“If the court is saying to the agency that the agency can't consider these sorts of factors, then agencies and government are going to be left really ill-equipped to deal with these current crises,” she said.
Traditionally, local public health departments have performed duties that involve addressing threats that pose a risk to the populations they serve, such as conducting food inspections and vaccination programs, as well as offering medical education services.
More and more, health departments have looked to curb health-risk behaviors such as smoking, overconsumption of unhealthy foods and beverages, and a lack of physical activity. Such conditions accounted for 84% of all healthcare spending in 2006, according to the Centers for Disease Control and Prevention. Half of all Americans reported having one or more chronic disease.
Because the health threats facing the public have changed, health advocates say so must the ability of health departments to deal with the new challenges they present.
Some fear that the court's ruling may lead other local health departments around the country to rethink efforts to implement similar types of regulatory initiatives out of concerns about facing the same kinds of legal barriers.
“Local health departments that are trying to champion a similar effort should go and review that local health department's current authority to make those types of decisions depending on the way the jurisdiction is set up,” said Truemenda Green, senior director for Healthy Communities and Chronic Disease Programs for the National Association of County and City Health Officials. “If they do not have that governing authority, then they should look to work strategically with community, business and other partners to help champion the effort through other venues.”
Part of the problem with the New York City plan may have been a lack of support from those the regulation was intended to protect, according to Dr. Terry Mason, chief operating officer for the Cook County Department of Public Health, which oversees approximately 2.5 million residents for 129 municipalities in the suburbs of Chicago. Public opinion of the measure has remained mixed throughout the two years since New York City first proposed restricting the size of sodas and other sugary drinks sold at restaurants and venues to 16 ounces.
Mason said his department currently is not seeking to impose a similar ban limiting food or beverage sales, but that such regulatory action could be an option in the future if it received enough public support.
“While we're not talking about legislation or ordinances to ban certain things just yet, I think that those types of things are going to come,” Mason said. “When people begin to really understand the relationship between overconsumption of unhealthy foods and beverages and chronic disease, they're going to be more supportive, and that kind of support is going to help us get this done.”
It was public support that led local health departments to successfully impose smoking bans in public places throughout the country, Mason said.
But some critics of such health-risk behavior regulations argue they are too simplistic to effectively address the complexities of an individual's dietary habits. A ban fails to take into account whether a person who consumes a soda engages in other healthy behaviors that may negate any negative effects a large-size soda might pose, for example.
“It assumes that the government knows what in fact is healthy food and should be eaten, which is by itself a flawed assumption,” said Daren Bakst, research fellow in agriculture policy at the Institute of Economic Freedom and Opportunity at the conservative Heritage Foundation, in Washington, D.C. “I think that with food and dietary decisions, this kind of sugary drink issue goes way beyond a smoking ban.”
Follow Steven Ross Johnson on Twitter: @MHsjohnson