Case #113
Title: Successful actions on public health in the US
Summary: The article points up the victories of the past few decades in public health, to show how research, advocacy, public discussion, and policy fit together in successful campaigns for change. It summarizes how public pressure exerted over time has made significant changes in the US. Three examples are given: lead in our environment, flouride, auto safety, and tobacco.

LEAD: Children in America today carry far less lead in their blood than they did just 20 years ago. Passage of the Clean Air Act of 1970 required automakers to reduce hazardous emissions drastically and the Environmental Protection Agency issued standards for the allowable amount of lead in gasoline. These regulations were consistently challenged by the lead and petroleum-refining industries. Then the Reagan administration pressured the EPA to roll back its lead standard. Activists from the Natural Resources Defense Council, the Environmental Defense Fund, Consumers Union, and other organizations fought back, and the press jumped on the story. In the face of that negative publicity and new research data, the EPA backed down and, instead of weakening the lead standard, it toughened it.

The 1990 amendments to the Clean Air Act prohibited the use of leaded gasoline on highways after 1995, complementing laws that ban lead in paint, food containers, and solder joints. The results have been impressive. The average blood lead level in the United States dropped by 78 percent between 1976 and 1994, largely because researchers and policy makers had overcome entrenched industry opposition in order to improve the public's health.

(This section advocates flouride in water, a view that remains very controversial, with strong feelings both sides.)

From the beginning, conventional wisdom had it that traffic accidents were the fault of bad drivers, not of the automobile. By the mid-1950s, however, both the American Medical Association and the American College of Surgeons were recommending that automobiles be designed for better passenger safety and equipped with safety belts. Ralph Nader's 1965 book "Unsafe at Any Speed" lambasted the automobile industry for its lack of concern about safety. GM hired private detectives to tail Nader and come up with dirt about his personal life, which they failed to do. When the attempted smear campaign came to light, Nader became an instant hero and used his new celebrity to promote auto safety.

This galvanized public opinion and provided the impetus for Congress to pass the National Traffic and Motor Vehicle Safety Act and the Highway Safety Act in 1966. As with lead, the new legislation precipitated legal and regulatory battles.

During the late 1970s and early 1980s, an extraordinary grass-roots movement took shape across the nation. The grass-roots groups Remove Intoxicated Drivers and Mothers Against Drunk Driving were formed in 1978 and 1980. They cultivated the media, and hundreds of newspapers and magazine articles reported on the victims of drunk driving and their families. Drunk driving was the subject of television specials and dramatizations. Activists formed local chapters and began telling their stories though the media, providing victims' services, lobbying government officials, and monitoring the courts.

The effect was stunning. Between 1981 and 1985, state legislatures passed 478 laws to deter drunk driving, and Congress passed the Alcohol Traffic Safety Act, providing extra funds to states that enacted stricter drunk-driving laws.

On average in 1950, 7.6 individuals were killed for every 100 million vehicle miles traveled. By 1999 that statistic had plummeted to 1.6 persons - a decrease of more than 75 percent.

Not long ago, a movie star drawing on a cigarette was considered the height of sophistication, and R.J. Reynolds and Philip Morris were considered so powerful that few dared to challenge them.

Now, planes are now smoke-free, as are many restaurants and offices; Joe Camel has been put out to pasture; and the $246-billion settlement between the tobacco companies and the states made front-page headlines. Americans have given up smoking in record numbers, and many of those who continue are trying to kick the habit. The percentage of adult male smokers in the United States dropped in half from 1965 to 1998. Research, advocacy, media coverage, public education, politics, and government contributed to this unexpected transformation.

During the years of pressure to accomplish this turnaround, the tobacco industry fiercely opposed the reform measures and used every trick available to scuttle them at the Federal level.

Equally if not more important were local ordinances and state laws banning smoking in public places and making the sale of cigarettes to minors illegal. As an anti-tobacco advocate recalled, "The tobacco lobby could never win at the local level. The reason is that all the health advocates are local activists who run the little political organizations. On the local level, the lobby couldn't compete with them."

While Americans' attitudes toward smoking have changed, the tobacco industry remains a formidable force. While the victories won so far are a cause for cheering, it is too early to celebrate them as permanent.

The authors give the following INGREDIENTS OF SUCCESS:

1. Highly credible scientific evidence can persuade policy makers and withstand attack from those whose interests are threatened.

2. Public health campaigns need advocates who are passionately committed to their cause, who have the inner resources to withstand the tremendous pressure applied by the affected industries, and who continue to fight even at the risk of their professional reputations. Ralph Nader and other crusaders have had a tremendous effect on social policy. But advocacy from outside the system is rarely enough. When government agencies and their leaders speak out, new ideas about public health become more acceptable to the mainstream media and the populace. Similarly, campaigns for change gain legitimacy from the backing of authoritative groups such as the American Medical Association on seat belts and the American Cancer Society on tobacco.

3. Public awareness and discussion depend on a partnership with the media. Advocates need the media to reach the public, and the media, looking for good stories, also need the advocates. Behind virtually 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 solution.

4. Law and regulation, often at the federal level, have been critical elements in focusing Americans' attention on health concerns, providing policy direction, and setting standards that have led to improvement in the public's health. Despite all the criticism they have received, federal laws and regulations have vastly improved people's health. They have been and continue to be the underpinning that protects the health of the American public.

Imagine what we could do if we had strong social movements against homicide, HIV infection, unhealthy foods, and physical inactivity. Without the energy of such social movements, the United States will be doomed to suffer from inferior health, no matter how much we invest in basic research or medical technologies. Yet if we combine research with committed advocacy, and follow up with intelligent policy making, we can do much to improve America's health not with miracles but with just hard work.

Location: US
Action: Corporate/Economic Abuses, Conservation, Health
Setting: Developed World
Extent of Action: National
Categories: Corporate/Economic Abuses, Conservation, Health
Outcome partially successful
Source: American Prospect, June 4, 2001, p.26
Prepared By: alb 6/01
Rating: 1