health.

journal of law, medicine & ethics Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status.1 Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions.2 Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues.3 For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness.4 While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. African-American men, for example, are more than twice as likely as their white counterparts to die of prostate cancer. In addition, 36% of adults with a disability are obese compared to 23% of adults without a disability, and smoking prevalence for people with disabilities is approximately 50% higher than for people without disabilities.5 Among the 10 leading causes of mortality in the U.S., minority populations experience the highest rate of death.6 The reported reasons for these disparities vary, including individual factors such as limited access to health care and differences in cultural beliefs, social norms, and socioeconomic status.7 Any analysis of how these health disparities arise and how they are perpetuated must include the interplay between individual factors and broader environmental conditions. Research on the connections between health and the environment, specifically the built environment, has shown that the burden of illness is greater on minority and vulnerable populations, and on those of low socioeconomic status.8 The high prevalence of noxious land uses and ready availability of tobacco products and inexpensive, unhealthy foods in communities where low-income families and people of color are more likely to live, work, and play provide salient examples of how the built environment can impact health and exacerbate health disparities.

Domestic Legal Preparedness and Response to Ebola

Initial cases of Ebola in the U.S. raise varied legal issues as discussed at a late-breaking session at the 2014 Public Health Law conference. Session presenters share their perspectives on (1) state and local powers to quarantine and isolate persons, and (2) hospital preparedness underlying the treatment of Ebola patients.

Land Use Laws and Access to Tobacco, Alcohol, and Fast Food

journal of law, medicine & ethics Montrece McNeill Ransom The built environment has a powerful impact on health choices and outcomes. As early as 1926, the U.S. Supreme Court in Euclid, Ohio v. Amber Realty Co.1 recognized zoning ordinances as a proper exercise of the state’s police power in that they protect the health and safety of the community. Today, there is both substantial public health experience in and a strong legal basis for using zoning and land use law to limit the availability of consumer products that contribute to ill health. Tobacco, alcohol, and poor diet are among the top three actual causes of death in the United States. This session will focus on the application of traditional city planning tools including zoning and conditional use permits (CUP) to address these public health threats.