Public health law is a field that focuses legal practice on the governments legal authorities and duties that will ensure conditions for citizens to be healthy, along which making sure there is a balance between the authorities and duties and individual rights and legally protected interests. Public health law is a broad topic that can range from legal interpretation to ethics and health policy. The overall objective is to make sure that the citizens are getting the assistance they need, public health practitioners and attorneys have been working to collaborate and create pathways that will advance public health through law.
The Constitution, International agreements, legislations, regulations, and case law are all forms of legal authority that are used in historically and in modern public health to achieve advances in the public health sector. Issues such as infectious disease control, occupational health, injury prevention, emergency preparedness and response, and food safety have had important achievements made in those areas through the use of statues, regulations, and litigation.
Every level of government is relevant in making sure that these achievements occur. The Constitution reserves primary power to regulate health, safety, and welfare for the common good to the states under the 10th Amendment. These powers are also known as police powers. Police powers allow states to promote laws that will better the general welfare and health of the citizens. Isolation and quarantine, community vaccinations, responses to public health emergencies are all examples of police powers. The Constitution leaves this area of police powers broad to ensure that the states can effectively protect the interest of the citizens, however, citizen’s rights to privacy and expression are still protected and limit the state’s powers.
Local governments, tribal governments, and federal governments all have public health authority. The federal government through tax, interstate commerce, and interest of national security have been able to enact federal laws that override state and local laws. Tribal government have an independent authority to address the individual public health concerns in their communities. They work closely with state and federal governments to provide public health services for the citizens that live on their reservations.
All three governments have law and public policy tools that can be used to improve population health in this country. Most of the tools are for improving or protecting health whereas others involve actual health agencies. These tools include but are not limited to: taxation and spending; altering the informational environment; altering the physical environment; direct regulation; indirect regulation; and deregulation.
PUBLIC HEALTH LAW TOOLS
The Centers for Disease Control and Prevention (CDC) has published a video on YouTube that focused on the tools to address emerging health concerns. CDC understands that law is “a critical tool for protecting and promoting the health of the public.” The area of taxation and spending powers that the federal government has allows for taxation on cigarettes and other “sin” taxes such as alcohol to help fight the problem of cigarettes and alcohol falling into the hands of children and to deter adults from purchasing by increasing the prices to make them more undesirable. This is done with the hopes of lowering levels of lung cancer and alcoholism in communities, along with other alcohol and tobacco related diseases such as liver cancer and emphysema.
Altering the informational environment is a tool because food or drug labeling will let you know the type of product you are consuming. The disclosure of health information allows consumers to make their own informed decisions on what they put into their bodies. Direct regulations are tools that require you to wear seat belts in the car, licensure of medical care providers and facilities, and have fluoride in the drinking water. There are indirect regulations like tort litigation in tobacco and deregulation such as criminalization of HIV risk behaviors that help keep the public safe from exposure.
All of these tools are in place to protect citizens from harm and promote health and safety. Depending on the community and neighborhood being looked at, different tools are more beneficial to certain areas than others.
SOCIAL DETERMINANTS OF HEALTH
Social determinants of health are conditions in the environments that people are born, live, and work in. It is widely known that eating well and staying physically active will keep our bodies healthy. Society knows that smoking and drinking is harmful to our organs and that being immunized and seeing a doctor will help us monitor our health. However, keeping our bodies healthy also rely on: social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; safety in workplaces; cleanliness of our water, food, and air; and our social interactions and relationships. These are all the conditions which allow some Americans to be healthier than others and why as a country we aren’t as healthy as we could be.
In order to figure out how to help a community it must first be understood what the social determinants are of the citizens that live in that community. Those that live in affordable housing without access to healthy foods and access to education will suffer more than those who don’t. Life expectancy of Americans increased from 69.7 years in 1950 to 78.8 years in 2015. However, despite the overall improvement, substantial gender and racial/ethnic disparities remained. Life expectancy was lower in rural areas and varied from 74.5 years for men in rural areas to 82.4 years for women in large metro areas. The rural-urban disparities continued to increase during the 1990-2014 time period. Racial/ethnic, socioeconomic, and geographic disparities were particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, diabetes, COPD, HIV/AIDS, homicide, psychological distress, hypertension, smoking, obesity, and access to quality health care The health inequities between population groups and geographic areas have continued and have been a major policy concern.
