Public health advocates worry after soda limits lose in New York

New York City's plan to limit the size of sodas and other sugary drinks was shot down June 26 by a state appeals court. The ruling highlights the potential challenges local public health departments face in attempting to address concerns linked to the rising prevalence of chronic disease.

“The nature of chronic diseases requires cross-disciplinary approaches in which socio-economic behavioral factors are considered,” said Sara Mark, executive director of the Center for Constitutional Governance at Columbia Law School. Mark recently co-authored an opinion piece for the Huffington Post where she argued that the court's ruling limited the city health department's ability to effectively address new types of public health threats.

“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 addressed population health risks through food inspections, vaccination programs and medical-education services, as examples.

But increasingly, they have also sought to curb health-risk behaviors such as smoking, overconsumption of unhealthy foods and beverages and sedentary lifestyles. Such conditions accounted for 84% of all healthcare spending in 2006, according to the Centers for Disease Control and Prevention, and half of all Americans reported having one or more chronic diseases.

Because public health threats have changed, advocates say the ability of health departments to deal with those new challenges also must change.

Some fear that the court's ruling may lead other local health departments to reconsider efforts to implement similar regulatory initiatives, out of worry that they may face similar legal barriers.

Dr. Terry Mason, chief operating officer for the Cook County (Ill.) Department of Public Health, which oversees approximately 2.5 million residents for 129 municipalities surrounding Chicago, said his department is not currently seeking to impose a similar ban, but it might in the future, with 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.”

But some critics of such health-risk behavior regulations argue they're too simplistic to effectively address the complexities of an individual's dietary habits.

Follow Steven Ross Johnson on Twitter: @MHsjohnson