Motherboard, Reverse Detail: This is a green motherboard, photographed with red-gelled flashes.

The Future of Race-Based Clinical Algorithms

By Jenna Becker

Race-based clinical algorithms are widely used. Yet many race-based adjustments lack evidence and worsen racism in health care. 

Prominent politicians have called for research into the use of race-based algorithms in clinical care as part of a larger effort to understand the public health impacts of structural racism. Physicians and researchers have called for an urgent reconsideration of the use of race in these algorithms. 

Efforts to remove race-based algorithms from practice have thus far been piecemeal. Medical associations, health systems, and policymakers must work in tandem to rapidly identify and remove racist algorithms from clinical practice.

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Grocery store.

How Restrictions on SNAP Harm Health

By Molly Prothero

One of President Biden’s earliest actions in office was to sign an executive order asking Congress and the US Department of Agriculture (USDA) to expand the Supplemental Nutritional Assistance Program (SNAP).

President Biden proposed that Congress extend the 15% SNAP benefit increase, originally passed in late December. Biden’s executive order also directed the USDA to issue new guidance documents enabling states to increase SNAP allotments in emergency situations and update the Thrifty Food Plan, the basis for determining SNAP benefits, to better reflect the cost of a nutritious diet today.

President Biden’s actions stand in sharp contrast to Trump, who sought to limit the reach of SNAP benefits during his time in office. In December 2019, Trump’s USDA issued a final rule restricting SNAP eligibility for unemployed adults without dependents.

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Society or population, social diversity. Flat cartoon vector illustration.

Bias, Fairness, and Deep Phenotyping

By Nicole Martinez

Deep phenotyping research has the potential to improve understandings of social and structural factors that contribute to psychiatric illness, allowing for more effective approaches to address inequities that impact mental health.

But, in order to build upon the promise of deep phenotyping and minimize the potential for bias and discrimination, it will be important to incorporate the perspectives of diverse communities and stakeholders in the development and implementation of research projects.

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Gavel and a house on a white background. Concept art for eviction.

Why Biden’s Extension of the Eviction Moratorium Isn’t Enough

By Molly Prothero

On President Joe Biden’s first day in office, he signed an executive order calling on the U.S. Centers for Disease Control and Prevention (CDC) to extend its federal eviction moratorium through March 2021.

But this action protects only a subset of tenants who meet specific qualifications and, crucially, know to fill out a CDC Affidavit and submit it to their landlords. And despite skyrocketing COVID-19 case counts, most state eviction moratoriums have now lifted, leaving tenants vulnerable to displacement and homelessness.

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Doctor or surgeon with organ transport after organ donation for surgery in front of the clinic in protective clothing.

How to Encourage Organ Donation

By James W. Lytle

Last week, Bill of Health published a Q&A with Phil Walton, the Project Lead for Deemed Consent Legislation with the National Health Service Blood and Transplant Division, and Alexandra Glazier, the President/CEO of the New England Donor Services.

In the first part of this conversation, Walton and Glazier described the various frameworks undergirding organ donor registries in their home countries. Walton detailed the “deemed consent” or “opt-out” registry employed by Wales and England, while Glazier detailed the opt-in, prompted choice framework in the U.S.

In this second installment, Walton and Glazier discuss strategies to encourage organ donation, regardless of the opt-in or opt-out framework. The conversation also touched on health disparities and strategies to address them.

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Empty classroom.

Can Schools Require the COVID-19 Vaccine? Education, Equity, and the Courts

By Emily Caputo and Blake N. Shultz

As school systems consider policy options for the spring semester, both vaccination requirements and proposals to address inequities in access to education may be top of mind. However, policymakers should be aware of the possible legal challenges they may face.

The COVID-19 pandemic has created an educational crisis in the United States by disrupting the learning of millions of students across the country. School closures, remote learning, and generalized societal stress have all raised serious concerns about persistent harm to adolescent learning and development — particularly among low-income and minority students.

While the pandemic has exposed widespread inequities in educational opportunity, it has also revealed the relative inability of the courts to promote access to education. A recent California lawsuit illustrates the manner in which students must rely on state-level, rather than federal, protections to ensure equal access to education. And COVID-19 vaccination requirements, which could facilitate a return to in-person education, are likely to result in lawsuits, and may be struck down by a skeptical and conservative Supreme Court.

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Police car.

Police Should Not Be Enforcing Emergency Public Health Orders

Cross-posted from COVID-19 and The Law, where it originally appeared on November 9, 2020. 

By Daniel Polonsky

On a weekend when police officers were handing masks to white residents in parks around New York City, NYPD Officer Francisco Garcia forced Donni Wright, a 33-year-old Black man, to the ground and knelt on his neck. Officer Garcia was one of 1,000 NYPD officers dispatched to enforce social distancing and mask-wearing. He had been investigating a report of individuals not wearing masks, although he himself was not wearing one. Police Chief Terence Monahan had previously assured reporters that the police would be educating the public and only breaking up large gatherings, not bothering individuals merely walking outside—“They don’t have a mask, we’ll give them a mask.” But Officer Garcia, who has settled six lawsuits for police misconduct for a combined $182,500, did more than educate that day. Multiple officers were in the middle of arresting two individuals after allegedly spotting a bag of marijuana when Mr. Wright spoke up in their defense. In response, Officer Garcia called him a racial epithet and accosted him, causing severe injuries to Mr. Wright’s back, ribs, and chest. What started as social distancing enforcement ended in racist, excessive use of force.

This incident highlights the overlap between the twin crises state and local governments face: halting the spread of COVID-19 and grappling with the systemic racism that characterizes the American system of policing.

Click here to read the full post on COVID-19 and The Law.

White jigsaw puzzle as a human brain on blue. Concept for Alzheimer's disease.

Detecting Dementia

Cross-posted, with slight modification, from Harvard Law Today, where it originally appeared on November 21, 2020. 

By Chloe Reichel

Experts gathered last month to discuss the ethical, social, and legal implications of technological advancements that facilitate the early detection of dementia.

“Detecting Dementia: Technology, Access, and the Law,” was hosted on Nov. 16 as part of the Project on Law and Applied Neuroscience, a collaboration between the Center for Law, Brain and Behavior at Massachusetts General Hospital and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

The event, organized by Francis X. Shen ’06 Ph.D. ’08, the Petrie-Flom Center’s senior fellow in Law and Applied Neuroscience and executive director of the Center for Law, Brain and Behavior at Massachusetts General Hospital, was one of a series hosted by the Project on Law and Applied Neuroscience on aging brains.

Early detection of dementia is a hopeful prospect for the treatment of patients, both because it may facilitate early medical intervention, as well as more robust advance care planning.

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Sign that reads "Racism is a pandemic too."

Editor’s Choice: Important Reads on Race and Health

By Chloe Reichel

Racism was embedded in the founding of the United States and has persisted in virtually all aspects of our society through the present day.

In 2020, structural racism was made especially apparent in the disproportionate toll the COVID-19 pandemic has taken on communities of color, which can be traced back to the social determinants of health, and in grotesque displays of police violence, such as the killings of Breonna Taylor, George Floyd, Ahmaud Arbery, and Elijah McClain.

Racism is the public health issue of our time, after having been woefully un- or under-addressed for centuries. The following posts, which were published on Bill of Health this year, highlight some of the most pressing issues to confront, as well as potential ways forward.

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