Law and public health: Advocacy in action

Journal of Public Health Policy,  2002  by Pertschuk, Michael

• E-mail
• Print
• Link

A forthcoming article in The American Prospect by Steven Schroeder and Stephen Isaacs reminds us what we can learn from success stories in health. Looking back a half century they consider work in fluoridation against tooth decay, control of lead exposures, reductions in car crash deaths and injuries, and decline in tobacco use.

* Throughout most of the 20th century, dentists confronted hordes of children with rotting teeth-but by 1988 the American Dental Association reported that through fluoridation, half of the school children in the US had never had a cavity in their permanent teeth.

* Average levels of lead in Americans' blood dropped precipitously-78% between 1980 and 1991.

* Safer cars, improved highways, lower speed limits, better emergency medical services, and less drunken driving have sent fatality rates tumbling-a decrease of 75% since 1950 in lost lives per 100 million vehicle miles.

* Since 1996, the percentage of adult male smokers has declined from a high slightly over 50% in 1966 to about 2.8%. Despite the occasionally perverse byproduct of greater equality, the percentage of women smoking has fallen from a high of 34% in 1966 to 24%.

Common to each of these successes, Schroeder and Issacs conclude was the combination of credible health science and responsive local, state, and federal laws and regulations. And critical to each was the emergence of passionate and skilled advocates!

For lawyer advocates like me and Dick Daynard, Ralph Nader, and others, M. Jourdain's self-revelation that he had unwittingly been speaking prose for years applies to our vocation in public health: I'd been a public health practitioner for some 15 years before I realized it.

Working with the Senate Commerce Committee in the 1960s and 19705, working with Nader, Joan Claybrook, Sid Wolfe, Andrew Maguire, Abe Bergman, and other pioneer advocates, we helped shape laws governing death by auto crashes, children's burn injuries from flammable sleepware, safety closures to prevent childhood drug poisonings, violent death from exploding natural gas pipelines, silent deaths from unregulated electronic radiation, and chokings from mal-designed cribs-and, to our shame, we also accepted weak, industry-dictated laws mandating pathetic warnings and hidden liability protections for the tobacco industry.

In the 70s, Dick Daynard's avocation was his volunteer leadership of Massachusetts GASP, a pioneering smokers rights advocacy group. At first, this passion was unconnected with his day job-teaching law. But his greatest contribution to public health came from the strategic application of the lawyerly tool of litigation to the achievement of public health goals-a tool that evolved from an "all thumbs, no fingers" hammer to a calibrated instrument of public policy.

Others among you have made the same journey from law to public health. Steve Teret actually moved from the law office and trial court to the Johns Hopkins School of Public Health-all the while keeping his eye firmly on the prevention of death through gun violence by litigation and regulation.

At the same time, Sid Wolfe was moving from research medicine at NIH to join forces with Ralph Nader, Joan Claybrook, and Alan Morrison and form the robust Public Citizen team of public health advocates ringing the changes on legal strategies for public health goals.

A decade ago, whenever I was approached by a young person who wanted to challenge the corporate purveyors of death and disease, I realized that virtually nothing in my law school training, even at Yale which aspired to the broadest of legal training, had prepared me for the tasks of a policy advocate.

I reflexively urged them to head for a law school like Northeastern or Queens, which focused on public interest advocacy. And then I began to add, that a masters in public health, say at Johns Hopkins or at Berkeley, would be a very useful complement.

I don't know how firmly the curriculum for your dual degree program is set, but just the concept began to conjure up in my mind the glorious courses of study that, looking back on a career of advocacy learned by making hideous mistakes, I wish I'd had access to.

For example, Schroeder and Isaacs also observe in their article on lessons learned from successes in public health that "behind every public health and safety measure enacted in this half-century, has been a media advocacy campaign to dramatize both the risks and the public policy solutions."

So I would have loved to have had access to a course that captures the strategic genius of Tony Schwartz, the political communicator who developed the famous, or infamous, anti-Goldwater "Daisy Petal" commercial, and went on to produce hundreds of public health commercials skewering the tobacco companies, the gun nuts, the booze merchants, and other corporate threats to public health. And I'd like to have had the cross-disciplinary benefit of applied communications research ranging from the new political science media-effects research to research in the role of metaphor in attitude formation uncovered by the cognitive linguists. And the fruits of political communications research on the uses of polling and focus groups.