The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

In August 2005, the Competitive Enterprise Institute , a conservative advocacy organization, filed a lawsuit in Louisiana challenging the legality of the 1998 Master Settlement Agreement . The suit alleges that the MSA, under which the states receive monetary payments and the four major tobacco companies are insulated from price competition, violates the Compact Clause and other provisions of the U.S. Constitution. This lawsuit threatens to unravel of one of the most significant opportunities to improve public health in United States (...) history. We consider the merits of the lawsuit, the problems with the MSA that it highlights, and the potential consequences of the suit for public health. (shrink)

In August 2005, the Competitive Enterprise Institute, a conservative “think tank” and advocacy organization, filed a lawsuit in the Federal District Court for the Western District of Louisiana against the Louisiana Attorney General challenging the legality of the 1998 Master Settlement Agreement. If successful, this lawsuit could lead to the unraveling of one of the most significant opportunities to improve public health in United States history.Under the MSA, forty-six states agreed to end their litigation against the four largest tobacco companies (...) in the United States, who in turn agreed to pay the states an estimated $206 billion. The CEI alleges that the MSA is unconstitutional. Specifically, the suit alleges that the MSA established a cartel under which the states receive monetary payments and the four major tobacco companies are insulated from price competition – and that this arrangement violates the Compact Clause of the U.S. Constitution. (shrink)