The Public Health Workforce and Willingness to Respond to Emergencies: A 50-State Analysis of Potentially Influential Laws

Abstract

Law plays a critical role in all stages of a public health emergency, providing an infrastructure for planning, response, and recovery efforts. A growing body of research has underscored the potential for certain types of state laws, such as those granting liability protections to responders, to influence the public health workforce's participation in emergency responses. It is therefore especially important to focus on particular state-level laws that may be associated with individuals' increased or decreased willingness to respond. We conducted a systematic identification and analysis of specific state emergency preparedness laws that may affect individuals' willingness to respond and offer recommendations for policymakers seeking to promote more effective responses to public health emergencies.

Promoting public health legal preparedness for emergencies: review of current trends and their relevance in light of the Ebola crisis

“…Studies dealing with preparedness are designed to reveal and resolve ethical and legal dilemmas in order to promote an optimal response for future situations. In addition to extensive coverage of legal aspects dealing with pandemic scenarios ( 3 , 19 , 34 , 48 , 49 ), publications also consider the impact of PHLP on issues such as legal triage ( 10 ), motivating health workers during emergencies ( 2 , 48 , 49 ), human rights during crises, legal coordination of relevant emergency bodies ( 10 ), and the effect of an emergency declaration on health system management ( 2 , 50 ). Hodge ( 19 ) notes that upon declaration of a public health emergency the Model State Emergency Health Powers Act (2001) authorises public health officials to undertake a set of activities dealing with early detection, as well as to care for and protect public health, treat exposed or infected persons, and seek out-of-state volunteers.…”

“…In the former, the majority of studies focused on the effectiveness of infrastructural laws, international regulations, and the need for more flexible regulations ( 30 , 58 ). In developed states, studies focused on internal legislation, legal issues that might arise during emergencies, and advanced planning for future challenges ( 2 , 19 , 56 ).…”

“…On the other hand, the variance that exists among the states influences knowledge management, which in turn affects health knowledge implementation within the framework of public health laws ( 59 ). Rutkow et al ( 2 ) analysed differences between individual states in an effort to identify laws that impact the public health workforce and willingness to respond to emergencies. These differences can be well noted concerning emergency management, such as ensuring accessibility of the public to information via media that is influenced by cultural characteristics as defined in the Model State Emergency Health Powers Act (2001) ( 19 ).…”

“…Planning for the prevention and mitigation of morbidity, mortality, and environmental damage is fundamental to public health system preparedness for emergencies ( 1 ). An essential element in this planning process is the creation of a legal infrastructure to be activated during all phases of the emergency ( 2 ) from pre-event to recovery. The existence of a legal framework is particularly important in large scale crises ( 3 ) and scenarios requiring humanitarian assistance ( 4 ).…”

Legal Protections to Promote Response Willingness Among the Local Public Health Workforce

“…The legal environment, which establishes infrastructure and parameters for a response, offers one potential avenue for improving response willingness. 6 We examined whether the presence of 3 hypothetical legal protections-1) ensuring priority health care for workers' families, 2) granting workers access to mental health services, and 3) guaranteeing access to personal protective equipment-influences LHD workers' self-reported response willingness for 4 emergency scenarios. The legal protections we selected were responsive to challenges or concerns that LHD workers had noted in previous research regarding factors that may increase emergency response willingness, 4 and none are currently required by state law.…”