Beginning in the 1950s, American orthopedic surgeon and noted sports car fanatic Dr.

John States was working as a physician at the Watkins Glen International Speedway in New York state. While working the job, Dr.

States witnessed countless high-speed crashes. But he noticed that even though the racecars were going much faster than cars on the highway, the drivers were actually more likely to walk away from crashes without serious injury compared to drivers on the open road. Dr.

States credited this to safety precautions like seat belts and helmets. Back then, there were few safe driving laws in place, and driving-related deaths and injuries in the U. S. were skyrocketing.

Most cars didn’t even come with seat belts! Dr. States knew that a change was needed.

Over the next several decades, he conducted research on severe crashes, and even designed and patented his very own seatbelt. He became one of the country’s leading advocates of seat belts and challenged policymakers in New York to improve automotive safety. Finally, in 1984, New York became the first U.

S. state to mandate the use of seat belts– thanks largely to Dr. States’ decades of work. Today, 49 states have adopted similar seat belt laws, and seat belt use has continued to grow–from 11% in 1981 to around 90% in 2020, saving almost 15,000 lives in 2017 alone, while cutting the risk of serious injury by 50%.

Looking back, we might call this an almost perfect, fairytale-ending to a story about how public health and policy can come together to improve and save lives. But it’s not always so simple in the moment. If you’ve been paying attention since about 2020, you’re no doubt familiar with the tension that can come with crafting health policy.

When public health crises arise, the people who make policies can often find themselves in the difficult position of having to balance some people’s freedom to do what they want with other people’s right to be healthy. Hi, I’m Vanessa Hill, and this is Crash Course Public Health! INTRO When we talk about health and policy, we’re talking about policies that change human behaviors or their environments to improve overall health and wellbeing.

That’s health policy. It sounds simple enough, but sometimes it can get complicated. Like, consider the issue of smoking in indoor public settings.

This impacts the health of the smoker, but also the health of the non-smoking people around them, because they can wind up inhaling the same potentially harmful chemicals that that smoker is inhaling voluntarily. Governments have struggled for a long time with how to tackle this issue, but it wasn’t until 2004 that Ireland​​ became the first country ​​​​​​in the world to ban smoking in all indoor workplaces. These smoking bans, as well as seat belt laws like the ones recommended by Dr.

States, are an example of a mandate, or a legal order that tells people or companies how to act. Again, assuming that you’re living in a world that was affected by the COVID-19 pandemic, the idea of a mandate may be familiar to you. But policies don’t–and often can’t–just tell people to be healthier.

So, policymakers need a few different tools in their health policy toolbox. Some of these tools are policies that aim to educate people. Take healthy eating, for instance.

There’s no all-knowing frozen-pizza-bagel police who are going to come knocking if we’ve had one pizza bagel too many. Which today, as a non-American, I learned is actually just a bagel with pizza toppings on it. But flip that pizza bagel box over and we see a list of nutrition facts that are there to remind us exactly what we are–and aren’t–putting into our bodies.

In the U. S., those nutrition facts are there because of the Nutrition Labeling and Education Act, which was signed in 1990 and basically says that people have a right to know what they’re putting into their bodies. This is why even the most eye-catching, mouth-watering, stomach-grumbling food packaging out there still needs to clearly feature those oh-so-recognizable nutrition facts.

This can include other information, too. Like in some countries, there are warnings on the front of products that contain excessive levels of things like sugar or sodium. Another complicated – and heavily debated but known to be good – issue that policy makers must grapple with is vaccination, or boosting the body’s defenses against a disease with a vaccine.

Consider measles, a highly infectious disease most commonly associated with health complications among children. In 1912, measles became common enough in the U. S. that it was named a nationally notifiable disease, which is a disease that healthcare providers must report to local health departments.

Measles continued to be so common that, by 1963, nearly every child was expected to get measles by the time they were 15, and up to 4 million people in the U. S. were infected every year. Measles was also responsible for up to 500 deaths and 48,000 hospitalizations each year.

However, policies requiring childhood vaccinations over the last several decades have meant that an increasing number of people have become vaccinated against measles, improving overall childhood health. And in the year 2000, measles was declared eliminated from the U. S.-- thanks largely to the push from government and public health authorities to get kids vaccinated.

For the record, “eliminated” doesn’t mean that there hasn’t been a single case of measles– just that there hasn’t been an observed spread of the disease that lasted longer than a year. Different countries approach vaccination policy in different ways. In a 2019 analysis of over 140 countries, 89 were found to have some form of nationwide mandatory vaccine policy for children.

And in 20 countries, including the U. S., vaccination was only mandatory for entry into school. Meanwhile, 33 countries recommended childhood vaccinations but didn’t mandate them.

