Critical Opportunities: New Journal Article, Videos Offer Proposed Legal and Policy Changes that Can Impact Public Health

Sep 13, 2013, 11:57 AM

Ten new videos released today by Public Health Law Research (PHLR), a national program of the Robert Wood Johnson Foundation, with direction and technical assistance from Temple University, offer suggestions of proposed changes to laws and policies that can impact public health, such as fortifying corn masa flour to prevent neural tube defects and increasing taxes on alcohol to reduce consumption.  The five-minute videos offer examples of PHLR’s “Critical Opportunities” initiative—brief presentations which showcase legal approaches to improving public health.

“Laws can be cost-efficient and popular tools for achieving public health goals. This initiative captures specific actionable, evidence-based ideas for creative ways of using law or legal interventions to improve a public health problem,” said Scott Burris, JD, director of the PHLR program.

The release of the videos is accompanied by an article published this week in the American Journal of Public Health, “Critical Opportunities for Public Health Law: A Call to Action.” It outlines five high-priority areas where evidence suggests legal interventions can have big impacts on health, and calls for a national conversation to continue to identify and prioritize opportunities for legal and policy action.

“The Centers for Disease Control and Prevention, the Institute of Medicine, and others have called for better, smarter use of legal interventions to advance public health,” said Michelle Mello, JD, PhD, the lead author of the article and professor of law and public health at Harvard University. “That’s no small task, but there’s a treasure trove of great ideas to draw on and evidence to back them up.”

PHLR has also developed a toolkit for use by organizations or instructors to host Critical Opportunities sessions at their meetings or in classrooms. The toolkit offers a how-to guide for using the format to identify ways laws can be used to address public health issues.

All ten of the new Critical Opportunities videos are available here. To highlight just one of the presentations, NewPublicHealth recently spoke with Adam Finkel, ScD, of the University of Pennsylvania Law School, about his Critical Opportunity presentation on the benefit and limitations of “smart disclosures,” an alternative to regulations and laws for improving public health.

NewPublicHealth: What is a smart disclosure?

Adam Finkel: They are being touted as comparable or alternative to traditional regulations. So, instead of the government mandating something be restricted or that risk be reduced, they give citizens and companies the opportunity to know what they’re up against and then make their own choices to reduce risk or harm. It’s a “do-it-yourself” regulation that does not require that you can’t be harmed, but gives you a chance to decide on how much risk you want to take.

NPH: Are smart disclosures good replacements for regulations?

Finkel: There are cases where it’s better to give people a choice than to require that something be banned. For example, some diet sodas contain aspartame and there’s a subgroup of people with a genetic problem called PKU and consuming aspartame can damage their brains. Rather than deny aspartame to everyone, products that contain aspartame have warning labels for people with PKU. It’s good when people can know their own circumstances and exposures, and the disclosures promote informed choice so that people at risk get to not buy things that put them at risk, and people who are not at risk get to buy it.

NPH: And what are some problems with smart disclosures?

Finkel: Smart disclosures are being touted as a favorable alternative to regulations because they empower consumers and workers to make smart choices. But what if some disclosures are misleading, incomplete, inaccurate or missing in action?

An example of an inaccurate disclosure would be that companies are allowed to round down a nutrient constituent, such as trans fats, to zero if they contain less than half a gram of the constituent per serving. So manufacturers have created small serving sizes that let them round down.

An example of an incomplete disclosure would be institutional cans of tuna fish. No one had thought to test those containers for mercury, even though that’s the form most commonly served to kids at school. And it turns out that solid albacore tuna is higher in mercury in the bigger packages.

And an example of missing in action is permissible exposure limits of workplace chemicals measured against the Environmental Protection Agency’s Reference Concentrations. But many of those date back to the 1960s and provide zero information to workers about how risky their exposures are, and no one has ever created a compendium of work-based limits for the workplace

NPH: What do you think needs to happen?

Finkel: I propose a presidential commission to develop a priority list of health essential disclosures and to review the existing ones for accuracy and clarity and work with agencies to enforce the changes. It’s feasible, though I think it will be a hard sell. However, industry and government both have an interest in avoiding conflicting and multiple sources of information.

This commentary originally appeared on the RWJF New Public Health blog.