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?

Public Health Law Research (PHLR), a program of the Robert Wood Johnson Foundation, will hold its annual meeting in New Orleans this week. NewPublicHealth will be on the ground covering sessions on research in public health law as well as posting interviews with conference speakers including Thomas Farley, MD, MPH, Health Commissioner of New York City and Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

In advance of the conference, NewPublicHealth spoke with Diana Silver, PhD, MPH, assistant professor of public health at the Steinhardt School of Culture, Education and Human Development at New York University. Silver’s research looks at the impact of public and private services on health and well-being for children and families, especially in urban America. Her presentation at the PHLR annual meeting is called “Are More Laws Better?” with a specific  look at what has happened to traffic fatalities between 1980 and 2009 as new laws have been implemented in some parts of the country.

NewPublicHealth: Tell us about your research on laws and traffic fatalities.

Diana Silver: The motivating idea here was that there are multiple laws at the state level that govern traffic safety. Some deal with alcohol, some deal with restraining children one way or another in the car, some are about the vehicle itself such as seatbelts or speed limits. The laws vary at the state level, and they create, in some sense, really different environments that people are exposed to. We have now categorized across 30 years 25 different laws in all 50 states. 

What we found is that there are some laws that virtually all states have adopted, mostly because there’s been a federal mandate to do so, like a minimum legal drinking age. But many laws vary across states, and so we were interested to find out what factors predicted whether a state would pick up new laws and how quickly they would do that. Then, how do these different packages predict, or are they associated with reductions in motor vehicle fatalities?

NPH: How was your research different than other research that looks at this data?

Public Health Law Research, a national program of the Robert Wood Johnson Foundation housed at the Temple University Beasley School of Law, recently released a new, comprehensive online portal called LawAtlas that allows users to explore variation in laws across U.S. states and over time. Having more information about state laws, and their effect on health over time, is a critical step toward understanding what works to improve health. LawAtlas offers:

• Interactive Law Maps to show how certain laws differ by state and how they have changed over time.
• Policy Surveillance Reports to summarize the state of various public health laws across the country
• Data that public health law researchers can work with to expand upon existing research

NewPublicHealth caught up with Damika Webb, JD, Law Fellow at the Center for Health Law Policy and Practice at Temple University, at last week’s APHA Annual Meeting to chat about LawAtlas and how it can be used to better understand why policy surveillance is critical, and what we can learn from a program like LawAtlas.

NewPublicHealth: Why is it important to conduct research to know whether particular laws and policies are working to improve public health?

Damika Webb: By measuring the dimensions of a law, you can figure out which components of the law are having a positive or negative effect on health outcomes.

NPH: Why is it important to track how public health laws and policies differ from state to state?

While post-tropical-cyclone storm Sandy is still packing some punches in several states, other communities are beginning to clean up, and unearth the lessons learned. One critical lesson: how to get more people to pay attention to evacuation warnings in the next emergency. Many city and state leaders urged community members to heed warnings to evacuate before Sandy hit, to help protect themselves and reduce the risk for first responders. Yet at least hundreds of people, likely more, stayed at home to ride out the storm. Some died and others had to be rescued in in dangerous situations, or after suffering through the worst of the storm. NewPublicHealth asked James G. Hodge, Jr., J.D., LL.M, Director, and Network for Public Health Law, Western Region, about the legal issues surrounding orders to evacuate in an emergency.

NewPublicHealth: Are there laws that require people to heed orders to evacuate? 

James Hodge: Yes, many states’ emergency laws include authorization for mandatory evacuations of affected zones, but enforcement is tough to accomplish. As a result, evacuation orders may be issued, but citizens may choose not to follow them.

NPH: And are there legal consequences for people who don't heed the orders? 

James Hodge: Yes, in some instances. Not only may they place themselves in peril, government may not be legally obligated to rescue affected citizens who remained in place especially if conditions will not allow for safe and effective response efforts. Issues like these arise in nearly every disaster with advance warnings, including hurricanes, floods, and wildfires. Regrettably, some citizens who choose to remain in harm’s way may be negatively impacted. This is a terrible and avoidable consequence of major disasters. Ultimately, governmental efforts to force evacuations, however, are resisted by a minority of persons who are unwilling to leave for varied reasons. Emergency responders and public health authorities seek to assist them to protect their life and health, but are not legally obligated to do so when conditions do not allow for their own safety.

