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Based at the Temple University Beasley School of Law, the Center for Public Health Law Research supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. It works by developing and teaching public health law research and legal epidemiology methods (including legal mapping and policy surveillance); researching laws and policies that improve health, increase access to care, and create or remove barriers to health (e.g., laws or policies that create or remove inequity); and communicating and disseminating evidence to facilitate innovation.

Public Health Law Research Call for Proposals Coming in June

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Public Health Law Research (PHLR) program of the Robert Wood Johnson Foundation will be opening its fifth call for proposals (CFP) in early June. Short-term studies are no more than 18 months long, and will be funded up to $150,000 each. Applicants are expected to submit a detailed proposal of no more than 23 pages.

As with past CFPs, PHLR will look favorably on multidisciplinary teams that seek to investigate laws broadly impacting public health.

More information about the call is available on PHLR’s website, and more detailed instructions outlining the proposal elements, selection criteria and eligibility criteria will be released in June.

A New Collection of PHLR

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By Scott Burris

The latest issue of the Journal of Health Politics, Policy and Law showcases the range of projects and researchers filling out the field of Public Health Law Research.  An excellent introduction by the editors, Michelle Mello and Wendy Parmet, says it better than I could, but here’s a taste:

Two studies look at public health policy-making – Abiola et al on HPV vaccination, and VanSickle-Ward and Amanda Hollis-Brusky on statutory ambiguity in contraceptive mandates.   Two studies evaluate local legal interventions to address lead poisoning – a sweeping ordinance in Rochester and a novel specialty enforcement court in Philadelphia.  Sampat and Amin quantitatively examine the impact of a provision of Indian patent law that was widely expected to prevent evergreening, finding signs that the law on the books may not be working as advertised in practice.  Finally, Cannon and colleagues bring new methods and attention to the question of whether zoning laws can deliver better health, in this instance through increasing the walkability of neighborhoods.

The group of authors includes doctors, lawyers, economists, sociologists, historians and health researchers. Mello and Parmet offer some pithy thoughts on what all this shows us about the current state of PHLR’s development.  Worth a read.

More on NSF and NIH Funding

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By Scott Burris

Here’s where some in Congress would like us to go:

ScienceInsider reports:

The new chair of the House of Representatives science committee has drafted a bill that, in effect, would replace peer review at the National Science Foundation (NSF) with a set of funding criteria chosen by Congress. For good measure, it would also set in motion a process to determine whether the same criteria should be adopted by every other federal science agency.

Whether or not you think of this as a partisan attack on science, it challenges the idea of science as an independent way of pursuing knowledge. The fact that this is even on the table, and could be taken seriously, shows how effective the attack on science has been.  It seems to reflect a terrible paradox:  on the one hand, social scientists are pissing some people off in a big way, which is a good sign we are doing something right in the inconvenient truth department; but on the other hand, I don’t see a lot of people rising to our defense, which suggest we matter to fewer people than we should.

This bill may or may not go anywhere, but anyone who cares about evidence-informed governance and the ability of the US to solve its problems ought to be concerned.

 

A Tale of Two Polities

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By Scott Burris

Last week, Northeastern University’s effort to convene a much-needed conference on the future of health policy was a casualty of the successful manhunt for the Boston Marathon bombers.  One hardly wants to make too much of a stymied conference given all the human damage of the bombing and its aftermath, but all of us who had gathered for the meeting regretted that we would not hear from the panelists, and sympathized with organizers who had put so much into planning it.  In recognition of that, I am summarizing here what I planned to say there.  It is a tale of two polities that seem to compete for existence in our perceptions of the politics of public health.

One public health is incredibly popular with citizens and lawmakers alike – demonstrated by polling and passage of legislation.  I’ve recently blogged on this here.  The other public health is the despised nanny state, big government, the sequestered and slashed-to-the bone struggling provider of essential services that don’t get no respect and don’t deserve the meager tax dollars we still pay in. We see this in budget cuts, in hyperbolic allegations of “corruption,” and in disingenuous advocacy for a radical caveat emptor regime for all legal products.

