Local Public Health Policymakers’ Views on State Preemption: Results of a National Survey, 2018

Abstract

<i>Objectives.</i> To learn about local health policymakers' experiences and responses to preemption-the ability of a higher level of government to limit policy activity at a lower level. <i>Methods.</i> Between March and June 2018, we conducted an anonymous Web-based survey of mayors and health officials in US cities with populations of 150 000 or more. We used descriptive statistics to analyze multiple-choice responses. We analyzed open text responses qualitatively. <i>Results.</i> Survey response rates were 28% (mayors) and 32% (health officials). Nearly all respondents found preemption to be an obstacle to local policymaking. When faced with preemption, 72% of health officials and 60% of mayors abandoned or delayed local policymaking efforts. <i>Conclusions.</i> Preemption is viewed as an impediment across a range of public health issues and may stifle local policy activity (i.e., have a chilling effect). Those working at the local level should consider the potential for preemption whenever seeking to address public health concerns in their communities. <i>Public Health Implications.</i> Local governments should engage with advocates, practitioners, and public health lawyers to learn about successful and failed efforts to meet public health objectives when faced with preemption.