Surveillance in public health is the means by which people who are responsible for preventing or controlling threats to health get the timely, ongoing, and reliable information they need about the occurrence, antecedents, time course, geographic spread, consequences, and nature of these threats among the populations they serve. “Policy surveillance” is the ongoing, systematic collection, analysis, and dissemination of information about laws and other policies of health importance.

Recent cases about the constitutionality of compelled speech in the reproductive health care context contain an irony that is difficult to ignore. Whereas courts tend to be highly permissive when considering governmentally-mandated speech by physicians to patients seeking abortions, they have often been more skeptical of disclosure requirements imposed on crisis pregnancy centers (CPCs), which are nonmedical centers whose entire mission is to dissuade women from choosing abortion, and which have at least in some cases utilized deceptive techniques to accomplish that goal. In other words, it appears that non-physicians seeking to keep women from seeking a legal form of medical treatment have greater First Amendment protections than physicians who care directly for those women and who are generally entrusted by the state to exercise professional judgment.

In “Selection against Disability: Abortion, ART, and Access,” Alicia Ouellette probes a particularly vexing point of intersection between ART and abortion: how negative assumptions about the capacities of disabled persons and the value of life with disability infect both prospective parents’ prenatal decisions about what pregnancies to pursue and fertility doctors’ decisions about providing services to disabled adults. This commentary first briefly describes what I view as Ouellette’s key points and her article’s most valuable contributions. It then suggests further expanding the frame of reference for Ouellette’s discussion. Viewing decisions about who can reproduce and what children will be born as fundamentally decisions about family suggests ways of drawing on intersectional approaches and growing public acceptance of nontraditional families to promote acceptance of people with disabilities as valued family members — without limiting reproductive liberties.

Denmark is a constitutional monarchy resting on the founding Constitution of 1849 and later amendments. The 179 members of parliament are democratically elected, and the government is formed on the basis of parliamentary principles. The queen functions as head of state without any power to intervene in legislative or executive matters. Greenland and the Faroe Islands are part of the kingdom, but self-governing. In total, the population is around 5.6 million. The country is divided into five regions and 98 municipalities. Members of both regional and municipal councils are democratically elected.

Antimicrobial resistance is a critical public health challenge, and the contribution of the widespread use of antimicrobials in food animals to bacterial drug resistance and human infection demands greater policymaker attention. Global consumption of antimicrobials in food animal production by 2030 is projected to rise by two-thirds due to increases in both food animal production and demand for animal products. In the United States (U.S.), the volume of antibiotics sold for use in food-producing animals is at least three times greater than that sold for human use. A One Health approach that emphasizes the connections among the health of humans, animals, and the environment is needed to address antibiotic resistance in an integrated manner. This approach holds the promise of collaboration across multiple disciplines, including doctors, veterinarians, food safety professionals, and environmental health experts.

Most babies born each year in the U.S. undergo mandatory newborn screening to detect serious medical conditions that can cause devastating effects if treatment is not initiated prior to the onset of symptoms. Not all of the blood collected from newborns is used during routine newborn screening, and many states retain the residual dried blood samples (DBS). DBS have a broad range of potential uses, from program evaluation to public health and biomedical research unrelated to newborn screening. State laws vary regarding whether parental consent is required to use DBS for secondary research, but federal now requires parental consent for the use of DBS in federally funded research.

These teaching materials explore the specific powers of governments to implement control measures in response to communicable disease, in two different contexts:

• The first context concerns global pandemic diseases. Relevant legal authority includes international law, World Health Organization governance and the International Health Regulations, and regulatory authority of nations.

• The second context is centered on U.S. law and concerns control measures for drug-resistant disease, using tuberculosis as an example. In both contexts, international and domestic, the point is to understand legal authority to address public health emergencies.

State law efforts to regulate abortions have accelerated. Between 2011 and 2013, state legislatures enacted 205 abortion laws — 16 more than in the entire decade before. Most laws take direct aim at surgical abortions, although some also target chemical abortions that use drugs like RU-486, a common chemical abortifacient sold under the trade name Mifeprex.

