When President Obama signed the Food Safety Modernization Act (FSMA) into law in 2011, it was described as the most sweeping reform of the nation’s food safety laws in nearly a century. Public health advocates hailed the law for shifting regulatory authority from reaction to prevention. What received less attention was a first-of-its-kind provision that protects workers who expose food safety lawbreakers.
The law’s whistleblower provision, also known as Section 402, amends the federal Food, Drug and Cosmetic Act to provide “protection to employees against retaliation by an entity engaged in the manufacture, processing, packing, transporting, distribution, reception, holding, or importation of food” for reporting or testifying to a violation of the Food, Drug and Cosmetic Act or for refusing to participate in activities the worker “reasonably” believes to be a violation. Just a few weeks ago, OSHA issued its final interim rule on the whistleblower provision, outlining the agency’s procedures for handling FSMA-related complaints of employers retaliating against employees who raise food safety concerns. The provision is the first food industry-specific law designed to protect whistleblowers.
“It’s the gold standard of whistleblower protections — the Cadillac version,” said Amanda Hitt, director of the Food Integrity Campaign at the Government Accountability Project, a whistleblower advocacy and protection organization. (Here’s an example of the new whistleblower provision in action.)
Previously, a patchwork of different state and federal laws might have protected some food industry whistleblowers, Hitt told me, but left others with little recourse if they were fired after speaking up. However, with the new FSMA provision, “we get a nice uniform exception for the safety of public health,” she said. In a very real way, the whistleblower provision creates “civilians who are deputized to oversee food safety, to become inspectors in real time on the floor,” Hitt noted.
“Any time you get a uniform statutory set-up, you’ll get a much better informed workforce,” Hitt said. “With a patchwork that varies from state to state, you won’t get that sort of education inoculation. …What we would love to have is a totally educated workforce, but that’s probably not going to happen. What usually happens is you get better trained (human resources) staff and better educated industries and you hope they have appropriate training around whistleblower activity.”
Even though one wouldn’t imagine that the food industry favors whistleblower protection, Hitt said that getting the whistleblower provision included in FSMA wasn’t particularly difficult. Hitt’s colleague Tom Devine, legal director at the Government Accountability Project, said FSMA was swept up in a wave of whistleblower rights that Congress routinely wrote into major regulatory legislation between 2006 and 2010. Devine said that not only was the Democratic majority at the time sympathetic to whistleblower rights, but the law also followed a “major paradigm shift in corporate speech” with passage of the Sarbanes-Oxley Act, which was crafted in the wake of corporate frauds such as the Enron scandal. Sarbanes-Oxley puts in place criminal penalties for retaliating against whistleblowers.
While the FSMA provision is the first food industry-specific whistleblower protection, Devine noted that the industry’s workers had some prior protection “through the backdoor of other statutes.” For example, if the food company is publically traded, a whistleblower would be protected via Sarbanes-Oxley, though that worker would most likely be an accountant or bookkeeper, not someone who’d witness a food safety violation. Whistleblower protections written into environmental laws, such as the Clean Water Act and Clean Air Act, could also apply to food industry workers, depending on the violation being reported. Still, the FSMA provision is the first to specifically protect food industry workers and apply to food manufacturing practices.
“Whistleblower protection creates a safe channel for the free flow of information from the front lines where food safety breakdowns occur to all of society’s stakeholders who should be warned about them,” Devine told me. “(The FSMA) whistleblower provision reflects the current gold standard for free speech rights in the private sector. It was a landmark breakthrough for food safety.”
Gaps in protection
The provision isn’t perfect, though. First, it only applies to food industries that come under U.S. Food and Drug Administration authority. Whistleblowers in food industries regulated via the U.S. Department of Agriculture, such as beef and poultry producers, aren’t covered. Also, the complaint process, which is overseen by an OSHA investigator, has some gaps too, Devine said. For example, once OSHA makes its preliminary finding that a worker was a victim of retaliation, the agency gives the employer a chance to argue that finding. However, the worker doesn’t get the same chance to defend the preliminary finding. In other words, Devine said, once OSHA issues a preliminary finding, the worker is effectively shut out of the process.
Another big gap is that the provision doesn’t pin down who’s responsible for educating workers on the new whistleblower protections.
