Soraya Ghebleh - Improving Public Health Despite Constitutional Impediments

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This is a presentation of research written by Kate Whelley-McCabe, Soraya Ghebleh, Caitlin Stanton, and AJ Von-Tassel, that looks at how to improve the public's health despite constitutional …

This is a presentation of research written by Kate Whelley-McCabe, Soraya Ghebleh, Caitlin Stanton, and AJ Von-Tassel, that looks at how to improve the public's health despite constitutional impediments.

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  • 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