Evidence for Policy: Nice If You Can Get It

By Scott Burris

Sometimes researchers can tell policy makers pretty confidently what public health law interventions really make a difference. The PHLR website has more than 50 Evidence Briefs that summarize the results of systematic reviews of the evidence on interventional public health laws conducted by the Cochrane and Campbell Collaboratives, and the Community Guide to Preventive Services.. We know, for example, that  there is significant evidence to support water fluoridation as an effective public health intervention aimed at reducing tooth decay (Portland, are you listening?). We know that workplace smoking bans prevent heart attacks. For laws like these, we have numerous high quality studies, sometimes even experiments, that show whether or not the law is effective.

Unfortunately, problems don’t wait for evidence, and usually by the time there is a substantial body of evidence in place to review, most states have already made their policy decisions. What do we do when there is a problem that demands action, but there is no clearly effective legal action to take?

One of these days we’ll blog about what we think should happen. But for now, we can look at what often does happen. Usually, it resembles the fads we see in fashion: One state tries something, and other states follow, until a lot of states are doing something that might, or might not be working.

Here’s an example: Thanks in particular to some excellent coverage in the New York Times, distracted driving recently began to get a lot of attention. Since 2001, 41 states have passed laws dealing with cell phones in cars, most in just the last few years. (Here’s a study.) Given how common and popular  it has become to text and talk while driving, states seized on texting by teens as the core of the problem, or at least the part of the problem most easily dealt with. Thirty-seven states have texting bans that apply to novice drivers. Thirty-two states ban hand-held device use for at least some drivers.

The problem is that we have no basis in science to believe that texting or otherwise manipulating a device is the only, or even the most dangerous, aspect of using these devices in the car. Some research suggests that the danger is distraction itself, and that it comes from talking too, even with a hands-free device. The silliest outcome of a focus on manual manipulation of key pads by drivers came in my own Commonwealth of Pennsylvania, whose legislature last year preempted Philadelphia’s hand-held ban and substituted a state-wide ban on texting only. Aside from the questions already raised, legislators are now facing up to the fact that the ban is unenforceable: How is a police officer supposed to know whether a driver is texting, or just dialing?

We can’t blame legislators because they have to solve problems before we have full knowledge of the best solution. Still, here are a couple of suggestions: If you have to act before the evidence comes in, how about funding an evaluation of your new law to see if it works? And while you are at it, why not make sure your state has already passed the public health laws we already know work and repealed the ones that don’t.

Temple University Center for Public Health Law Research

Temple University Center for Public Health Law Research

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.

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