Maximizing Community Voices to Address Health Inequities: How the Law Hinders and Helps

Abstract

This paper highlights the need to apply an equity lens when assessing the impact of preemption and related legal doctrines on community health. Community autonomy to set and pursue public health priorities is an essential part of achieving health equity. Unfortunately, the priorities of organized industry interest groups often conflict with health equity goals. These groups have a history of successfully using law to limit community autonomy to pursue public health measures, most notably through preemption and related legal doctrines. We examine this phenomenon using two examples. First, we look at dental association efforts to block the spread of dental therapists in Indian Country. Native dental therapists have been improving the oral health of native people in Alaska for over a decade; yet the national and state dental associations have sought with mixed success to leverage state and federal laws to hinder other tribal governments from utilizing these providers. We compare these efforts with a restaurant association-led movement to limit what municipal governments can do to address food-based health inequities, focusing on a “model” ALEC bill that started in Ohio. Finally, we discuss how municipalities and Tribes are fighting back and continuing to pursue health equity for their communities.