“The law should have had a provision that required every employer to post the rights and train its staff, both management and employees, in the new rules of the road for freedom of speech, but that didn’t happen,” Devine told me.
Devine said that retaliation is a “very significant barrier to exposing the truth,” noting that even employees with comfortable salaries can find themselves bankrupt due to legal expenses. During his career, Devine has worked with about 400 food industry workers, noting that whistleblower disclosures have been “indispensible” in stopping government attempts to deregulate meat and poultry inspection.
Hitt added that whistleblower protections not only help level the playing field between employer and employee, but between companies and consumers.
“Whatever rights consumers enjoy implies an ability for employees to speak up safely,” she said.
According to the Centers for Disease Control and Prevention, food-borne illness affects about 48 million Americans every year, of which 128,000 people are hospitalized and 3,000 die. Researchers estimate that food-borne illnesses cost the country between $14 billion and $16 billion every year in medical costs, lost productivity and premature death.
To learn more about whistleblower protections and the food industry, visit the Food Integrity Campaign.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
“The United States is facing an industrial chemical safety crisis,” Chemical Safety Board Chairperson Rafael Moure-Eraso told the Senate Environment and Public Works Committee on March 6th. He spoke at hearing held to discuss President Obama’s August 2013 Executive Order on chemical facility safety, which Obama issued following the catastrophic incidents at the West, Texas fertilizer plant and Louisiana petrochemical facilities. In the wake of the Freedom Industries chemical release in West Virginia, improving the nation’s chemical safety has taken on a new urgency. Yet while the Senate committee is pressing the US Environmental Protection Agency (EPA) to help prevent future chemical disasters, federal legislation has been introduced that would, if enacted, impair current chemical safety policy and make it harder for the public to obtain information about chemical hazards, either in industrial storage tanks or consumer products.
Released on February 27th, the draft Chemicals in Commerce Act (CICA) is being offered as the House bill to reform the Toxic Substances Control Act (TSCA), the US law that regulates chemicals in commerce. Environmental health advocates and industry representatives agree that TSCA, enacted in 1976 and not updated since, is badly in need of revision. Among other problems, TSCA has allowed some 60,000 chemicals in use when the law was passed to remain on the market without full safety testing. This means that many chemicals, including the one that contaminated Charleston, West Virginia’s water supply (MCHM), are being used without any publicly available comprehensive information about their environmental or human health effects.
In addition to leaving the public with inadequate information about chemicals’ health effects, TSCA also makes it so difficult to ban a chemical’s use that only five have been barred under this law. Chemicals with well-recognized adverse health effects, like formaldehyde and other respiratory irritants, continue to be ingredients in numerous consumer products, including cleaning products, toiletries and cosmetics. Cleaning professionals, salon workers, and others can be exposed to these products for many hours each week.
The Senate introduced the Chemical Safety Improvement Act (CSIA) (S. 1009), its TSCA-reform bill, last year. It has bipartisan support but is opposed by many environmental health advocates and state lawmakers because of provisions that would preempt state law, weaken existing health protections and fail to protect communities directly impacted by toxic pollution. The House CICA, sponsored by Representative John Shimkus (R-IL), who chairs the House Energy and Commerce Committee’s Subcommittee on Environment and the Economy, includes more extensive state-law preemption provisions than the Senate bill as well as elements that would make it even harder than it currently is for the EPA to restrict hazardous chemicals.
The state preemption provisions have garnered the spotlight in this debate because more than half of all US states have enacted laws that either restrict the use of individual chemicals or require reporting on how they are used. These state-level actions have come in response to growing scientific evidence of potential adverse health effects of numerous widely used chemicals, and how difficult TSCA makes it for the EPA to restrict chemical use. The CICA would preempt such regulations, prevent states from acting independently and also prevent state and local governments from collecting information about chemicals from companies that make or use them. “The breadth and scope of CICA’s preemption provisions are truly stunning and deeply disturbing,” wrote Environmental Defense Fund Senior Scientist Richard Denison.
“This bill would do nothing whatsoever to protect the public from the health impacts of toxic chemicals and would instead roll back the very limited oversight that we currently have,” said Andy Igrejas, Director of Safer Chemicals, Healthy Families, a coalition of 450 environmental and health organizations.
