Public Health

“Public health” as defined by the Institute of Medicine is “what we, as a society, do collectively to assure the conditions for people to be healthy.” Public health officials commonly use regulations to reduce risk or harm to the population under their surveillance. To reduce the risk of public harm, governments sometimes infringe individuals’ civil liberties, such as their freedom of movement and bodily integrity. For example, upholding the detention of a person with tuberculosis, a California appellate court declared in 1966 that “health regulations enacted by the state under its police power . . . in a general way are not affected by constitutional provisions, either of the state or national government.” Counterbalancing the state’s ability to enforce public health measures is the “harm principle.” The “harm principle” is a core value of public health law and holds that competent adults should have freedom of action unless they pose a significant risk to other people or to property.

The HOAP index’s Public Health Subindex analyzes state-level regulations affecting the following personal and business interests: (1) access to and use of e-cigarettes, (2) the ability to purchase naloxone over the counter to counteract opioid overdoses, and (3) the promotion of “Good Samaritan” laws meant to protect nonprofessionals who intervene in a drug overdose or cardiac arrhythmia.

E-cigarettes, which have been growing in popularity since they were introduced to the US market in 2007, are under strict regulatory scrutiny. Public health officials fear e-cigarettes’ potential for stimulating nicotine addiction, youth access, and the renormalization of smoking. However, multiple clinical studies suggest that electronic cigarettes might decrease smoking-related morbidity and mortality. Therefore, states that regulate e-cigarettes less receive higher scores for this indicator.

As a result of increasing opioid addiction and overdose, communities and government agencies are actively working to provide liberal access to naloxone, a prescription drug that is safe and can reverse overdose and respiratory depression. States that permit over-the-counter purchases of naloxone scored higher for this indicator.

A 911 call can mean the difference between life and death for someone experiencing a drug overdose or cardiac arrhythmia. Good Samaritan laws provide those assisting an injured or endangered person with some legal protection from liability for any harm that occurs during that assistance. Good Samaritan laws also protect people who intervene to prevent harm from an opioid overdose from criminal prosecution for possession of drugs or intoxication. States that grant more protection to people attempting to help others scored higher for this indicator.