Making Impactful Public Health Policy Change:
The Legislative Process from the Inside of the
Maryland General Assembly
Friday, May 6, 2016
MANASA REDDY
MPH CANDIDATE IN HEALTH SYSTEMS AND POLICY
Outline
Preceptor Organization
Objectives and Rationale
Methods and Approach
Bills
◦ Smoking in cars with children
◦ Correctional education
◦ Syringe exchange programs
Challenges
Conclusions
Questions
Introduction
Preceptor Organization:
The Office of Delegate Clarence Lam, MD,
MPH in the Maryland General Assembly
Duties:
◦ Researching existing policies in Maryland and
other states
◦ Writing policy briefs
◦ Drafting testimony, and
◦ Responding to constituent letters
Photo credit:
msa.maryland.gov/mdmanual/07leg/html/gaf.html
Rationale and Objectives
• Broadly: Sometimes only limited or insufficient protections in
place for Marylanders against public health and social problems
• Personally: Wanted to gain exposure to all aspects of the policy
making process.
Methods
•Reviewed existing policies in Maryland and other states
•Reviewed interventions for their effectiveness and cost in the public
health and grey literature using PubMed, Google, and the General
Assembly website, mga.leg.maryland.gov.
Childhood Second-hand Smoke Exposure in Cars
•Smoke disproportionately harms young children and associated with increased risk of mental
health and behavior disorders such as depression, anxiety, and attention deficit hyperactivity
disorder (ADHD) in children (3).
•Exposure to smoke in a confined space, such as a car, amplifies these effects.(1,2)
•Secondhand exposure in cars disproportionately affects disadvantaged children (3, 4)
•Annually, childhood smoke-exposure costs us:
o $40 million in direct medical costs for asthma (1)
o $644 million for medical care for ADHD (2)
o $2.9 – 9.23 billion to the education system (2)
1.
2.
3.
Semple S, Apsley A, Galea KS, MacCalman L, Friel B, Snelgrove V. Secondhand smoke in cars: assessing children's potential exposure during typical journey conditions. Tobacco control. 2012;21(6):578-83.
Northcross AL, Trinh, M., Kim, J., Jones, I.A., Meyers, M.J., Dempsey, D.D., Benowitz, N.L., Hammond, S.K. Particulate mass and polycyclic aromatic hydrocarbons exposure from secondhand smoke in the back
seat of a vehicle. Tobacco control. 2012;23:14-20.
Bandiera FC, Richardson AK, Lee DJ, He JP, Merikangas KR. Secondhand Smoke Exposure and Mental Health Among Children and Adolescents. Archives of pediatrics & adolescent medicine. 2011;165(4):332-8.
HB 1431: No Smoking in Cars with Children
•Sought to penalize smoking in cars
with children
•Outcome: Withdrawn
Educational Opportunities for the Incarcerated
•22,087 Marylanders behind bars
• most from disadvantaged backgrounds and
• during their most productive years
•Fewer than half of inmates have a high school degree (1)
•95% of those incarcerated each year will eventually be released (2).
1.
2.
Education and Workforce Training Coordinating Council for Correctional Institutions: Activity Report 2015. State of Maryland, Department of Labor, Licensing and Regulation; Maryland Department of
Public Safety and Correctional Services, 2015.
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, “Reentry Trends in the United States,” March 1, 2016. http://www.bjs.gov/content/reentry/reentry.cfm; hereinafter
“Reentry Trends.”
HB 1195: Correctional Education
•Education can empower inmates to return to the
community as productive members of society
o Improved earnings: GED programs in prisons
on increase post-release earnings by 15% on
average (1)
o Potential reduction in recidivism: The Bard
Prison Initiative in NY has reduced recidivism
by 4%.
•HB1195 proposed a task force to explore such
options
•Outcome: Did not pass House Appropriations
Committee
1. Tyler JH, Kling, J.R. Prison-Based Education and Re-entry Into the Mainstream
Labor Market. National Bureau of Economic Research. 2006.
Opioid Addiction
•464 heroin-related deaths in Maryland in 2014 (1)
•27.4% of HIV cases and 38-54% of HCV cases attributable to injection drug use
(2,3)
•High cost of treating each case of HIV (estimated at $380,000 over the course of
a lifetime) and HCV ($84,000 for a full course of treatment) (4)
1. ARTIGIANI, E. E., WISH, E.D. 2014. Patterns and Trends of Drug Abuse in the Baltimore/Maryland/Washington, DC, Metropolitan Area—Epidemiology and
Trends: 2002–2013 Proceedings of the Community Epidemiology Work Group.
2. DANIELS, D., GRYTDAL, S., WASLEY, A. 2009. Surveillance for Acute Viral Hepatitis - United States, 2007. Morbidity and Mortality Weekly Report, 58.
3. 2015b. HIV Among Injection Drug Users in Maryland, 2013. Maryland Department of Health and Mental Hygiene.
4. BIRNBAUM, H. G., ET AL. 2011. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain medicine, 12, 657-667.
HB 468: Syringe Services
•HB 468 proposed to expand syringe
exchange services in MD, and increase
preventive education and linkage to
addiction treatment programs
•Given high cost of treatment, many
programs would be cost-effective even
if they only prevented one case
•Outcome: Passed by House and Senate!
Challenges and Observations
•Slow-moving process
•Cost a common barrier to implementation
•Need to manage different stakeholders’ needs
•Value of hearing personal experiences in testimony
References
1.
Semple S, Apsley A, Galea KS, MacCalman L, Friel B, Snelgrove V. Secondhand smoke in cars: assessing children's potential exposure during typical journey conditions.
Tobacco control. 2012;21(6):578-83.
2.
Northcross AL, Trinh, M., Kim, J., Jones, I.A., Meyers, M.J., Dempsey, D.D., Benowitz, N.L., Hammond, S.K. Particulate mass and polycyclic aromatic hydrocarbons
exposure from secondhand smoke in the back seat of a vehicle. Tobacco control. 2012;23:14-20.
3.
Bandiera FC, Richardson AK, Lee DJ, He JP, Merikangas KR. Secondhand Smoke Exposure and Mental Health Among Children and Adolescents. Archives of pediatrics &
adolescent medicine. 2011;165(4):332-8.
4.
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, “Reentry Trends in the United States,” March 1, 2016.
http://www.bjs.gov/content/reentry/reentry.cfm; hereinafter “Reentry Trends.”
5.
Education and Workforce Training Coordinating Council for Correctional Institutions: Activity Report 2015. State of Maryland, Department of Labor, Licensing and
Regulation; Maryland Department of Public Safety and Correctional Services, 2015.
6.
Tyler JH, Kling, J.R. Prison-Based Education and Re-entry Into the Mainstream Labor Market. National Bureau of Economic Research. 2006.
7.
ARTIGIANI, E. E., WISH, E.D. 2014. Patterns and Trends of Drug Abuse in the Baltimore/Maryland/Washington, DC, Metropolitan Area—Epidemiology and Trends: 2002–
2013 Proceedings of the Community Epidemiology Work Group.
8.
DANIELS, D., GRYTDAL, S., WASLEY, A. 2009. Surveillance for Acute Viral Hepatitis - United States, 2007. Morbidity and Mortality Weekly Report, 58.
9.
2015b. HIV Among Injection Drug Users in Maryland, 2013. Maryland Department of Health and Mental Hygiene.
10.
BIRNBAUM, H. G., ET AL. 2011. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain medicine, 12, 657-667.
Questions?