LawAtlas and Public Health: Q&A with Scott Burris and Damika Barr

Aug 15, 2013, 3:12 PM

Public Health Law Research’s (PHLR) LawAtlas is a comprehensive content management tool that enables users to track and analyze key laws aimed at improving health and access to health care. From interactive law maps to policy surveillance reports to “reams” of digital data, it offers an expansive view of how health and the law are intersecting throughout the country. In fact, LawAtlas just today released two new data sets, one on Child Restraint Systems and one on Dental Hygienist Scope of Practice Laws.

NewPublicHealth spoke with Scott Burris, Director of PHLR’s National Program Office, and Damika Barr, Legal Analyst and LawAtlas Manager, about what LawAtlas means for the public health community—and their hopes for its future.

NewPublicHealth: What are you learning about the value of LawAtlas to the public health and law communities?

Scott Burris: I think there are two things that people really like about this. One is getting law as data. So, we take law and it’s a bunch of words that people in health often don’t want to cope with or don’t really appreciate. It’s not what they do. We turn it into data that they understand, that they can use, that fits right into their broader lifestyle, as it were. Meeting the needs of people doing epidemiology and science, that’s one part of it. The other part is just a great demand to see law laid out in this geographical way so that everyone can see what states have what laws and how any particular policy is progressing across the states.

Damika Barr: We’re finding that this is eye opening because you can finally see the dimensions of the law across jurisdictions over time with your own eyes, and it’s really easier for our researchers or the public health law communities and providers to see the dimensions as compared to looking at a long table with many columns. Researchers can start to ask more detailed questions or about more dimensions of the law than they would have if they were just limited to a table.

NPH: We’ve seen a couple of the ways that LawAtlas is being used already, including the study by Hosea Harvey that looked at youth sports concussion laws. What are some other innovative ways you’re seeing LawAtlas being used in research?

Burris: I think it’s not so much “innovative ways" as what important things can LawAtlas show us? LawAtlas in itself was an innovation in that it allows people to more efficiently code the characteristics of the law and more easily publicize it, but what we’ve learned in recent research is how you can answer important questions with it.

Our grantee, James Macinko, and his colleagues were looking at patterns of adoption of laws across the 50 states. One of the things used in their work was a table that showed the adoption curves of various important policies over the last 20 years. Again and again, the work they did shows how rapidly interventional public health laws are adopted across 50 states and how widely they’re adopted. And from my point of view, it really refutes the common assumption that using law as a tool for public health is somehow unpopular or politically difficult when, in fact, it’s just the opposite. When you take the laws and lay them out over time and space as we have, you see again and again this very rapid adoption across the country of laws that seem to work. That’s one thing.

Another thing I think that we notice when researchers start to gather the law systematically and identify its key characteristics is we often see a discordance—especially in new areas of legislation—between what the epidemiology is telling us about the health threat and what the legal response is, at least initially. So, for example, with distracted driving, which was the first dataset that we did on LawAtlas, we found that there was an increasingly heavy emphasis on restricting manual manipulation of your device while driving, even though the best that we can tell the risks come from the concentration of the focus on your conversation or your device task, rather than using your hands to do it. And then you mentioned Hosea Harvey’s work. One of the things that he was able to show very clearly by looking at the laws is that they’re all focused on what to do to prevent a second concussion. So far we don’t see a lot of policies that are aimed at preventing an initial concussion. I think both of those are kind of typical of the insights that you can get about the underlying description of the problem you might say, or about the shape of proposed legal solutions that you wouldn’t get unless you systematically looked at and analyzed the law as people do with the LawAtlas dataset.

NPH: So some of the issues or the gaps that you’re seeing revealed by LawAtlas analysis are, for example, ways that the evidence base isn’t quite matching up with what the policies are most prevalent around?

Burris: I wouldn’t want to exactly leave it at that. What we’re seeing I think is that it’s apparently not uncommon that in the early days of a policy response to a particular problem, policy is not necessarily driven by—or is not necessarily consistent with—what we seem to know about the nature of the problem. Or it only takes on a piece of the problem. That’s why it’s so important to monitor the implementation of laws and their effects over time, as we do at PHLR, because that’s the only way you’re going to find out whether this initial guess or initial judgment of policymakers about the best way to deal with the problem will really be borne out once it’s put into practice.

Barr: Everything Scott said applies to all of our datasets, and I think one of the things that people can’t see that’s happening that in some ways is innovative to LawAtlas is when we launched in October we began with 50 state surveys or 50 state assessments, but some of the interest that we’ve had are from boards of health or health departments. So we’re currently working with a couple of health departments or other organizations to do local laws and policies, and soon on LawAtlas you’ll be able to see coding that is looking at what’s happening in a county or what’s happening in a city or what’s happening with a policy at a university or a park, so we’ll be able to go from looking at just what’s happening in the state to really drilling it down to smaller communities.

NPH: Who else are seeing finding this really of use or who are you working with so far from local health departments?

Barr: We have research teams out of universities who are understanding that for some laws—for example, for distracted driving—you may have a law that’s in effect for the state, but you’ll find that local cities are passing their own laws and so they need to figure out which law is most effective. Is it the distracted driving law, the state law, or is it the county’s inattentive driving law or policy?

NPH: So you can look across different levels of policy and see how they’re interacting and what’s working. What do you both see as the future of LawAtlas? Are there other topics that you’re hoping to add? Different ways you expect it might be used? What would you like to see as the next level of LawAtlas?

Burris: What we’d like to see most of all is really that this is adopted—that policy surveillance becomes normal, accepted and supported. So that what people are seeing and liking about LawAtlas is that it enables the ongoing monitoring and evaluation of legal interventions in health, and we think legal interventions should be monitored and evaluated like every other major intervention, and the first step to that is to get that initial legal data and to maintain it over time. So, we’re hoping that local health departments and state health departments and researchers coming to use LawAtlas on the workbench is part of the process of gathering the momentum as a community. That as a public health community they identify some substantial but finite number of key domains, key policies that we think need to be monitored and evaluated, and then to work out where we get the resources to do that monitoring and evaluation, which we hope we can facilitate as LawAtlas. We’ve kind of created the possibility and we’ve developed some strategies and techniques for doing it efficiently, and now we want to work with the community to figure out how to institutionalize it and get the most bang for that work across our field.

>>Bonus Link: The Wall Street Journal recently reported on a proposal that could take effect next year that would change how car seats need to be secured in cars.

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