Tuesday, January 14, 2014

Excellence in State Public Health Law


For the last 3 days a team from Minnesota has been meeting with similar teams from 7 other states to learn about how to use public policy approaches to advance public health initiatives. The program is conducted by the Aspen Institute and funded by the Robert Wood Johnson Foundation. Entitled Excellence in State Public Health Law (ESPHL), the premise of the program is that teams consisting of state health commissioners, state legislators, and policy directors in governors' offices could learn from each other and collectively advance public health policies; legislators and policy directors could learn about public health while public health folks could learn about policy development.

Each team at the meeting was focused on a different public health issue that was relevant to its state. Hawaii focused on improving the oral health of children. Washington State is trying to increase the number of "Baby Friendly Hospitals" as a way to increase breast feeding rates and reduce obesity. Arkansas is attempting to increase the physical activity levels of girls. Louisiana is working to improve the vending options in their office building and strengthen their retail food regulation. Virginia is also looking at improving the quality of food served in public facilities and is working on establishing a model public health policy development process. Rhode Island is hoping to create a Neighborhood Health Station that would integrate primary care and public health and get financed through a Primary Care Trust Fund established by an insurance claims tax. Connecticut is trying to align and organize (regionalize) its 169 independent local public health agencies.

The focus chosen by Minnesota is to find the policy initiatives that could reduce the negative consequences of high risk (binge) drinking. The Minnesota Team consists of 2 senators (Chris Eaton and Jeremy Miller), 2 representatives (Susan Allen and Nick Zerwas), the governor's legislative director (Jamie Tincher), three commissioners (Lucinda Jesson DHS, Mona Dohman Public Safety, and me), and one MDH assistant commissioner (Manny Munson-Regala). (Tincher and Jesson were unable to join us this weekend.) The make-up of the Minnesota team recognizes the Health in All Policies approach that will be necessary to have an impact on high risk alcohol use. Policies like increasing the price of alcohol, lowering the Blood Alcohol Concentration (BAC) for DUI designation, eliminating drink specials, and increasing the use of ignition interlock systems (among many others) will probably come out of legislative committees other than health and human services, if they come at all.

After evaluating the research evidence of effectiveness of various interventions, polling Minnesota residents about their support of these initiatives, and considering the political feasibility of these initiatives in an election year, the MN team decided to focus on enhancing and expanding the use of ignition interlock systems - systems that prevent a car from being started if the driver has been drinking. This has been shown to be an effective intervention and our polling shows that 85 percent of Minnesotans are supportive of this approach.

However, as we began to look more closely at ignition interlock, we realized that there are some significant issues that need to be addressed before we can think about changing current policy. The biggest hurdle will be overcoming the cultural norm of excessive alcohol use in MN and the belief that severe penalties should not be levied on first offences. Given that culture, expanding the use of ignition interlock systems more broadly and thus affecting many more people may be a tough sell in our state.

In addition, there are multiple other perplexing issues. For example, ignition interlock systems can be affected by severe cold. These systems are also quite expensive to the individual and to the monitoring agency. And how this approach may disproportionately affect low income and other disadvantaged communities is a real and significant issue. Our discussion proved that seemingly simple solutions seldom are. It also proved the value of engaging a diverse team with varied perspectives when trying to come up with solutions to "wicked" problems.

Although we weren't able to finalize our policy approach at this meeting, our team is committed to continue to work together to come up with a recommendation about how to proceed with ignition interlock. More importantly, our team recognizes that high risk drinking and other alcohol-related issues will not be resolved by a 1 year project like this ESPHL project. They recognize that the misuse of alcohol is a significant public health problem in Minnesota and that it is past time for a serious and concerted effort to be made to address the issue with thoughtful and well-informed public policies.

The Minnesota ESPHL team is committed to the long-term task of developing those policies. So, stay tuned.


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