What do we make of these two radically different views of where public health now stands in the public’s regard? My claim is that the former is largely the truth – public health is popular, not despised – but the latter view is what is driving budgets and a lot of policy. The action points follow: a sustained fight to mobilize public support and win more battles over budgets and laws. I see three main strands of work:

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While We Sleep?

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By Scott Burris

Nothing threatens a know-nothing more than the prospect of someone knowing something. Hence there has been increasing pressure on and from some in Congress to reduce government funding of social science research.  I hope every reader of this blog is aware that an appropriations rider added by Tom Coburn has drastically restricted NSF funding of political science research. That’s an ugly development, on par with the scandalous cuts to CDC that put paid to its gun research agenda years ago.

But the big funder of social and behavioral research in health is the NIH. In the past two weeks, I have heard via two different insiders that the agency is under pressure to significantly cut back on social and behavioral research, at least research with any important links to public policy. Now it is true that NIH does far too little policy-relevant research as it stands, but many fine researchers do important work related to law and policy with NIH support, and the important influence of law on health means we need more, not fewer, NIH-supported careers.

So I am hoping I am getting false information. What are you hearing?

Further On the Fake Anti-Government Electorate

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By Scott Burris

In recent posts, I have been pointing to research that suggests that government intervention for public health is actually rather popular as a general matter. Now comes a neat paper that takes on the question of whether politicians actually know what their constituents want.  I read it as further evidence that our politics is being shaped by a lot of well-supported anti-government noise-making that has been allowed to flourish unchallenged.

The paper in brief: the authors surveyed candidates for state-level legislative office, and used a technique called multi-level regression and post-stratification (MRP) to localize opinion poll data to legislative districts. They then compared what candidates think their constituencies believe on key issues (health care reform, gay marriage, welfare reform) with what the polls say their constituents believe.  They find that both conservatives and liberals significantly overestimate the conservatism of the people who elect them:

“In districts where supporters of these policies outnumber opponents by 2 to 1, liberal politicians appear to typically believe these policies enjoy only bare majority support while conservative politicians typically outright reject the notion that these policies command widespread support.”

The paper is worth reading for its findings (and to allow you to personally assess its limitations – this has not yet even been peer reviewed.) A more detailed summary with some of the charts is on Dylan Matthew’s Washington Post blog.

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More on the M&M Study

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By Scott Burris

Stephanie Morain and Michelle Mello’s recent paper in the March issue of Health Affairs is an extremely important contribution. It reports on a survey of American adults investigating their support for a range of current health interventions, and finds – contrary to the myth being propagated in politics and the media – that people strongly support the public health mission and the interventions that accomplish it. There is no better way to celebrate the end of Public Health Week than by sending a pdf to every one you know.

Having praised the piece, though, I want now to disagree with one part of the authors’ analysis. The table below shows the support for a fruit basket of public health interventions.

From this, M&M conclude “that the greater the restraint a legal intervention imposes on individual liberty, the greater public opposition to the intervention is likely to be. There was much support among our respondents for strategies that enable people to exercise healthful choices—for example, menu labeling and improving access to nicotine patches—but little support for more coercive measures, such as insurance premium surcharges.”

I don’t see that in the data.

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Updating OSHA Inspection Policies

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by Adam M. Finkel, Sc.D.

For many of the federal agencies that promulgate and enforce regulations to protect public health, safety, and the environment, the era of “big government” never even began.  The U.S. Occupational Safety and Health Administration (OSHA) is a prime example: the agency employs about 2,000 inspectors, who are collectively able to visit roughly 100,000 establishments each year to look for unsafe and unhealthy conditions in the workplace.  This may sound like an ample effort, until one considers the scope of the problem: OSHA’s rules apply to more than 8 million establishments, and every year more than 4,500 workers die in traumatic occupational accidents, while epidemiologists estimate that about 40,000 additional workers die prematurely from chronic over-exposures to toxic substances.

