Section 4. Supporting Local Ordinances to Modify Access to Unhealthy Products and Practices

 

Communities often try to improve health not only by encouraging individual choices, but also by creating environments that make healthy options easier to access. They may build or improve sidewalks, walking and biking paths, parks, recreation facilities, and other spaces that support physical activity.

Food environments provide another example. What people eat is shaped by many factors, including cost, availability, marketing, time, culture, transportation, and what foods are offered in schools, workplaces, stores, and other community settings. Communities may therefore look for ways to expand access to nutritious food while reducing environmental conditions that encourage excessive consumption of products associated with health risks.

A school, for example, might provide water and a wider variety of nutritious snacks in vending areas. A grocery store might make fruits, vegetables, whole grains, and other nutritious options more visible and affordable. These approaches do not remove individual choice; they change the environment in which choices are made.

This section examines ways communities can modify access to products and practices that may contribute to harm. In some situations, this may mean limiting access. In others, it may mean changing how products are marketed, sold, displayed, used, or regulated; providing clearer information; or creating safer and healthier alternatives.

What do we mean by unhealthy products and practices?

In this section, "unhealthy products and practices" refers broadly to products, activities, or conditions that can increase the risk of harm to individuals or others when they are used, experienced, or carried out in particular ways.

The level of risk varies. Some products may be harmful in almost any form of exposure, while others may present risks only in particular amounts, circumstances, ages, or patterns of use. Practices can also affect people beyond the individual involved, as in secondhand smoke, impaired driving, environmental pollution, or unsafe workplace conditions.

Modifying access does not always mean banning a product or practice. Depending on the circumstances, communities may use age restrictions, safety standards, pricing policies, zoning, education, product placement, warning labels, licensing, organizational policies, or other approaches.

Examples of products or practices for which access, distribution, marketing, or use may be regulated or otherwise addressed include:

• Food safety. Food that is contaminated, improperly handled, incorrectly stored, or otherwise unsafe can cause serious illness. Inspection, sanitation, labeling, food-handling standards, and public education can help reduce these risks.
• Tobacco and nicotine products. Tobacco use and exposure to secondhand smoke can cause serious health problems. Governments and institutions may use age restrictions, smoke-free policies, taxes, advertising restrictions, product-placement rules, cessation support, and other strategies to reduce exposure and use. Specific laws and age requirements vary by jurisdiction and may change over time.
• Food and beverage environments. Diet-related health is influenced by the availability, affordability, marketing, and placement of food and beverages as well as individual preferences. Schools, workplaces, retailers, and communities can expand nutritious options and consider how marketing and product placement influence purchasing and consumption.
• Alcohol. Alcohol use can create health and safety risks, particularly when it involves impaired driving, heavy use, unsafe environments, or use by people who are not legally permitted to purchase it. Communities use licensing, age restrictions, responsible-service practices, education, treatment and recovery services, and other approaches to reduce alcohol-related harm.
• Medications and household products that can cause harm when misused. Some medications, inhalants, solvents, and other products have legitimate uses but can create serious risks when used differently from their intended purpose. Packaging, labeling, secure storage, sales requirements, education, and appropriate health services may reduce harm.
• Performance-enhancing substances. Some substances used to increase athletic performance may create significant health risks when used without appropriate medical oversight. Sports organizations, schools, health professionals, and governing bodies may use education, testing, prescribing standards, and other safeguards.
• Infant feeding products and practices. Safe infant feeding depends on access to accurate information, adequate nutrition, safe water, appropriate health care, and reliable supplies. Families should receive evidence-informed information and support that respects their circumstances and feeding decisions. Marketing practices, product safety, affordability, and access to clean water can all influence health outcomes.

Some practices that may affect health do not depend on a particular product.

