On June 3, 2016, the O’Neill Institute for National and Global Health Law at the Georgetown University Law Center will gather leading governmental, academic and civil-society leaders to identify practical, workable solutions to legal and regulatory issues in the United States food system that are causing health issues.
Food is a fundamental part of life for every American every day. In the United States, food accounts for 13 percent of personal household expenditures, behind only housing and transportation costs.  The food sector is a major economic driver, contributing about $800 billion dollars annually to the U.S. economy.  Food is a labor issue, providing 17 million jobs in agriculture, food services, and manufacturing. 
But food is increasingly also a public health issue. Obesity costs Americans more than $300 billion dollars each year in medical and treatment costs and in decreased productivity.  Despite the abundance of food, one in seven Americans goes to bed hungry each night, including 12 million children.  The widespread use of antibiotics in livestock intended for human consumption is leading to alarming rates of antibiotic resistance. 
As this country prepares for a change in leadership, attracting attention to food issues must be part of the debate. The same overarching themes that have dominated the political landscape for decades persist: the environment, water, immigration, domestic and global security, civil rights, education, justice, and economic opportunity. Each of these is intertwined with our food system. Understanding the challenges and interconnections and offering solutions is fundamental to meaningful change.
Improving the US food system depends upon bipartisan acknowledgment of the problems, followed by a commitment to open, thoughtful and creative dialogue on reaching reasonable solutions. With consensus we can solve some of America’s most pressing nonpartisan concerns like hunger and obesity.
While many groups have examined food-related policy, management, and economic questions, this conference will uniquely focus on where the law can improve public health by strengthening the U.S. food system. The purpose of this conference is to generate a clear articulation of the range of legal and regulatory solutions available to whoever is elected in 2016. This conference will provide a resource for 2016 candidates, currently elected officials and their staff, attorneys in executive and legislative branch agencies, policymakers, and other key players working directly on food issues as well as other key political areas that directly impact our food system like agriculture, immigration and trade.
The essential vision for the O’Neill Institute rests upon the proposition that the law has been, and will remain, a fundamental tool for solving critical health problems in our local, national, and global communities. By hosting this conference, our aim is to contribute a more tangible understanding of the multiple ways in which law can be used to improve the food system. The O’Neill Institute hopes to encourage key decision-makers in the public, private, and civil society sectors to employ the law as a positive tool to enable individuals and populations in the United States to lead healthier lives.
To learn more about this conference, please visit our website. Registration coming soon.
, ,  Economic Research Service (United States Department of Agriculture), Ag and Food Sectors and the Economy
 Pianin, E. “New Lifetime Estimate of Obesity Costs: $92,235 Per Person” The Fiscal Times, May 15, 2015
National Antimicrobial Resistance Monitoring System (Centers for Disease Control) Antibiotic Resistance Threats Report and Foodborne Germs
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Traumatic Brain Injury (TBI) is a significant and largely hidden public health issue. It results in an approximated 373,000 hospitalizations each year in the United States with 99,000 survivors classified as disabled and costs an estimated 48.3 billion US dollars with most experts agreeing that these figures are underestimates of the true problem.
TBI has gotten increased media attention over the past several years because of the increasing amount of data demonstrating the role that contact sports, particularly football, may play in acquiring TBI and the chronic and degenerative outcome of repeated head injury, chronic traumatic encephalopathy (CTE). Currently, over 100 former NFL players have been posthumously diagnosed with CTE and a study by the Mayo Clinic found CTE in 32% of men who played contact sports at an amateur level but found no traces in the brains of men who did not. Even President Obama has weighed in on the impact of football on TBI stating in an interview that football will likely need to become less violent over the coming years in light of the evidence of the long-term impact on players.
The increased media attention around TBI has meant that we are getting better at identifying and understanding the causes and outcomes of TBI in sports and other obvious risk scenarios like car crashes, but there is a significant and important population who is being left out of the discussion- victims of domestic violence. We know that domestic violence is a widespread problem in America and it is estimated that around 3 million couples engage in some form of physical violence and one in four married women are struck by their spouse at some time in their marriage. There is a distinct lack of evidence around the health impact of domestic violence, but it is estimated that between 3-21% of female victims need medical care after an incident of domestic violence and between 22-35% of all women’s visits to emergency care are a direct result of domestic violence.
