Public Health Issues to Watch in 2015
Infectious disease outbreaks, electronic cigarettes, prescription drug abuse, motor vehicle injuries, and marijuana possession are just a few of the hot topics expected to impact state health departments and public health in 2015. The U.S. healthcare industry is undergoing a large transformation and important decisions about health and healthcare are occurring at the state level. This year, our national healthcare expenditures are projected to hit $3.2 trillion, or $10,000 per person. As public health issues dominate the nation, health departments are predicting that many ongoing and emerging health threats are expected to make headlines this year.
"Each year, state legislatures across the country consider numerous proposals that have implications for the public's health," says Andrea Garcia, ASTHO's director of state health policy. "This year, given the national attention focused on the public health system's response to Ebola and the measles outbreak, we can expect states to address gaps and strengthen their laws to address future health threats."
Infectious Disease Outbreaks and Response
Since the first confirmed imported case of Ebola hit the United States in September 2014, and with the most recent multi-state measles outbreak affecting 17 states, state health departments are increasing efforts to prevent and control infectious disease outbreaks. In late 2014, several state legislatures met to discuss state health departments' ability to respond to infectious disease outbreaks; some states, however, rely heavily on federal funding for this work. Since the United States is facing ongoing budget pressures, states may need to provide their own funding to help control infectious diseases.
Recently, infectious disease outbreaks have sparked controversies, particularly isolation and quarantine policies regarding Ebola cases. Meanwhile, the current measles outbreak has ignited a vaccination debate. Given the attention to state isolation and quarantine policies, some states are evaluating existing powers and considering changes to their state laws, including employment protections for infected individuals and their caretakers. In addition, the current measles outbreak raises concerns because vaccination rules vary across states. All states require vaccinations, but there are some exemptions for individuals with weakened immune systems, allergies to ingredients, and previous negative reactions, in addition to religious and philosophical reasons.
Electronic cigarettes (e-cigarettes) continue to be a controversial issue across states, and many will consider new regulation approaches in 2015. Some states will consider requiring child-safe packaging for e-cigarette cartridges and solutions, while others are considering taxing the products. Many e-cigarette users disagree with these tax proposals, arguing that the devices are healthier than traditional cigarettes. New Hampshire will propose adding e-cigarettes to its clean indoor air laws, and Texas will consider prohibiting their use in schools. ASTHO has developed an issue brief that highlights the emerging issues that states face with regards to e-cigarettes.
"This is going to be one of the most introduced and debated topics in state legislatures this year, especially the tax issue," says Max Behlke, analyst for the National Conference of State Legislatures. With the popularity of e-cigarettes growing, more states are more likely to look to the new devices for revenue, according to The Pew Charitable Trusts.
Prescription Drug Abuse, Misuse, and Overdose
Prescription drug abuse is a growing epidemic in the United States. An estimated 2.4 million Americans have used prescription drugs nonmedically, according to results from the 2010 National Survey on Drug Use and Health. In 2014, ASTHO Past-President Terry Cline launched the ASTHO President's Challenge to reduce the nonmedical use of and unintentional overdose deaths involving controlled prescription drugs 15 percent by 2015. Forty-six states took the pledge to help reduce prescription drug abuse and deaths.
This year, states will continue to address this public health problem by establishing immunity for individuals who seek medical assistance for victims of overdoses, expanding access to the opioid antagonist naloxone, and requiring opioid education and addiction counseling for patients who are prescribed Schedule II or III controlled substances for chronic pain for extended periods. With $20 million in new funding in 2015, CDC will dramatically expand its work on this issue and provide more resources to states on the front lines of the epidemic.
Motor Vehicle Injuries
Motor vehicle injuries are a top cause of death among children in the United States. In 2012, more than 2.5 million Americans went to the emergency department, and almost 200,000 were hospitalized for crash injuries, according to CDC. To keep people safe and costs down, a number of states are considering bills related to motor vehicle injuries. In particular, California, Kentucky, North Carolina, and South Carolina are considering bills that require ignition interlock devices on all vehicles for individuals convicted of a DUI.
California is considering a bill requiring motor vehicle drivers to secure all children under the age of 2 in rear-facing child safety seats. Utah will consider a primary seatbelt law, and several states will consider repealing their motorcycle helmet laws. New Mexico will consider a bill to create a fatal injury diagnosis fund, which would require individuals to pay for motorcycle validating stickers indicating whether the operator is required by law to wear a helmet.
For more information about the issues that may affect state health agencies in 2015, see ASTHO's 2015 State Legislative and Regulatory Prospectus and this article in Governing.