Public health protections affect our health in countless ways, but they often operate in the background. In 2019, several moved to the forefront. Here are five that had the greatest impact.

1. The Epidemic: Opioids

While the opioid epidemic was not a new public health concern in 2019, it was the year when awareness moved into action. In August, an Oklahoma judge ordered New Jersey-based pharmaceutical company Johnson & Johnson to pay $572 million (later reduced by more than $100 million to reflect a mathematical error), in response to allegations that the company had contributed to the opioid crisis. It was the first case to go to trial of the thousands of similar cases brought against pharmaceutical companies and helped influence strategies for the similar cases that followed.

Beyond lawsuits against pharmaceutical companies, in October, an Eastern District of Pennsylvania judge ruled that the federal Controlled Substances Act did not prevent a nonprofit organization from opening a supervised injection site in a Philadelphia neighborhood ravaged by the opioid epidemic. Additionally, in September, the U.S. Department of Health and Human Services announced that $1.8 billion of federal funding would be provided to states to help combat opioid addiction.

2. The Outbreak: Measles and the anti-vaccine movement

In 2019, the conversation surrounding mandatory vaccination requirements for schoolchildren received renewed attention and made its way onto the priority list of many state legislatures. The “anti-vax movement” drew scorn both nationally and internationally as 2019 measles outbreaks threatened to strip the United States of its status as a “measles free” country. By early December, the Centers for Disease Control and Prevention had recorded nearly 1,300 cases of measles in 31 states, the greatest number recorded since 1992. The outbreaks were largest in areas where groups of people were unvaccinated.

To combat these outbreaks, the states of Washington and Maine passed legislation that removed the personal belief exemption for the measles, mumps, and rubella (MMR) vaccine requirement in schools. In June, New York eliminated the religious exemption to the vaccine requirement for all students in public, private and parochial schools.

3. The Tech Industry: High-tech health care

With reports that Americans spent approximately $3.65 trillion on healthcare in 2018, tech companies took notice and invested their resources heavily in healthcare.

In September, Amazon launched Amazon Care, a primary-care clinic available for Amazon employees in Seattle, that offers in-person, telemedicine, and prescription services, as well as options for at-home visits. Then in November, Google announced a partnership with Ascension, the country’s second-largest hospital system, to store and analyze medical data in the hopes of improving medical care. The partnership has led to the testing of software that allows medical providers to search a patient’s electronic health record by specific categories and also allows the provider to create charts to display the data, giving providers a clearer representation from which to glean patterns or problems.

In 2019, Apple revealed three new large research efforts, which will allow participants, through an Apple-device-supported application, to quickly and accurately share information with researchers from major research institutions.

The first completed study, “Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation,” was published in November in the New England Journal of Medicine. The “virtual study” did not require the more than 419,000 participants to go to a clinic or hospital to be monitored, but instead used sensors on the Apple Watch to detect the amount of blood flowing through the wrists to check for abnormal heartbeat, called atrial fibrillation. The information was then delivered to the participants’ iPhones and Apple Watches.

4. The newest promise and threat: home genetic testing

2019 was the year that brought the conversation about genetic testing to the forefront of consumers’ minds. In February, the home DNA-testing company 23andMe revealed that it had secured approval for a new genetics-based screenings, allowing the company to provide users with risk assessments for specified diseases. Robert Green, a medical geneticist at Brigham and Women’s Hospital in Boston, noted that the genetic screening tests used by these companies “are typically not as complete as the genetic testing you receive from your doctor.”

Early in the year, FamilyTreeDNA, one of the country’s largest at-home DNA-testing companies, admitted to users that it shared DNA data obtained through its tests with federal investigators working to solve crimes. The announcement sparked a debate over the privacy and ethical ramifications of a private company having access to and ownership of extensive genetic and personal data.

In December, Department of Defense officials issued a warning that many DNA testing companies were targeting military members with promotional discounts for testing kits. The warning noted that these kits have not been reviewed or approved by the Food and Drug Administration and advised military personnel that taking these tests could create security risks for those whose data are collected.

5. The Payers: Medicare for All

The issue of universal health care coverage grew steadily in prominence during the year. In February, Rep. Pramila Jayapal, Democrat of Washington, introduced legislation to create a system of “Medicare for all” by eliminating the program’s requirement that recipients be age 65 or older and dispensing with copayments, premiums, and deductibles. Proposals along these lines drew considerable attention among Democratic presidential candidates. Senators Elizabeth Warren and Bernie Sanders stood behind the concept of Medicare for all, including the elimination of private insurance, while other leading candidates like Joe Biden and Pete Buttigieg called for more modest reforms and objected to the elimination of private insurance.

These five developments in public health will continue as important issues in 2020, and they will affect all of us in one way or another for years to come.

Mara Smith is an associate general counsel for Brighton Health Plan Solutions, LLC, a third-party administrator and health plan management innovator operating on the East Coast.