• Problem gambling. Gambling can become harmful when it contributes to financial problems, distress, relationship difficulties, work disruption, or loss of control. Communities may respond through consumer protections, information, age restrictions, self-exclusion options, treatment resources, and other harm-reduction approaches.
• Training or competing in ways that create avoidable health risks. Athletes may experience pressure to train through injuries, overtrain, use unsafe performance-enhancing methods, or engage in extreme weight-control practices. Coaches, schools, sports organizations, health professionals, athletes, and families can help create environments that prioritize long-term health and safety.
• Unsafe or extreme weight-control practices. Pressure related to appearance, sport, social expectations, or body image can contribute to restrictive eating, disordered eating, or other behaviors that affect physical and mental health. Prevention efforts should avoid reinforcing weight stigma and instead promote supportive environments, body respect, access to appropriate care, and healthy relationships with food and movement.
• Sex without appropriate protection or prevention. Sexual health strategies can include access to accurate information, consent education, condoms and other prevention tools, contraception, testing, vaccination where appropriate, and confidential health services.
• Not using appropriate safety equipment. Seat belts, helmets, protective equipment, fall protection, and other safety measures can reduce the likelihood or severity of injury.
• Exposure to chronic or excessive stress. Stress is influenced not only by individual behavior but also by working conditions, discrimination, caregiving responsibilities, financial insecurity, unsafe environments, limited control over decisions, and other circumstances. Policies and organizational practices can reduce preventable sources of stress while expanding access to support.

Why modify access to unhealthy products and practices?

Communities may consider modifying access when evidence shows that a product, practice, or environment contributes to preventable harm and when changing access is a reasonable way to reduce that harm.

The purpose should not be to blame people for their health or assume that everyone makes decisions under the same circumstances. Community health is shaped by individual behavior, but also by income, housing, education, transportation, discrimination, working conditions, marketing, neighborhood environments, access to care, and other social and structural conditions.

Reasons for considering changes in access include:

• To support health and well-being. Safer environments, reliable information, supportive services, and accessible healthy options can help people pursue their own health goals and reduce preventable illness and injury.
• To reduce preventable community costs. Illness and injury can affect individuals, families, employers, health systems, schools, and public resources. Prevention can sometimes reduce these impacts while improving quality of life.
• To reduce harm to others. Some practices affect people who did not choose the exposure, such as secondhand smoke, impaired driving, unsafe products, workplace hazards, or environmental pollution.
• To support healthy development for children and young people. Young people benefit from safe environments, nutritious food, supportive relationships, accurate health information, recreation, preventive services, and developmentally appropriate safeguards around products and activities that can cause harm.
• To create environments that support healthy choices. Community policies and organizational practices communicate priorities through what they make accessible, affordable, visible, and safe.
• To create and sustain a healthy community. Community health includes physical and mental health as well as housing, education, food, economic security, environmental quality, social connection, equity, and other conditions that support well-being.

When should you support efforts to modify access to unhealthy products and practices?

Communities can consider modifying access whenever reliable evidence identifies a meaningful health or safety concern and changing the surrounding environment, policy, or practice could help address it.

Some particularly useful opportunities include:

• When new facilities, programs, or developments are being planned. It is often easier to build health, safety, accessibility, and environmental considerations into a new project than to change them later.
• When policies or organizational practices are under review. Regular policy reviews, planning processes, licensing decisions, public hearings, agency rulemaking, and organizational changes can create opportunities to examine whether existing approaches remain appropriate.
• When new evidence or community data identify a health concern. Research, local data, evaluation, or community experience may reveal that a product, practice, or environment is contributing to harm.
• When a concern has become more urgent. Rising injuries, illness, environmental exposure, or other indicators may signal that existing approaches need to be reconsidered.
• When related community initiatives are already underway. Work involving prevention, transportation, environmental health, food access, substance use, recreation, or other community priorities may provide opportunities for coordinated action.
• Before a problem becomes widespread. Early evidence of an emerging risk may allow communities to consider prevention and harm-reduction strategies before the consequences become more severe.

Who should be involved in modifying access to unhealthy products and practices?

The people involved will depend on the product, practice, and type of change being considered. Include people directly affected by the issue as well as people with professional, regulatory, business, community, and lived expertise.