A crop of new state laws focus on the subject of this Symposium, that is, what information abortion providers must give women about the procedures or drugs they seek. In the most controversial iteration of these “informed consent” statutes, abortion providers must “perform an ultrasound on each wom[a]n seeking an abortion and…show and describe the image” (the “speech and display provisions”). Some state laws regulating chemical abortions also force particular disclosures to women when receiving such drugs.

The return of individual genetic results to research participants has been widely discussed in the context of an explosion of genetic research utilizing an ever more rapid and inexpensive array of sequencing and bioinformatics platforms. To date, a number of consensus statements guide researchers as to the breadth and limits of their obligations for offering genomic research results to participants. Typically these recommendations are rooted in the result’s clinical validity, actionability, and potential health consequences, and are predicated on the informed consent of the participant. An emerging discussion is the challenging question of the degree to which researchers may additionally have responsibility for offering results to family members of the research participant. Some have argued that ethical obligations to relatives intensify as the significance and actionability of the result increase, while others claim that obligations to next of kin should follow the clinical model where the decision to share genetic results falls to the patient. A detailed reflection on the many ethical issues that arise in considering whether such a responsibility exists, and if so how to honor it, is presented in this issue of JLME by Wolf et al.

There was a moment in the 2012 campaign, when Mitt Romney attempted to “pivot” to the center and get away from the statements of those like Todd Akin who made comments about how in cases of “legitimate rape,” the victims’ bodies “have ways to try and shut that whole thing down.” The way Romney did it was to make clear that while he was against abortion, he would, of course, make an exception for women who had been raped or whose pregnancy was the result of incest. This has become something of a moderate orthodoxy to those who oppose abortion. Abortion should be criminalized, yes, but with these exceptions carved out. This shibboleth has found its way not only in the public position taken by many Pro-Life politicians, but also in legislation across several U.S. states, and even the Hyde Amendment, which prohibits federal funding for abortion, makes an exception for these kinds of abortions

France, a country with nearly 66 million inhabitants, contributed greatly to the construction of the European Union (EU) as one of the founder states. In 1957, the treaties establishing the European Economic Community (EEC) and the European Atomic Energy Community (Euratom) were signed by Belgium, France, Germany, Italy, Luxembourg, and the Netherlands in Rome. Today, they are referred to as the “Treaties of Rome.” The French contribution to the EU has strongly influenced the political views on the development of Europe, notably pushing for a large contribution of member states to the decision making processes and to the orientation of the EU policies.

This paper examines two policy initiatives that research shows can increase opportunities for physical activity and, in turn, improve health outcomes. These initiatives — shared use and Safe Routes to School (SRTS) — can and should be embraced by schools to improve student and community health. Fear of liability, however, has made many schools reluctant to support these efforts despite their proven benefits. This paper addresses school administrators’ real and perceived liability concerns and identifies four strategies for managing the fear of liability and mitigating any potential liability exposure.

Given the nature of scientific inquiry, biomedical and genomic researchers have forged innumerable ways to advance our understanding of human disease. In many cases, research requires the involvement of human subjects, and in a subset of these studies, the researcher may collect data and biospecimens from many participants, and even serially collect additional materials over time and across a number of geographically dispersed centers. The organized data and biospecimens are collectively known as research biobanks. Researchers have an obligation to disseminate findings from their research through publications and presentations to other professionals, and when possible, to the public. Sharing genomic data is increasingly being mandated; access to data can be obtained through collaborative or state-funded entities. For example, the database of Genotypes and Phenotypes (dbGAP) and the International Cancer Genome Consortium will grant approved research applicants access to de-identified individual level genomic data with accompanying demographic/clinical information.

A regulatory moment for prenatal health care is here. An increasing amount of legislative attention has concentrated on the decisions pregnant women make after prenatal testing. The impetus for this legislation is a new non-invasive prenatal genetic test (NIPT). From the beginning of pregnancy, cell-free fetal DNA travels across the placental lining into the mother’s bloodstream, increasing in quantity as the pregnancy progresses. Laboratories can now analyze that DNA for chromosomal abnormalities and for fetal sex at 10 weeks of gestation. NIPT, which relies on a sample of the pregnant woman’s blood, is painless, occurs early in pregnancy, and is available for clinical and commercial use. In 2013, major health insurance plans began to cover NIPT for certain populations of women, such as women over 35 years old. And private companies have started marketing prenatal testing kits directly to consumers, who return a blood sample from the prospective mother to a company laboratory.

