Public Health Policy and Legislation as
Tools to Drive Population Health
Edward P. Richards
Director, Program in Law, Science, and Public Health
Louisiana State University Law Center
richards@lsu.edu
White Paper - Legal Strategies to Manage Obesity and
Increase Physical Activity:
http://biotech.law.lsu.edu/cphl/slides/pennington-2012.htm
Levels of Action
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Federal
 Can implement a policy globally
 May be necessary for reimbursement changes
 Hard to change if you get it wrong
State
 Allows experimentation
Local
 Powerful in big cities, less effective in small cities
Legal Theories of Action
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(Increasing power order)
Parens Patria (state as parent)
 Protecting the individual
Police Power
 Protecting the general public
National Security Power
 Protecting the state itself
 Can we save the constitution and lose the union?
Modes of Direct Legislative Action
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Modify the environment through direct regulation
 Sanitation
Modify the environment through tax or other financial
incentives
 Cap and trade for power plant emissions
Directly mandate changes in individual behavior
 War on drugs
Financial incentives to change individual behavior
 Soda taxes
 Tobacco taxes
CDC Ten Great Public Health
Achievements
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Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious
diseases
Decline in deaths from
coronary heart disease
and stroke
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Safer and healthier foods
Healthier mothers and
babies
Family planning
Fluoridation of drinking
water
Recognition of tobacco
use as a health hazard
Public Health Failures
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Drug Policy
 Prescription pain killers kill more people than
illegal drugs
 The war on drugs has filled prisons and destroyed
the lives of millions
Sexually transmitted disease control
 Broke down in the 1970s with the bathhouses
 Enabled HIV and limited the effectiveness of HIV
control for 20 years
Is Obesity an Unintended Consequence of
Other Laws and Policies?
Can we successfully manage obesity
without addressing these underlying
drivers?
Agricultural Policy in the 1950s
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Make food staples more affordable
Make meat affordable for everyone
Unintended consequences
 Emphasis on processed grain based foods and
meat
 Supersizing as marketing edge
 Larger portions at home
 The snack culture
Land Use Law and Zoning
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Separate commercial and residential development
to make neighborhoods more healthful
 Single use zoning
Encourage green field development to reduce the
cost of housing
Low density housing requires automobiles, so
there is no need to walk
Single use zoning means to place to walk to
Building Regulations
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Fire regulations keep stairs closed and at the
edge of the building
Security regulations often limit routine access to
stairs
ADA and other regulations require easy access
for handicapped persons, but non-discrimination
regs also prevent this access from being limited
to disabled persons
Vending Machines in Schools
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Driven by budget cuts
Generate important income for many schools
Lead to the breakdown of rules against eating in
schools, otherwise no income
School Lunches – Why Fast Food?
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Many schools are overcrowded
Lunches are served to many more students than
the kitchens and cafeterias are designed for
Fast food, especially when it is supplied by third
parties, is the only way to serve the crowd
Physical Activity of Students
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Many schools do not require students to have
organized physical activity each day
 PE was cut as budgets were cut
 PE was cut to make more room for substantive
courses
Schools increased homework so students do not
have time to play after school
Failed Social Infrastructure
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Crime in poor neighborhoods
 Children cannot play outside
Food insecurity
 Contributes to obesity
Limited availability of grocery stores and produce
Failed k-12 education
 Probably the most important determinant of
obesity.
The Risk of Medicalization
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There are powerful forces that push the
medicalization of problems
This allows the problem to monetized
 Medical procedures
 Drug sales
Legislatures like these “fixes” and the dollars that
flow from them to their campaign funds
They can consume precious dollars and divert
attention from structural changes
Legislative Priorities
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Legislatures have limited in health issues
It is critical that this not be squandered with
ineffective legislation or legislation that has little
impact on health
Legislatures like “easy” legislation, such as
banning sodas, to avoid more critical issues
 “We passed a law, why isn’t the problem
solved?”
The Problem of the Long Term
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Legislatures do not like to deal with problems that
have no quick fix or whose fix is very expensive
 K-12 education
 Social infrastructural issues
If we find effective strategies for obesity control,
they will take a very long time for results
How do we keep legislative focus to keep
programmatic and research dollars flowing for
problems that do not have short-term fixes?