In the pursuit of optimal health, quality medical care is often considered a highly influential factor. However, this perception is not entirely accurate.
The World Health Organization (WHO) states that overall health is impacted by a multitude of factors, such as an individual’s social status and daily physical environment. In fact, WHO indicates that when it comes to health, “the more commonly considered factors such as access and use of health care services often have less of an impact.”
According to Eric Crosbie, an assistant professor of the School of Community Health Sciences at the University of Nevada, Reno, “There’s a common expectation among community health students that the focus of their studies will be on topics such as epidemiology and biostatistics, but there is another branch of health, that looks at how a variety of disciplines influence public health.”
Crosbie teaches a course on commercial and corporate determinants of health. Undergraduates in Community Health Sciences develop a well-rounded understanding of how disciplines like political science, economics and law impact public health.
Public Policy’s Importance to Community Health Professionals
Public health policy is a collection of government laws, regulations, plans and funding priorities that work together to improve the overall health of a community or population.
Community health professionals work alongside members of the medical community and government to support the development and creation of public health policies. These professionals use a multidisciplinary approach to identify trends or opportunities to improve public health. This comprehensive approach looks at a variety of factors that negatively impact health, commonly referred to as determinants of health.
“One of the first things students in Community Health Sciences learn about is determinants of health,” Crosbie says. Determinants of health include not only genetics factors, but also social factors, such as an individual’s physical surroundings, economic status and personal behaviors. For this reason, health issues addressed by public health policy are diverse and far reaching.
Public policies typically support public health by monitoring and regulating harmful consumer products, such as the minimum legal age laws for purchasing alcohol. Alternatively, the goal of other public policies may be to protect and prevent unsafe behaviors; mandatory seat belt laws serve as an example of this type of policy.
Current Public Policy Issues
According to Crosbie, “We’re seeing a new wave of literature that’s focusing less on biological determinants, and more on what is called commercial determinants. Basically, looking at how corporations from the tobacco, food, alcohol, pharmaceutical and fossil fuel industries influence and impact public health.”
Crosbie has spent the bulk of his research focusing on tobacco and tobacco control, documenting the strategies and tactics used by the tobacco industry. In his research, he discusses how other industries have followed and adopted the tobacco industry playbook. Three current public policy issues discussed in his research that community health professionals should know about include new developments in warning labels, illegal smuggling through self-regulation and the use of preemptive bills to stall progressive bills.
Greater Requirements for Warning Labels
The packaging and labels on consumer food products continue to increase in complexity. In addition to nutritional information, labels may also include allergy information; organic certifications; and, in the case of alcohol and cigarettes, warning information.
According to Crosbie, there is a new trend in consumer packaging that could hit store shelves soon. “In the U.S. all cigarette packages are required to have a textual warning; however, in some other countries, such as Canada, you’ll see cigarette packages have really graphic and repulsive images,” Crosbie says. “These graphic images illustrate the harmful health effects of smoking on the body, such as a picture of a healthy lung beside a cancerous lung.”
“There is evidence to support that these graphic images do reduce consumption of unhealthy products,” Crosbie says. A 2018 study conducted by the University of Melbourne and Cancer Council Victoria revealed that interest in purchasing a sugar-sweetened drink decreased by 18% when the product label had an image with the amount of sugar in the drink. The likelihood of purchasing the sugar-sweetened drink dropped by 36% when the product had an image of rotten teeth.
“One day we could possibly see similar graphic images being put on unhealthy food products in,” Crosbie says.
Preemptive Action to Prevent Progressive Bills
“By its pure definition, preemption is a legal way to transfer authority from a lower governing body to a higher governing body,” Crosbie says. For example, transferring authority from the local level to the state level or from the state level to the national level is an example of preemption.
“Preemption was used as a political weapon by the tobacco companies in the 1980s to basically stop the diffusion of local-level policy making,” Crosbie says. Many localities, he says, introduced clean air policies in the 1980s and 1990s to restrict public smoking in restaurants, shopping centers, hospitals and other areas. The tobacco companies responded by concentrating all of their efforts at the state level, with preemptive bills stating that localities should not be able to pass this type of progressive bill.
“The tobacco companies were basically trying to stop the momentum of these clean air laws, and they did just that,” Crosbie says. According to Crosbie, this strategy of preemption is now being implemented by the beverage industry to stop the momentum of another progressive policy aimed at reducing consumption of sugar-sweetened beverages.
“What’s beginning to happen is a movement to pass sugar-sweetened beverage taxes — essentially a taxation policy to reduce consumption of these unhealthy products,” Crosbie says. “And we’re seeing some states, like California, pass state preemption bills that say no locality going forward can adopt a policy that increases taxation on sugar sweetened beverages for the next 12 years.”
“Essentially history is repeating itself as we see the same preemptive strategy employed by the tobacco industry in the ’80s and ’90s being used presently by the beverage industry,” Crosbie adds.
Illegal Smuggling Through Self-Regulation or Voluntary Partnerships
“Self regulation, or trying to avoid regulation by creating voluntary partnerships, is a common practice across all industries, but it is particularly prevalent with tobacco companies,” Crosbie says.
High cigarette taxes are a considerable cost to tobacco companies exporting their product. “There’s been evidence finding that some tobacco companies attempt to evade these taxes by illegally smuggling their product — tobacco smuggling is a worldwide issue,” Crosbie says. “And most people are surprised to learn that tobacco companies actually partner with illegal groups, such as cartels, in order to help facilitate the smuggling and distribution.”
Creating self-regulation through voluntary partnerships is the strategy used by the tobacco companies to prevent authorities from detecting their involvement in illegal smuggling. “There are examples where a tobacco company will establish a memorandum of understanding, essentially a partnership, with border patrols and police groups that states that the company will take on the responsibility of preventing the illegal smuggling of their product. But at the same time this company is working directly with the illegal groups that smuggle the product.”
For community health professionals, this type of self-regulation is particularly concerning. By bypassing illegal smuggling regulations and avoiding the high taxes placed on their product, the tobacco companies are undermining the protective public health policies in place that work to reduce the harmful effects of smoking.
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