Category Archives: Public health law
Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government.
This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.
Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?
Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention].
Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science.
Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.
GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies.
Later today Lisa Simpson, MB, BCh, MPH, president and CEO of AcademyHealth, will moderate a “Washington Update” panel discussion at the sixth annual Keeneland Conference taking place this week in Lexington, Ky. The discussion will focus on issues to watch at the federal level and panelists include Paul Jarris, MD, MBA, Executive Director of the Association of State and Territorial Health Officials; Jeff Levi, PhD, Executive Director of Trust for America's Health; and Robert Pestronk, MPH, Executive Director of the National Association of County and City Health Officials.
NewPublicHealth spoke with Dr. Simpson ahead of the session.
NewPublicHealth: What will your “Washington Update” focus on?
Dr. Simpson: I have the good fortune of moderating a discussion with three important leaders from Washington—Jeff Levi, Paul Jarris and Bobby Pestronk—and we’ll be bringing an update about what is going on in Washington that affects the field of public health and public health services research (PHSR) specifically. We’re going to be talking about the general policy context and the conversation in Washington in terms of budget and priority and tradeoff, but also talking about how we think public health services research is informing the conversation and the kinds of questions that policymakers have.
NPH: How has public health services research evolved in the last few years in terms of informing the conversation?
Study: Chickenpox Vaccine Provides Long-Term Protection
A new study published online in the journal Pediatrics confirmed that the chickenpox (varicella) vaccine is effective at preventing chicken pox, and that the effectiveness does not wane over a 14-year period. One dose provided excellent protection against moderate to severe disease. Consistent protection was important because chickenpox infection in older teens and adults can be much more serious than it generally is in childhood, according to the study author, in an interview with HealthDay. The study data also suggest that the vaccine may also reduce the risks of shingles, another type of infection caused by the chickenpox virus that tends to affect people later in life. The study followed a total of 7,585 children vaccinated with varicella vaccine in their second year of life in 1995 for 14 years to see if they developed either chickenpox or shingles. Read more on vaccination.
EPA Proposes Measures to Cut Air Pollution, Improve Population Health
Based on input from auto manufacturers, refiners, and states, the U.S. Environmental Protection Agency (EPA) proposed new standards for cars and gasoline that will significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. Once fully in place, experts say the standards will help avoid up to 2,400 premature deaths per year and 23,000 cases of respiratory ailments in children. The measures will also prevent 3,200 hospital admissions and asthma-related emergency room visits, and 1.8 million lost school days, work days and days when activities would be restricted due to air pollution. Total health-related benefits in 2030 are expected to be between $8 and $23 billion annually. The new standards will reduce gasoline sulfur levels by more than 60 percent, which will also enable vehicle emission control technologies to perform more efficiently. Read more on environmental health.
New Jersey Bans Children from Tanning Beds
New Jersey Governor Chris Christie signed a bill into law on Monday banning children under 17 from using commercial tanning beds. Tanning before age 35 has been shown to increase the risk for melanoma by 75 percent. The new law also bans children under 14 from getting spray tans in tanning salons, which could impact social norms around young teens wanting to look tan if their friends look tan. Read more on safety.
While twelve states currently have laws regulating sales of electronic cigarettes (known as e-cigarettes) to minors, a new post on the Network for Public Health Law blog calls on more states to restrict sales to minors while the Food and Drug Administration continues their review of the device.
E-cigarettes contain nicotine, but no tobacco and often come in kid-alluring flavors such as chocolate and vanilla. According to the Network post, one small FDA study found carcinogens and toxins in e-cigarettes. Health experts are concerned that the electronic devices may also be a gateway tool for young adults to actual, cancer-causing, tobacco-filled cigarettes.
E-cigarette use has skyrocketed among adults, according to a recent study by researchers funded by the Centers for Disease Control and Prevention. In 2011, about 21 percent of adults who smoke traditional cigarettes had used electronic cigarettes, up from about 10 percent in 2010. Awareness of e-cigarettes rose from about four in 10 adults in 2010 to six in 10 adults in 2011.
