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Title: Professor of Health Policy & Management, Indiana University Fairbanks School of Public Health; Professor of Public Health & Law, Indiana University McKinney School of Law, Indianapolis, Indiana; Associate Editor for Legal Epidemiology, Public Health Reports
Education: JD, MPH, Boston University; BA in History, Indiana University-Bloomington
Public Health Law News (PHLN): Please describe your career path.
Silverman: After graduating from the Boston University dual degree program, I served for a couple years as Special Counsel to the Massachusetts Board of Registration in Medicine. In 1998, I moved to Springfield, Illinois, to take a position as an assistant professor in the Department of Medical Humanities at Southern Illinois University (SIU) School of Medicine. I spent 15 years at the SIU Schools of Medicine and Law, including five years as a department chair. In 2013, I moved from SIU to Indiana University, which was just launching its new school of public health. I found the chance to return to my alma mater as a senior faculty member irresistible, helping to build and shape a new school and work on a flourishing health sciences campus on difficult problems affecting the health of Hoosiers and the nation.
PHLN: What drew you to the intersection of public health and law?
Silverman: My time in law school coincided with Clinton health reform and the dawn of healthcare’s managed care era. I had incredible health law mentors at Boston University, in particular Wendy Mariner, George Annas, and Fran Miller. They sparked my interest by bringing these events into the classroom, along with their own fascinating work. I liked that we were wrestling with knotty questions about public health, healthcare, law, policy, politics, and ethics. I love that these challenges demand responses that are interdisciplinary, informed by evidence, sensitive to history and the unique needs of particular communities, and must be feasible and practical.
PHLN: What is the Grand Challenges program? What work are you doing on its newest initiative, Responding to the Addictions Crisis?
Silverman: Indiana is one of the states hardest hit by the opioid epidemic, and the site of the United States’ first rural HIV outbreak. Indiana University launched a $50 million initiative to fund projects aimed at preventing and reducing addictions and their associated morbidity and mortality in our state. The project I lead is called the Indiana Addictions Law and Policy Surveillance Project (or Health IN Law Project), and it has been funded for four years. One major aim of our project is grounded in legal epidemiology. Most of this type of research looks at how laws vary across different states. Our project is to collect, analyze, and share information about the characteristics of local Indiana law, specifically county and major municipality ordinances, and to assess how differences in those laws across jurisdictions might have positive or negative effects on the health of people with addictions.
A second aim of our project is evaluating the employees and practices of courts related to Medication-Assisted Treatment (MAT). More than one-third of adults who get involved with the criminal justice system are people who have substance use disorders. We want to understand how decisions about MAT are made and influenced within these systems, especially in problem-solving courts.
PHLN: What type of information are you gathering in your travels to all 92 counties in Indiana?
Silverman: When we started this project, we knew that doing legal epidemiology research on ordinances from 92 counties, plus about 20 cities, would be labor intensive. But what we found was even more complicated than we had imagined. Nearly half of Indiana’s 92 counties do not have complete, up-to-date versions of their local laws available in electronic format, either in commercial databases or on their local government websites. So, to collect these primary data, our team is now working with and traveling to dozens of county government offices across rural Indiana to collect, scan, and digitize the local laws. So far, we have collaborated with about two dozen counties and collected their ordinances, and we have another 20 counties left to go. Our project manager, Lindsey Sanner, has been invaluable in this effort. Over the last few months, she has logged countless miles and already burned through one portable scanner.
PHLN: What will this information mean for the Grand Challenges program? What will it mean for the larger public health law community?
Silverman:It will mean several things. The local ordinance-related part of our project has become about enhancing democracy, as well as policy surveillance. We plan to eventually make our database of ordinances available to the public. This process also has shed more light on how under-resourced our local governments and public health agencies are, especially in rural communities. For the Grand Challenge effort more generally, our project has resulted in peer-reviewed publications in major substance use-focused journals and numerous posters and presentations at local, national, and international conferences. We continue to develop manuscripts for publication, we are creating issue briefs, maps, reports, and articles for the general public, and we are in the process of developing several grant proposals to further our research efforts. For the larger public health law community, we know we’re going to be able to build on the approaches developed by colleagues like Jennifer Ibrahim in her research in Nebraska and offer some new insights into methods for conducting local legal epidemiology research. Hopefully, we will advance the discussion about the effects of local law on health outcomes.
PHLN: What are some of the opportunities for this research?
