Video: Why government is an essential protector of public health

September 25, 2013

Speaking at a California State Senate informational hearing held on Sept. 24, 2013, BMSG media researcher Andrew Cheyne talks about the government's role in protecting public health. He discusses how public perceptions of the government's responsibility to support health have changed over time and explains how media coverage can influence -- and often limit -- our understanding of health issues. A full transcript of his testimony is below.

Introduction: Illuminating government's role in protecting public health

Good morning. I'd like to thank Health & Human Services Subcommittee Chair, Senator Bill Monning, as well as Senator Mark DeSaulnier and Senator Bill Emmerson, for holding this hearing and for giving me the opportunity to speak. My name is Andrew Cheyne, and I direct the research program at the Berkeley Media Studies Group, a project of the Public Health Institute. For the last 20 years, we at Berkeley Media Studies Group have been studying public health issues in the media, examining how the stories that are told characterize the role of government, among other things. What we've learned is that it is hard for the average person to see the government's essential role as a protector of public health.

I'm happy to be here today, not only as a public health researcher to share what we have learned from our work, but also as the father of a 6-month-old son, as that experience has given me newfound appreciation for the government's protections that we all enjoy. I'm seeing the findings from our research through a new lens.

The cumulative benefits of campaigns to protect public health

I'm especially happy to be here today because this hearing is very important, on an issue that is often taken for granted. It's absolutely vital for public officials to take leadership as stewards for a healthy society. Our topic today is all about that. Let me tell you a brief story about why this is, from one of the most valuable lessons in the history of public health.

The story is about the fact that support for any policy change, especially those that are bold and controversial, takes time. Consider the state of New York, which just three years ago proposed a penny-an-ounce tax on sugary beverages. That effort failed, but in the same session of the legislature, lawmakers added a $1.60 excise tax on cigarettes that is credited with dramatically reducing smoking rates and healthcare costs. Why would New York legislators levy $1.60 on tobacco but balk at 12 cents on a can of soda?

That New York refused a few pennies on soda but didn't blink at $1.60 on tobacco has a hard fought history. For nearly 50 years, public health has pushed for policies to put warnings on cigarette packs and ads, remove vending machines, mount education campaigns, ensure smoke-free air, and institute tobacco taxes, all of which are evidence-based interventions that lower smoking rates and improve public health.

It wasn't always that way. In the early days of tobacco control, proposals for taxes met the same fate as New York's soda tax initiative. But strategies like taxes with far-reaching potential warrant continued attempts. Given our tobacco experience, it will take more than one attempt. Therefore, even though public health didn't win this round, I'm heartened by this effort.

The more a policy is proposed, the more people discuss and understand it. Policy proposals create opportunities for news coverage that set the agenda for public discussion. Now these discussions reflect some criticism for taxing sugary beverages. But each new attempt also gives people the opportunity to communicate the fact that someone -- and, as policy attempts mount in Richmond, El Monte, and elsewhere, growing numbers of someones -- support the policy. This helps set the stage for the day when it is a given that these beverages do damage to our society, and government needs to protect the public's health from that harm.

Understanding the responsibilities of government and individuals with respect to health

Perhaps one reason it takes so long to achieve these public health victories is because the news -- the institution so important for helping the public and policymakers understand public health issues -- is not always telling the whole story about the importance of government's success in protecting public health. Instead, research shows that the way the news tells stories means that news consumers focus on individuals and their actions rather than the role of institutions like government.

When new public health initiatives are proposed, they often create controversies that generate headlines. But after the attention dies down, the benefits to public health and safety that these policies produced become normal and expected -- and can fade into the background of society. They aren't "news" so the public doesn't get the story about what is working. No one wonders where the non-smoking section of the airport is anymore, or bemoans the fact that children can no longer purchase cigarettes from vending machines, or complains that an airbag saved their life. No new parent would leave the hospital without her newborn buckled safely in a car seat. We take it all for granted.

Not only do we take these protections for granted, but news coverage reinforces this idea by focusing on the notion of "rugged individualism," which presents problems or accomplishments as a matter of personal choice while minimizing how social forces -- and policies -- shape people's lives. This idea matters for government's ability to protect public health because it makes it harder for the public to see how government or other institutions are a critical part of the solution.