“There is a massive disconnect between this bill and where the public and market is going on a global level,” said Kathy Curtis, Executive Director of Clean and Healthy New York, noting that many major manufacturers and retailers – Walmart, Target and Johnson & Johnson among them – are voluntarily implementing policies to restrict use of chemicals associated with health hazards that the EPA has not yet restricted. The CICA would not interfere with such policies, but it would prevent states from establishing what are effectively legally binding safety nets to ensure that all products be similarly free of hazardous ingredients.
The American Chemistry Council (ACC) has welcomed the CICA, calling it “a balanced approach” that “will provide Americans with more confidence in the safety of chemicals.” It’s worth noting, however, that the chemical industry spent more than $61 million on lobbying in 2013 – lobbying that specifically included work on S.1009. Thus far in the 2014 campaign cycle, petrochemical companies and industry associations have donated almost $100,000 to Shimkus’ reelection campaign and nearly twice that much to House Energy and Commerce Committee Chair Representative Fred Upton (R-MI). Representative Paul Tonko (D-NY) Shimkus’ Democratic counterpart on the House Subcommittee has received less than $25,000 from these industry groups. And if there could be any doubt about the ACC’s support for Shimkus and Upton, there are the ACC-sponsored 2012 campaign ads.
FDA rejects industry proposal for cosmetic ingredient regulation
Industry’s hand in promoting legislation that would undermine existing chemicals regulation is directly apparent in the controversy that became public on March 6th when the Food and Drug Administration (FDA) released its letter to the Personal Care Products Council (PCPC) and Independent Cosmetics Manufacturers and Distributors (ICDM) detailing the FDA’s “profound disappointment” in the organizations’ “proposed draft legislation on FDA oversight of cosmetic safety.” The industry-supported proposal would, according to the FDA, prevent FDA from receiving most reports of illnesses or injuries caused by cosmetics products, virtually eliminate FDA’s ability to verify cosmetic companies’ assurances of product safety and authority to require cosmetics companies to register with the FDA and make it very cumbersome for FDA to declare an ingredient unsafe.
This draft was produced in response to an FDA proposal for enhancing agency oversight of cosmetics ingredients that FDA released last year after input from industry and environmental groups. In his letter to the trade associations, FDA Deputy Commissioner for Foods and Veterinary Medicine Michael R. Taylor wrote, that while the draft bill “creates the appearance of a modernized cosmetics regime, but a reality that actually prevents federal and State governments from protecting Americans from unsafe cosmetics.”
The proposed bill’s provisions “not only do not move us forward toward that goal, they would actually reduce FDA’s current ability to take action against dangerous cosmetics. Taken together with the sweeping preemption provisions, which almost completely eliminate States’ authority to protect their citizens from unsafe chemicals in cosmetics,” wrote Taylor, “the provisions of the draft industry bill could put Americans at greater risk from cosmetic-related illness and injury than they are today.”
What the industry is proposing, “demonstrates how far off the trade associations are from where consumer demand is right now,” said Janet Nudelman, Director of Program and Policy at the Breast Cancer Fund, which participated in the FDA-led policy discussions.
The Personal Care Products Council has said in a statement that it believes “the FDA’s response misrepresents the intent of our legislative proposals and we strongly disagree with their allegation that our proposed legislation would weaken their regulatory oversight of cosmetics.”
A long-standing labeling program
And while all of this was going on, ACC President Cal Dooley speaking at an industry-sponsored conference questioned the legality of the EPA’s plans for its Design for Environment (DfE) labeling program, saying it “doesn’t meet Federal Trade Commission guidelines for green labeling.” The program has been around for more than 15 years and works with industry, the environmental community and academia to evaluate environmental and human health concerns associated with chemicals used in manufacturing and products and promote use of safer chemicals. More than 2,500 products – including a great many professional cleaning products – have gone through this process and carry the DfE logo.
The EPA said it “has announced plans to engage stakeholders and the public in the redesign of the current label to ensure that it provides consumers with an easier to identify and understand label that better conveys the scientific rigors and benefits of the DfE Safer Product Labeling Program.”
