How do major
judicial rulings impact
health and equity?

United States v. Daniels challenged a long-established federal law, § 922(g)(3), that prohibits users of illegal substances from possessing guns. The U.S. Fifth Circuit Court of Appeals reversed a lower court ruling that convicted Daniels of possessing a gun while using cannabis. This court ruled the federal law unconstitutional as it applied to this case because the government failed to demonstrate how Daniels’ conviction aligned with a historical tradition of gun regulation. This case raises questions about the association between cannabis and other controlled substance use and violent behavior, and implications for public health and equity. This decision may have bearing on future challenges to firearm regulation, including § 922(g)(3), as courts consider what traits make an individual sufficiently dangerous to be legally prohibited from possessing a firearm.

The impact that United States v. Daniels has on equity is unclear. Decriminalizing certain types of substance use and contemporaneous gun possession could lead to reduced police activity in overpoliced communities. There is some evidence that “recreational marijuana laws” have led to a decrease in cannabis possession arrests, but other findings have shown that Black and other minoritized communities continue to be disproportionately arrested, charged, and convicted of cannabis-related offenses. It is therefore unclear whether reducing the potential for cannabis-related charges related to firearm possession will improve equity for Black and other minoritized Americans frequently targeted by law enforcement.

The potential association between cannabis use and increased violence by the user, however, could result in Daniels exacerbating health inequities. Increases in supplies of guns could lead to more violence in communities already disproportionately affected by gun violence. Further research to understand underlying mechanisms and sociodemographic impacts are warranted. 

There is strong evidence that Black men in cities, residents of economically distressed urban communities, victims of intimate partner violence, and areas with illicit narcotics markets are disproportionately impacted by gun violence. The risks these groups and communities face are often exacerbated by, or occur alongside, controlled substance use by perpetrators and/or victims of gun violence.

There are evidence-based strategies focused on who can own firearms, including Firearm Purchaser Licensing, or permit-to-purchase laws, and Domestic Violence Protection Orders and Extreme Risk Protection Orders. Promoting the adoption and strong implementation of these policies is one action that everyone can take to reduce the potential negative health and equity impacts of this case.

In June 2024, the United States Supreme Court ruled that cities can penalize unhoused individuals for sleeping in public, even if there are not enough shelter beds available. This decision reversed a previous court decision and sided with the City of Grants Pass and their ordinances, which prohibited individuals from using cardboard boxes, pillows, and blankets while sleeping in public property within city limits. This ruling overturned previous jurisprudence which ruled that the ordinance was unconstitutional as applied to homeless individuals, finding that it violated their constitutional right to be free from cruel and unusual punishment under the Eighth Amendment. Writing for the majority, Justice Neil Gorsuch argued that while the Amendment “serves many important functions, [it] does not authorize federal judges [to] dictate this Nation’s homelessness policy.” This decision from the nation's highest court effectively criminalizes homelessness and may exacerbate public health issues among an already underserved population.

The analysis found homelessness and lack of stable shelter presents myriad challenges to caring for one’s physical and mental health, in part due to exposure to the elements; lack of sanitation; inability to rest or get quality sleep; and lack of access to services, health care, substance use treatment, healthy foods, and other resources related to poverty. Homelessness is linked to increased rates of mortality from preventable causes, such as overdose, infectious diseases, exposure to extreme weather, violence, and cardiovascular disease. It also found a strong correlation between homelessness and increased rates of mortality from preventable causes due to significantly reduced access to health care, basic hygiene needs, and unstable environments.

There is strong evidence that minoritized groups, particularly members of the LGBTQ community who are also either Black or multiracial, will be heavily impacted by this ruling. Sexual and gender minority youths are disproportionately affected by homelessness, with 28% of LGBTQ youth reporting ever having experienced homelessness or housing instability. Identifying as both bisexual and either Black or multiracial tends to compound the risk of homelessness. These individuals are more likely to experience homelessness as minors and are less likely to have recently used emergency shelters or transitional housing.

This Hopkins Judicial Health Note does not focus on reasons that people may experience homelessness; however, in considering the health impacts of this case there are important points to consider. Lawmakers must address the issues that are leading to increased rates of homelessness, address the lack of affordable housing, and implement strategies to improve access to care for people experiencing homelessness. Changing the way we approach the issue of homelessness in the country can significantly improve health outcomes for communities across the nation. In addition, individuals and organizations interested in this issue should:

• Advocate for avoiding involuntary displacement to mitigate health harms, and promote viable alternatives.  
• Partner with people who experience homelessness in local efforts to avoid involuntary displacement and creating and implementing feasible solutions to address homelessness.