Well-structured, comprehensive health policy can change behaviors according to panelists Susan Kansagra, Manish Sethi and Giridhar Mallya. They have been working to address different health issues – gun violence, smoking, and obesity – and shared their strategies at Health Journalism 2013.
Giridhar Mallya, director of policy and planning at Philadelphia’s Department of Public Health, helped launch a campaign to combat obesity there and, after decades of rising obesity rates, the city is seeing declines. The key, Mallya said, was in treating the issue as an environmental disease rather than in individual problem, and that meant altering the environment to give people a chance at being healthy.
“Changing the context is really the sweet spot of public health,” Mallya said. “Change the context so people can default to healthy decisions.”
His multiprong approach included the following:
- Changing the built environment, including creating more safe spaces for people to park bicycles.
- Providing corner stores with financial incentives, training and marketing to sell healthier foods, and creating more food retail sites including farmers markets in food deserts.
- Swapping in vending machines with water and healthy snacks at workplaces and schools.
- Getting schools to stop selling candy bars as fundraisers, and limiting the use of candy and other unhealthy foods as rewards.
- Targeting a media campaign at the parents of young children that informs while making them feel empowered to act: “Do you know what your kids are drinking?”
- Passing legislation that requires menu labels at sit-down restaurants to include sodium amounts as well as calorie counts to help address the city’s concerns about high rates of hypertension.
Legislation and media campaigns have been effective in bringing down tobacco use rates in New York City, according to Susan Kansagra, assistant commissioner, New York City Department of Health and Mental Hygiene.
In 2002, New York passed the Smoke Free Air Act which banned smoking in bars and indoor work places. Back then, 60 percent of residents supported the ban and two years later, 75 percent supported it. Kansagra says that’s because two years after the ban, bars and restaurants saw growth in profits, employment was up, and bar workers’ nicotine levels or second-hand smoke exposure decreased.
Smoking rates have had one of the fastest declines from 22 percent in 2002, to less than 15 percent today, Kansagra said. And when health officials launched a media blitz on the dangers of tobacco, calls to the New York state ‘quit line’ would jump by 40,000, Kansagra says. She projects the ban will save 50,000 lives by 2052.
For Manish Sethi, a trauma doctor and director of theOrthopedicInstituteCenterfor Health Policy atVanderbiltUniversity, it is unclear how effective legislative efforts will be at reducing gun violence. After seeing too many young people – mainly black men between the ages of 18-25 – come through his emergency room with gun shot wounds, Sethi decided to focus his attention on school-based violence prevention programs.
“Imagine being on the third floor of an operating room and routinely telling family members your child is dead because they were injured by something we could have probably prevented,” Sethi said.
He has piloted a three-month program for 71 sixth graders in Nashville, aimed at providing kids with tools to deal with conflict. Sethi says pre- and post-tests showed a change in the kids’ understanding of how to address interpersonal issues. He said it’s still too early to tell if the program will result in a marked decrease in school violence, but he wants to expand the program to schools and districts county-wide. For Sethi, government actions with community partnerships can make a difference.
On the question of whether government policies to curb unhealthy behaviors unduly limit personal freedoms, Mallya said our choices are already limited by industry actions that bombard people with ads for unhealthy products and encourage bad behaviors.
Someone needs to play the role of constraining those messages, Giridhar says, and “if we aren’t playing that role, I don’t know who is.”