Population Health and Federalism:
Whose Job Is It?
It is one of the happy incidents of the federal system that a
single courageous state may, if its citizens choose, serve as
a laboratory; and try novel social and economic experiments
without risk to the rest of the country.
—New State Ice Co. v. Liebmann, 285 U.S. 262, 311 (1932)
(Brandeis, J., dissenting)
WHAT DO INFECTIOUS EPIDEMICS, hurricanes, cigarettes, and handguns have in common? First, each can harm the health and well-being of multiple populations. Second, the source of each of these threats extends beyond the boundaries of any single locality or state, yet each of these public health threats affects different regions differently. Third, optimal interventions for each of these threats would include local, statewide, national, and perhaps international components. Yet, in the United States, efforts to protect diverse populations from each of these dangers are hampered by uncertainty and confusion as to whether the job belongs primarily to the federal government or to the states.
Sometimes, as evident in the bungled response to Hurricane Katrina in 2005, poor communication and coordination between federal and state officials is the cause of the problem.1 Sometimes, as was also true when Katrina struck, public health protection is jeopardized by constitutional doctrines that raise doubts as to the authority of each level of government