How Legal and Policy Levers Can Amplify Efforts to Reach Healthy People Goals
Each of these tools have been used to shape the built environment, information environment, and socio-economic and social environment.
Altering the Built Environment: Public health has a long history of reducing harms by altering the built environment, such as workplace safety laws, traffic policies, and fire codes. Legal and policy tools to address sanitation, zoning, housing codes, and toxic exposures or emissions have also impacted rates of infectious and chronic diseases. Local governments play a particularly important role through zoning, licensing, and permitting authority. They can encourage healthier choices about harmful products and services—for example, by reducing the number of retailers that sell tobacco or firearms. They can also promote healthy behaviors like physical activity and choosing nutritious foods by making it easier to establish grocery stores or recreational facilities.
Altering the Information Environment: Several legal and policy tools can alter the information environment and advertising that impact health and behavior. First, governments at all levels can sponsor communication campaigns to educate the public and can shape social norms in ways that influence health. Second, laws and policies can compel businesses and other entities to provide information about their products and services, such as instructions for safe use, disclosure of contents or ingredients, and health warnings. Third, harmful or misleading information in private marketing can sometimes be curtailed, most often through advertising restrictions.
Some of the most common forms of these restrictions are known as time and place restrictions. For instance, prohibiting television advertising for certain kinds of products or during times of the day when children represent a higher viewership are examples of time- and place-based restrictions. In some cases, advertising content itself can be restricted, such as prohibiting the use of cartoon characters or other elements that appear especially attractive to children—or prohibiting the use of some qualifiers, like the word “light” in cigarettes. However, these kinds of activities may be subject to constitutional or cultural constraints. To address the First Amendment interest in protecting freedom of speech—including that of commercial speech—governmental restrictions must be narrowly tailored to promote an important governmental interest. Litigation to determine if a restriction is permissible can be costly—so even if a law or policy approach would be upheld in a legal challenge, it can still cause a chilling effect.
Additionally, in recent cases the Supreme Court has increased protections for commercial speech, which will impact public health. For example, graphic warning labels on tobacco packages were determined to impermissibly infringe on the speech rights of tobacco companies, even though they are an effective public health intervention to reduce tobacco-related harms. Pharmaceutical companies have also argued that FDA restrictions on off-label advertisements for drugs violate the First Amendment. The opioid crisis and litigation may shine new light on this, given how manufacturers and distributors promoted opioids. Beyond speech-related constitutional interests, there are powerful moral, cultural, and economic interests implicated in efforts to alter the information environment around controversial topics such as sexual practices, reproductive health, smoking, food and beverage consumption, and safe storage of firearms.
Altering the Social and Socioeconomic Environment: Epidemiological research consistently demonstrates that household and neighborhood socioeconomic conditions strongly correlate with morbidity, mortality, and functioning. Some research goes further, concluding that the overall level of economic inequality in a society is correlated with public health; societies with wide disparities between the rich and the poor tend to have poorer health than societies with smaller disparities. Redistributive policies are highly controversial and politically charged, with opponents frequently claiming that such policies are beyond the public health enterprise. Additionally, some economists believe that a free-market economy with limited governmental intervention is necessary to sustain prosperous societies that support health. Nonetheless, research suggests that social and economic policies that increase access to educational, employment, and housing opportunities—and support access to health care and good nutrition—generally raise the standard of living and improve health outcomes.