Policies also affect our health in ways that aren’t quite as obvious as giving our immune systems a boost – like by environmental regulations. For example, in 1970, with the help of health experts, politicians, and factory workers, the U. S. passed the Clean Air Act, which regulated the emissions of hazardous pollutants from things like vehicles and factories.

From 1970 until 2020, the combined emissions of six common air pollutants was found to have decreased by 78%. This has had strong health impacts by preventing premature deaths and other negative health outcomes like asthma, bronchitis, and heart attacks. But around the world, governments have had a lot of success improving health through policies and programs.

Let's go to the Thought Bubble–and while we’re at it, let’s go to Brazil! So for a long time, Brazil has been pretty clear about one thing: health is a human right. Its constitution literally says that “Health is a right to be enjoyed by all and a duty of the State.” And Brazil takes this very seriously.

Whether you’ve lived in Brazil your whole life, or you’re a foreign resident in the country, Brazil offers free health care in its hospitals and clinics as part of its universal health care program. It’s also been very quick to respond to disease outbreaks, such as HIV infections and subsequent AIDS cases. As global cases of AIDS doubled or even tripled among certain groups from 2006 to 2015, Brazil responded rapidly to the trend - thanks in part to community-led efforts - by providing free treatment to all HIV-positive adults who sought care.

In 2017, Brazil became the first country in Latin America to incorporate a preventative pill for HIV into its health care policy, by making the pill available to whoever wanted it. The pill has been tested and proven to dramatically decrease the chances of contracting HIV when someone takes it every day. To help make this possible, the Brazilian Health Ministry made a deal with the drug’s manufacturer to buy the drug for about 75 cents per dose, which drastically increased accessibility to preventative treatment for people in Brazil.

Thanks, Thought Bubble. So, these are some of the ways that we use policy to influence our health. But it turns out that a lot of the policies that impact our health aren’t actually “health policies” in the traditional sense.

Instead, these policies have indirect, unintended consequences on our health–and often not for the better. Consider zoning laws, which basically regulate how land is used and developed. They regulate what land can be used for homes, shopping malls, factories, and so on.

And these are supposed to be laws about land–not people. But it turns out that people also use land for, you know, existing– so, it shouldn’t be a surprise that these laws also affect human health. Like, an indirect result of zoning laws is that people living in low-income and densely populated communities often find themselves living dangerously close to industrial facilities.

This can lead to exposure to poor air quality and toxic waste, which can increase the rates of asthma, cancer, and chronic disease. When it comes to who creates and drafts these policies, we’re mostly talking about governments. Most countries also have a department of health or a ministry of health or a something of health, which is a government branch dedicated to overseeing and improving population health in that country.

And often, this power is spread out across different levels of government. Like in the United States, the power to create and enforce health policies is shared between the federal government, states, cities, and smaller localities. But pathogens and diseases don’t really care about our imaginary political and geographical lines.

So, who helps countries coordinate their efforts to respond to, say, a global public health crisis? No, literally–WHO. The W-H-O - or the World Health Organization– is an agency of the United Nations responsible for overseeing international public health.

The W-H-O is made up of around 8,000 doctors, public health specialists, scientists, and other experts who help governments and scientists learn from each other, share resources, and work together to keep the global community healthy. But not all health policies have their origins in fancy wood-paneled government rooms or high-tech research labs. Some of the biggest drivers of innovations in health policy have begun on the streets, with groups of everyday people coming together to demand health policy change.

These are social justice movements. After all, health is a human right, and activists have long been a part of the story of how health has been protected and improved. One such movement has revolved around the HIV and AIDS epidemic since the 1980s, as governments around the world avoided taking action against the rapidly spreading disease.

Just in the United States, over 40,000 people were HIV-positive by 1987. And globally, more than 60,000 people had died from the syndrome. In response, citizens in the U.

S. formed the AIDS Coalition to Unleash Power, or ACT UP, an organization that protested the FDA’s slow and opaque drug-approval policy, which resulted in thousands dead from lack of access to life-saving drugs. Following widespread protests around the country, the process was accelerated and better information about the disease and treatment became more widely available to the public and public health community. Policies are an opportunity to break down barriers to health and improve health for, well, pretty much everyone!

But without continued evaluation of our policies and without placing affected communities and health experts at the forefront of policy efforts, these policies can also lead to health inequities and systemic failures that let people down. Health policies are important, but for health to truly improve for everyone, health should be considered in all our policies–whether they’re about car safety, air pollution, or yes, even pizza bagels. I’ll see you next time.

Thanks for watching this episode of Crash Course Public Health, which was produced by Complexly in partnership with the American Public Health Association. If you want to learn even more about Public Health, head over to APHA’s YouTube channel to watch “That’s Public Health” a series created by APHA and Complexly. Crash Course was filmed in the Castle Geraghty studio in Indianapolis, IN, and made with the help of all these brainy people.

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