Exploring Social Determinants of Health through a Public Health Law Lens

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1 Public Health Law Series Webinar Exploring Social Determinants of Health through a Public Health Law Lens Thursday, July 14, 2016

2 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 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 after the session has ended. Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens

3 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 to connect via the mobile app. Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens

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

5 Public Health Law Series Webinar Exploring Social Determinants of Health through a Public Health Law Lens Thursday, July 14, 2016

6 Moderator 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 Taking Public on Health Tobacco Law Regulation Series: Webinar: Exploring Social Determinants of Health through Public Health Law Lens

7 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 Taking Public on Health Tobacco Law Regulation Series: Webinar: Exploring Social Determinants of Health through Public Health Law Lens

8 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 Taking Public on Health Tobacco Law Regulation Series: Webinar: Exploring Social Determinants of Health through Public Health Law Lens

9 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 Taking Public on Health Tobacco Law Regulation Series: Webinar: Exploring Social Determinants of Health through Public Health Law Lens

10 Click to edit Master title style Social Determinants and Lawyers Working our Way Upstream Scott Burris Professor of Law and Public Health, Temple University Director, Public Health Law Research Program

11 Bad News: Mortality

12 Bad News: Inequality Piketty T, Saez E. Inequality in the long run. Science May 23, 2014;344(61 86):

13 Social Determinants

14 Social Determinants Structural interventions: Changing the environment Social determinants of health (e.g., inequality) Particular pathologies (e.g., HIV) Individual interventions: Helping people cope with current environment

15 Social Determinants Changing the environment Social determinants of health Particular killers CVD meds Individual interventions

16 Social Determinants Changing the environment Social determinants of health Particular killers Stress reduction counseling CVD meds Individual interventions

17 Social Determinants Changing the environment No smoking laws Social determinants of health Particular killers Stress reduction counseling CVD meds Individual interventions

18 Social Determinants Changing the environment Social determinants of health Greater equality at work and in the community No smoking laws Particular killers Stress reduction counseling CVD meds Individual interventions

19 Social Determinants Social determinants of health (e.g., inequality) Structural interventions: Changing the environment Dignity Equality Cooperation Security Morality Opportunity Care Particular pathologies (e.g., HIV) Individual interventions: Helping people cope with current environment

20 Social Determinants Social determinants of health (e.g., inequality) Structural interventions: Changing the environment Dignity Equality Cooperation Security Morality Opportunity Care Reduce smoking Particular pathologies (e.g., HIV) Individual interventions: Helping people cope with current environment

21 Social Determinants Social determinants of health (e.g., inequality) Structural interventions: Changing the environment Dignity Equality Cooperation Security Morality Opportunity Care Social support Reduce smoking Particular pathologies (e.g., HIV) Individual interventions: Helping people cope with current environment

22 Social Determinants Social determinants of health (e.g., inequality) Structural interventions: Changing the environment Dignity Equality Cooperation Security Morality Opportunity Care Social support Reduce smoking Health care Individual interventions: Helping people cope with current environment Particular pathologies (e.g., HIV)

23 Ways law matters Social determinants of health Drug policy Public safety Housing OSH and work law School discipline Criminal justice Health

24 Ways law matters 1. Laws shape contexts Social determinants of health Drug policy Public safety Housing OSH and work law School discipline Criminal justice Health

25 Ways law matters 1. Laws shape contexts 2. Laws influence behavior Social determinants of health Drug policy Public safety Housing OSH and work law School discipline Criminal justice Health

26 Law: Missing in Action?

27 Law: Missing in Action? Deaths attributable to: Racial segregation: 176,000 Low education: 245,000

28 Kingdon Streams Policy Problem Politics

29 Kingdon Streams Policy Problem Politics

30 Kingdon Streams Policy Problem Politics

31 A Long Term Perspective Impact Arguments that work now Arguments that work in 10 years Arguments that work in 20 years Legal Scholarship

32 Transdisciplinary Health Law Access to Evidence and Expertise Expertise in Designing Legal Solutions Help Engaging Communities and Building Political Will Support for Enforcing and Defending Legal Solutions Policy Surveillance and Evaluation Better Health Faster

33 Summary ENGAGE TIME

34 Summary ENGAGE S P A ENGAGE C I R A D V TIME E N C T O C C I A E C C E Y

35 Centers for Disease Control and Prevention New Tools to Achieve Health Equity: Section 1557 of the Affordable Care Act Dawn Pepin, JD, MPH Public Health Analyst Carter Consulting, Inc. Public Health Law Program Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention

36 CDC Public Health Law Program Disclaimer The 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.

37

38 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, Image: Equity and social justice, Kingcounty.gov, Last Updated October 27, 2015

39 Health Disparities and Discrimination in the United States Discrimination in the healthcare context can often lead to poor and inadequate health care or health insurance or other coverage for individuals and exacerbate existing health disparities in underserved communities. 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 Proposed 45 CFR Part 92

40 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 ; Proposed 45 CFR 92

41 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 ; Proposed 45 CFR 92

42 Enforcement Federal HHS Office for Civil Rights Federal courts

43 What is missing? Sexual Orientation Chronic Disease Etc.

44 States

45 Dawn Pepin For more information, contact CDC CDC INFO ( ) TTY: 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.

46 Beyond Statutes & Regulations: Increasing Recreational Access with Shared Use Agreements & Policies July 14, 2016 Presented by Ellie Gladstone, Senior Staff Attorney

47 Healthier communities for all through better laws and policies.

48 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 ChangeLab Solutions

49 Public Health Law and Policy are more than just legislation

50 Local ordinances Zoning language Resolutions Hospital policy School/agency policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

51 How do you build a healthy community?

52 Shared Use Occurs When government entities or nonprofit organizations agree to open or broaden access to facilities for community use

53 Increase opportunities for physical activity

54 Getting from here

55 to here

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

57

58

59

60 Local ordinances Zoning language Resolutions Hospital policy School district policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

61 Local ordinances Zoning language Resolutions Hospital policy School district policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

62 Local ordinances Zoning language Resolutions Hospital policy School district policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

63 Formalizing Shared Use 1) Shared Use Agreements 2) School District Policies Creative Commons Flickr: jk5854

64 Shared Use Agreements Formal contract Between > 2 parties With terms and conditions For use of the property

65 Shared Use Agreement: Lemon Grove, CA Photo credit: Lemon Grove HEAL Zone

66 School District Policies Community Use of Facilities Open Use

67 Community Use of Facilities

68 Open Use Policies Community access For individual play and recreation For free Without formal partnership or agreement

69 Open Use Policy: Hamilton County, TN

70 Local ordinances Zoning language Resolutions Hospital policy School district policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

71 Local ordinances Zoning language Resolutions Hospital policy School/agency policy language Contracts/agreements State/federal laws University policy Organization policy Hospital policy

72 Feasibility and success can depend on state law Authority Liability Funding

73 Shared Use Resources

74 Thank You! ChangeLabSolutions.org

75 Q&A Please type your questions in the Q&A panel. Public Health Law Series Webinar: Shared-Use Exploring Social Agreements Determinants to Support of Health Public through Health Public Health Law Lens

76 Thank you for attending Please join us for this upcoming webinar: Combating the Zika Virus: Mosquito Control and the Law Thursday, July 21 2:30 4:00 p.m. (ET) Learn more at: networkforphl.org/webinars Public Health Law Series Webinar: Exploring Social Determinants of Health through Public Health Law Lens

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