This Article thus expands the extant literature by considering the legal and ethical dimensions of wastewater surveillance more thoroughly and more broadly. It arrives at an auspicious time, as the United States moves into a vaccine-mediated phase in which COVID-19 is less likely to give rise to broad stay-at-home orders and more likely to trigger narrower, more targeted interventions. It seeks to offer guidance for the legal and ethical use of wastewater surveillance along two dimensions. The first dimension considers the circumstances under which wastewater monitoring should be deployed for detecting and responding to COVID-19 specifically. The second dimension zooms out, to consider whether and how this surveillance infrastructure, largely created in response to the COVID-19 pandemic, might be deployed for other uses, and examines the legal and ethical difficulties that may attend these broader uses.

 Natalie Ram, Professor, University of Maryland Carey School of Law
Lance Gable, Professor, Wayne State University Law School
Jeffrey L. Ram, Professor, Department of Physiology, School of Medicine, Wayne State University

This Article examines the use of minimum age cutoffs to define eligibility for social insurance, public benefits, and other governmental programs. These cutoffs are frequently used but rarely examined in detail. In Part I, I examine and catalogue policies that employ minimum age cutoffs. These include not only Medicare and Social Security but also other policies such as access to pensions and retirement benefits, eligibility for favorable tax treatment, and eligibility for discounts on governmentally provided goods and services. In Part II, I examine different rationales underlying eligibility and discuss the imperfect fit between these rationales and the use of age cutoffs, as well as the likelihood that cutoffs will exacerbate disparities and disadvantage those with atypical life plans. In Part III, I consider different ways that age cutoffs might be reformed. One, the most realistic, is the option proposed for Medicare: extending eligibility downward to people earlier in life. But other options exist as well. One option, often advanced by those further to the political left, would completely eliminate age-based eligibility cutoffs in favor of universal programs such as Medicare for All. Another option would adjust age cutoffs upward or downward based on factors like geography or occupation, rather than basing eligibility on a one-size-fits-all cutoff. Yet another would replace age-based eligibility cutoffs with eligibility time periods, which are limited but can be started and ended flexibly: people could give up some eligibility time later in life in order to receive access during earlier periods.

 Govind Persad, Assistant Professor, University of Denver Sturm College of Law

In Part I, this Article examines the health justice framework through which laws are understood as determinants of health equity. In Part II, this Article argues that when unaddressed for low-income individuals, legal needs serve as social determinants of health. Applying the health justice framework, the Article examines the major domains of social determinants of health (“SDOH”) and identifies areas of law for which unmet legal needs contribute to poor health and health inequity. Specifically, it analyzes how the five major domains of SDOH of the Healthy People 2030 paradigm of the U.S. Department of Health and Human Services (“HHS”) implicate legal issues in the fundamental area of human need identified as critical for access to counsel by the ABA. This Part explores the exacerbation and urgency of these challenges created by the pandemic and examines racial inequities driven by structural racism that create a compounding burden of health disparities for people who are both low-income and people of color. In line with the health justice framework’s exploration of how law can be leveraged to mitigate inequities, Part II concludes by examining how legal representation can address fundamental legal needs that affect health, providing support for access to counsel in these areas.

Finally, in Part III, this Article engages with potential critiques of an emphasis on individual legal representation as a downstream and overly individualistic approach to health justice. This Part addresses these critiques and argues that individual legal representation to enforce extant laws is required for health justice to address the immediate, health-harming legal issues affecting individuals from marginalized communities and improve their health and well-being. However, even though such individual legal advocacy is necessary, it is insufficient. Instead, legal representation should be used as a platform for advocacy in pursuit of structural change through law, policy, and systems reform. This Article proposes a multitiered, integrated clients-to-policy approach for lawyers to facilitate health justice to improve the health of individuals and pursue structural reform to address health equity up-
stream.

This Article takes a closer look at digital contact tracing in the United States during the coronavirus pandemic and why it failed. It begins by explaining the shortcomings of traditional analog methods and the resulting need for digital contact tracing. It then turns to the norms regarding consent, the scope of the data collected, and the limits on subsequent use necessary for cooperative surveillance. We argue that any successful digital contact-tracing program must incorporate these elements. Yet while necessary, those strategies alone may not be sufficient. People justifiably lack trust in public health authorities, in new technologies, and in the tech industry itself. Consequently, we conclude that public health authorities must do more than simply seek consent, minimize collection, and prohibit subsequent use. They must take proactive steps to establish public confidence in digital contact tracing.

Emily Berman, Associate Professor & Royce R. Till Professor, University of Houston Law Center

Leah R. Fowler, Research Assistant Professor and Research Director of the Health Law & Policy Institute, University of Houston Law Center

Jessica L. Roberts, Professor of Law, Leonard H. Childs Chair in Law, Professor of Law, and Director of the Health Law & Policy Institute, University of Houston Law Center