Equity First: Conceptualizing a Normative Framework to Assess the Role of Preemption in Public Health
Equity First: Conceptualizing a Normative Framework to Assess the Role of Preemption in Public Health
复制标题
DOI：
10.1111/1468-0009.12444
复制
发表时间：
2020-01-17
影响因子：
6.6
通讯作者：
Montez, Jennifer Karas
中科院分区：
文献类型：
--
作者：
Carr, Derek;Adler, Sabrina;Montez, Jennifer Karas
政策要点先发制人是一种法律原则，上级政府可以限制甚至消除下级政府对某一问题进行监管的权力。一些州立法机构越来越频繁地利用先发制人的手段来阻止可能减少健康不平等的地方政策。尽管有最近的趋势，但先发制人本质上并不反对公共健康、公平或良好治理，而是反映了其使用者的目标和价值观。现有的评估先发制人的框架未能协调其促进和阻碍健康公平的潜力。公平优先的优先购买框架可以促进逐案评估优先购买是否可能加剧不平等，或者是否是解决现有不平等的适当反应。开发和实施这样一个框架需要强有力的经验证据。背景 由于健康的各种社会决定因素分布不均，健康和福祉的差异与个人居住的地方密切相关。在美国，邮政编码通常比遗传密码更能预测一个人的健康状况。当社区寻求纠正这些不平等现象时，许多人发现，由于国家的先发制人，他们的邮政编码也决定了他们通过地方政府行动寻求更公平法律的能力。优先权是一种法律原则，上级政府可以限制甚至消除下级政府规范某一问题的权力。方法 我们使用 PubMed、WestLaw 和 Google Scholar 等在线数据库进行文献综述，调查有关先发制人对公共卫生和健康公平影响的现有学术成果。我们还与先发制人、公共卫生和公平专家共同主办了一系列跨部门、跨学科的研究会议。根据我们的研究结果，本文回顾了法律和政策在健康不平等的起源中的作用，并强调了先发制人如何造成和减轻这种不平等。我们展示了植根于纠正健康不平等的规范框架如何能够推进更公正的预防方法，并概述支持未来行动的研究议程。研究结果 法律和政策一直是造成健康不平等的核心，虽然这些工具可以促进健康公平，但一些州立法机构越来越频繁地使用先发制人的手段来阻碍可能改善健康和公平的地方政策。然而，先发制人本质上并不反对公共健康、公平或良好治理。例如，先发制人的联邦民权法就反对政府批准的歧视。然而，现有的评估先发制人的框架未能调和其促进和阻碍健康公平的潜力。结论 现有抢占框架的缺陷表明需要新的方法来将公平性提升为评估抢占的核心考虑因素。我们建议制定一个公平优先的优先购买框架，以建立基于证据的标准来评估优先购买何时会增强或抑制公平，并制定一个研究议程，以开发为该框架提供信息和实施所需的证据。公平优先的先发制人的重新概念可以帮助确保地方政府仍然是创新之地，同时允许州和联邦政府阻止可能造成或延续不平等的地方行动。
Policy PointsPreemption is a legal doctrine whereby a higher level of government may limit or even eliminate the power of a lower level of government to regulate a certain issue. Some state legislatures are using preemption with increasing regularity to thwart local policies that have the potential to reduce health inequities. Despite recent trends, preemption is not inherently adversarial to public health, equity, or good governance but rather reflects its wielder's goals and values. Existing frameworks for assessing preemption fail to reconcile its potential to both advance and hinder health equity. An equity-first preemption framework can facilitate case-by-case assessments of whether preemption is likely to worsen inequities or whether it is an appropriate response to address existing inequities. Robust empirical evidence is needed to develop and operationalize such a framework. Context Due to the inequitable distribution of various social determinants of health, disparities in health and well-being are tied to where an individual lives. In the United States, a zip code often better predicts a person's health than their genetic code. As communities seek to redress these inequities, many find that, due to state preemption, their zip code also dictates their ability to pursue more equitable laws through local government action. Preemption is a legal doctrine whereby a higher level of government may limit or even eliminate the power of a lower level of government to regulate a certain issue. Methods We conducted a literature review to survey existing scholarship about the effects of preemption on public health and health equity using online databases such as PubMed, WestLaw, and Google Scholar. We also cohosted a series of cross-sector, interdisciplinary research convenings with preemption, public health, and equity experts. Based on our findings, this article reviews the role of law and policy in the genesis of health inequities and highlights how preemption has both created and alleviated such inequities. We demonstrate how a normative framework rooted in redressing health inequities can advance a more just approach to preemption and outline a research agenda to support future action. Findings Law and policy have been central to creating health inequities, and while those same tools can promote health equity, some state legislatures are using preemption with increasing regularity to thwart local policies that may improve health and equity. Nevertheless, preemption is not inherently adversarial to public health, equity, or good governance. Preemptive federal civil rights laws, for example, have countered government-sanctioned discrimination. However, existing frameworks for assessing preemption fail to reconcile its potential to both advance and hinder health equity. Conclusions Shortcomings in existing preemption frameworks demonstrate the need for new approaches to elevate equity as a central consideration in assessing preemption. We propose the development of an equity-first preemption framework to establish evidence-based criteria for assessing when preemption will enhance or inhibit equity and a research agenda for developing the evidence necessary to inform and operationalize the framework. An equity-first reconceptualization of preemption can help ensure that local governments remain places of innovation while allowing states and the federal government to block local actions that are likely to create or perpetuate inequities.