“What we have concerns about is a public-sector entity that is assessing the safety of chemicals and should they also get into an arena where they are making determinations … that some product is safer for consumers than other products that they’ve already determined are safe for use,” said Dooley as reported by E&E. The program, Dooley said, according to the report, was “unprecedented” in having a federal agency “developing a label that has the potential for significant market implications.” EPA did not respond specifically to the ACC’s questioning of the label’s legality.
There seems to be a pattern here; while state and local governments – and many manufacturers – are responding to growing public is demand for safer chemicals and more information about chemicals used in products – industry trade associations appear to be working to counter that progress. – The House Subcommittee on the Environment and Economy has scheduled a hearing on the Chemicals in Commerce Act for March 12th.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Ensia, The Washington Post, Salon and The Nation.
It started with a yawn. Then a conversation about whether daylight savings time (DST) begins too early in the year. “On Monday, kids will be going to school in the dark and with one hour less sleep,” said my mom. My brother remarked: “There are more accidents in the days immediately following the time change.” I was skeptical about his car accident remark, but didn’t want to open my mouth without some facts. Here’s some of what I learned with just a minute of searching on PubMed.
Researchers with Stanford University School of Humanities and Sciences assembled data from U.S. fatal automobile accidents over a 21 year period. Varughese and Allen examined the mean number of accidents on the weekend of the time change, and compared it to the weekends immediately before and after the time shift. The authors reported a significant increase in fatal motor vehicle accidents on the Monday immediately following the springtime switch to DST (t = 1.92 (p = 0.034)).
Researchers with the Karolinska Institute in Stockholm also examined the rate of motor vehicle accidents on the first Monday of DST, and the Monday’s immediately preceding and following the switch. Lambe and Cummings used data from the Swedish National Road Administration for crashes occurring from 1984 through 1995. The rate was calculated as the number of incidents per 1000 person-years for each of the study years. In the springtime switch, they reported an accident rate ratio of 1.11 (95% CI, 0.93-1.31) for the Monday immediately following DST implementation. The rate ratio in the fall declined to 0.98 (95% CI, 0.84-1.15) when individuals potentially gained one hour of sleep.
Cathleen Zick with the University of Utah examined whether DST led to greater engagement by adults in physical activity. She used data from BLS’s American Time Use Survey for the periods 2003-2009. Zick compared responses to the survey’s “moderate-to-vigorous physical activity” (MVPA) variable from respondents in Colorado, New Mexico and Utah. She compared that data to responses from Arizona residents, a state that does not observe DST. She found that despite the additional evening hour of daylight, adults aged 18-64 did not affect time spent on MVPA.
Researchers with William Beaumont Hospital in suburban Detroit examined the incidence of acute myocardial infarction (AMI) over one-week periods of time from the switches to and from DST. Jiddou and colleagues reported an incident rate of 1.17 (95% CI 1.00 to 1.36) for the week following the time change. They indicated that the greatest increase in AMI occurred on the Sunday immediately after the spring shift to DST (1.71, 95% confidence interval 1.09 to 2.02; p <0.05).
Other studies in the literature include evaluations of a DTS effect on the sleep/wake cycle of college students (here), diurnal pattern of urban PM10 (here), cyber loafing (here), and work-related injuries (here, here), including those among coal miners (here).
I was skeptical of my brother’s assertion of a daylight saving effect. I shouldn’t have been.
A few of the recent pieces I’ve liked:
Jim Morris, Lisa Song and David Hasemyer in a collaboration between the Weather Channel, InsideClimate News, and The Center for Public Integrity: Fracking the Eagle Ford Shale: Big Oil and Bad Air on the Texas Prairie
Brigid Schulte in the Washington Post: ‘Mad Men’ era of U.S. family policy coming to an end?
Tom Frieden at The Health Care Blog: CDC: Together We Can Provide Safer Patient Care
Farida Jhabvala Romero at Reporting on Health: California County Seeks to Eliminate Health Safety Net for the Undocumented
Ted Genoways at OnEarth: Hog Wild: Factory Farms are Poisoning Iowa’s Drinking Water
Celeste wrote last week about poultry workers asking the White House and the USDA to abandon the proposed poultry rule that would allow poultry-processing lines to speed up. At rates of up to 175 birds per minute, these faster-moving lines would make work even more hazardous for poultry workers, who already experience high rates of musculoskeletal disorders. Following the visit of a delegation of poultry workers to Washington, DC, Catherine Singley of the National Council of La Raza published a blog post featuring the words of poultry worker Bacilio Castro from the North Carolina Worker Justice Center. He said:
You want to know what’s in the chicken on your plate? Tears. Tears of the mothers who can’t lift their children because of the pain in their wrists and shoulders from working on the line. We are not asking you to stop eating chicken. We are simply asking to be treated as human beings and not as animals.
