State administrative agencies can adopt regulations with public health implications and impacts on health equity. This includes regulations adopted by health-focused agencies that govern in areas of traditional public health. It also includes regulations adopted by agencies that make decisions regarding education, employment, the environment, and other sectors that mold the social determinants of health. Sometimes, such decisions reinforce or exacerbate structural inequities. Unwinding structural inequities necessitates incorporating meaningful input from community members, especially ones who live these inequities, can help determine how inequities should be addressed. However, the procedural rules that govern how agencies seek feedback are often not conducive to meaningful community engagement. Many states set process for how state agencies must adopt rules through state administrative procedure acts (APAs). State APAs often require notifying the public about proposed rules and requesting feedback on the proposals. However, these rules are often not designed to garner meaningful community input. This presentation will first discuss what we know from public health about effective community engagement. Next, it will review sample and model state APA provisions around public participation in rulemaking. It will establish inconsistencies between effective community engagement best practices and state APA requirements around public participation in rulemaking. Finally, this presentation will provide recommendations about how state APAs could be modified to enhance meaningful community feedback. These modifications could contribute to unwinding structural inequities by incorporating community perspectives more effectively into agency rules and by requiring agencies to consider and respond to community concerns.

Health policy evaluation is a critical step of the policymaking process to ensure equity in public health practice. Specifically, within State and Territorial health departments, it is essential to objectively review their utilization of evidence-based practices to inform public health policymaking, in efforts to promote accountability within their policies and actions. A diverse, interdisciplinary team of researchers from the University of Pittsburgh School of Public Health, The College of Health Sciences at Jackson State University School of Public Health, and the Pennsylvania Department of Health (PA DOH) collaborated on a health equity policy review of PA DOH’s policy inventory. The purpose of the policy review is to provide revision recommendations to PA DOH. The revision recommendations will be disseminated to PA DOH in efforts to maintain social justice and prioritize upstream policy change. The methodology consisted of developing a conceptual framework to inform a qualitative codebook, which was used to code PA DOH’s policy inventory. The findings of the project will serve as a model for other State and Territorial health departments to evaluate their policies and procedures as well. As more health equity policy reviews are conducted, we can strive towards mitigating health disparities and promoting health equity as a nation.

Background

Laws and public policies are increasingly being recognized for their contributions to racial and ethnic health inequities. Legal epidemiology approaches can provide important evidence for policy change to advance health equity. However, adaptations to traditional legal epidemiology methods are necessary to center community voice and inform real-time policymaking processes.

Objectives & Purpose

Guided by robust community engagement that identified community policy priorities and an opportunity to integrate health equity into the East Point Comprehensive Plan, which is a state-mandated process and document used to guide local planning, development, and zoning decisions. We conducted a rapid-response policy mapping study using a legal epidemiology approach that identified jurisdictional variation in the inclusion of equity language in Comprehensive Plans and used our findings to inform the East Point Comprehensive Plan update.

Results

We developed a legal coding protocol, quality control measures, and a coding instrument. We reviewed Comprehensive Plans across 32 jurisdictions and found that 12 included the term equity, 7 included an equity statement, and 11 mentioned the term health. We presented our findings to our Community Advisory Board and City Council. The draft 2022 update to the Comprehensive Plan mentioned equity 50 times (increase from 0 times in 2017), included a community-informed equity statement and named health equity as a community goal.

Conclusions

Comparing jurisdictional approaches to equity in Comprehensive Plans using a legal epidemiology approach was beneficial to informing the policymaking process.

Recommendations/Implications

Methodological considerations should be balanced with community priorities and local policymaking processes and timelines.

Law quickly emerged as a primary, non-pharmaceutical tool to slow the spread of COVID-19. By July 1, 2020, state governments had issued an extraordinary number of laws and policies — more than 1,000 legal measures including stay-at-home orders, face mask mandates, and gathering bans. While systematically tracking policy responses across jurisdictions is essential to better understanding the role and impact of law during the pandemic, the rapid deployment of such policies necessitated the need for adjusting traditional policy surveillance.

Thanks to scoping support from an academic research center – including a robust codebook and research protocol – a non-profit organization hosting a multinational internship program developed a crowdsourcing approach to conduct rapid legal mapping to track the policy landscape. Over 250 volunteers were able to track over 8,000 COVID-19 orders at the federal, state, tribal, and local levels in near real time for more than two years. The research protocol made this possible despite few of the volunteer team having had legal training. The resulting database contains quality, open access, machine-readable legal data that may be used to understand the role of governing bodies in the response effort and to improve decision-making during future pandemics.

This presentation will discuss the crowdsourcing methods used to rapidly track COVID-19 executive orders from many jurisdictional levels. The presentation will also detail the civic empowerment the volunteer coding team experienced and explore ways in which this interdisciplinary policy tracking model can be utilized during future public health crises.

Our society is in a critical moment when public health researchers and practitioners working in health department settings are acknowledging how the communities they serve confront inequitable systems that are embedded in laws and policies and drive health disparities. Researchers and practitioners seek to better engage communities to understand and address these systemic drivers. They also seek concrete and reliable tools and practices that can support their efforts. One such tool is legal epidemiology (“legal epi”), or the scientific study of how laws affect health. Legal epi relies upon the deployment of rigorous scientific methods to capture what laws say and do in order to examine their implications for population health. Increasingly, public health practitioners and researchers recognize the potential of legal epi to inform their understanding of the legal and policy sources of systemic and structural inequities. At the same time, they are also prioritizing direct engagement with communities they serve.

Historically, legal epi and community engagement have been neither attenuated nor intertwined. Community engagement has been recognized in legal epi methods as a best, but not imperative, practice. This presentation will identify legal epi as a key tool that can build the capacity of practitioners and researchers who seek to address health equity challenges as well as highlight community engagement as an imperative methodological feature of the legal epi process.