Promoting Health Intervention Strategies from Social and Behavioral Research (2000) / Chapter Skim
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Paper Contribution J: Legal and Public Policy Interventions to Advance the Population's Health
Paper Contribution J: Legal and Public Policy Interventions to Advance the Population's Health
Pages 390-416
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From page 390... ...
First, government interventions are aimed at individual behavior through education, incentives, or deterrence. For example, health communications campaigns educate and persuade people to make healthier choices, taxing and spending powers discourage risk behaviors or encourage healthy activities, and police powers deter risk behaviors by imposing civil and criminal penalties.
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From page 391... ...
Policy makers need to know if legal interventions achieve their intended goals (e.g., reducing risk behavior)
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From page 392... ...
Finally, I draw some conclusions about the use of the law as a tool for achieving public health goals. How important is the law, what risks are entailed in legal strategies, and how can legal interventions best be used in combination with other public health strategies?
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From page 393... ...
Still, high taxation of inherently dangerous products such as cigarettes and alcoholic beverages is not universally supported. On one level, businesses and consumers denounce increased taxation of hazardous products as they would any tax liberal government overreaching and economically burdening the population.
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From page 394... ...
The conditional spending power is akin to a contract: in return for federal funds, the states agree to comply with federally imposed conditions.4 For example, in the mid-1980s, Congress appropriated highway funds on the condition that states adopt a 21year-old minimum drinking age. Since a major purpose of highway funds is traffic safety, the Supreme Court upheld this public health measure.5 Congress' power to set the terms upon which state appropriations shall be distributed is an effective regulatory device.
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From page 395... ...
Public health authorities understand that many factors influence behavior, but information is a prerequisite for change. The population must at least be aware of the health consequences of risk behaviors to make informed decisions.
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From page 396... ...
As a result, government regulation of commercial speech is an important strategy to safeguard consumer health and safety. First, government is concerned with advertising that increases use of hazardous products and services such as cigarettes, alcoholic beverages, firearms, and gambling.
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From page 397... ...
, mandate businesses to alter product designs to promote safety (e.g., air bags in automobiles, trigger locks on firearms, safety caps on medicines) , or modify sales practices (e.g., sale of cigarettes or alcoholic beverages to children)
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From page 398... ...
. We do not understand a state of mind that permits plaintiff to think that only he himself is concerned." If public health authorities continue to press for regulation of self-regarding behavior, it will certainly be important to be able to point to empirical evidence of effectiveness in reducing harms within the population.
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From page 399... ...
There exists a vast potential for using tort litigation as an effective tool to reduce the burden of injury and disease. Attorneys general, public health authorities, and private citizens resort to civil litigation to redress many different kinds of public health harms: environmental damage or exposure to toxic substances, unsafe pharmaceuticals or vaccines, and hazardous products such as tobacco, firearms, or alcoholic beverages.
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From page 400... ...
Furthermore, a manufacturer cannot attribute blame for harm to government entities the way it can on those who purchase and use hazardous products. Finally, discovery powers in civil litigation may provide needed evidence about the industries' intentions in design, promotion, and sale.
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From page 401... ...
Sometimes policy makers enact laws that criminalize or otherwise penalize provision of, or access to, the means for achieving behavior change. Consider government regulation designed to impede access to sterile syringes and needles even though public health authorities recommend their use to reduce transmission of bloodborne diseases such as HIV and HBV (hepatitis B virus)
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From page 402... ...
Empirical Evaluations of Public Health Regulation: Do Legal Interventions Work? The five models of public health regulation just described are all highly complex, involving trade-offs between competing public goods as well as conflicting public and private interests.
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From page 403... ...
Consider the methodological constraints in identifying the causal effects of specific laws designed to reduce driving while under the influence of alcoholic beverages. Several different kinds of laws may be enacted within a short period of time, making it hard to isolate the effect of each law, publicity about the problem and the legal response may cross state borders, making state comparisons more difficult, people who drive under the influence may also engage in other risky driving behaviors (e.g., speeding, failing to wear safety belts, and running red lights)
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From page 404... ...
The regulatory measures that have received a great deal of attention include reduction in cigarettes and motor vehicle crashes. Funding agencies and researchers should give much greater attention to systematic evaluation in other areas of governmental intervention that have not been subjected to systematic evaluation.
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From page 405... ...
The most successful legal strategy to reduce youth access imposes civil penalties against the store owner (not just the clerk) , has progressive increases in fees culminating in suspension or revocation of the tobacco retailer's license and has regular enforcement using minors in unannounced purchase attempts to monitor compliance.
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From page 406... ...
called motor vehicle safety one of the 10 great public health achievements of the twentieth century. Motor Vehicle Safety Regulation (including driving while under the influence of alcoholic beverages)
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From page 407... ...
The Highway Safety Act also created the National Highway Safety Bureau, which later became the National Highway Traffic Safety Administration (NHTSA)
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From page 408... ...
One successful strategy has been to increase the minimum legal drinking age from 18 to 21 years of age. This strategy reduced traffic fatalities in the target ages, compared with states that did not adopt such laws (Hingson et al., 1983, Cook and Tauchen, 1984, GAO, 1987, Decker et al., 1988, O'Malley and Wagenaar, 1991, Jones et al., 1992, Hingson, 1996~.
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From page 409... ...
Child restraint laws, however, appear to have an insignificant effect on reducing the high-risk behavior of children traveling in the front seat of a car. Interventions aimed at promoting the use of rear seats by children traveling in motor vehicles continue to be very important (Segui-Gomez, 1998~.
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From page 410... ...
Regulatory strategies have gone well beyond individual-level interventions. Legislation enacted in 1966 enabled the federal government to set safety standards for new vehicles and to develop a coordinated national highway safety program.22 The Highway Safety Act of 1970 charged NHTSA with the responsibility of reducing deaths, injuries, and economic losses resulting from motor vehicle crashes.
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From page 411... ...
1989. New Mexico safety restraint law: Changing patterns of motor vehicle injury, severity, and cost.
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From page 412... ...
1988. Reduction in motor vehicle fatalities associated with an increase in the minimum drinking age.
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From page 413... ...
1999. Effectiveness of graduated driver licensing in reducing motor vehicle crashes.
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From page 414... ...
1996. Lowering state legal blood alcohol limits to 0.09%: The effect on fatal motor vehicle crashes.
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From page 415... ...
NHTSA (National Highway Traffic Safety Administration)
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From page 416... ...
1988. Is the Florida safety belt law effective?
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