Public Health Policy & Legal Issues

SESSION AUDIO:
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MODERATOR:
Michelle A. Larkin, J.D., M.S., RN

PANELISTS:

Ellen Jones, Ph.D., M.S., CHES

Facilitators and Barriers to State Obesity Policy

The objective of this study was to examine qualitative factors that influence the passage of childhood obesity legislation in states with lowest and highest rates of childhood obesity, and states with few and many childhood obesity bills enacted. In order to identify states with different levels of childhood obesity policy action, legislation on sixteen evidence based topic areas was analyzed. Data sets included NETSCAN and NCHS.  The topic areas included nutrition and vending standards, health and PE credit, BMI reporting, safe routes to school, local authority, model school policies, taskforces, farmer’s markets, farm to school programs, walking and biking trails, menu and product labeling, soda and snack taxes, and childcare physical activity and nutrition standards.  States were assigned to tertiles based on the total number of bills enacted and most recent childhood obesity rates.  Eight states were assigned to a 2x2 table to represent both high policy action and low policy action and high and low childhood obesity states.  Legislators from 8 states were interviewed by phone using a semi-structured guide.  The interviews were coded and analyzed. Two to three phone interviews were conducted in each of the eight states with legislators who serve on health committees.  Legislators from all states expressed some concern for childhood obesity in varying levels.  Overall, legislators were divided in their perceptions of bill attributes, evidence base, and likelihood of successful policy interventions. Legislative perception varied among states with high and low policy action and high/low obesity rates.  Contextual factors including time in session, term limits, party, public support, family factors, and type of legislature contributed to differences.  Results form this qualitative study will add to the body of knowledge around state and local health policy enactment by further describing the facilitators and barriers identified by state legislators themselves.

Patricia Sweeney, J.D., M.P.H., RN

State Public Health System Emergency Preparedness and Response: A Legal Network Analysis

Co-Investigators: E.F. Bjerke, J.D., C. Keane, Sc.D.

The Public Health System (PHS) is an interdependent network of public and private agencies, institutions, and individuals that includes not only governmental public health agencies, hospitals, and health care providers, but also involves law enforcement, civic groups, faith institutions, emergency medical services, and more. Each interdependent agent of this system, however, is directed by and accountable to a set of laws that are unique to that organization’s contribution to and its place within the public health system (federal, state, or local). As noted in the IOM report “Crossing the Quality Chasm,¹” the real power of a system lies in the way the parts come together and become interconnected to fulfill a specific purpose. The objective of this research project was to determine if the agents of the PHS, with independent legal authorities and duties, are directed by law to function as an interconnected and efficient preparedness and response system. Utilizing the electronic legal database Lexis/Nexis, and a precise, systematic search methodology, the laws directing 27 public health system agents in each state were identified and collated into a database. Using qualitative research methodology, the text of each statute was then coded as to the agent being directed, the action to be taken, the purpose of the action, the goal to be accomplished, the timeframe for completion, the condition that triggered the action, and whether the action was statutorily mandated or at the discretion of the actor. The legal network analysis revealed remarkable variability in the preparedness and response direction legislators have given PHS agents, both across and within states. This research provides an evidence base of the legal infrastructure directing the nation’s public health systems emergency preparedness and response activities.

¹ Institute of Medicine. Crossing The Quality Chasm: A new Health System for the 21^st Century. National Academies Press. 2001.