In a special edition of the Journal of Law, Medicine, and Ethics (JLME) featuring the National Public Health Law’s 2025 Conference, ChangeLab Solutions senior attorney, Jami Crespo, co-authored two timely articles. The first article examines the erosion of public health protections and equity-focused policies in recent Supreme Court rulings. The second explores the critical role of public trust in public health data modernization.
The Detrimental Shift: How the Judiciary is Eroding Our Health
For more than a century, US courts generally deferred to public health authorities, recognizing their expertise and the necessity of swift, science-based action to protect population health. This deference supported legal interventions that substantially increased life expectancy, reduced morbidity, and advanced health equity. In recent years, however, courts — particularly the Supreme Court — have retreated from this approach. Specifically, Supreme Court–driven doctrinal shifts favoring free exercise challenges, limiting deference to administrative agencies, and undermining equal protection have eroded public health authority and constrained governments’ capacity to protect health and improve equity.
Drawing on an empirical review of 30 lawsuits filed between January 2024 and May 2025 challenging governmental and institutional health equity initiatives, the article demonstrates that the majority of these cases resulted in the invalidation or abandonment of equity-focused policies. These findings illustrate how contemporary judicial rulings are limiting governments’ and institutions’ authority and ability to safeguard health, particularly the health of our most vulnerable and marginalized populations. The paper concludes with a call to action: a coordinated public health strategy to build and sustain a jurisprudence that supports the fair, effective, and evidence-based exercise of public health authority.
Trust, Transparency, and the Fragile Promise of Data Governance in the Era of Modernization
Public health data modernization in the United States has accelerated since COVID-19 exposed systemic weaknesses in fragmented data infrastructure and governance. Technical solutions have advanced, but legal and relational barriers still complicate data sharing across jurisdictions. Traditionally, interjurisdictional data sharing has relied on individually negotiated Data Use Agreements (DUAs), a process that is both resource-heavy and often opaque. To address this, the Centers for Disease Control and Prevention have proposed a Core DUA to standardize terms and reduce the administrative burden. However, its success depends on trust — a fragile foundation increasingly strained by politicization, perceived lack of transparency, and controversial federal actions involving sensitive data.
Jurisdictional concerns about compliance, security, and misuse underscore the need for governance frameworks that prioritize clarity, reciprocity, and accountability. Coercive approaches risk deepening fragmentation and undermining collaborative governance. Ultimately, modernization efforts will fail without supporting trust as the cornerstone of public health data governance. This article examines legal variation, transactional friction, and evolving jurisdictional perspectives to illuminate the critical role of trust in shaping the future of public health data systems.
4/16/2026