The authority to act to protect and promote the public’s health has emerged over the course of our Nation’s history, and has enabled many of modern public health’s greatest achievements. Today, public health agencies use their authority to promote health, prevent the spread of infectious disease, protect against environmental hazards, advance equity and assure local public health infrastructure and health services. During declared emergencies, state and federal authorities have broader powers to act to assist governments, suspend or modify legal requirements, pass and enforce law and expend funds for the health, safety and welfare of society. Recently, some states have moved to limit public health powers. Such efforts pose a mounting challenge for public health’s response to COVID-19 and future threats.

Themes

• Public health emergency declaration: On January 31, 2020, the first nationwide public health emergency was declared in response to COVID-19, and has been in place since. Emergency declarations at state and federal levels trigger authorities and resources unavailable in non-emergencies.
• Scope of public health authority: Through the police powers of the state granted under the 10th Amendment of the U.S. Constitution, public health can pass and enforce regulation for the health, safety and welfare of society. During COVID-19, these actions included isolation and quarantine requirements, vaccination mandates, revised standards for licensure of medical professionals, and other public health emergency response efforts.
• Threats to emergency powers: Recently, some states have moved to limit emergency powers and public health authority in response to perceived government overreach and outrage over handling of the pandemic. Such laws seek to prohibit mask wearing, ban the use of quarantine, block employer vaccine mandates, give legislatures unilateral power to stop public health actions, and more. These threats to emergency powers may compromise public health’s ability to respond effectively to COVID-19, health equity and future public health threats.

Equity & Systems

New laws to limit emergency powers and public health authority are concerning given their potential to create and perpetuate inequities. For example, preemption which may prevent communities from acting to deal with their own populations and relevant issues as needed. We can better understand the influence of policy on health and equity through a “Health and Equity in All Policies” approach to policy-making. Such approaches hold promise for centering equity in public policy discourse and advocacy, and transforming policies and systems for equity.