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

Learn how to support efforts to use local ordinances to limit access to unhealthy products and practices.

 

 

Obesity in the United States and some other developing countries is, by all reports, moving toward epidemic proportions. A large number, perhaps a majority, of American adults and, more disturbing, American children, are overweight. The causes of this situation are generally thought to be twofold: a lack of exercise and a high-fat, high-calorie diet.

Communities often try to encourage residents to exercise by making it easier. They create or upgrade sidewalks and walking and bike paths, convert old railroad lines to bike trails, and develop public facilities for swimming, tennis, soccer, and other sports, making it more likely that people will exercise.

Unhealthy food is another matter. You can’t ban high-fat, overly-sugared, non-nutritious, or high-calorie food: it’s not poisonous, not harmful in small quantities, and many people enjoy it, and are able to eat it in moderation with no ill effects. Far too many people eat far too much of it, however, and that’s the problem. How do you make it less likely that people will eat too much unhealthy food, while not dictating their choices?

Just as communities try to make exercise more attractive by making it easier and more rewarding, perhaps you can change people’s consumption of unhealthy food by making it a bit harder.  If supermarkets devote more room to healthy food and less to high-calorie snacks and soda, for instance, there’s a possibility that people would buy more carrots and fewer cookies.  If schools eliminate vending machines, or fill them with apples and water instead of chips and soda, it is likely that kids will eat fewer unhealthy snacks and possibly pick up healthier eating habits.

This section is about ways to support efforts to make access to unhealthy products and practices more difficult. Some of those ways involve limiting access to some people, or in some places or altogether.  Others, like those above, are simply ways to make it a bit harder or less convenient to use unhealthy products or engage in unhealthy practices. All are aimed at creating healthier individuals and a healthier community, and improving the quality of life for everyone.

What do we mean by unhealthy products and practices?

We all know what the terms “unhealthy products” and “unhealthy practices” mean. They’re products and practices that can be harmful, in either the long term or the short term, to those who use or engage in them, and/or to others as well. The others could be those they live, work, study, or otherwise spend time with, or bystanders who could be injured or placed at risk by the use of the product or the practice (e.g., being exposed to secondhand smoke).

Modifying access to these products and practices isn’t necessarily a simple matter of forbidding them by law. For the most part, the things we’re talking about are legal, although not necessarily for everyone (it’s illegal in the U.S. to sell alcohol to people under 21, for instance) or in all circumstances (many communities have passed bans on smoking in public indoor spaces).  Many or most of these products and practices can’t be completely banned, but they can be limited in ways that can contribute to individual and community health.                  

Examples of unhealthy products and practices to which access is limited in some places or circumstances:

• Food that is unfit to eat to begin with, or that is improperly handled or preserved, leaving it open to harboring harmful bacteria. Some people believe that any food that is treated or raised other than naturally can be harmful.  The European Union bars food that has been genetically modified or irradiated, for example. Most developed and many developing nations have some sort of inspection program to ensure that food sold to consumers is fit to eat.
• Smoking is harmful both to the smoker and to those around him.  Statistically, smoking kills approximately 25-50% of smokers who continue the practice (primarily through heart attack, stroke, and lung cancer), and a smaller but significant number of those who live with second-hand smoke.  In the U.S. and much of Europe, smoking is now prohibited or limited in certain public spaces, ranging from only restaurants in some communities to all public buildings and facilities in others.The sale of cigarettes to children under 18 is illegal in the U.S., and tobacco is usually kept behind the counter, where it can only be supplied to customers by store personnel. High taxes on tobacco in some countries serve to limit its sale as well, as do restrictions on tobacco advertising.
• High-calorie, high-fat food – soda and junk food, such as french fries, potato chips, fast-food-chain milk shakes, etc. – poses a considerable health risk. Attention has been growing on childhood obesity, which can contribute to heart disease, diabetes, and other chronic, life-shortening illnesses. Many parents try to restrict their children’s diets to healthy foods, and many schools have begun to eliminate snack-food vending machines and to provide healthier school lunches.In the UK, advertising of unhealthy food on TV is restricted to late-hour adult-oriented programming.
• Alcohol, which can be highly addictive, can have serious physical, social, and psychological consequences for drinkers. Youth are particularly at risk, since they generally have less judgment and restraint than most adults, and can be affected developmentally by overuse. Furthermore, the earlier alcohol use begins, the greater the potential for abuse and alcoholism.  As a result, most countries have a minimum age at which youth can legally purchase and drink alcohol (ages range from 0 to 21, with 18 being most common).  Most countries also have fairly strict laws against drunk driving, which can have serious consequences for the driver and others in the community.
• Over-the-counter drugs that can be used to get high. When these are abused, their status is sometimes changed so that they must be prescribed by a doctor. (This happened in the 1970’s with a version of Robitussin cough syrup that contained a good amount of codeine, an opiate often used as a recreational drug.) Other widely available products that are sometimes abused include some solvents and glues, which, if sniffed for their effects, can cause brain damage and other serious problems.
• The use of anabolic steroids, Human Growth Hormone, and other performance-enhancing drugs.Most of these drugs have been banned by virtually all school, college, and professional sports associations for years, and are only available by prescription in many countries. Leaving aside their effect on the outcome of athletic contests, steroids and other similar drugs can have medical consequences ranging from skin rashes to heart attacks and cancer.
• Infant formula. In developing countries, feeding babies formula can lead to serious health problems and death. There is often a lack of clean water to mix the formula with, illiteracy can prevent parents from understanding how to use it properly, and many families can’t afford to buy as much as they need.  Additionally, there have been claims that Nestle has supported the distribution of free powdered formula samples to hospitals and maternity wards; after leaving the hospital, the formula is no longer free, but because the supplementation has interfered with lactation the family must continue to buy the formula. Although a world-wide boycott of Nestle products (Nestle is the world’s largest supplier of infant formula) eventually led to most formula companies agreeing not to promote or advertise formula in the developing world, many continue either to exploit gray areas of the agreement, or to ignore it altogether. The result is often a malnourished baby, or one with diarrhea, which can be a death sentence in developing nations.