Silverman: The mapping process will be valuable in and of itself. It will allow us to compare how different jurisdictions in the state are (or are not) using local law to address similar problems. Thanks in part to the Regenstrief Institute, Indiana has some of the most robust health informatics systems in the country. Once we have these ordinances catalogued and analyzed, we will then be able to work with our social science and health services research colleagues, as well as community and state collaborators like the state health departmentexternal icon, Family and Social Services Administrationexternal icon, and Management Performance Hubexternal icon, to merge our law databases with available health and other data to assess the variations in effects that local policies may have on the lives of vulnerable Hoosiers.
PHLN: What are the challenges to scanning all the local ordinances that impact public health? How do you work to overcome these challenges?
Silverman: First, there are the logistical and technical obstacles to overcome. Who in local government has copies of all the local ordinances? We have found that the most reliable collaborator in the counties have been the county auditor. So, when we reach out to a community, we need to get in touch with, get buy-in from, and schedule an appointment with that official. Indianapolis is in the middle of the state, and some of these counties are as far as 200 miles away, so you have the travel-related time and resources to consider. When we arrive at the site, the ordinances might be filed away in three-ring binders, stapled, and stowed in individual folders. To scan them, we need to take each ordinance out, carefully remove the staples, scan them, label the scanned file, re-staple the originals, put them back in their folders and then back into the binders—hopefully no worse for wear than when we received them. When we’re done, we leave the local officials with a jump-drive with all the electronic documents on them. We also have to face research-related challenges. One of the biggest issues we’ve run into is that, unlike state or federal laws, which are organized based on the law’s subject matter, local ordinances are filed chronologically. Therefore, we have made the decision that we need to scan all of the ordinances, and we will wait to assess them for relevance in our next project phase.
PHLN: What is the benefit of having the same information collected for every state?
Silverman: We know that laws, as they are created, interpreted, and implemented, significantly affect the ability of people to flourish. And we also know—from situations like the recent measles outbreaks, or smoking and vaping rules, or the regulation of electric scooters—that variations in the substance and implementation of local law can result in significant local variations in health outcomes. If we could systematically collect and understand the content and implementation of local law the way we do health interventions, we can improve our ability to promote evidence-informed and evidence-based policymaking at the local level, as well as at the state and federal levels.
PHLN: What is home rule?
Silverman: Home rule is the delegation of powers down to a more local level. In Indiana, it gives local municipalities more freedom to govern themselves.
PHLN: How has the concept of home rule impacted the project?
Silverman: It significantly complicates the relationship between state law and local law. We have to thoroughly understand and map out what rules apply statewide, which rules allow counties or cities to retain local authority, and when local rules are preempted by state law, etc.
PHLN: What have you learned from the data collection thus far?
Silverman: We have learned a great deal about local government and governance. We’re gaining greater expertise in running complex legal epidemiology projects. We expect to really dig into the data analysis in the new year and are excited to see what we uncover there.
PHLN: What other organizations collaborate with Indiana University’s Grand Challenges program, specifically under the Responding to the Addictions Crisis initiative?
Silverman: There are more than 30 projects currently funded under this initiative, ranging from basic science about pain and its treatment, to data science, to Extension for Community Healthcare Outcomes (ECHO) projects that use telemedicine to connect with and educate healthcare providers treating vulnerable populations in rural and underserved areas, to workforce development and translational research. Collaborators include state and local government officials and agencies, community social service agencies, healthcare providers and systems, and, of course, thousands of community members from across our state.
PHLN: What advice would you give others who might be interested in completing a similar project?
Silverman: This type of project needs significant support for infrastructure, an engaged, interdisciplinary team, and time. You also need to be very careful in how you collect and develop your data. In this area, CDC’s Public Health Law Program has been an invaluable partner to us, helping us train our team members on best practices for legal epidemiology research and answering questions as new issues arise.
PHLN: Where can others interested in your project learn more?
Silverman: You can follow our project on Twitter at @HealthINLaw, learn more about the Addictions Grand Challenge at addictions.iu.edu,external icon and you can always get in touch with me by email.
PHLN: Have you read any good books lately?
Silverman: I really enjoyed Madeline Miller’s Circe, Steve Martin’s Born Standing Up, and The Path to Power, book 1 of Robert Caro’s biography of Lyndon Johnson.
PHLN: Do you have any hobbies?
Silverman: I’m a piano player, and I love playing and listening to music. I enjoy traveling with my family and looking for and going to good and interesting places to eat wherever I am.
PHLN: Is there anything else you would like to add?
Silverman: Thank you for this opportunity. I’m thrilled to be a part of the public health law community and to have had a chance over the last two decades to participate in its growth and development.
Source of original article: Centers for Disease Control and Prevention (CDC) / Public Health Professionals Gateway (tools.cdc.gov).
The content of this article does not necessarily reflect the views or opinion of Global Diaspora News (www.globaldiasporanews.net).
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