are in areas where the public health agency plays a critical or lead role and policies are designed explicitly to affect health. These are the focus of this chapter. Legal and public policy tools for the public’s health include


  • taxation, incentives, and spending (e.g., cigarette and other “sin” taxes and allocation of the tax to combat the problem, may include pricing policies and financial incentives);
  • altering the informational environment (e.g., food or drug labeling, and disclosure of health information);
  • altering the built/physical environment (e.g., zoning, toxic waste);
  • altering the natural environment (e.g., clean water, air, environmental justice);
  • direct regulation (e.g., seat belts, helmets, drinking water fluoridation, folate fortification of grain-based products, iodized salt; licensure of medical care providers and facilities);
  • indirect regulation (e.g., tort litigation in tobacco); and
  • deregulation (e.g., distribution of sterile injection equipment or criminalization of HIV risk behaviors).

Most of the tools above refer largely to interventions aimed specifically at improving or protecting health, and some involve public health agencies directly. However, the distinctions between health-oriented and non-health policy are blurred in some areas, especially the built/physical environment, where zoning and land use have become increasingly focused on health. Box 3-1 provides examples of public policies in each of the categories above as applied to food and nutrition.

Using the Law to Achieve Population Health Objectives

The principles that form the basis for legal interventions by public health agencies and others in government to protect and improve the public’s health include discharging the statutory duty to protect from harm and promote health and safety. In many cases, this is done by intervening to attenuate externalities—negative side effects of individual actions such as speeding, addressed by imposing speed limits, and of business sector actions such as emitting air pollution, addressed by setting and enforcing air quality standards. Some legal interventions are more controversial than others and starkly illustrate the challenge of balancing public goods and individual freedoms due to varying norms/attitudes, expectations, and values that may inform both public opinion and decision-making by legislators in different jurisdictions.

The history of motorcycle helmet laws—using the tool of direct regulation—illustrates the arguments on both sides of a piece of legislation,

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