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Equity First: Conceptualizing a Normative Framework To Assess the Role of Preemption in Public Health

Preemption is a legal doctrine whereby a higher level of government may limit or even eliminate the power of a lower level of government to regulate a certain issue. Based on the findings of a literature review and consultations with experts in relevant fields, this article highlights how preemption has both created and alleviated health inequities. It proposes the development of an equity-first preemption framework to establish evidence-based criteria for assessing when preemption will enhance or inhibit equity and a research agenda for developing the evidence necessary to inform and operationalize the framework. An equity-first reconceptualization of preemption can help ensure that local governments remain places of innovation while allowing states and the federal government to block local actions that are likely to create or perpetuate inequities.