Public Health Protections Are Not Sign of a Nanny State

Cries that we live in a nanny state that protects people who need no protection ignore an extraordinary fact: public health measures have had a long, proud history in this country and are all around us, reducing harm and disease and enabling people to live longer, fuller, and more productive lives, speakers told a recent state Senate subcommittee hearing.

Public health advances are so numerous and ingrained that we take them for granted. They run the gamut, including immunizations for children to attend school, secondhand smoking laws, helmets to ride bicycles and motorcycles, car seats for infants, seatbelts, nutrition labeling of food, drinking water standards, encouragement to breast feed, violence protections, licensed child care providers, elimination of junk food from schools, improved safety of cars, sanitation, occupational safety and health laws, blood alcohol limits on drivers, clean air laws, child pool safety laws – and much more, speakers said.

As a result of public health and contributions from other fields, life expectancy has gone from 47 years in 1910 to 81 years of age today, said Ron Chapman, MD, MPH, director of the state Department of Public Health.

Many of the public health measures instituted by government were unpopular when first proposed but once adopted, complaints ceased and the benefits to health became evident. As a result, behavior norms changed.

“Support for any policy change, especially those that are bold and controversial, takes time,” said Andrew Cheyne, CPhil, research director for the Public Health Institute’s (PHI) Berkeley Media Studies Group.

The Senate Budget Subcommittee hearing, “Public Health in a Free Market,” was held to increase understanding of the government’s role in intervening to protect the public’s health. Among the speakers were three from PHI programs: Linda Rudolph, MD, MPH, co-director of the Center for Climate Change and Health who also leads a project to advance the integration of Health in All Policies in California; Thomas Greenfield, PhD, scientific director of the Alcohol Research Group, and Cheyne. Other presenters included Harold Goldstein, DrPH, executive director of the California Center for Public Health Advocacy, and Marice Ashe, JD, MPH, CEO for ChangeLab Solutions.

“We’re trying to understand what is an appropriate role of government in regulating the sale of certain products or the manufacture of certain materials where there is a proven consequent health risk either in the environment or in things that people consume,” said Sen. Bill Monning, who chairs the subcommittee on Health & Human Services.

Rudolph, a former deputy director in the Department of Public Health’s Center for Chronic Disease Prevention and Public Health, addressed the kind of pressure public officials face in finding public policy solutions to public health problems.

“I’m sure in your role as legislators you’ve heard a lot of arguments against the use of public policy for public health: ‘Government shouldn’t limit individual choice, people need to take responsibility for their own health, don’t interfere with the market, the science isn’t settled, don’t act until you know everything, and public health regulations are bad for business,’ ” Rudolph said.

But, she continued, public policy is needed to preserve and protect health for everyone because it is so important to everyone – and because society depends on health.

“Health has innate value because good health makes it easier for us to pursue other things we want to do, like make a living, raise a family, spend time with friends, participate in organizations,” she said. “Health enables participation in the workforce and enables good productivity. Poor health affects productivity not just of individuals but also caretakers, and poor health increases school absence. Good student health improves student performance.”

Government stepped in to protect public health when infectious diseases were the scourge in the past, and today it is just as appropriate to look to public health interventions to stop the epidemic of obesity and chronic diseases that are largely preventable, Chapman said.

Obesity rates threaten to bankrupt the health care system, largely because the environment we live in has changed dramatically, said Goldstein. “There is now junk food everywhere, portion sizes have increased dramatically, and the food and beverage industry spends $10 billion a year advertising unhealthy foods and beverages to our kids.”

Individuals make their choices for diet and physical activity within that environment, “within that social, economic and political context,” Goldstein said. “To the extent it’s about the environment, that’s where public policy comes in. … Federal, state and local policies are crucial for addressing those kinds of problems that have general social impact.”

Rudolph pointed to inequities in health that are “striking, persistent and frankly unacceptable” in primarily nonwhite, lower-income communities. She called for state agencies to take the “next steps” to make a “health in all policies” approach a reality and make decisions based on this lens, not just in the Department of Public Health but in other arenas that impact on health, such as in transportation, agriculture, finance and education.

She also called for establishing a “California health and wellness trust” that would ensure a permanent funding source for community and public health programs “that we know work.”

Recent ballot box defeats of soda taxes in California and smaller sugar-sweetened beverage sizes in New York City certainly won’t be the final word on efforts to reduce consumption of these drinks that are a major contributors to the obesity epidemic, speakers said. Monning is the author of a bill, SB 626, that would institute a one-cent tax per ounce on these drinks, raising about $1.6 billion a year for repairing the damage from the beverages by supporting physical education, more fruits and vegetables in schools and childhood obesity prevention activities.

We only have to look at the experience of the tobacco control movement to understand how a once-controversial idea becomes accepted, evolves into a norm and stamps out a major health problem, speakers said. Although fought by industry, over 50 years public health advocates successfully pushed for warnings on cigarette packs and ads, education campaigns, secondhand smoking laws and tobacco taxes. In California, within just the first 11 years after voters passed the tobacco control initiative known as Proposition 99, dramatic changes had occurred: a 27 percent decrease in smoking and a 19 percent decrease in lung cancer deaths, Goldstein said.

Repeating efforts to pass these measures with far-reaching public health benefits allows people to become more comfortable with them and better informed, Cheyne said. Each new attempt “gives people the opportunity to communicate the fact that someone … supports the policy. This helps set the stage for the day when it is a given that these beverages do damage to our society, and government needs to protect the public’s health from that harm.”

Greenfield suggested the committee consider a measure for reducing public harm from over-consuming alcohol: minimum alcohol pricing. Currently, alcohol is more affordable than ever – and 15 times more affordable than in the 1960s, he said. Heavy drinking causes significant harm, including to families, passengers in a drunk driver’s vehicle and finances, vandalizing of property, vehicle accidents, and assaults.

Monning said he and fellow committee member Mark DeSaulnier would review the testimony and consider options for developing a legislative package.

“One of the key purposes of this hearing was to establish more of a foundation and more public awareness of the historic role of government in promoting public health and protecting health,” Monning said. “We need to reacquaint the public with the critical role public policy plays in protecting people.”

Carolyn Newbergh is a writer and editor in the communications department of the Public Health Institute.

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