Public and organizational decision-makers

• Local councils, boards of health, planning bodies, and other appropriate public agencies
• Managers or owners of markets, restaurants, entertainment venues, and other relevant businesses
• Organizational leaders and boards
• Employers and industry representatives

Health, education, and community professionals

• Health care professionals
• Public health professionals
• Community and human service professionals
• Educators
• Coaches, dietitians and nutrition professionals, behavioral health professionals, and others with relevant expertise

People affected by the product, practice, or proposed change

• Consumers and community members
• Parents and caregivers
• Young people
• Retailers, workers, and business owners
• People with lived experience related to the health or safety issue
• Community-based and resident-led organizations

Meaningful participation is especially important when a proposed restriction will affect one group more than others. People should have opportunities to explain how a proposal may affect their health, autonomy, finances, work, culture, accessibility, or daily life.

How do you support local efforts to modify access to unhealthy products and practices?

Methods of modifying access

Communities have several options. Some involve law or regulation; others involve organizational policy, economic measures, environmental design, business practices, education, services, or voluntary agreements.

Laws and ordinances. Governments may establish requirements or restrictions intended to protect public health and safety. Depending on the issue and jurisdiction, these may address:

• Products whose sale or possession is prohibited under applicable law
• Age or licensing restrictions on particular products
• Requirements related to traffic safety, occupational safety, public consumption, or other activities
• Restrictions on smoking or other exposures in specified public or shared spaces

Because laws differ across jurisdictions and change over time, use current official sources when describing specific legal requirements.

Regulations. Government agencies may establish regulations addressing areas such as:

• Product labeling and hazard information
• Food production, handling, and inspection
• Workplace health and safety
• Medication and product safety
• Pollution, emissions, waste disposal, and environmental protection

Businesses and organizations may also establish internal health and safety policies. These should be lawful, evidence-informed, relevant to the actual risk, and designed to avoid unnecessary discrimination.

• Maintaining smoke-free workplaces and providing support for employees who want to stop using tobacco or nicotine products
• Providing nutritious food and beverage options in schools or workplaces
• Requiring appropriate safety equipment for hazardous work or activities
• Establishing safe-driving expectations for employees who drive as part of their work

Taxes and other economic measures. Governments may use taxes, fees, subsidies, incentives, or other economic policies to influence behavior or help address community costs associated with particular products or practices.

Economic measures should be evaluated for both effectiveness and equity. A policy that increases prices may reduce use while also placing a greater financial burden on households with fewer resources. Communities should consider whether complementary supports or alternatives are needed.

Voluntary actions by businesses and institutions. Businesses may change products, services, marketing, purchasing, environmental practices, or workplace policies in response to evidence, employee input, customer priorities, community concerns, or organizational values.

Examples might include:

• Increasing the availability and visibility of nutritious food and beverage options
• Improving the nutritional variety of workplace or institutional food options
• Providing employee assistance, behavioral health, substance use treatment, or recovery supports
• Reducing waste and using recycled or more sustainable materials
• Establishing reasonable limits on excessive work hours and supporting employee well-being
• Limiting the availability or promotion of products associated with significant health risks
• Responding promptly to credible product-safety concerns
• Following current age-verification and sales requirements for age-restricted products

Environmental and physical design. The built environment can affect behavior without removing choice.

• Traffic-calming measures on residential streets
• Designing checkout areas and other spaces to reduce marketing of products to young children
• Secure placement of products that are legally restricted by age
• Designing parks, sidewalks, buildings, schools, and workplaces to support safety, accessibility, movement, and social connection

Enforcement of existing laws and regulations. In some situations, additional rules are unnecessary because appropriate standards already exist but are not being implemented consistently.

• Laws governing sales of age-restricted products
• Air- and water-quality requirements
• Smoke-free environment requirements
• Food-safety requirements
• Building, environmental health, and chemical-safety codes

Enforcement should be consistent, transparent, and attentive to whether penalties or enforcement practices create unintended inequities.

Public education. Accurate and accessible information can help people understand risks, evaluate options, and make informed decisions.