We know that head injuries are one of the most common reported injuries for victims of domestic violence, that women are more prone to developing a post-concussive syndrome after a head injury and that women also have worse outcomes than men in 85% of TBI indicators. We also know that survivors of a mild TBI resulting from assault experience worse post-concussive syndrome than survivors of other types of brain injuries. All of these elements point to increased risk of long-term disability for female survivors of domestic violence. This is important because it is very likely that we are significantly underestimating TBI in domestic violence cases. Up to 20% of brain injuries are never reported, hospitalization for TBI is infrequent, the majority of domestic violence victims who show signs of TBI never receive a formal diagnosis and emergency rooms do not routinely screen for it. Further, victims of domestic violence may not report violence for fear of legal involvement, insurance loss, shame related to being a victim of domestic violence, fear of further violence or simply because they may not be able to remember the full extent of the assault, particularly where it led to a loss of consciousness.
All of this points to a sizable and already marginalized group of women who may have widespread and significant disability that is going undetected and untreated by the medical and legal community. Some of the symptoms of TBI such as aggression, poor memory, mood swings may be manifesting in female domestic violence victims in other ways. For example, 64% of all women who have been psychiatrically hospitalized have a history of domestic violence, how many of these women were institutionalized because of undiagnosed and untreated TBI? We cannot know because there have been no studies to explore persistent impairments or disabilities secondary to domestic violence.
Our medical and legal systems need to do better. We can provide training for police and emergency medical personnel around the risk factors for TBI in domestic violence situations, particularly for women, and systematically screening female emergency attendees for signs of domestic violence could increase the identification of TBI. Understanding of symptoms of TBI in victims of domestic violence could help courts and police to more effectively and empathetically question victims of domestic violence who may have memory lapses due to their condition. Identification of TBI in domestic violence victims could lead to more appropriate criminal sentencing of those who act violently in the home taking into account the full range of harm that they have inflicted on their partners. Better understanding of the prevalence of TBI in domestic violence victims could raise awareness in the broader community and help generate appropriate ways to assist those who are suffering from a TBI disability. Just as we are looking at how to mitigate risks for TBI as a society in contact sports such as football, we need to look at ways to identify and mitigate risks for victims of domestic violence.
Social media had an unexpected guest Monday night during the 2016 Grammy Awards. While many people were tweeting the latest red carpet looks, Taylor Swift’s multiple wins or Adele’s disastrous performance, an anti-tobacco campaign managed to take over social media. This may sound odd, considering anti-smoking ads are rarely considered trending topics or hip. However, the Truth campaign, created an ad that included our Internet favorite— cat videos. Using a montage of cute cat clips, the anti-smoking group presents the fact that cats are susceptible to secondhand smoke and are twice as likely to get cancer if their owner smokes. The video is accompanied with the hashtag #catmageddon with the logic being that smoking = no cats = no cat videos. And who would want to live in a world like that?
I’ve previously written about just how important the first three years of life are for brain development, and how food insecurity, malnutrition, stress and abuse can disrupt normal development of brain architecture and circuitry with life-long repercussions. This week, a study came out suggesting that exposure to something much more ubiquitous may have a similar effect on the brain: sugar.
Researchers from Australia looked at the impact of drinking high volumes of sugary drinks on the brain development of rats. They found that sugary drinks caused more changes to the region of the brain that controls emotional behavior and cognitive function than extreme stress or abuse in early life.
They “found that chronic consumption of sugar in rats who were not stressed produced similar changes in the hippocampus as seen in the rats who were stressed but not drinking sugar.”
We know that the first three years of life are when we see the most rapid development of the brain and central nervous system. Hence, during this period, children are particularly vulnerable to circumstances that can interfere with cognitive development, and go on to cause irreparable damage impacting the rest of their life.
Many studies have previously demonstrated the links between highly stressful experiences early in life and long-term consequences for that individual’s physical and mental health. What is most concerning about this study is that sugary drinks had a similar impact as early life stress on the hippocampus, a part of the brain important for learning and memory, which we also know is impacted by early-life trauma. The researchers noted that though this research cannot be performed in humans, the brain circuits associated with stress responses and feeding are generally the same across species.
Meanwhile, the soda industry continues to target children around the world
At the same time, a new report released last week by the Center for Science in the Public Interest shed light on soda industry behavior, which is following in the footsteps of tobacco and spending billions of dollars each year to increase soda consumption in lower-income countries. The report found that found that Coca-Cola has invested $12.4 billion in Mexico, which in 2013, had the highest per capita soda consumption in the world at 135 liters and leads the world in obesity.