The Washington Post’s Kimberly Kindy reports that in addition to messages from poultry workers and food-safety advocates, members of Congress are hearing from chicken-industry lobbyists. “The National Chicken Council has been spending an average of more than $500,000 annually lobbying Congress, according to lobbying records,” she notes. A Charlotte Observer editorial contrasts this heavy spending with the often-unnoticed suffering of vulnerable poultry workers:
On Thursday, poultry workers from across the country met with lawmakers and administration officials on Capitol Hill to explain how the current combination of line speeds and repetitive motions already do damage to their hands and wrists. It’s rare that these workers, most of whom are Latino and black, have any voice. At work, they are often reluctant to complain for fear of being fired or turned over to immigration authorities.
… In a 2008 Charlotte Observer investigation, reporters spoke to more than 130 poultry workers, three-fourths of whom complained of hand and wrist injuries. Several suffered from later stages of carpal tunnel syndrome and were unable to straighten fingers or pick up objects like spoons. Some were afraid to use their trembling, weakened hands to pick up their young children.
… N.C. Sen. Kay Hagan, who is running for reelection in 2014, supports the USDA rule changes because they would free inspectors to concentrate on food safety, her office told the editorial board. But the changes also show disregard for the North Carolina workers who are among the most vulnerable. They need more advocacy and more safety – not more chickens, with the pain they surely would bring.
The Charlotte Observer’s 2008 investigative series The Cruelest Cuts should be required reading for anyone who supports allowing poultry-processing lines to speed up.
In other news:
LAist: Oscars television viewers, though evidently not event attendees, saw saw the name of 27-year-old Sarah Jones, a camera assistant killed by a train during a film shoot, during the award ceremony’s “In Memoriam” segment. Despite rules requiring rail-company representatives to be on site (in addition to other safety measures) when films are shot on railroad tracks, no such representative was present when Jones was killed.
The Tennessean: At a Tennessee legislative committee hearing, Rocky Tallent told lawmakers about how his 27-year-old son Michael was killed while working as a temp worker on a construction job for which he was given inadequate training. He spoke in support of two safety-related bills introduced by Representative Mike Stewart; one of them would require employers to fix serious safety hazards even if they are appealing violations, and the other would include information about companies’ safety records in questionnaires to evaluate bidders for state-funded construction projects.
Denver Post (here, too): Those who worked at the Rocky Flats nuclear weapons facility in Colorado between April 1, 1952 and December 31, 1983 and have developed one of 22 types of cancer no longer have to reconstruct their histories of radiation exposure in order to qualify for medical compensation. Many former Rocky Flats workers who’ve spent years fighting for compensation are relieved at the decision, but some say the date range leaves out workers who had dangerous exposures.
Jacksonville Daily News (North Carolina): The latest research into the water contamination at the Camp Lejeune military base finds that the contamination began even earlier than previous estimates suggest. This has implications for the many servicemembers and their families who lived on the base while the contamination was present and are now experiencing cancers and other health problems that may be related to those exposures. A USA Today article notes that although President Obama signed a law offering health benefits to exposed former Marines and their families, Obama’s Justice Department is arguing in a Supreme Court case for time limits on lawsuits involving toxic contamination.
In These Times: Several workers have been killed on the construction sites of stadiums and other projects preparing for the 2014 World Cup and 2016 Summer Olympics in Brazil.
Brian Castrucci, who’s worked in city and state health departments and is now Chief Program and Strategy Director at the de Beaumont Foundation, likes to ask people two questions: Do you know who your primary care provider is? And, Do you know who’s head of your local public health department? The fact that many people can answer the first question but not the second, he says, demonstrates why public health needs to partner with health care.
