2016 Year in Preview, Part Three

In the third installment of our look ahead at public health headlines in the coming year, Mailman faculty contemplate how policies argued on Capitol Hill could play out locally, nationally, and around the world. On the issues of gun control, smoking, and the Trans Pacific Partnership, they explore creative ways to implement regulations and question whether policy changes always work to favor public health.

Trade Deal Looms Large

After months of secret negotiations by trade representatives, Congress will likely vote up or down on the Transpacific Trade Partnership sometime in the first half of the year. Backed by the Obama Administration, the TPP has critics across the political spectrum, from Bernie Sanders to Donald Trump, who see it as a giveaway to Wall Street or China. Representing 12 countries and 40 percent of the world economy, the TPP, everyone agrees, has major implications for public health.  

Bhaven Sampat, associate professor of Health Policy and Management, says there is concern that TPP would restrict the supply of low-cost generic drugs. For one, the trade deal disallows member countries from enacting laws that restrict pharmaceutical companies from filing secondary patents that “evergreen” their exclusive right to market a drug. So-called patent linkages create a further barrier, blocking the generic version of a patented drug regardless of whether the patent is valid or not. A third provision ensures exclusivity for biologic drugs for eight years, in effect giving companies a patent without the need to file for a patent. According to Sampat, these aspects of the TPP aim to complete the globalization of U.S.-style drug patent protection, which began with the 1995 Trade Related Intellectual Property Rights (TRIPS) agreement.

On the other hand, Sampat says the TPP could be good for the health of people living in countries like Vietnam if, as the agreement’s proponents predict, elimination of trade barriers boosts their economy, raising the standard of living for millions. He suggests a more nuanced analysis: “In contrast to how the agreement is presented in the press, there is a lot of uncertainty about its costs and benefits, from both an economic and public health perspective.”

Smoke-Free Public Housing  

In November, the U.S. Department of Housing and Urban Development proposed a federal rule to ban smoking in public housing nationwide. Currently in a comment period until January 19, the proposed rule, if passed, would affect nearly 1 million households, including more than 400,000 New Yorkers. While some public housing residents embrace the possibility of the ban, others see it as coercive and paternalistic.

In an ongoing research project, Diana Hernández, assistant professor of Sociomedical Sciences, is exploring a community-based method to lower smoking rates in South Bronx buildings where a ban is already in place. In collaboration with SoBRO, the South Bronx Overall Economic Development Organization, Hernández and her team are training resident “building ambassadors” to communicate the risks of smoking and serve as liaisons between tenants, property managers, and the research team. If successful, the method could help implement and enforce the federal ban should it become law.

“Residents themselves have a vital role to play in this effort—their knowledge and engagement are essential to promoting health,” Hernández wrote in a TEDMED blog post.

Gun Safety

On January 4, President Obama announced new executive actions to reduce gun violence through stronger background and increased access to mental health care. In his speech, the President framed his decision in public health terms, saying, “We do research when cars, food, medicine, even toys harm people so that we make them safer.” But when it comes to guns, he noted, “Congress actually voted to make it harder for public health experts to conduct research into gun violence.” It’s true: While the 2016 budget for the National Institutes of Health includes a $2 billion funding increase, zero dollars are allocated to research into gun violence; for the last twenty years, Congress has explicitly forbidden it.

Guns are the leading cause of premature death in the United States and in 2014 alone claimed more than 33,000 American lives. In 2015, the country saw mass shootings on a daily basis, culminating in the December 2 tragedy in San Bernardino, which killed 14 and injured 17. 

Despite funding limitations, Mailman researchers Sara Abiola and Bindu Kalesan are seeking new ways to address the issue. Kalesan, adjunct assistant professor of Epidemiology, focuses on quality of life for the estimated 70 percent of gun violence victims who survive death only to live with lifelong disabilities such as paralysis and PTSD. Abiola, assistant professor of Health Policy and Management, looks at whether gun policies can have a spillover effect, fostering a feeling of safety that translates to physical activity and other healthy behaviors. The key for gun violence, she says, is developing an approach that “targets the home, school, and community environments that give rise to the problem.”

Read Part One of the Transmission 2016 Year in Preview for faculty takes on the presidential election, the Summer Olympics, and the spread of Zika virus; and Part Two, which looks at issues affecting children's health, from early education to obesity and climate change.