NPH: What’s your best public health guidance for people facing emergencies such as hurricanes?

James Hodge: When authorities issue an order to evacuate, do it! The risks you take in the face of these disasters are too great not to. Safe and effective evacuation is your best option.

A new study out this week finds New Jersey’s law requiring novice drivers to display a red decal on their license plates was effective in helping police officers enforce regulations unique to new drivers, and in preventing crashes. New Jersey is the first state in the nation to enact a decal law, which went into effect in May 2010 as part of N.J.’s Graduated Driver Licensing (GDL) law. Nearly every state has a GDL law on the books, but “Kyleigh’s Law,” named for a teen driver killed in a 2006 N.J. crash, is the first one that helps support enforcement of GDL restrictions using a visible decal.

The study showed that in its first year of implementation, the New Jersey decal law prevented an estimated 1,624 crashes by probationary drivers.  Allison E. Curry, PhD, MPH, director of Epidemiology and Biostatistics at the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia, was a lead author on the study, published in the American Journal of Preventive Medicine. The study was funded by a grant from Public Health Law Research, a national program of the Robert Wood Johnson Foundation.

NewPublicHealth caught up with Allison Curry to get her take on why decals work as a law to help protect the public’s health.

NewPublicHealth: Can you summarize the new study?

Allison Curry: Graduated driver licensing (GDL) was first introduced in the U.S. around the mid-1990s and since then it’s been really effective in reducing the burden of crashes on teens. New Jersey in particular has a really progressive GDL program, and it’s served as one of the models in the U.S. But even so it still has what we would still consider an unacceptable number of crashes each year. So by introducing decals, New Jersey was trying to take their law a step further in improving the effectiveness of their GDL program.

What we wanted to understand was if the decals really did have an additional safety benefit for both adolescents and other road users. The aims were to examine the effect of the decals on both the police’s ability to enforce graduated driver licensing restrictions among probationary or intermediate drivers, as well as the crash rate among intermediate drivers (those who are in the stage between licensed permit holder and full unrestricted driver). We did this by linking New Jersey’s crash and licensing database in order to compare the rate of crashes and citations in the two years before the decal requirement was implemented, compared to the year after it was implemented.

NPH: And what were the findings?

What new laws or changes to existing laws—even simple ones—could dramatically improve public health in communities across the country?

Last week's Public Health Law Conference closed with a “Critical Opportunities” event discussing just that. During the session, seven presenters pitched their ideas for laws to solve critical public health issues. The presenters were each given five minutes to share the background of the issue to be addressed, their idea for the law, evidence that it could work and the feasibility of implementing the change.

Paul Kuehnert, a senior program officer for the Robert Wood Johnson Foundation and director of its Public Health team, believes enacting new laws could have a positive effect on public health.

“We need to focus on improving the quality and impact of public health across the country—by building the evidence for what works, advancing smarter laws and policies and strengthening public health departments,” he said in his introduction.

Alan Schwarz spent the majority of his career as a baseball reporter before authoring dozens of stories for The New York Times unearthing the dangers of concussions in football at all levels—from the professional leagues down to kids’ leagues. He was working as a freelancer when first approached about the public health issue. The end result was a series that made him a Pulitzer Prize-finalist and helped change the face of football.

NewPublicHealth sat down with Schwarz before he delivered a keynote address at the 2012 Public Health Law Conference to discuss how his interest in sports-related concussions began and what he thinks about the impact he made on public health.

NewPublicHealth: How did you come to report on this issue?

Alan Schwarz:  Most regularly I was, along with David Leonhardt, the Keeping Score columnist for the Times sports section on Sundays, where every week we looked at some phenomenon through a statistical lens. But my beat was exclusively baseball. However, I came to know a fellow named Chris Nowinski, former Harvard football player turned professional wrestler, who had written a book about concussions and how serious they were. This was the summer of 2005.