According to data from the Labor Department, analyzed by the AFL-CIO (read the report here – page 97), the ratio of OSHA inspectors to number of covered establishments is such that it would take OSHA between 26 and 243 years to inspect all of the jobsites in each state once only.

So OSHA—and the nation’s workers—can ill afford for its inspectors to spend time checking out establishments that are fully compliant with all regulatory and other norms, while at the same time miss opportunities to find and fix instances of grave danger elsewhere, before workers are killed or stricken with disease.

This is where modern methods of statistical analysis, in particular the concept of “predictive policing,” come in.

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Anti-Bullying Legislation: Safer Schools through Legal Intervention

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By Marizen Ramirez, PhD, MPH

Bullying is the most frequent form of peer victimization in schools, impacting about 10-25% of all children across the United States. The effects of bullying on children have been well-documented, from psychological and physical harm, poor academic performance, alcohol and drug use, and violent behaviors. In its most extreme form, relentless bullying has even driven some young people to suicide. The 2011 documentary, Bully, depicts the tragic stories of Tyler Long and Ty Smalley, who, because of the chronic ridicule and physical harassment they faced, took their own lives.

Stories like Tyler’s and Ty’s have pushed bullying into the public eye, making it a public health issue of national importance. Across the country, efforts abound to prevent bullying and to help provide safe, welcoming environments for our children when they are at school.

Bullying prevention is being approached in a few different ways. National campaigns like Stop Bullying Now! work to increase awareness about bullying and strategies for prevention. Since its inception, the Stop Bullying Now! campaign has provided resources, including an online toolkit of educational materials, to schools and youth clubs throughout the country. Schools have also implemented a variety of anti-bullying curricula to improve school climate and prevent bullying behaviors in schools. Among these programs are the famous Olweus program developed in Norway in the 1980s, and Positive Behavior Interventions and Supports (PBIS), a program targeting the reduction in school-wide behavioral problems including bullying. The effectiveness of curricula, such as Olweus and PBIS, in reducing rates of bullying in American schools has yet to proven, however.

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Public Health Protection under the EPA Lead and Copper Rule

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Dr. Yanna Lambrinidou and Dr. Marc Edwards

It is generally safe to assume that, when it comes to contaminants in drinking water, consumers are protected by regulation and proactive water utilities.

One noteworthy exception is the federal law promulgated to protect the public from lead at the tap. Known as the Lead and Copper Rule (LCR), this law splits responsibility for minimizing exposures between utilities and consumers. The rationale for this “shared responsibility” approach is that in the majority of cases lead leaches into water from lead service lines (LSLs) (i.e., the pipes that connect water mains to individual homes) and lead-bearing home plumbing materials (e.g., lead solder, leaded brass). These sources of lead are often partly or fully inside the home – LSLs and lead solder were used routinely until 1986, and the use of leaded brass will continue to be legal until 2014. Moreover, differences in plumbing and water usage (e.g., volume, flow), make lead leaching in every house unique. Under the LCR, utilities are required to monitor a small number of homes considered “high risk” for lead in water, but consumers are responsible for having their own water tested and for adopting health-protective water-use practices that minimize the risk of exposure.

When utilities detect elevated lead levels in more than 10% of the homes they sample, they must tell consumers how to avoid exposure by, for example, flushing stagnant water before use and avoiding consumption of hot tap water (especially for reconstituting infant formula). They must also implement a LSL replacement program.  Although full LSL replacement is the only way to eliminate the risk from lead pipes, the LCR requires utilities to replace only the portion of a LSL that they own. The consumer-owned portion of the line is left in place, unless homeowners agree to pay for its removal, which can cost several hundred to several thousand dollars.

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