FOOD DESERTS
Food policy has become a key interest for public health practitioners with the increase in food-borne illnesses and diet-related diseases. Once of the major legal themes is food access. Food deserts, in general, relates to geographic areas where residents’ access to affordable, healthy food options (particularly fresh fruits and vegetables) are unavailable due to the absence of grocery stores within convenient traveling distance. As there is no definitive definition to define food deserts, a noticeable relationship involving neighborhoods and health exists and also provides implications of the reality of physical and environmental factors as well as social dynamics. When it comes to the nature of poverty in urban cities it is difficult to gain access to healthy foods in those communities without reliable transportation. The health of people living in these areas with little access to healthy food options is usually poor. Conducted research has further implied that food deserts are most commonly found in communities of color and low-income areas where many people don’t have cars.
Citizens who live in low-income neighborhoods are typically disadvantaged due to easy access to unhealthy food options at corner stores or fast food restaurants that are cheap and within walking distance from where they live. Healthier food options are strategically placed in neighborhoods that aren’t as economically disadvantaged which may be further substantiated with statistics for individuals in food desert communities and perhaps additional health related issues. A study at the national level was conducted which allowed supplementary evidence as to why the need for healthier food options exists for low- income neighborhoods. The comprehensive study of 21, 976 US zip codes contained 259,182 full-service restaurants and 69, 219 of those restaurants were fast-food restaurants. It was found that these establishments were highly concentrated in low and middle-income neighborhoods than in high-income neighborhoods. It is predicted that the socioeconomic factors impact the location of healthy food options. Specifically, areas of lower household incomes will have fewer healthy food options than those of higher income levels. Evidence has shown those socioeconomic factors and other factors such as "lack of green space, lack of transportation, lack of sidewalks and bike lanes, pollution exposure, and easy access to fast food have created a toxic environment in the majority of U.S. low-income neighborhoods." Social influence plays a key role in driving healthy behaviors in populations with poor access to resources. All of these factors aid in the prevalence of food-deserts in low-income areas and the reason the people that live in these areas suffer from health disparities.
ADDRESSING THE PROBLEM
The first tool I would use to address the problem is policy tools on the physical environment. Laws and regulations are used as prevention strategies to secure safer behavior among the population. This can be done using the environment. The law alters the physical environment to facilitate safer behavior. For example, laws on fast food or liquor store density have been established to lower the amounts of fast food and alcohol consumption in certain areas. This is a way that the government actively steps in to lower the risk of food and drug related diseases.
There is a strong ability to target unhealthy food choices from different angles. First, federal agencies should use their authority to regulate businesses and require them to produce some type of healthy food options with prices that are significantly more expensive than the unhealthy choices. Depending on the amount of schools present in a city there should be a required amount of grocery stores or farmers markets that provide healthy food options in those areas. If policy mandates that half the amount of corner stores in urban areas be replaced with a grocery store or a farmer’s market that provides fresh fruits and vegetables, people would have access to the foods they need within walking distance of their homes. This would eliminate the issue of not being able to get access to healthier food options due to lack to transportation.
The second tool would be taxing and spending powers that Congress have to regulate the risk behavior. Congress has the power to provide economic relief for certain kinds of private spending or taxation that can regulate private behavior by penalizing risk taking activities. For example, taxing and spending has been used to create higher taxes on tobacco and alcoholic beverages to discourage unhealthy or dangerous behaviors that come with smoking and drinking. Higher taxes can be placed on restaurants that have significantly higher prices for healthier foods to encourage restaurant owners to serve healthy foods at a cheaper price. Congress could also use its spending power to regulate money into buying out corner stores and replacing them with farmers markets or healthy grocery store options.
The third tool I would use would be policy on informational environments which includes education. Education is used as a tool to provide the population with awareness of health consequences of risk behaviors and allows informed decisions to be made before indulging in habits that can be harmful to their bodies. Agencies deliver messages via commercials, billboards, and labeling on food products to educate the populations about the health consequences for engaging in these behaviors. This same method can be used to notify citizens of where there are healthy places to grocery shop in the area and how to access these locations. If the population is aware that there are healthier options in the vicinity and they are cost efficient some may be willing to extend the extra effort to get to these places for better food options. Agencies can promote and provide information on where health food stores and farmers markets are located for citizens to shop at and educate them on why shopping at those stores would be more beneficial for the health of their family.
Conclusion
Despite the overall health improvement, significant social disparities remain in a number of health indicators, most notably in life expectancy in areas healthier foods are not readily available. Specific disparities in various health outcomes indicate that there is an underlying significance of social determinants in disease prevention and health promotion associated with unhealthy eating and unavailability of healthy food options. In order to overcome these health issues a mandated and systematic approach to providing health food stores needs to be established to help lower the amount of food deserts plaguing low and middle-income communities. Health inequalities according to social factors needs to become a priority so that the life expectancy gap can continue to close.