time to reading and other academic pursuits. Yet children need to engage in physical activity to focus in the classroom, Ashe said.

State and local governments have the authority to create policy through what is called “police power.” This power does not refer to police officers or traditional law enforcement, but to the authorities given state and local governments to protect the health, safety, and welfare of the community. The police power allows governments to regulate private rights as necessary and constitutional to promote and protect the public interest. A classic use of police power is a regulation that permits the government to quarantine an individual with an infectious disease to keep that person from infecting others. Such laws can create a tension that needs to be balanced between the rights of individuals and the public good, said Ashe. Other examples of the police power in the context of chronic disease prevention include banning cigarette giveaways near schools, creating farmers’ markets through zoning provisions, and instituting menu labeling requirements.

As broad as police power is to protect the public health, it is subject to constitutional limits. First, laws cannot be arbitrary and oppressive; rather, they must be rationally related to the public health protections they seek to effect. Further, they must be reasonably designed to correct a condition adversely affecting the public health. Finally, they cannot violate state and federal constitutions. Ashe discussed four local strategies based on police power designed to increase physical activity in communities: comprehensive plans, “complete” streets, safe routes to school, and joint-use agreements.

Comprehensive Plans

Comprehensive plans are land use planning tools that serve as the blueprint for future development, laying out how land can be used. They are broadly stated, long-term policy guides for the physical, economic, and environmental use of an area. These plans can be powerful, said Ashe, because changes to the use of land must comply with them. However, they do not necessarily change current uses. Instead, licenses may not be renewed over a long term, or a business may not be able to expand or change hands. Because the current uses of land have taken a long time to develop, changes in those uses also will take a long time. The comprehensive plan is the starting point for change, said Ashe.

In California, for example, comprehensive plans traditionally have been required to include a “health and safety element.” Ironically, that element has had nothing to do with public health outcomes under the purview of a local health department, but rather involved the deployment of police, fire, and ambulance services. Within the past decade, local health departments have been becoming involved in the writing of comprehensive plans and have been inserting outcomes related to the prevention of com-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement