Public Health Law Research Annual Meeting: Q&A with Scott Burris

Jan 15, 2013, 5:30 AM

Scott Burris, JD, is the director of Public Health Law Research, a program at the Robert Wood Johnson Foundation at Temple University. Ahead of PHLR’s annual meeting in New Orleans this week, NewPublicHealth spoke with Burris about the meeting and the impact of legal research on the public’s health.

NewPublicHealth: What’s most exciting for you about the upcoming conference?

Scott Burris: We’re very excited that we sold out again. We’re going to be standing-room only. That’s great enthusiasm. We all want to see the results of research in the field and so I’m looking forward to those sessions on Thursday when people present their work. And I’m really looking forward to what’s signified by the great interest in attendance beyond our grantee pool, and that is the momentum that’s now behind law as a tool for intervention in public health. And I think, even more than that, the real momentum is behind using research as the key way to figure out which laws you want to use [to impact public health] and which you don’t. The fight now about the gun issue has been coming back to that theme again and again. It’s not just that there’s an appetite for reasonable, effective regulation of firearms—it’s that it’s often hard to know what that would be because of two decades of efforts to suppress data and suppress research. People are saying we’ve got to have good research to help us come up with common ground.

NPH: How much do you think the gun issue will be a factor in discussions both in presentations and in audience conversation when you meet this week?

Scott Burris: I actually think it won’t leap out as a primary, explicit focus of discussion because it represents the same issue we talk about again and again that says that we have health threats, health problems that can effectively be addressed by law, but we have to have enough political space for innovation, for people to try things on a small scale. We have to have support for evaluation so we can figure out whether those innovations are effective. And then we have to go through a cycle of continuing to look at the refinements of the interventions and figuring out which parts of them work best. We’ve seen that happen in a lot of the public health law research area around driving. We’ve seen it happen, to some degree, in the smoking area. Really, every area we have people working in that same dynamic is relevant, and so I think that the gun example is just an instance of this broader theme that law is making a huge difference in public health. But law also often requires politics, law requires lawmaking, and to get laws passed requires consensus, and consensus requires a common view of reality. We all don’t have to agree on everything and there are definitely important values that can differ and then make a difference to public health politics, but it really helps to know that we can save lives or prevent injuries if we do X, Y and Z. It’s surprising how often people come to that point; you can have enough consensuses to get law passed.

NPH: The Public Health Law Research program is a few years old now. What changes do you see in some of the research worked on and published?

Scott Burris: I think what’s happening is we’re breaking down silos. So you could look across the different topic areas that people were working in, and there were very different degrees of scientific specification, very different degrees of data availability and appreciation of how important it was to have data available about population outcomes relative to the law. And what’s happening when you start talking about public health law research, injury research, HIV research or obesity research, is that researchers start to look at people who they had not recognized are their peers and colleagues before, and you start to have a greater sharing of methods and perspectives.

NPH: Looking at the very important topics at the annual meeting, injury prevention comes up quite a bit. I was wondering if you’re seeing that increase as a topic for grants you’re giving and proposals people are making and why that’s important.

Scott Burris: As injury prevention becomes more important to the public and policymakers, it actually becomes more important to us. And injury prevention is particularly well suited to legal intervention because very often we know the very end of the story. For example, somebody was having an overdose on opioids and they didn’t have the antidote available. So you can talk about how the law should make that antidote more available. It’s something that in the realm where people understand the case you’re making, they see the harm you’re preventing. It’s the world in which people are most comfortable with public health legal intervention.

By contrast, if you’re talking about working on improving health by changing where we live, learn, work and play, you’re asking people to take in a lot more, a lot longer causal chain and to get behind and get excited about changes in law that don’t have that kind of immediate payout. So we’re always going to see lawmakers look at injury and ask “what can we do about this?” And they’ll often come up with some pretty effective immediate things to close off that pathway, the harm.

That said, the big killers in the United States continue to be associated with the chronic diseases—cancers and lifestyle diseases, diabetes and so on. So those also require legal solutions, and I think it’s really important for the Public Health Law Research Program to continue to support the harder tasks of, say, evaluating whether a soda tax or a new school food policy is ultimately having an impact down the road on childhood diabetes or early adult diabetes. So the bigger task is harder, but it’s just as important.

NPH: The plenary and keynote speakers are Thomas Farley, health commissioner of New York City, and Pamela Hyde, administrator of the federal Substance Abuse and Mental Health Services Administration, who I think everyone in public health would like to be hearing from now. What questions do you have for them?

Scott Burris: There’s one question I would ask both of them, which is what do they need from research? What do they see as the most important questions they need answered as they look ahead to the work that they want to do? And then I’d ask kind of a health systems and services research question. Tom Farley runs probably the most dynamic, best respected local public health agency in the country. For me, it’s the one that’s a source of constant innovation. So, what does he think local health departments really need now? What should we be campaigning for and how should we be supporting them, helping them to thrive as instruments of coordination of health change in the community? For Pam, I’d ask the same question, but formulate it in a slightly different way as a federal employee. I’d ask what it takes for an agency like yours—or FDA or CDC—in the next few years to be really effective.

Editor’s Note: NewPublicHealth will be speaking with Commissioner Farley and Administrator Hyde this week and will pose Scott Burris’ important questions.

NPH: “Critical Opportunities,” a sort of “speed presenting” on legal issues, gives researchers five minutes to present a legal issue they think merits attention and got its debut at last year’s PHLR annual meeting. Concepts introduced so far include the legal issues surrounding laws on beverages that may pose health risks and requiring adults to get whooping cough vaccines. You’ll have a Critical Opportunities session again on the last day of the conference. What results have you seen from the concept?

Scott Burris: What we’ve had so far is a lot of great ideas exchanged and a lot of really fun meetings, and I think we’ll have that again. People really like the critical opportunities event, and the big test now is whether we can start to push the ideas in different venues. That’s going to be the challenge for next year. This year we’ve had a great time requesting ideas, and that’s been part of a broader process of really showing appreciation that’s out there for law as an effective tool.

We’re going to see that public health legal interventions are more than the sum of their individual parts and individual topic area. They are all about the idea that we don’t have to just sit by and let bad things happen because there’s nothing we can do about it. I think there’s a certain amount of doom and gloom because you hear we have no money or you hear government doesn’t work, but there are so many cases in which, without spending a lot of money, government has worked. And, in fact, people are happy with it. You just don’t hear people saying, gee, I hate the seatbelt law. They buy seatbelts, they understand it, and, in fact, if they thought about it, it would be “I’m glad they passed it because I probably wouldn’t have started it without a prod, but now I’ve gotten the prod and now its second nature, I don’t mind.” I think that’s true of a lot of the laws. You’re just really helping people move to a different place, so they’re going to be just as comfortable once they get there—and a lot safer.

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