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In response to the opioid epidemic, counties and cities across the United States waged In re: National Prescription Opiate Litigation, better known as the opioid MDL, against manufacturers and distributors of opioids. The county and city plaintiffs appear to have taken their litigation strategy straight from Big Tobacco playbook of the 1990s. This is to the great disdain of state attorneys general, who fronted Big Tobacco litigation with state-sponsored parens patriae litigation. The state attorneys general vehemently assert that the MDL claims are the province of state governments rather than local governments. However, the attorney general-led Big Tobacco litigation of the 1990s left much to be desired. While the states were able to procure a $206 billion tobacco Master Settlement Agreement in 1998, a seemingly enormous win for tobacco victims, the state attorneys general allocated a devastatingly low amount of the proceeds to the intended purposes of smoking cessation programs and public health initiatives. Just like Big Tobacco litigation, a global opioid settlement purported to resolve the MDL claims seems inevitable—and states are eager to undermine local efforts in reaching a settlement. This Note argues that state attorneys general should not be permitted to overthrow settlement negotiations in the county-and-city-led opioid MDL, positioning that counties and cities are better suited than states to implement evidence-based public health initiates in their own communities. Spending shortfalls of the Master Settlement Agreement demonstrate precisely why allocating settlement money to the states guarantees little to no spending accountability. This Note further identifies three reasons why, despite many similarities in the litigation tactics between tobacco and opioids, a global opioid settlement agreement will be far smaller than the $206 billion tobacco Master Settlement Agreement of 1998. Therefore, a smaller settlement would be best utilized by apportioning settlement proceeds directly to the local governments, which are the most impacted by the opioid epidemic.

Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

OBJECTIVE: To examine factors associated with suffering harm from another person's alcohol consumption and explore how suffering such harms relate to feelings of safety in nightlife. DESIGN: Cross-sectional opportunistic survey (Global Drug Survey) using an online anonymous questionnaire in 11 languages promoted through newspapers, magazines and social media. SUBJECTS: Individuals (participating November 2014-January 2015) aged 18-34 years, reporting alcohol consumption in the past 12 months and resident in a country providing ≥250 respondents (n=21 countries; 63 725 respondents). MAIN OUTCOME MEASURES: Harms suffered due to others' drinking in the past 12 months, feelings of safety on nights out (on the way out, in bars/pubs, in nightclubs and when travelling home) and knowledge of over-serving laws and their implementation. RESULTS: In the past 12 months, >40% of respondents suffered at least one aggressive (physical, verbal or sexual assault) harm and 59.5% any harm caused by someone drunk. Suffering each category of harm was higher in younger respondents and those with more harmful alcohol consumption patterns. Men were more likely than women to have suffered physical assault (9.2% vs 4.7; p<0.001), with women much more likely to suffer sexual assault or harassment (15.3% vs 2.5%; p<0.001). Women were more likely to feel unsafe in all nightlife settings, with 40.8% typically feeling unsafe on the way home. In all settings, feeling unsafe increased with experiencing more categories of aggressive harm by a drunk person. Only 25.7% of respondents resident in countries with restrictions on selling alcohol to drunks knew about such laws and 75.8% believed that drunks usually get served alcohol. CONCLUSIONS: Harms from others' drinking are a threat to people's health and well-being. Public health bodies must ensure that such harms are reflected in measures of the societal costs of alcohol, and must advocate for the enforcement of legislation designed to reduce such harms.