This article explores the connection between health and democracy, positing that public health is rooted in political decisions and that improving health outcomes and advancing health equity requires strengthening inclusive, representative democracy. It describes the relationship between civic health, civic and voter participation, power, and health outcomes, and demonstrates that communities with higher rates of civic and voter participation are linked to better population health outcomes. The authors assert that public health practitioners have the opportunity and the responsibility to improve health by democratizing their practice and supporting policies and approaches which strengthen civic health and promote civic and voter participation. The authors also provide detailed stories from two health agencies — Wisconsin and Minnesota — illustrating these efforts in action and offer several strategies for how practitioners can incorporate this work into their scope of practice.

Dantuluri examines the ongoing prescription stimulant shortage driven by the Drug Enforcement Administration’s quota restrictions and an ineffective and fragmented system of drug governance. We extend this analysis to carceral health systems, which operate under similar logics of control in managing risks, diversion, and liability around medications for opioid use disorder. In drawing these parallels, we explore how perceptions of risk, suspicion, and restrictive oversight can produce scarcity, reinforce stigma, and elicit judgments around “deservingness” that may ultimately widen treatment gaps. We conclude with actionable recommendations that align with public health ethics to promote equitable access to evidence-based treatment.

What does it mean to be a citizen? To be equal in birth and stature as others born in the same land? How does law answer these questions and are the answers satisfying? Have the goalposts of citizenship shifted such that old, exlusionary notions of citizenship based on wealth, race, and sex now dangerously infect our society? These questions and this Essay are derived from the 2025 Presidential Address given at the Law and Society annual meeting.

Drug overdose and drug-related harm are major sources of preventable injury and death in the United States. The criminalization and stigmatization of people who use drugs continues to inform law and policy that is ineffective at preventing this harm. While harm reduction interventions such as syringe services programs (SSP) have been widely adopted, the laws that govern these programs often impose restrictions that make SSP operation more difficult and less effective. For example, 23 state permit SSPs to operate only if they receive authorization from state or local government officials, and 5 states continue to adhere to some version of a “one for one” exchange model. This article presents data on these and other state laws that impede the work of SSPs. It also highlights ways the experience and expertise of people who use drugs can be integrated into the creation and implementation of SSP operational models. Removing barriers to these life-saving programs is critical to decreasing drug-related harm.

The 2025 Public Health Law Conference theme — Connection. Collaboration. Community. — acknowledges this critical time in public health — a time when survival and progress both require working together to best leverage laws and policies. This symposium issue of the Journal of Law, Medicine & Ethics is dedicated to an examination of some of the critical topics discussed at this conference.

What does conducting law and society scholarship have anything to do with wilting blooms? In this essay, Lynette J. Chua makes the connection between the two through her reminder to law and society scholars to study the taken-for-granted, an intellectual project that has become all the more urgent as politicians and activists contest concepts such as citizenship, gender, territories, religion and rights. She also calls upon fellow law and society scholars to be humble – for the significance and impact of our research, like flowers, could come and go with the seasons.

When a prospective participant in clinical research appears perhaps to lack decision-making capacity, many investigators do a capacity evaluation themselves, and if the person lacks capacity, reach out to the next of kin, presuming them to be the legally authorized representative (LAR) to consent (or not) on that person’s behalf. However, that approach often does not actually comport with applicable law. This article begins with some history, explaining how, if there is no state law specifically governing clinical research, Institutional Review Boards have been instructed to base their policies concerning capacity determination and surrogacy selection on that jurisdiction’s laws governing ordinary healthcare. A deep dive into many states’ statutes reveals a remarkable, hitherto largely unrecognized diversity of provisions that, in turn, create unexpected legal and ethical hazards for investigators whose research participants may lack capacity. Several potential resolutions are suggested.

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 paper 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.