Let me give you one example. At Berkeley Media Studies Group, we studied the origins of personal responsibility arguments in tobacco control, an area of public health where strong health gains have been made through government actions that protect the public's health, even while the tobacco industry poured millions of dollars into fighting against them.

By examining the first national fights over tobacco regulation, we found something quite extraordinary: In the 1950s and 1960s, the tobacco industry did not question whether the government was accountable for protecting the public's health. When it became clear that cigarettes harmed health, the industry did not lambast the idea that the government should protect the public's health, as is so common today. Instead, industry voices were part of many who said that if there is a health harm, government has a role to play in solving it. Despite its intensity, the attack on the responsibility of government is relatively recent; it has not always been a prominent feature of our political landscape. It is important to reinvigorate enthusiasm for sensible policies that provide broad social benefits.

Appreciating the broad range of government actions to protect health

New policy proposals generate debate and news coverage that often evokes the question: What is the government's proper role in ensuring a healthy population? Our research consistently finds that the news often tells an incomplete story that hides the many ways in which government effectively protects the public's health, and we know there are many:

  • The government is a source of information to help individuals make healthier decisions, from warnings on packages of cigarettes to cancer disclosures on buildings in California thanks to Proposition 65;
  • Government takes population-wide actions to boost health, such as iodizing salt or mandating immunizations;
  • Government enacts rules to protect individuals from preventable harm, such as zoning and emissions regulations limiting exposure to industrial pollutants at the Port of Oakland, or blood alcohol from the dangers of intoxicated driving;
  • Subsidies for low-income seniors to have affordable telephone access through the Life-Line program enable our elders to live independently longer, with the safety to reach help in times of need;
  • Public health worked with public works agencies to build sewage and sanitation systems that reduced infectious disease and simultaneously reduced rodent populations and prevented flooding;
  • Public health also worked with transportation agencies to introduce seat belts, safer road designs, and other innovations that together have led to major declines in rates of automobile crash deaths;
  • We know that building bike and pedestrian infrastructure creates more jobs, decreases air pollution and greenhouse gas emissions, and increases physical activity, all of which improve both health and academic performance for students;
  • And we know that "farm-to-fork" activities help to protect agricultural lands, support local economies, and increase healthy eating.

Conclusion: A personal experience with, and gratitude for, government's health protections

I'd like to conclude by illustrating the importance of making government visible by telling you about the birth of my son MacEwan.

  • Having a natural childbirth was important to my wife, so we stayed at home as long as was manageable before going to the hospital, something made possible only by a government-financed and maintained system of roadways;
  • We were fortunate enough to have a hospital experience that promotes breastfeeding -- the single most important health advantage one can offer a child -- which may soon become a reality in all California hospitals with SB402;
  • We brought the baby home in a car seat and vehicle designed with safeguards to ensure our precious cargo was as well-protected as possible -- that's an improvement from government that's happened in my lifetime, since I wasn't brought home from the hospital safely tucked into a car seat;
  • My wife and I were each able to take time off from work to care for the baby, thanks to state disability and federal Family and Medical Leave policies that prioritize bonding with newborn children;
  • Our transition back to work was, of course, difficult, but made easier knowing that our child care provider is properly licensed and follows county and state rules for best practices; and
  • His health is already building from state-mandated and subsidized immunizations, and we are looking forward to his first flu shot this week.

Going forward, we know that our journey as parents, and his path -- and his health -- as a growing boy will be touched by government for years to come, including by the availability of the clean tap water he will drink; the public education from kindergarten to post-secondary we're sure he will achieve; the now healthier meals and drinks available in schools; and the safety features of the cars he'll drive. The list could go on, but I can't bear to think that far into the future.

Leadership and innovation aren't always easy, but we owe it to the people we serve to work together to find the best ways to solve complex problems. Government support -- our mechanism for pooling our talent and resources -- will help us to do that. Our democratic system requires two things: not only for public servants to be responsive to the needs of the citizenry, but also for citizens to be active and to petition our government with demands. From this perspective, an initiative to protect public health that emerges as a community concern and becomes a legislative proposal reflects the fact that the government is all of us, and provides a structure for addressing shared needs.

I thank you for investigating this critical issue, and I urge you and your colleagues to continue to lead this state to a healthier future for all of our communities.

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