Effectiveness of the Policies and Laws in Town or City

In this week`s Saturday seminar, scientists look at some of the areas where state laws anticipate local authority and the factors that influence those decisions. Cities have many good reasons to have strict food safety standards. However, a subset of food safety laws prevent people from sharing food with members of the homeless community. These laws range from requiring a permit to share food in public spaces to strengthening food safety regulations that food communities are no longer able to meet food safety regulations. For example, some food safety laws may require permits for grocers or limit gastronomy to hot meals only in certain locations. Such laws have the effect of making it more difficult to be homeless instead of helping to solve the problem. Limiting food exchanges – especially in conjunction with anti-vagrancy measures – often punishes the homeless and those who want to help them. The United States now has the highest incarceration rate in the world, with state and federal costs of $80 billion in 2010 alone (DOJ, 2013). This remarkably high incarceration rate is due to policies adopted by federal and state governments beginning in the early 1980s, particularly with respect to mandatory convictions, “three strikes and you are out,” and the increase in drug-related incarceration (Blumstein and Beck, 1999; Mauer, 2001). Three studies on the greatest relevance of design and fair execution assessed the impact of imposing bans on weekend sales days. Two of these studies have shown that restricting sales days is associated with a decrease in excessive alcohol consumption and associated harm, and the third is not.

According to the standards of the Community Guide, there is insufficient evidence on which to base a determination of effectiveness. However, these studies support the general conclusion that increased sales days are directly associated with excessive alcohol consumption and associated harm. An important example is the application of non-compete obligations between employees and companies. These agreements prevent workers from accepting new jobs from competing employers, thereby limiting external employment opportunities and worker mobility. As Shown in Figure 4, the vast majority of states enforce these agreements – California is a notable exception – albeit to very different degrees. This has led to a patchwork of policies across the country: states like Florida (in orange) enforce non-compete rules in a relatively employer-friendly way, while other states (in blue) don`t enforce them at all. Some states, such as Virginia, apply non-competition, but do so in a relatively worker-friendly manner. School policy is not technically a law, but it is included here to recognize the strong impact it can have on local communities. All communities want their children to have a safe and supportive learning environment. But some punitive school discipline policies can actually hurt the students they were meant to protect. Common examples include zero-tolerance policies that do not give school officials flexibility in discipline, as well as exclusion measures – such as suspension and expulsion – to punish minor or vague violations.

The problem with many of these policies is that they can be applied inconsistently or ill-defined (for example, policies that punish “insubordination” or “deliberate defiance”). Recommendation 6-5: Payers and government and non-government providers should redouble their efforts to improve the quality of care, improve public health, and control health costs35 with a particular focus on improving population health for the most vulnerable and underserved. As a strategy to focus on health disparities, the Centers for Medicare & Medicaid Services could conduct research on payment reforms that could advance the consideration of social risk factors in the value-based payment programs they oversee. Jaywalking is one of the most noticeable symptoms of roads and cities created for people who drive, rather than for people who ride on foot, bike or public transport. Jaywalking laws have the laudable goal of preventing people from crossing roads in a way that could lead to collisions. But in practice, these laws can also lead to the criminalization of normal human responses to poorly designed roads. While it`s a common reaction to blame pedestrians for breaking the rules, the dangerous paths they cross are often the result of local government decisions about where to place homes, shops, streets, and zebra crossings. And while jaywalking laws are well-intentioned, research shows that they don`t really make roads safer. At the very least, jaywalking laws can impose hefty fines on people who walk – fines that are often much higher than those for parking tickets.

In extreme cases, jaywalking laws can have unfair consequences for people who don`t drive a car. Property (Palamar et al., 2015). In practice, this meant that, for example, 5 grams of crack imposed the same penalty (5 years in prison) as 500 grams of cocaine. Although inequality was recently revised to an 18:1 ratio by the Fair Sentencing Act, 2010, researchers and community advocates have long argued that any inequality targets cracks and thus poor and minority users (Palamar et al., 2015). As a result, federal drug policies, which punish crack cocaine more than powdered cocaine, have exacerbated the widespread racial inequality that characterizes criminal penalties for drug use and possession. The high fiscal and social costs of incarceration have prompted federal and state policymakers to reconsider criminal and sanctions rules. While mandatory minimum sentencing legislation has been passed at the federal level, changes have been introduced to reduce penalties for low-level non-violent drug-related offences committed by individuals without links to large organizations or gangs, and to reduce sentences for some inmates (DOJ, 2013). Texas and Arkansas have also reduced their prison populations by identifying alternative sanctions for low-level drug offenders. Similarly, Kentucky has shifted resources from prison beds to treatment services for offenders with behavioral problems and greater community supervision.

Other government initiatives, such as the drug courts, have found that a reduction in the number of days of sale and the resulting reduction in excessive alcohol consumption and related harms can have an impact on overall alcohol sales. Therefore, these restrictions can be combated by companies involved in the production, distribution or sale of alcoholic beverages. In fact, the alcohol industry has tended to support measures to lift restrictions on sales days,35 although some industry groups or sole proprietorships have supported maintaining Sunday sales bans.36 Research on sales days conducted in the United States has been conducted primarily at the state level. However, more research is needed to assess the effectiveness of local restrictions on sales days in preventing excessive alcohol consumption and related harm. The powerful role that education plays in achieving – or reducing – unjust health outcomes was discussed in Chapter 3. Academic achievement predicts life expectancy and indicators of health status such as obesity and morbidity due to acute and chronic diseases (see, for example, Woolf et al., 2007). The level of adult education, in particular the educational success of the mother, is linked to the health and well-being of her children. In all regions of the United States (Montez and Berkman, 2014), the gradient in health outcomes by education level has increased over the past four decades (Goldman and Smith, 2011; Olshansky et al., 2012), which leads to a wider health gap between Americans with high and low levels of education. Therefore, policies and practices aimed at increasing academic achievement and reducing educational disparities play a key role in reducing health inequalities.

Occupancy standards are laws that determine how many people can live in a dwelling. These laws aim to promote health and safety by controlling dangerous overcrowding in residences. In general, these standards set limits on the number of family members who can live together in a single housing unit, and then set a lower ceiling for non-relatives living together. The height of these plugs varies greatly from city to city. Occupancy standards are not only impractical – because they do not take into account the size of different housing units – but also unfair because they are generally based on a complaints-based system. Relying on community-generated complaints can lead to unfair outcomes, as complaints may be motivated by biases such as prejudices against tenants or residents of low-income neighborhoods. Occupancy standards also treat unrelated persons differently from family members. Unrelated people who live together are often more likely to find themselves in more precarious housing situations – for example, when low-income people or students live together to reduce costs. Chapter 4 discusses the importance of communities and the fact that they are not only the place of change, but also possess free power and can leverage their own power and assets to bring about change. However, as this chapter recognizes, it can be difficult for communities to promote health equity on their own.

This chapter describes the impact that policies and laws can have on communities. To support long-term change, it is necessary to address the broader context of issues that influence community efforts and success. The criminal justice system plays an important role in developing health equity through multiple mechanisms. The first, which is conceptually simple, includes the health screening and treatment services that the system provides to adult and youth inmates and probation officers.