Even more concerning is that although both Coke and Pepsi have made public pledges to avoid marketing to children, the report noted many examples of the industry using cartoon characters, advertising at schools, young celebrities and even Barbie to specifically target children. The report refers to a study from South Africa, where sugar-sweetened beverages were the third-most commonly consumed food or drink among urban children aged 12 to 24 months.
The report makes a number of recommendations – all very familiar to the public health community – including to restrict the sugar content of drinks, levy taxes on sugary drinks, restrict marketing and many others.
Time to step up the fight against the soda industry
Given what we know about the dangers of sugar, and that unlike most food products, soda provides no nutritional value, it seems ridiculous that corporate giants like Coke and Pepsi are still setting the agenda worldwide.
Many low and middle-income countries are already struggling with serious physical and cognitive developmental problems due to malnutrition; one in four of all children in the world are stunted and in developing countries this can rise to one in three. At the same time, the vast majority of overweight or obese children live in developing countries, and we know that sugary drinks are a major contributor to the obesity epidemic.
If, as this new research suggests, sugary drinks are another risk factor for child cognitive development – it’s even more concerning that we seem to be doing so little to curb the soda industry’s influence worldwide. How much more evidence of harm must we wait for before governments will start taking real action?
Yesterday the White House released the proposed budget for fiscal year 2017. It includes a $5 million funding increase to the CDC and a $9 million increase to HRSA to support viral hepatitis prevention and treatment initiatives, with an emphasis on addressing the Hepatitis C epidemic. The $5 million at CDC will fund increased efforts to stop the spread of Hepatitis C in young people, reduce viral hepatitis deaths, and reduce mother-to-child transmission of Hepatitis B and C. The $9 million in increased funding for the Ryan White HIV/AIDS Program at HRSA will support a new initiative to treat those co-infected with both Hepatitis C (HCV) and HIV.
The budget also includes a proposal for $1.1 billion to pay for drug treatment for people addicted to opioid medications or heroin. This is in response to the exponential increase in opioid addiction rates and heroin overdose deaths seen in the last decade. The plan seeks to support expanding treatment capacity for opioid abuse, and increase access to these services to more people by making the services more affordable. It also includes $500 million for the Department of Justice and HHS to improve prescription-drug overdose prevention strategies, which includes increasing access to the overdose-reversal drug naloxone.
Prescription opioid drug abuse has become a significant health problem in this country over the past 10 years. The government has addressed the liberal prescribing of these drugs by enacting stricter limitations and accountability to providers. However, these restrictions had the unfortunate side effect of causing many of those addicted to painkillers to start abusing heroin, because it provides a similar effect and was easier to obtain following the government crackdown.
At first glance, these budget requests do not seem to have a direct link to one another. However, there is a significant correlation between the Hepatitis C and opioid abuse epidemics that has been overlooked in these budget proposals, and indicates a missed opportunity by the government to concurrently provide funding to address both of these public health concerns.
The current rise in Hepatitis C cases in the U.S. can be largely attributed to infections among people who share needles during injection drug abuse of drugs such as heroin. The CDC estimates that between 2.5 and 4.7 million Americans are infected with HCV. The broad range of uncertainty in that number is due to the asymptomatic nature of the infection, whereby many people are not aware of their status and unknowingly pass on the infection when engaging in risk behaviors such as injection drug use. This correlation between higher HCV infection rates and injection drug abuse is also a significant contributor to the rise in HCV cases among young people, which is an issue the CDC’s budget proposal specifically seeks to address.
A review of the essential components of the President’s opioid abuse plan indicates no provisions to ensure comprehensive testing or educational interventions for high risk infections from injection drug use such as HIV and HCV as part of the widespread outreach and treatment strategy outlined in the proposal. Such ready access to a large number of people who are at particularly high risk for these infections would be an ideal opportunity for the government to integrate interventions that both address opioid abuse prevention and treatment and the need for improved Hepatitis C testing, treatment and prevention.
Standing alone, the CDC’s $5 million budget increase to address viral hepatitis is likely insufficient to have the desired impact on reducing new incidence of infection and promoting prevention measures. However, if these funds were included as part of a comprehensive strategy like the opioid abuse initiative, the CDC could avoid incurring expenses on outreach and identifying high-risk persons, and focus the funds on providing direct services such as testing and education.
The government should consider more holistic health intervention strategies that effectively address correlated public health concerns, allow for more efficient uses of federal dollars, and maximize desired outcomes. It is also essential that the level of funding the government provides for such initiatives is adequate to effectively respond to the scope of these public health challenges.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.