State legislatures recently got underway across the country and many will be considering some critical public health law measures, according to a recent blog post from the Network for Public Health Law.
Critical issues include:
- A smoking ban in Kentucky which could stall in committee
- A bill in Kentucky which could restrict the work of local boards of health.
- A law in Ohio that would require health departments to enter into agreements for shared services and to become accredited.
- Read the Network blog post.
- Use the state legislative tracking page from the Association of State and Territorial Health Officials to follow state public health agendas for 2013.
The Aspen Institute’s Justice and Society Program, with funding from the Robert Wood Johnson Foundation, is accepting applications for a new project, the Excellence in State Public Health Law program.
The one-year program will bring together and provide resources to teams in eight states to work together to address their respective public health priorities, such as tobacco control and disaster preparedness. At the program’s conclusion, each team member will be recognized as a Fellow in the Excellence in State Public Health Law Program.
As the application process begins, NewPublicHealth spoke with Meryl Chertoff, JD, Director of The Aspen Institute’s Justice and Society Program, and program director of the Excellence in State Public Health Law Program, and Leah Devlin, DDS, MPH, former health official of North Carolina and a past president of the Association of State and Territorial Health Officials, who is a consultant to this program.
NewPublicHealth: Tell us about the program.
Meryl Chertoff: The post-Affordable Care Act period is an excellent opportunity to focus on public health innovation through state legislative and regulatory activities. The goal of the program is to provide key people working in public health law with additional tools, networks and opportunities to share best practices and innovations in their state. Especially in a time of economic shortfalls, we have to do more with less. We have to support legislators, advisors to governors and relevant agency officials in their ongoing efforts to use public funds in the smartest way and to build the partnerships that they need in order to effectively leverage the assets that are available to them. We are very much hoping that the initiatives that are undertaken will utilize evidenced-based research in order to improve public health
Leah Devlin: And it’s about building partnerships, which is important in this environment because there are so many new governors, new legislators, and new state health officials. We have our biggest health gains when we develop a sound health policy. So bringing together these high level leaders within a state who may be working together on a public health issue for the first time will be a very powerful approach. It is important to note that the teams can also include local health directors who are also critical players for successful health policy development in states.
NPH: Who will be part of the teams?
A new study funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation at Temple University, addresses the consequences of weak penalties for domestic violence offenders in the U.S.
Domestic violence, also known as intimate partner violence, accounts for an estimated 1,200 deaths and two million injuries among women each year. The new study, authored by Frank Sloan, PhD, professor of health policy and management at Duke University, and published in the journal Risk and Uncertainty, reviewed data from the North Carolina administrative courts and found that there are often repeat offenses for men arrested for domestic violence and that penalties don’t seem to significantly reduce repeat arrests or convictions.
Sloan points to low prosecution rates and minimal fines as reasons behind many repeat offenses. The study did find, however, that defendants who hired a private lawyer are less likely to be arrested or convicted during the follow-up period because the added costs may be a deterrent.
The keynote address at last week’s 2013 Public Health Law Research (PHLR) annual meeting was from Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.
“People are just beginning to wake up to the knowledge that behavioral health [issues are] so common and that half of all Americans have a mental health issue at sometime in their lives,” Hyde told meeting attendees. Depression, according to the World Health Organization, is the most common medical disorder worldwide. And among the eight million people in the past year who had a mental illness or a substance abuse disorder, only 6.9 percent received treatment.
“The country has to spend as much time helping children develop their emotional skills as they do their soccer skills,” said Hyde.
Just prior to the PHLR meeting, NewPublicHealth spoke with Administrator Hyde about public health law research and some new initiatives aimed at helping address behavioral health in the United States.
NewPublicHealth: What research is critically needed on mental health issues to help improve awareness and treatment?