Examples include:

• Nutrition, ingredient, or product-safety information
• Tobacco- and nicotine-prevention and cessation information
• Peer sexual health education and access to prevention resources such as condoms, testing, and appropriate health services
• Journalism and public information examining environmental, consumer, workplace, health, or medication-safety issues

How to go about supporting efforts to modify access

You may be joining an existing community effort or helping develop a new initiative. In either case, begin with a clear understanding of the issue, the evidence, the people affected, the available options, and who has authority to make relevant decisions.

Supporting an existing effort

If an organization, public agency, coalition, or resident group is already working on the issue, learn what it is trying to accomplish and where additional participation would be useful.

• Understand the goals, strategies, and responsibilities of the existing effort before deciding how you can contribute.
• Include people and organizations affected by the proposed changes, particularly those who may experience unintended burdens or barriers.
• Understand which public agencies, organizations, governing bodies, businesses, or other institutions have authority over the relevant policy or practice.
• Identify people within those institutions who can explain the decision-making process, provide technical information, or help ensure that proposals receive appropriate consideration.
• Use reliable evidence and distinguish established findings from assumptions or recommendations.
• Understand significant concerns and competing perspectives, including evidence that may challenge your preferred approach.
• Use appropriate communication channels to share accurate information.
• Make public participation opportunities clear and accessible so community members can provide their own perspectives.

Research. Research may include scientific evidence, local data, policy analysis, evaluation of similar efforts, and the experiences of people affected by the issue.

Personal stories can provide important context, but people should choose whether and how their experiences are shared. Do not use someone's hardship primarily as a communication strategy without meaningful consent.

Support and logistics. Community participation may be easier when organizations provide practical supports such as accessible meeting spaces, interpretation, childcare, transportation, food, virtual participation, or other accommodations.

Developing a new initiative

If your group is taking the lead, begin by developing a shared understanding of the issue rather than assuming in advance what the solution should be.

• Assemble a group that reflects the people, communities, organizations, and sectors affected by the issue. Include lived experience as well as professional, institutional, business, and technical knowledge.
• Assess community conditions and readiness for change. Ask what people already know, what concerns they have, what barriers exist, what changes they consider acceptable, and what resources or alternatives would make change more feasible.

Behavior does not occur in isolation. Lasting change is more likely when environments, policies, services, and social conditions support the healthier or safer option.

Avoid treating community members as "targets of change." People affected by the issue should have opportunities to help define the problem and determine which strategies are appropriate.

• Decide what kind of modification is appropriate. Consider several questions before choosing an approach:

How serious is the risk, and under what circumstances does it occur? Consider the likelihood and severity of harm, how much evidence is available, and whether risk changes according to age, dose, setting, frequency, or other conditions.

Does the product or practice create risks for people who did not choose the exposure? Risks to others may justify different protections from risks primarily affecting the person making the choice.

Do people have accurate information about the risks? If important information is missing, difficult to understand, misleading, or intentionally withheld, education, labeling, disclosure, or other transparency measures may be appropriate.

Does the product or practice also have legitimate benefits? Some medications, technologies, and activities carry risks while also serving important purposes. Policies should be designed carefully enough to reduce preventable harm without unnecessarily restricting beneficial uses.

What alternatives are available? Restrictions are more workable when people have realistic, affordable, accessible alternatives. For example, changing food environments is more useful when nutritious options are available and affordable.

Who controls the relevant conditions? Responsibility may be shared among manufacturers, retailers, institutions, regulators, employers, health systems, community organizations, and individuals. Strategies should address the level where meaningful change can occur.

What unintended consequences might result? Consider whether a restriction could increase stigma, create inequitable enforcement, reduce access to needed services, shift risk elsewhere, or create burdens for particular communities.

The answers to these questions can help determine which institutions and community partners should be involved and what combination of strategies may be most appropriate.

Community change often requires sustained participation, communication, and follow-through. Advocacy can be one part of that process, but effective advocacy should provide accurate information, create meaningful opportunities for participation, and remain open to revising a proposal when evidence or community experience identifies significant problems.

