Closing the gap in evidence around public health law

The law can be as effective in addressing poor health outcomes as any pharmaceutical – yet there is virtually no research evaluating its impact or unintended consequences, according to a leading US law and public health expert.

Every year, legislatures in the US pass more than 1000 health laws, plus thousands of other laws that also impact health, but there is virtually no research investigating whether these laws achieve positive health outcomes, said Professor Scott Burris, Professor of Law and Public Health at Temple University, Philadelphia.

“We need to think of the law as a treatment. We wouldn’t tolerate that gap in research for a pharmaceutical,” said Professor Burris, a world leader in conducting empirical approach to the study of public health law.

Professor Burris was speaking at a seminar co-hosted by The George Institute for Global Health and The Australian Prevention Partnership Centre, which is working to build the evidence base around public health law to inform policy decisions in Australia.

He said the law had been central to most public health advances of the 20th Century, such as universal vaccination and road safety laws, but it could also influence health in other, more complex ways. For example, tax laws had created greater social inequality in the US, and city zoning laws entrenched disadvantage in vulnerable groups.

Unintended consequences

There were often unintended consequences of the law, for example the ‘stop and frisk’ laws in the US that led to greater mental distress in young black men, who were disproportionately targeted by police.

Professor Burris said sometimes the publicity around the passage of legislation achieved behaviour change even before the laws were enacted, as happened when New York City was considering reducing the portion sizes of soft drinks. And even when there was initial public resistance to the passage of a new law, in time behaviours that were mandated usually became social norms, such as wearing seatbelts or the use of child restraints.

Yet despite the substantial resources required to enact and enforce legislation, the way the law influenced behaviour was poorly understood and research in this area was underfunded. Most scientific literature around public health law consisted of commentary and review rather than genuine empirical evidence.

After Professor Burris received US$20 million funding from the Robert Wood Johnson Foundation to establish a research program around the evaluation of public health law, his first goal was to break down the cultural barriers between lawyers and scientists so that public health law would be researched in the same way as any other social behaviour.

“It’s purely a false belief that legal practices can’t be measured like any other social phenomenon,” he said. “We needed to treat law as a normal human behaviour that could be studied by scientific means.”

As part of the project, his team launched the Law Atlas, which provides datasets for policy makers and researchers to compare laws across different international jurisdictions and to track their effect.

Professor Burris said public health law needed to offer five key services: access to evidence, expertise in designing legal solutions, engagement building with communities and policy makers, support for enforcing and defending legal solutions, and policy surveillance and evaluation. These required an interdisciplinary approach, he said.

“Often with law reforms, loss is measured in morbidity and mortality, people whose deaths could have been prevented. It’s not about how we can reinvent public health law, but how we can do it better or faster.”

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