The happiest place on Earth got seriously ill in 2015. A large outbreak of measles started in Disneyland in California, and the highly contagious and often deadly disease ultimately spread to 307 people across North America. It was only stopped after public health agencies traced thousands of potentially infected people and isolated the sick ones, quashing the epidemic.
Local health agencies protected lives early this year in Oregon, when an outbreak of Legionnaires’ disease in Multnomah County hospitalized four and killed one. Health department workers went door to door, notifying 100 people that their building’s water was contaminated with disease-causing bacteria. The workers helped them relocate and provided safe meals.
During the COVID pandemic, public health officials protected people by requiring masking and physical distancing. In 2020, for instance, Kansas counties that adopted mask mandates, aided by health departments, had significantly fewer hospitalizations, deaths and cases than did counties that rejected masks.
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But now politicians in many states are trying to prevent this kind of lifesaving work. They are passing laws that take control of public health and safety measures away from local agencies and put it in the hands of state legislatures, which have no medical expertise. In recent months at least 15 states have enacted or are considering laws that severely limit the authority of county and city agencies to close dangerous facilities or isolate people infected with deadly and contagious illnesses such as measles or COVID, as well as other public safety actions. Hundreds of similar bills are under development, according to a report from the Network For Public Health Law and the National Association of County and City Health Officials.
“It’s equivalent to taking away the ability of doctors to write prescriptions,” says Georges Benjamin, executive director of the American Public Health Association. “These are proven public health strategies going back hundreds of years.” The bills and laws prevent local authorities from responding quickly to local conditions, which is dangerous because things change fast during a disease outbreak and different threats require different responses.
Many of the bills appear fueled by the misplaced anger of Republican lawmakers at health measures taken to contain the pandemic, including activity restrictions and business closures or occupancy limits. Some examples of new legislation are:
Ohio passed a law giving the state legislature the power to void “any order or rule for preventing the spread of contagious or infectious disease” from the governor or the state health department. The law also restricts the ability of local health agencies to issue isolation and quarantine orders and allows the state to override local decisions.
Kansas approved legislation that designates local politicians, such as county commissioners, as the local health authority, and says that health boards cannot issue many types of orders unless those politicians grant approval. The law also limits contact tracing, an essential public health tool to find people exposed to dangerous diseases, as it did during the Disneyland outbreak.
Florida enacted a law that automatically ends emergency health orders after seven days and requires a majority vote by local government officials to extend them. It gives the legislature unilateral power to terminate orders issued by the governor during a state of emergency.
Montana passed legislation that prohibits local health orders that limit physical attendance at houses of worship.
It is true that health orders such as quarantines restrict individual freedom. But agencies cannot impose such measures arbitrarily, says Benjamin, and they are subject to quick review by courts. Health officials have had tremendous success in preventing the spread of illness and saving lives by customizing fast responses to different diseases. A salmonella outbreak at a restaurant calls for different measures than a hepatitis outbreak in a homeless population, or a person with tuberculosis who has been traveling around a county, or a bacteria-contaminated city water supply. Limits such as an automatic seven-day cutoff will prevent the most effective reactions and lead to illness and death.
The politicians who voted to hobble health are up for election, both this year and next. Voters can rescind these harmful actions by voting them out of office and supporting candidates who will protect health and well-being. Legislators have the right to review laws and change them. They do not have the right to practice medicine.