Work through appropriate public decision-making processes. If a law or ordinance is being considered, understand which governing body has authority, what procedures it follows, and how residents can participate.

Provide decision-makers with reliable information about the health or safety concern, the proposed response, likely costs and benefits, alternatives, and possible unintended consequences. People who disagree may be raising legitimate concerns about effectiveness, liberty, cost, implementation, equity, or other issues that should be considered.

Work with public agencies on policies or regulations. Learn which agency has authority, how its rulemaking or policy process works, and what evidence it needs.

• Establish clear and professional communication with relevant agency staff
• Understand the agency's structure, authority, responsibilities, and formal decision process
• Identify staff who can explain technical requirements or help participants understand the process
• Present evidence-informed options and remain open to changes that improve feasibility or address legitimate concerns
• Use established public-comment, administrative-review, oversight, or accountability processes when concerns remain unresolved

Work with businesses and industries. Businesses can play important roles in improving community health through product practices, employee supports, environmental protections, accessibility, purchasing decisions, and other policies.

Include businesses in planning when appropriate, while recognizing that their interests may differ from those of workers, consumers, residents, or regulators. Clear goals, evidence, transparency, and accountability can help partners identify areas of shared interest.

Organizations may also help businesses identify technical assistance, financing, government programs, or professional expertise that makes health- or safety-related changes more feasible.

Conduct public education. Public education should help people understand an issue and make informed decisions, not simply generate support for a predetermined outcome.

Guidelines include:

• Include people with relevant lived, community, scientific, professional, and organizational knowledge in planning
• Use accurate and current evidence and acknowledge important uncertainty
• Use plain language and provide information in languages and formats community members can access
• Communicate risks clearly without unnecessarily stigmatizing, frightening, or shaming people
• Use communication channels identified by the intended audience as relevant and trustworthy
• Include people directly affected by the issue when they choose to participate, without expecting one person to represent an entire community
• Use forums, listening sessions, community meetings, presentations, and other opportunities for two-way communication
• Use media and community communication channels appropriately
• Use community networks and word of mouth
• Use websites, email, social media, text messaging, video, and other digital tools where appropriate

Use community organizing or collective action when appropriate. Community members may use organizing, public meetings, petitions, public comments, demonstrations, legal processes, and other forms of civic participation when they want decision-makers or institutions to address an issue.

Collective action should be grounded in accurate information, clearly defined goals, meaningful community participation, and attention to the rights and safety of everyone involved. Different situations call for different approaches, and groups should periodically assess whether their strategy remains effective and aligned with community priorities.

Continue evaluating and adapting. If a change is implemented, examine whether it produces the intended results.

Ask:

• Has the relevant health or safety risk changed?
• Who has benefited?
• Are some communities experiencing unintended burdens?
• Is the policy or practice being implemented consistently?
• Are appropriate alternatives and supports available?
• Do community members believe the approach is useful and fair?
• Should the strategy continue, change, expand, or end?

Community health work is ongoing, but persistence should include a willingness to learn. Continuing an approach simply because substantial effort has already gone into it is not enough. Evidence, community experience, and changing conditions should guide what happens next.

In Summary

Modifying access to products and practices that can contribute to harm is one tool communities may use to support health and safety.

Depending on the issue, strategies may include laws and regulations, organizational policies, economic measures, environmental design, voluntary business practices, enforcement of existing standards, public education, increased access to safer alternatives, prevention services, or a combination of approaches.

The goal should not be to treat people as though they are incapable of making their own decisions. Effective community health strategies respect autonomy while recognizing that choices are influenced by environments, resources, marketing, policies, social conditions, and the availability of realistic alternatives.

Before modifying access, examine the evidence, the severity and distribution of risk, potential benefits, impacts on others, available alternatives, legal responsibilities, possible unintended consequences, and the experiences of people who will be affected.

The strongest approaches combine reliable evidence with meaningful community participation, transparent decision-making, access to supportive resources, and ongoing evaluation. When changes are made, communities should continue examining whether they are improving health and quality of life without creating unnecessary or inequitable barriers.