Chris called me up. I got lots of calls from lots of young writers at that time and tried to be nice to them and Chris sent me the manuscript and it was incredible. It was really, really well done, and I thought “this is a very important book.” So I introduced him to a few people I knew here in New York in publishing, because I thought this was really good stuff. Well, no one really gave him the time of day, frankly. No one thought it was commercial enough to succeed as a book. And that was that. I didn't hear from him again, nor did I expect to.

NPH: Then what happened?

Cynthia Hallett, executive director of Americans for Nonsmokers’ Rights, will speak today about tobacco policies at a Public Health Law Conference session on innovative community policy. The other presenters include Aaron Wernham of the Health Impact Project and Marion Standish, director of community health at the California Endowment. NewPublicHealth caught up with Ms. Hallett before the session.

NewPublicHealth: What is the focus of the panel discussion you’re a part of?

Cynthia Hallett: We will be sharing some of our collective experiences on successful health policy efforts and some of the resources that would be available for others as they’re thinking about what kind of health policies they want to try to pursue at the community level.

NPH: What will you be presenting about tobacco?

Martin Fenstersheib, MD, MPH, director of the Santa Clara County Public Health Department in California led a session on safe outdoor activity for kids and adults at the 2012 Public Health Law Conference. NewPublicHealth spoke to Dr. Fenstersheib about what is keeping our communities from safely getting outside to play—violence, blight and communities built for cars—and solutions grounded in evidence-based public health law.

NewPublicHealth: You presented at a key session on making outdoor physical activity opportunities safer. What makes this an important issue for you?

Dr. Fentersheib: Often when we talk about physical activity, we hear people say that all we need to do is convince kids to go outdoors. A lot of us then say, “when we were kids, our parents let us out of the house in the morning and we came back at nighttime and all was well.” There wasn’t any problem with that. But, of course, we’ve all become aware of safety as a barrier to outdoor physical activity. And the issue has to do with not only criminal or violence safety, but safe streets generally. Do cars in an area make it less safe for example? And, is our environment built in a way that it is safe for kids to walk to school? My presentation will be an overview of the benefits of physical activity, and what some of the barriers are.

We’ll also look at the legal side of the issue, including a study on mixed use land zoning. I think the bottom line is that safer neighborhoods will have more of a mixed use flavor so that you don’t have to go far to get to work or play or to recreational areas. In such neighborhoods, there are stores and other places for you to go, and you’re closer to public transportation. The data to be presented will show that the crime rates in those areas are lower than in pure industrial areas or areas where there isn’t mixed use. Mixed use is helping to improve the built environment in the communities in which we live by having more eyes on the street, by having people basically looking out for one another and be more of a community.

NPH: What are examples in Santa Clara of new plans to create safer outdoor spaces for children and adults? 

More than 500 public health legal experts, advocates, practitioners and researchers gathered in Atlanta, Georgia, this week to discuss the top issues facing the field. William Foege, MD, MPH, kicked off the conference with a keynote address at the 2012 Public Health Law Conference. Foege is a celebrated epidemiologist and physician who played a leading role in many of the important public health campaigns of the past half-century, including efforts to eradicate smallpox. Dr. Foege previously served as the director of the Centers for Disease Control and Prevention and formed the Task Force for Child Survival and Development.

In his keynote address, Dr. Foege said, “Every public health decision is based on a political decision. The basis for political decisions is law.” He also urged attendees to take action. “Burying our heads is no longer an option. There are solutions, but they require changing the laws that affects what happen to our health.”

We caught up with Dr. Foege to get his take on the critical role of public health law.

>>Follow continued coverage of the Public Health Law Conference.

NewPublicHealth: As keynote speaker, what was important to you to convey to the hundreds of people in public health capacities attending the 2012 Public Health Law Conference?

Dr. William Foege: What I have emphasized is that the law is probably the second best tool we have ever had in public health after epidemiology. We’ve used it for a long time even if we did not have a formal organization, and when one looks at all of the spectrum of things accomplished from fluoridation to school entry requirements for immunization to what’s happened with air quality and water quality, you realize that this has been very important for public health.

NPH: What is one public health issue you’d point to that has been helped significantly by laws to carry it forward?