. "Paper Contribution J: Legal and Public Policy Interventions to Advance the Population's Health." Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press, 2000.
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Promoting Health: Intervention Strategies from Social and Behavioral Research
alters the informational, physical, social, or economic environment to facilitate safer behavior. For example, government demands accurate labeling and instructions or restricts commercial advertising of hazardous products; enacts housing and building codes to prevent injury and disease; and regulates the environment in diverse ways.
Despite the importance of legislation and regulation to promote the public's health, the effectiveness of government interventions is poorly understood. In particular, policy makers often cannot answer important empirical questions—do legal interventions work and at what economic and social cost? Policy makers need to know if legal interventions achieve their intended goals (e.g., reducing risk behavior). If so, do legal interventions unintentionally increase other risks (“risk-risk” trade-offs)?3 Similarly, cost is important because, if legal interventions are very expensive, they can reduce opportunities to spend those resources in more effective ways.
Policy makers need to understand not only the cost or effectiveness of an intervention, but also the burdens it imposes on individuals and groups. Public health regulations can intrude on personal interests, economic interests, and the rights of minorities. Some public health regulations affect personal interests in autonomy, privacy, expression, or liberty. Other regulations affect economic interests in property and, more generally, dampen economic development. Still other regulations are unjust because they disproportionately burden vulnerable groups such as the poor and racial minorities. The laws themselves may be unfair or they may be enforced selectively and in a discriminatory manner. These intrusive regulations should concern us not only because freedom has intrinsic value in our democracy, but because denial of human rights can undermine public health efforts (Mann et al., 1994). Even detriments to professional opportunities and economic prosperity can have health effects. Researchers, for example, have long understood the positive correlation between socioeconomic status and health (DHHS, 1991).
In this paper, I first examine legal interventions as a tool in achieving the public's health and safety. Here, I present five models of public health regulation: (1) economic incentives and disincentives (taxing and spending powers); (2) the informational environment (education, labeling, and commercial speech regulation); (3) direct regulation (penalties for engaging in risk behavior); (4) indirect regulation (the tort system); and (5) deregulation (dismantling legal barriers to desired public health behaviors). In relation to each of these five models, I explore the trade-offs entailed between advancing the population's health and invading private rights and interests. Second, I examine the empirical question, do legal interventions work? Here, I present data from two of the most studied areas of intervention—one involving disease control (cigarettes) and the other
Consider one study reporting that helmet laws reduce the use of bicycles: The benefits of cycling, even without a helmet, have been estimated to outweigh the hazards by a factor of 20 to 1. Consequently, a helmet law, whose most notable effect was to reduce cycling, may have generated a net loss of health benefits to the nation.” (Robinson, 1996).