Disaggregation of public health data by race and ethnicity is critical to understanding health disparities and driving progress toward health equity. While the federal government updated the minimum set of categories federal agencies must use when collecting race and ethnicity data, implementation of these standards remains uncertain. Additionally, federal standards set a floor; states can adopt laws requiring additional data collection specific to their population. As of May 2025, 13 states have passed laws to require disaggregation of race and ethnicity. One state – New York – is implementing the Asian and Native Hawaiian/Pacific Islander (NHPI) Data Disaggregation Law. Challenges include finding effective pressure points for the state agencies that are required to update data and helping agencies access funding for necessary changes. In California, the 2024 Latine and Indigenous Health Disparities Act builds on previous data disaggregation legislation for the Asian and NHPI community in California. Challenges with the bill’s adoption included pressure to narrow the agencies affected by the law and creating an appropriate implementation timeline. Key considerations in the adoption of a state data disaggregation law or policy include educating policymakers about the importance of data disaggregation, determining the scope of the policy, and preparing for implementation.

When returning to their communities after incarceration, individuals face elevated rates of mortality and other poor health outcomes. The reentry period provides a critical opportunity for interventions to improve health, but, historically, a prohibition on federal Medicaid coverage during incarceration has created barriers to care after release. To address these barriers, many states have applied for Medicaid section 1115 reentry waivers to expand access to Medicaid coverage for certain pre- and post-release services. These waivers present an important opportunity to improve care access during reentry, but, if driven by carceral entities, they run the risk of replicating carceral systems that harm health. This article advocates for an alternative approach: centering the perspectives of people with lived experience of incarceration in all aspects of waiver design, implementation, and evaluation. Drawing on personal and professional experience, the authors explore the value of centering lived experience in health policy and identify successes, challenges, and lessons learned from California’s waiver. This article also explores the importance of centering lived experience in information sharing and privacy practices in waiver implementation. Across these areas, waivers driven by lived experience can promote dignity, autonomy, and wellbeing, dismantling carceral approaches that reinforce stigma, erode trust, and perpetuate inequities.

Every US state requires drivers to pass a knowledge and skills examination before obtaining their driver’s license. Surprisingly little is known about the progression of people through the examination process. To date, no research has been conducted on the proportion of individuals who pass from one stage of the driver examination process to the next compared to those who fail and are required to be reexamined. The purpose of this study was to follow the progression of a cohort of new drivers in Washington State as they advanced through the driver examination process. We reviewed driving records for 2,604 teens who started a driver education course in 2024. Of those who attempted the knowledge test at least once, 96 percent passed their knowledge test and 85 percent passed their skills exam. There were significant differences in pass and fail rates by sex, race, and household income. The overwhelming majority of new drivers passed both the knowledge and skills exams after two attempts. The fact that teenagers have a high risk of crashing in the first year of licensure suggests that the full safety potential of the knowledge and skills exams are not being realized.

Employer complaints about rising health care costs have been ubiquitous for a number of years. Survey evidence, though, finds widespread employer shortcomings in the processes they use to select and monitor health plan service providers. The evidence provides a data-driven basis to assess whether employers meet their fiduciary obligations, leading to the conclusion that employers need to increase their diligence or face the possibility of significant liability. The increased diligence may also mitigate health care costs.

In their article Objective Standards of Medical Judgment: A Myth of Abortion Law, Graber et al. explore the different legal standards for evaluating if a physician properly offered abortion care under a medical exception to states’ abortion restrictions. While this piece focuses tightly on the use of legal standards to limit access to abortion care, it should be understood in the broader context of a legal and political environment that is increasingly shifting the locus of medical decision-making power from the medical profession to state actors. We agree with Graber et al. that physicians should use their voices to speak out and educate the community on the medical decision-making process. But we are concerned that some state and legal actors are intentionally looking to improperly encroach upon the practice of medicine.

This essay compares and contrasts the disciplines of sociology and law and society. I then outline how sociology can enrich law and society with stronger theory-building and better linkages of theoretical frameworks to empirical data. I next consider how law and society can enrich sociology, including by encouraging sociologists to take seriously law’s constitutive nature and to engage more directly with their work’s normative implications. Throughout, I draw primarily on research on U.S. immigration enforcement, which is both my area of study and a site of rich cross-pollination between the two fields.