Municipal laws and policies affect the social, economic, and legal conditions of civic and private lives of immigrants in profound ways, including both direct access to health services, as well as broader social determinants, such as employment, housing, education, transportation, and law enforcement.

Municipalities (counties and cities) range widely from being hostile to or welcoming of immigrants (both documented and undocumented). On the more welcoming end of the spectrum are what are often referred to as “sanctuary cities,” which limit cooperation with federal immigration law enforcement, beyond prosecuting violations of state and local criminal laws.

However, at least nine states have laws that pre-empt local municipal protective laws and policies in some fashion because of political and social controversies over enforcement of federal immigration laws.

Using rigorous mixed methods, the research team will systematically examine the consequences of state preemption of protective municipal laws and policies on the health and well-being of immigrants. There are three main components to the project:

1. A national legal analysis of state pre-emption laws;
2. A profile of municipal laws and policies affecting the Culture of Health for immigrants; and
3. Community-focused qualitative research of the effect of state pre-emption on the Culture of Health for Latinx immigrants in municipalities previously identified as sanctuaries.

The findings have the potential to help inform states that are debating the adoption of pre-emption laws and those that have pre-empted protective municipal laws and policies with identifying and possibly mitigating any potential detriments to health and well-being.

Local governments are often on the forefront of enacting innovative public health policy, and local control over public health issues is especially vital to address social inequities. Pre-emption removes the ability of local governments to enact these laws and may hinder public health policy adoption and diffusion within a state and across the country.

Although pre-emption is increasingly being used as a policy tool, it is unclear whether states are pre-empting local control over four policy domains—tobacco control, firearm safety, paid sick days, and food and nutrition policy—while simultaneously not enacting state-level laws. Nor has there been research into which states are more likely to pass pre-emption and which populations are most affected by state pre-emption of public health policies.

The research team will address the following five critical knowledge gaps:

1. Are states pre-empting evidence-based policies related to tobacco control, firearm safety, paid sick days, and food and nutrition policies?
2. Are states that pre-empt evidence-based policies simultaneously enacting evidence-based policies or, alternatively, not acting while pre-empting the ability of communities to enact evidence-based policies?
3. Which legislative policy strategies are being used by states to pass pre-emptive laws on these public health topics?
4. Which population and state-level characteristics are associated with state pre-emption of public health policies within and across states?

The findings will provide policymakers, researchers, advocates, and public health practitioners with new insights and practical tools to assess the true implications of pre-emption on evidence-based public health policy enactment and diffusion.

State pre-emption is an emerging and highly contentious policy movement with potentially significant consequences on population health. Yet robust analyses to examine whether pre-emption affects health have yet to be conducted. Furthermore, pre-emption’s effect on geographic inequities in health has been largely neglected in policy debates. But it is becoming increasingly clear that state pre-emption laws could reshape the spatial distribution of health, with profound consequences for health care delivery systems and state and local budgets.

The research team will attempt to fill these important knowledge gaps by examining pre-emption policies in labor and economic resources (including minimum wages and paid sick, family, and medical leave) and the physical environment (including natural gas extraction and pesticide use). They will focus on three research questions:

1. To what extent do state pre-emption laws influence birth outcomes and working-age adult health behaviors and mortality?
2. Does pre-emption have disproportionate consequences for the health of certain demographic and geographic populations? (i.e., do the consequences differ by sex, race, education level, or metropolitan status?)
3. Does pre-emption reduce or expand local variation in birth outcomes and working-age adult health behaviors and mortality?

Examining the role of state pre-emption policies on local health outcomes and equity is vital because these policies have the potential to drive large-scale, systemic changes in population health.

For more on this topic:

• "Equity First: Conceptualizing a Normative Framework to Assess the Role of Preemption in Public Health"

Public health practitioners and tobacco control advocates agree that pre-emption (a higher level of government stripping lower levels of government of their authority over a specific subject matter) has an adverse impact on tobacco control efforts. Pre-emptive state laws may prohibit local tobacco control measures, such as restrictions on marketing and promotion of tobacco products, licensure of tobacco products, smoking in public or private sites, and on youth access to tobacco products. These laws prevent local governments from taking action to protect residents from the well-documented dangers of tobacco use and secondhand smoke exposure.

To raise awareness of the risks created by state pre-emption laws on tobacco control, the research team will examine the enactment or repeal of various tobacco control state pre-emption laws between 1997 and 2017 to determine whether these laws are associated with changes in the county-level smoking prevalence among adolescents and adults, as well as the sales of tobacco products. The team will also examine whether majority-minority counties are disproportionately impacted by state pre-emption laws, potentially exacerbating health disparities.