Grassroots Public Health: Q&A with Jill Birnbaum, American Heart Association
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.
Jill Birnbaum: Yes. It is almost exclusively food, and it’s not just state preemption—we are exceptionally vulnerable federally as well.
GC: Ohio, Alabama, and Florida, among others, have already adopted state laws preempting local nutrition policies. What do you see on the horizon for state preemption in obesity preemption field?
Jill Birnbaum: We remain incredibly vulnerable on this front because our ability to fight these insider efforts requires two things. One is experienced lobbyists on our side inside the state capitols. Those we currently have — while they’re passionate, committed and very talented — don’t match the resources of industry in the state legislatures, and certainly not at the federal level. And two, further education of the public health community is needed. In tobacco, it’s part of our DNA that preemption needs to be avoided. But we’re not there yet on the obesity front. We’re fortunate to have people that have [tobacco control experience] transitioning into the obesity movement, but we also have a lot of new advocates and need to bring them along in that understanding that preemption is something to be avoided.
GC: One obesity policy advocate predicted that there could be a “tsunami” of state preemption in 2013. Do you think that’s an accurate assessment?
Jill Birnbaum: I do, and it’s because [the food industry] has seen these local victories, and we don’t have that sensitivity [about preemption] yet among obesity prevention advocates. That tsunami could easily be there, depending on the level of organizing by industry to promote preemption.
One recent example was a [state] constitutional amendment that, if passed, would preempt all taxes on foods and beverages. That happens by ballot measure, and the ability to do it differs from state to state. We lack the resources at the field level to fight these battles and [the industry is] very powerful, whether it’s the grocers or the restaurants or the food industry within a state.
In California they had several local propositions around sugar sweetened beverage taxes. We estimate we were outspent 70 to one. It gives you a sense of how much industry is willing to spend. They’re trying their best to keep the movement from happening, whether it’s by legislative preemption or constitutional amendments, and my sense is they’re willing to do whatever it takes right now to fend us off long enough that, they hope, we will move on to something else.
GC: What do you see on the horizon at the federal level?
Jill Birnbaum: We’ve already been touched by preemption with the federal menu labeling law. This is an example of where preemption can be very challenging, not only in terms of movement building, but also in getting the federal government to take a leadership role. We still haven’t seen the [menu labeling] regulations. That law has still not been implemented. It was passed as part of the Affordable Care Act [in 2010], and we don’t know when we’ll see the regulations. And once we get those regulations, we assume that they won’t be as fully implemented as we would have hoped. Then we’ll have to deal with the downstream of preemption, which is: “Oh yeah, there’s absolutely nothing we can do to at the state or local level” to go above and beyond the federal regulations.
As of right now, I don’t see any major federal preemption risks on the horizon. But that said, we are always vulnerable at the federal level.
GC: Who do you think needs to be involved in deciding about federal or state preemption?
Jill Birnbaum: When it comes to federal preemption, there needs to be involvement of those outside of Washington. We’ve proven in tobacco control that federal leadership is not always what’s needed in public health policy. In fact, staying away [from an issue at the federal level] may be the decision that we make. The advantage we’ve had in tobacco is that we had those conversations, and we’ve opposed moving smokefree policy at the federal level — opposed having it even introduced — in an effort to avoid bad policy. But we got there by having those discussions across the community.
In obesity policy, we’re still in our infancy in having federal, state, and local leaders come together and discuss how to advance our agenda at each of those levels. It needs to be a strategic discussion. If our endpoint is helping consumers demand healthier food, how do we use all of the tools in our toolbox to get there? Preemption then becomes part of that discussion before we even introduce legislation.
GC: What’s your takeaway message for obesity prevention advocates, and public health professionals in general, about preemption?
Jill Birnbaum: I hope we get to a place where the default position is that we oppose it. We should have those discussions before we’re faced with a difficult choice in a compromised position – so, before we introduce legislation at the federal or state level that could become a vehicle for preemption. We need to have those discussions on bottom lines, and the discussions need to be inclusive of those who are working at the federal, state, and local levels.