Pamela Hyde: Often people don’t think of behavioral health as part of the larger public health message or initiatives or infrastructure in the country and so they don’t think about mental health research when they think about other kinds of public health research. But you can think about behavioral health needs in the same way. It is just important to protect people from lost hope as it is to protect them from bacteria in the water.
Thomas Farley, MD, MPH, Health Commissioner of the New York City Department of Health and Mental Hygiene, is the keynote speaker at the opening session of the Public Health Law Research annual meeting that started yesterday afternoon in New Orleans. In advance of the meeting, NewPublicHealth spoke with Dr. Farley about the role of legal research in moving the public health agenda forward, how New York City is doing in the weeks following Hurricane Sandy, and the flu epidemic hitting the city that prompted New York State Governor Cuomo to declare a public health emergency earlier this week.
NewPublicHealth: What will you focus on during your address at the Public Health Law Research Program annual meeting?
Dr. Farley: I will be going through a number of policies that we have put in place here in New York City to promote health. Most of those will be around food, but some will be around tobacco. So that includes things such as our raising of tobacco taxes, our smoke-free air rule and around our prohibition on the use of trans fats in restaurants, our calorie labeling initiative and our portion rule [limits on beverage sizes at some food outlets]. And I will share some thoughts about the role researchers can play in policy development for an agency like ours.
NPH: How important has legal research been for some of the recent public health initiatives that have been introduced in New York City?
Citric acid-based drinks have been linked to devastating tooth erosion, especially in Central Appalachia where the drinks are widely consumed by people of all ages. The issue was selected for a five-minute “Critical Opportunities” presentation that garnered more votes than any other issue in the session at the most recent Public Health Law Conference. This year, the issue has moved to a general session on the main day of the Public Health Law Research (PHLR) Annual Meeting, as an emerging issue in public health law. Priscilla Harris, JD, an associate professor with the Appalachian School of Law in Grundy, Va., will present “Finding Legal Interventions to Impact Purchase and Consumption of Sugar-Sweetened Beverages and Citric Acid Drinks: Trying to undo the damage of the Dew.”
According to the American Dental Association, 65 percent of West Virginia's children ages three through seven suffer from tooth decay—and near-constant sipping of Mountain Dew and other citric acid-based drinks plays a role. Harris, together with Dana Singer, JD, a program developer and researcher at the Mid-Ohio Valley Health Department and Mary Beth Shea, a dental hygienist with the health department, spoke at an information session to the Mid-Ohio Valley Board of Health a few weeks ago to present the research they have worked on to show the damaging health effects of the beverages for the people of the region. NewPublicHealth spoke with the three public health professionals just before the PHLR annual meeting began.
NewPublicHealth: What research are you working on to look at the impact of citric acid on tooth health?
Priscilla Norwood Harris: We conducted surveys to determine purchase and consumption patterns for sugar-sweetened beverages and citric acid drinks. We also interviewed and sent surveys to dentists in Central Appalachia about their perceptions of oral health problems in the region. We also went to five clinics that offer medical, dental and vision care to low-income people, and asked patients about these drinks. In addition, have almost 2,000 surveys of students in grades K through 12. We have also reviewed journal articles, many from Europe, that examine the issue of dental erosion. While it’s under the radar here in America, the studies we’ve reviewed are making the connection between dental erosion and the citric acid in drinks.
A lot of the attention in the U.S. has been focused on the sugar in these drinks and their contribution to obesity as well as the sugar with regard to oral health and cavities. Unfortunately, the acids in these drinks and the connection to dental erosion have been almost ignored. “Mountain Dew Mouth,” a term used in Central Appalachia for severely damaged teeth, involves the acids in these drinks, which can take away the tooth’s enamel.
Mary Beth Shea: From a dental health professionals’ perspective, we see a high number of adults who have said they didn’t have a clue that the beverages they’re consuming are causing the damage in their mouth and they haven’t had money for dental care.