By Scott Burris, JD
On this, the last day of National Public Health Week 2015, we’re looking forward by looking backward. There is nothing new about using law and policy to promote healthier environments, products and behavior. There is no good future for public health that does not include even more, and more effective, legal interventions.
Evan Anderson and I wrote in 2012 about the legal regulation of health-related behavior over the past half-century. The story we told offered several reasons for unabashed optimism about what law can do for health. The record is clear that law works, and works across a wide range of different health threats. We pointed to CDC lists of Great Public Health Achievements from the last century and the first decade of the 21st. Every one of them — from high levels of vaccination, through motor vehicle safety and cancer prevention to maternal and child health – could not have been successful without law and policy.
We live in an era where government intervention in health and health care is dismissed by some as over-reach or nannyism, but Evan and I found little empirical support for the proposition that public health law is headed for the graveyard of unwanted things.
When examined empirically, we see that most people expect their government to protect them from health threats and support healthier behavior and environments – and support the use of law to do that. Research by Stephanie Morain and Michelle Mello finds that there actually was much support for strategies that enable people to exercise healthful choices.
But there’s an even better measure of law’s popularity: its continued and extensive use. Time and time again we see legislators of all ideological colors across the country turning to law to address society’s most pressing health issues. Evan and I included a graph showing the “adoption curves” of legislation in areas like traffic safety and youth sports concussions. Frequently the diffusion of legal health interventions follows a steep curve from initial adoption in one place to nearly 50-state saturation. There is sometimes organized opposition by industries whose interests will be affected, and sometimes regular people get mad. But when the idea is a good one, like requiring safety belts or getting rid of transfats, people quickly adopt new norms and soon forget why they ever thought drunk driving or returning to play with a concussion was okay.
We can’t do public health without law, and most Americans – including our lawmakers – don’t want us to. That doesn’t mean there are no challenges ahead. Legal doctrine – as Wendy Parmet has argued – is not as friendly to public health measures as it used to be or should be. We have a great record of showing what works through public health law research, and the methods for the field have never been better understood, but there is still too little funding invested in figuring out what laws work and which ones don’t. We’ve made great strides integrating what lawyers and scientists do with the law in public health, but we have more to do to build a truly transdisciplinary model of public health law research and practice.
As we celebrate Public Health Week at PHLR, we are looking forward to taking part in a new, broader initiative to study how law and policy contribute to a Culture of Health. We know for sure there will be a wide and various range of law and policy to measure.
