Legal Strategies to Manage Obesity and Increase Physical Activity

Abstract

Protecting the public's health and safety is a core function of government. The governments of the original colonies enforced public health laws before the American Revolution and their powers were retained by the states when the Constitution was ratified. In 1850, the first demographic study of deaths in the United States, the Report of the Sanitary Commission of Massachusetts (the Shattuck Report), found that the average life expectancy in the United States was between 25 and 35 years. The major cause of mortality was infectious disease spread through inadequate sanitation. The Report led to a model public health law that formed the basis of a national sanitation movement. Over the next 100 years, life expectancy more than doubled. The sanitation movement, combined with vaccinations and measures to control tuberculosis and other diseases that are spread through person-to-person contact, reduced the burden of infectious diseases in the United States. Law was integral to this public health revolution.

As individuals live longer, chronic diseases such as diabetes, cardiovascular disease, and cancer displace infectious diseases as the major risk to individual health. These diseases are exacerbated by increases in the prevalence of obesity and physical inactivity. Alarmingly, the most dramatic changes in obesity and physical activity levels occur in children. There are aspects of these conditions that fit the public health model and should be subject to interventions based on well-understood public health law paradigms. Other aspects may demand a hybrid approach of behavioral change through education coupled with legal interventions, as has been required for conditions such as alcoholism.

This White Paper begins with an analysis of the legal authority and mechanisms for federal, state, and local public health law interventions. Public health law is a complex mix of federal, state, and local regulations, and there are many useful approaches beyond seeking specific legislation. It is critical to understand how the different levels of public health authority interrelate when one is planning regulatory strategies. In many cases, agencies have the flexibility to implement new strategies without new legislation. This saves time and allows a more flexible response. The White Paper concludes with a review of sample strategies targeted to different aspects of the problem. This is augmented with tables to allow a quick overview of the legal principles and strategies.

Keywords: public health, health law, obesity, diabetes, physical activity, exercise, legislation, police power, schools, workplace, zoning, livable communities, administrative law

JEL Classification: I18, I31