“US medical providers are giving people some of the best medical care in the world, but if they’re returning patients to communities and environments that are antagonistic to good health, patients will still fare poorly,” Castrucci explains. “Public health can help create environments that are supportive of the medical interventions people are getting from the healthcare system.” For instance, doctors might recommend that patients with diabetes and high blood pressure engage in regular physical activity, but it’s hard for people to follow those recommendations if they live in communities with few safe opportunities for exercise. Public health departments can play a role in identifying such communities and working to make them more supportive of healthy lifestyles.
With a new tool called the Practical Playbook, the de Beaumont Foundation, Duke Community and Family Medicine, and the Centers for Disease Control and Prevention aim to help local and state public health professionals and local, state, and regional primary-care groups collaborate with one another to improve their communities’ health and reduce healthcare costs. It offers tips and resources for partners working through each stage of the integration process: organize and prepare; plan and prioritize; implement; monitor and evaluation; and celebrate and share. The Practical Playbook site also contains a wealth of success stories, including the following:
Indiana’s Asthma Emergency Department Call Back Program conducts outreach to asthma patients seen in the emergency department of Parkview Health emergency rooms in northeast Indiana to help patients improve their asthma management. With support from the Indiana Department of Health, the not-for-profit Parkview Health system has a trained community health nurse or respiratory specialist contact patients soon after an emergency department visit for asthma to assess patients’ needs and offer assistance. Patients who cannot afford medication to control their asthma are enrolled in Parkview’s Medication Assistance Program, and those without a medical home are referred to a Parkview physician, community health center, or free clinic. The program also works with the Fort Wayne-Allen County Department of Health and local school districts to provide families with resources to help manage asthma and avoid future hospital visits. A survey of program participants found that 59% reported missing zero days of school or work since joining. Program resources available on the Practical Playbook website include contact forms that Parkview Health uses for the initial contact with asthma patients following their emergency department visit and six months after the initial contact. A program evaluation found 38 fewer asthma-related emergency room visits and nine fewer hospitalizations after the program’s first year, for an estimated savings of more than $600,000.
Massachusetts’ Mass in Motion program helps 33 communities support healthy eating and active living. In response to an alarming ride in statewide obesity rates, especially among African-Americans and Latinos, the Massachusetts Department of Health partnered with local organizations and healthcare teams (Massachusetts Department of Public Health, the Harvard Pilgrim Health Care Foundation, The Boston Foundation, Blue Cross Blue Shield, Tufts Health Plan Foundation, MetroWest Health Foundation) to provide technical assistance and support for 11 pilot sites to build capacity and establish multi-sector partnerships to increase active living and healthy eating, with an emphasis on health equity. With a federal Community Transformation Grant and funding from Partners HealthCare, the program was able to scale up. Communities are participating in Healthy Corner Store, Adopt-a-Park, Farm to School, and Safe Routes to School Programs; improving sidewalks and roads to encourage walking and biking; and launching community gardens and mobile veggie markets. In an early analysis of body mass index (BMI) levels, five Mass in Motion communities saw a 2.4% decrease in BMI levels classified as overweight or obese, while other communities experienced only a 0.4% decrease. Mass in Motion’s Practical Playbook page links to the program’s annual highlights and information on Community Transformation Grants.
Michigan’s Healthy Futures program is a partnership between Munson Medical Center and local health departments to assure pregnant women and new mothers have the healthcare and resources they need. The partners launched the program in response to findings that many women were not able to get necessary prenatal care and that families had complex health needs that could not be addressed within the scope of doctor’s visit. Now, expectant mothers participating in Healthy Futures get support from a registered nurse during pregnancy and during the first two years of their children’s lives. They also receive newsletters covering topics such as immunizations, safety, and nutrition. Research has found that among enrollees, breastfeeding rates and immunization rates for two-year-olds are higher than national, regional, and state averages. The program’s Practical Playbook page includes links to the Healthy Futures newsletters that go to women at various stages of pregnancy and to parents throughout their children’s first two years of life.
The Practical Playbook doesn’t just aim to lengthen the list of success stories, though; it’s part of a larger effort to build a system that integrates primary care and public health in order to address the chronic illnesses that account for a growing share of the US disease burden. In 2012, the Institute of Medicine released the report Primary Care and Public Health: Exploring Integration to Improve Population Health. It recommended bringing the two sectors together and identified a set of core principles for integration efforts. Dr. J. Lloyd Michener, who chairs the Department of Community and Family Medicine at Duke University Medical Center and served on the IOM committee that produced the report, recalls, “In putting the IOM report together, we noticed that there were lots of examples of successful primary care-public health integration, but people didn’t know about them.”
