摘要：Disaster responses often involve coordination among multiple levels of government and public and private sector collaboration. When emergencies raise health concerns, governments must include public health and health care systems in their response. A state government’s declaration of “public health emergency” can provide that state’s health sector with flexibility and guidance about response parameters. Although events including Hurricanes Katrina and Sandy and the H1N1 influenza outbreak provided opportunities for states to deploy their public health emergency powers, little has been reported about how states have used their authority to declare a public health emergency. I present a systematic identification and analysis of states’ public health emergency declarations, examine why these declarations were issued, and discuss their potential value. Disasters and emergencies raise unique challenges for governments, in large part because of their unpredictability and potential for vast destruction. When a disaster occurs, the response often involves coordination among governments at the local, state, and federal levels, as well as collaboration between the public and private sectors. 1 This collaboration can be facilitated or impeded by laws at all levels of government. 2 Every state has the ability to issue a declaration of “emergency” or “disaster” to facilitate a response by, for example, temporarily suspending certain laws and implementing interstate emergency agreements. This type of multifaceted response arose after Hurricane Katrina because the Emergency Management Assistance Compact was invoked by affected states, 3 and Louisiana’s governor temporarily suspended deadlines for in-state legal proceedings. 4 When emergencies raise health concerns for affected populations, such as exposure to a novel infectious disease, governments must actively include both public health and health care systems in their response. Without advance planning, medical supplies may prove insufficient, and a surge in demand for prevention and treatment services may overwhelm health care professionals. 5 A governmental declaration of “public health emergency” can provide a state’s health sector with flexibility and guidance about the parameters of a response. State laws specify how this declaration may be made, typically through a gubernatorial executive order or proclamation. The declaration may enhance public health aspects of a response by, for example, waiving state licensure laws to temporarily allow out-of-state health care professionals to practice in an affected state and enabling the rapid distribution of medical supplies such as vaccines. 6 Although state laws typically allow for rapid responses to varied emergencies, the concept of a distinct public health emergency declaration gained traction shortly after the terrorist attacks of September 11, 2001, and the subsequent mailing of anthrax-tainted letters to members of Congress and others. Familiarity with this concept was driven, in part, by the development of the Model State Emergency Health Powers Act, an effort to provide states with guidance regarding laws to prepare for and respond to public health emergencies. 7 This increased awareness, along with other initiatives to update states’ public health laws, 8 led some states to include a declaration of “public health emergency” with accompanying public health emergency powers in their laws. 9 In the decade since these events, numerous emergencies with public health impacts have occurred, including Hurricanes Katrina (2005) and Sandy (2012) and the H1N1 influenza outbreak (2009). 10 These events presented states with opportunities to deploy their public health emergency powers, yet little has been reported about how states have actually used their authority to declare a public health emergency. I present a systematic identification and analysis of public health emergency declarations in states whose laws contain the explicit authority to issue such a declaration. I examine why states have chosen to declare public health emergencies and the legal means by which they have done so. Additionally, I consider how states’ public health emergency declarations differ from their general emergency declarations, and discuss the potential value of state-level public health emergency declarations.
