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The Next Four Years: Public Health

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This is the second of a series of posts by Frontier Group analysts on the policy challenges facing the United States in the next four years. This series will run periodically through Inauguration Day.

As Elizabeth Alexander said at President Obama’s first inauguration in 2009, “I know there’s something better down the road. We need to find a place where we are safe. We walk into that which we cannot yet see.”

We’re now four years further down the road. When it comes to public health, safety remains an elusive goal. And emerging threats – combined with new understanding of old threats – make actions to prevent disease all the more important in the next Obama administration.

Public Health Is a Social Problem

Every year, millions of Americans die prematurely from preventable illnesses. Chronic diseases – including diabetes, cancer, heart disease and strokes – are responsible for 7 of 10 deaths among Americans each year and consume 75 percent of the nation’s health care dollars.

As individuals, we have some control over the risk factors for developing chronic disease. We can avoid smoking. We can improve our diets and engage in exercise. We can forego alcohol abuse.

However, some threats that contribute to the prevalence of chronic disease we must address as a society, rather than as individuals. For example, exposure to air pollution from vehicles and power plants can trigger heart attacks and strokes. And exposure to toxic chemicals contained in consumer products can cause cancer and predispose people to developing obesity and diabetes.

These threats affect all of us, with little regard for how we choose to live our lives. Reducing our exposure to these threats requires collective action to compel business interests to alter behaviors that put public health at risk.

In its first term, the Obama administration made some important progress on this front. However, now that re-election is no longer on the president’s to do list, hopefully the administration can re-dedicate itself to reducing threats to public health and make larger strides in the next four years.

Slow Progress Toward Cleaner Air

The Obama Administration acted to reduce air pollution in several important ways over the last four years, but left important actions incomplete.

For example, in 2012, the U.S. Environmental Protection Agency (EPA) finalized the first national standards limiting mercury and other toxic air pollution from existing coal- and oil-fired power plants. These standards will reduce public exposure to mercury and other toxic air pollutants, protecting the health of every American – especially children. EPA estimates that when the standard is fully implemented – which could be up to four years after it goes into effect – reduced emissions will annually prevent:

  • 11,000 premature deaths,
  • 4,700 heart attacks,
  • 5,700 emergency room visits and hospital admissions,
  • 130,000 asthma attacks, and
  • 540,000 fewer days of work missed due to illness.

Additional public health benefits will flow from new EPA rules limiting tailpipe emissions from passenger cars and light trucks, and from new rules requiring power plants to reduce their contribution to unhealthy air pollution in downwind states.

However, the Administration – in an apparent attempt to appease complaints from the business community after suffering heavy losses in the 2010 midterm elections – failed to tighten federal health standards for ozone pollution, bucking the advice of public health experts and its own staff scientists.

In 2008, the Bush Administration had settled on an ozone standard of 75 parts per billion – significantly higher than recommended by EPA scientific experts. In 2011, the EPA under Lisa Jackson determined that a standard of 65 parts per billion would better meet the public health goals of the Clean Air Act. EPA calculated that a standard at this level would prevent up to 7,200 additional deaths, 11,000 emergency room visits and millions of missed work and school days each year.  And, since no level of exposure to ozone is truly safe, a more stringent standard would save even more lives.

However, the administration failed to act, allowing health-threatening levels of smog to persist in many communities across America.

Revisiting air quality standards for soot and smog – and accelerating progress toward meeting those standards – should be among the very first items on the public health to-do list in President Obama’s next term.

Toxic Chemicals in Consumer Products Remain a Lurking Threat

The Obama administration has made much less progress on the more insidious problem of exposure to toxic chemicals through common consumer products.

For example, in March 2012, the Federal Drug Administration decided not to ban bisphenol-A from food packaging. The FDA failed to act despite the fact that scientists have linked the chemical to a wide litany of developmental disorders and chronic diseases – including diabetes, obesity, heart and vascular diseases, allergies and asthma, prostate and breast cancer, and a variety of insidious neurobehavioral and reproductive defects. Manufacturers commonly use bisphenol-A in canned food linings, plastic food containers, paper receipts, and other items that people contact regularly in their daily lives. Practically every American has detectable levels of the chemical in their bloodstreams.Canned food linings contain bisphenol A, a toxic chemical.

The FDA did ban bisphenol-A from baby bottles, but the action wasn’t as significant as it looked on the surface. Consumer and advocacy pressure at the state level had already led all manufacturers to voluntarily phase out the chemical from baby bottles and sippy cups. In fact, the American Chemistry Council – a leading defender of bisphenol-A – supported this limited action “based solely on the grounds that these uses have been intentionally and permanently abandoned by all major product manufacturers.”

Dozens of chemicals of concern like bisphenol-A remain in common use in everyday commerce. Toxic flame retardants lie menacingly inside the couches where we sit. Phthalates and formaldehyde lurk in furniture and floor coverings. Toxic non-stick chemicals erode from our cookware. Pesticides contaminate our food supply.

Manufacturers regularly engage in deceptive practices to delay and deflect regulatory efforts. And when public outcry becomes loud enough to prompt action, chemical companies can introduce new threats in place of the old, promising that they are safe when the reality may be just the opposite. Advocates working to protect public health from toxic chemicals risk a drawn-out game of “whack-a-mole,” where eliminating one threat results in new dangers sprouting.

Part of the problem is that the federal government has too little authority to act. As reported by the Chicago Tribune in a landmark 2012 series about toxic flame retardants, the Toxic Chemical Safety Act (TSCA), the nation’s prime chemical safety law, “allows manufacturers to sell products without proving they are safe and to treat the formulas as trade secrets. Once health effects are documented, the law makes it almost impossible for the EPA to ban chemicals.”

The U.S. Senate Environment and Public Works Committee, led by Senator Frank Lautenberg, has passed a bill to improve the way the nation regulates toxic chemicals and prevent further public health crises. However, with no Republican support, future action on the legislation remains highly uncertain.

In the absence of federal action, states like California have been working on their own approaches to improved chemical safety. California’s Green Chemistry Initiative, in particular, holds promise as a model way to make sure that the chemicals used in commerce are the safest alternatives available.

The U.S. EPA was scheduled to award $20 million in grant funding for new academic centers to advance green chemistry science and practices. However, the agency cancelled the program without explanation in April 2012.

The administration has a great deal of work to do to reduce the threat of toxic chemicals lurking in our homes and our food supply.

Prevention Is the Key

The Obama administration rightly prioritized preventative health care within the Affordable Care Act. Preventing problems before they start is always better than trying to undo the damage after it has already happened.

Prevention needs to extend beyond the actions of the health care system, however. Public health is a social problem. It sometimes requires us to act collectively to eliminate threats that are beyond individual control.

In the next four years, the Obama administration should steer us down the road to somewhere better, somewhere safer, past the threat of toxic pollution that we cannot see.That road leads to a future where we no longer use polluting fossil fuels for energy or transportation, and every American can breathe clean air. It leads to a place where businesses design their products to be safe for human health and the environment. It leads to a place where we no longer have to worry about our homes, our furniture, or our food making our children sick.

Let’s make sure that the administration takes the right turns.