Michener, who also worked on the Practical Playbook, stresses that he and his colleagues are working to “build on local strengths and expertise.” He points out that with the Affordable Care Act starting to reward healthcare providers for prevention (with initiatives such as accountable care organizations and shared-savings models), primary-care practices have new incentives to invest in improving the health of the populations they serve. But they don’t always know that public health can be a key partner. “We’re trying to help public health departments and primary-care providers take advantage of the tools the ACA provides, as well as the knowledge and experience that clinicians and public-health practitioners can share with one another,” he says.
The jump in rates of heart disease, diabetes, and other chronic diseases has also made the integration necessary. “We’ve gone from a time when disease was primarily caused by microbes to a time when it’s originating in social and environmental conditions – but our healthcare system hasn’t necessarily made the switch,” says Castrucci. “We need to allow public health to address some of the upstream concerns – and public health has 300 year old infrastructure and experience to do it.”
by Jonathan Heller
In his farewell address, President Dwight D. Eisenhower famously warned Americans about the growing power of the military-industrial complex. More than 50 years later, Nicholas Freudenberg, Distinguished Professor of Public Health at City University of New York, has issued a warning no less grave about “the corporate consumption complex” – the interconnected web of corporations, financial institutions and marketers that, in the name of individual rights, promote and profit from our unhealthy habits.
In Lethal but Legal: Corporations, Consumption, and Protecting Public Health, Freudenberg argues that “In a global economy that focuses relentlessly on profit, enhancing the bottom line of a few hundred corporations . . . has become more important than realizing the potential for good health.” According to Mark Bittman of The New York Times, “Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.”
To turn this destructive calculus around, Freudenberg told Bittman, “What we need is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Instead of asking “Do people have the right to smoke?,” Freudenberg and Bittman agree, we should ask: “Do people have the right to breathe clean air?” Instead of “Do junk food companies have the right to market to children?” we should ask: “Do children have the right to a healthy diet?” Instead of “Do we have a right to bear arms?” we should ask: “Do we have the right to be safe in our streets and schools?”
Reframing the debate with these questions, Freudenberg says, has led to changes in the food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive industries.
But we must go further. The labor practices of many industries also have huge impacts on health. The unspoken assumption today is business owners have the right to run their businesses as they see fit. Neoliberalism proclaims that reducing government regulation is essential for a healthy economy. But don’t workers have the right to live healthy lives?
In the past, the answer has only sometimes been yes. The once-powerful alliance of labor and workplace safety advocates won a series of rights for workers, including the 40-hour week and weekends off, a minimum wage, and occupational health and safety standards. But the political pendulum has swung back in the direction of corporate power, and dangerously too far.
- Minimum wage hasn’t kept up with inflation, so many people are working but not earning enough to escape poverty. Living in poverty has a huge impact on health and well being. Efforts to raise the minimum wage are in progress across the nation, and public health professionals should be supporting these efforts.
- About 40% of U.S. workers – and 70% of restaurant workers – are not given paid time off for illness. Health Impact Assessments conducted by Human Impact Partners (HIP) on paid sick days legislation show clearly that workers and society as a whole benefit when workers take time off and avoid spreading infectious disease. Visits to emergency rooms also drop.
- Wage theft – the illegal withholding of wages or the denial of benefits rightfully owed to an employee – is a common occurrence among low-income workers. HIP has begun a Health Impact Assessment of wage theft in Los Angeles and are finding that employers stealing their workers’ income has significant negative affects on physical and mental health and well-being for families and children.
- Both in the U.S. and abroad, too many business owners cut corners on worker safety to increase profit. The recent garment factory fires in Bangladesh and Pakistan that killed and injured hundreds of workers are a clear example.
What obligations do corporations have back to society and their workers? Should profits for owners be valued over everything else, including health? The public health community should lend its support to campaigns that seek to ensure that corporations are not allowed to profit at the expense of workers. Asking those questions, and others, is a good start.
Jonathan Heller is co-director of Human Impact Partners, an Oakland, Calif., nonprofit that conducts community-based studies of the health and equity impacts of public policy.