Antibiotic resistance (ABR) is a common-pool resource challenge like those that global environmental scholars have been addressing for decades. Just like clean air, fish stocks, and oceans, antibiotic effectiveness shares the two defining qualities of a common good: it is rivalrous in that it is limited or subtractable upon use, and it is non-excludable in that it is very difficult to stop people from abusing them inappropriately. This is because each use of antibiotics increases the likelihood that affected bacteria will adapt and evolve in ways that makes them less susceptible to these bacteria- harming antibiotics. The natural development of resistance is what separates antibiotics from most other medicines — the use of which do not affect the effectiveness of these medicines for others.

Obesity is a public health problem in the United States. Experts have identified the regulation of food marketing as a policy strategy to address obesity and poor nutrition. However, the First Amendment can be a barrier to reducing exposure to problematic food marketing. In recent years, courts have become increasingly protective of speech, and particularly of “commercial speech,” or advertising, which can make it more difficult to regulate certain marketing practices.

In the pediatric clinical setting, the parent/guardian will almost always be the authorized representative and designated recipient of clinical and research results, making the issue of to whom results should be returned in the pediatric setting less complex than in adult settings. It is also clear that, in genomic research related to pediatric diseases such as cancer, results may be of considerable clinical, ethical, and personal significance for parents in a number of ways, including a genomic explanation of the origin of their child’s cancer, implications for the genetic testing and medical care of other siblings and of the parents themselves, and reproductive planning with regard to the recurrence risk for future children to have an increased risk of cancer. However, what remains unclear is which results should be disclosed, and under what circumstances, to parents of deceased children.

Most proposals for new international agreements aim to address important global challenges. If the goal is to solve problems, then the value of these agreements depends on their ability to influence the world — to shape norms, constrain behavior, facilitate cooperation, and mobilize action. A recent review of empirical studies has suggested that many international agreements fail to achieve their aspirations. The review indicates that the form in which states make commitments to each other — through an international legal agreement or through other means — may not be as important as commonly thought. It is the content of the commitments and how these are supported by mechanisms to encourage implementation that matter the most. When developing proposals for new international agreements, like the one that has recently been proposed to address antibiotic resistance (ABR), attention to implementation mechanisms should therefore be equal to if not greater than the attention paid to its form.

In addressing the creation and regulation of biobanks in different countries, a short descriptive introduction to the social and cultural backgrounds of each country is mandatory. The State of Israel is relatively young (established in 1948), and can be characterized as a multi-religious (Jewish, Muslim, Christian, Druz, and others), multi-ethnic (more than 14), multi-cultural (Western “Ashkenazi” Jewry, Oriental “Sfaradi” Jewry, Soviet Jewry, Israeli Arabs, Palestinian Arabs) society, somewhat similar to the American melting pot. The current population is 8.3 million, a sharp rise resulting from a 1.2 million influx of immigrants from the former Soviet Union in the 1990s. Seventyfive percent are Jewish, 20% Arabs (the majority of whom are Muslims), and several other minorities. The birth rate is 3.8 per family, the highest in the Organization for Economic Cooperation and Development (OECD).

In early 2013, the Indian Central Drugs Standard Control Organisation, under supervision of the Health Secretary, introduced new rules governing the conduct of clinical trials involving human participants. Among other provisions, the rules require that sponsors of research compensate participants who are injured during the course of their research participation. The rules presumably were drafted to protect citizens from harm caused by biomedical research without unduly restricting access to the benefits that research can provide. While requiring compensation for injury is widely-acknowledged as a critical component of ensuring ethical conduct of human subjects research, in this case the legal restrictions do not match the ethical justifications that support a compensation requirement. To see this, it is important to examine the context in which the rules were written, the justifications for rules of this type, and what mechanisms are available to bring the effects of the rules into alignment with the norms their passage sought to promote.