There are also unhealthy practices that don’t require the use of a specific unhealthy product.

• Problem gambling. For some people, gambling becomes the focus of their lives.  There is the continual need to gamble, to make back money lost, to get more money to gamble.  This can lead to problems in finances, relationships, work, and other areas of life.

• Overtraining, playing with injuries, or taking extreme weight-control measures to improve athletic performance. High school and college athletes may be encouraged – or may push themselves – to engage in these activities in the hopes, not only of winning, but of moving on to the pro ranks. Muscle and joint injuries, often career-ending, and other medical problems probably far outnumber professional contracts as a result.
• Extreme weight-control measures to enhance body image. Young women are particularly subject to believing they’re too fat, and resorting to diet measures that can turn into full-fledged eating disorders.
• Unprotected sex.  This has always had medical consequences – STD’s (sexually transmitted diseases, such as gonorrhea and chlamydia), pregnancy – but since the onset of HIV/AIDS, those consequences have become even more serious.
• Not using seatbelts, motorcycle and bike helmets, and other safety devices.
• Experiencing stress – in work or other areas of life – serious enough to affect your relationships and the general quality of your life and the lives of those close to you. Stress isn’t all bad.  A certain amount can keep you functioning at your peak, if you’re in control of the forces that cause it. Studies show, however, that people in high stress situations with little or no control over their options are affected in a number of negative ways, including compromised physical and psychological health. It is in the interest of society to limit these situations through such mechanisms as sexual harassment laws and workplace safety regulations.

Why modify access to unhealthy products and practices?

So, people use unhealthy products and do unhealthy things. They’ve done that for thousands of years. Why bother to try to change human nature?

It’s not necessarily human nature to endanger your own health or quality of life.  As often as not, it’s a matter of not knowing that what you’re doing is unhealthy, or of not believing that it will affect you, even though it affects others. Furthermore, society has a vested interest in keeping people healthy, since healthy people contribute to the health of the community as a whole.  A short list of reasons for trying to prevent the use of unhealthy products and practices:

• To encourage healthy lifestyles and improve health and life expectancy for everyone. One aspect of a healthy community is that it has healthy members. Physically and psychologically healthy people are in general more productive, happier, and more able to contribute fully to the life of the community than those weighed down by illness, injury, or other health problems, or by stress or anxiety caused by their lifestyles and choices.
• To prevent or alleviate social expense. In countries that have national health plans – virtually all developed countries except the U.S. – everyone pays when someone needs medical care, since the system is generally funded by taxes.  In the U.S. and other countries where private insurance covers a good part of most health care, everyone also pays: the more insurance companies pay out, the higher the cost of insurance for all.  And, the more expensive private insurance, the less likely people can afford coverage and the more likely they will only access emergency services (oftentimes costing much more in terms of human life and financial resources). Also, since business picks up the cost of much of the country’s health insurance, and since the cost of health care also helps determine how much individuals and families have to spend, that cost affects the national economy.  The U.S., with the world’s highest GDP (Gross Domestic Product – the total value of goods and services produced in the country each year), spends 16% of it on health care.

Business and the economy are also affected by the fact that employees who are out of work because of illness or injury aren’t producing anything.  If they can’t work at all, either permanently or for a period of time, they not only produce nothing, but don’t contribute to the expense of government (i.e., they pay no taxes.)  Using unhealthy products and practices is thus not only costly to the individual, but to the society as well.

• To improve the quality of life for everyone in the community. Everyone is touched by the use of unhealthy products and practices.  Even if an individual does everything she can to maintain her own health, she may be injured by a drunk driver, stressed by the health problems of other family members, or sickened by second-hand smoke or carelessly-handled food.  Making unhealthy products and practices less available makes the community better for everyone, not just those whose health is directly affected.
• To improve the chances of healthy child development. Children, who lack judgment, self-restraint, and the knowledge to understand the effect of their present actions on their future, are most at risk.   Access to unhealthy choices affects them in two ways. First, it’s important for their physical and emotional well-being that they get proper nutrition, exercise, and support of various kinds in order to grow and flourish. Overeating, lack of exercise, unhealthy food, alcohol, and tobacco are even worse for children and youth than they are for adults, since they both interfere with healthy development and set the pattern for lifelong unhealthy habits.

Second, in addition to proper nutrition and exercise, children need emotional nurturing, a safe environment to learn and play in, a social network, opportunities for self-expression, and intellectual stimulation in order to fully develop their physical, intellectual, social, psychological, and creative capacities.  That means that they need healthy adults as caretakers, role models, and teachers to help them grasp why some choices are healthy and some are not, distinguish between the two, and make the choices that are best for them.  Thus, children are deeply affected not only by their own choices and health, but by those of the adults around them.  Since one of the main purposes of any community or society is to raise healthy children to be competent and productive adults, it is in the community’s interest to safeguard both children and adults by discouraging the use of unhealthy products and practices.

• To send the right messages to youth. If the community is serious about protecting the health and well-being of children and youth, it must practice what it preaches.  A commitment to healthy products and practices implies setting some limits on unhealthy ones.  If the community is unwilling to take that step, it is likely that children and youth – always on the lookout for adult hypocrisy – are unlikely to pay attention to “Do as I say, not as I do” warnings about unhealthy choices.
• To create and sustain a healthy community.  A healthy community depends on the health of all its citizens.

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

The short answer here is whenever there’s an opportunity.  But what does an opportunity consist of?  Here are a few answers to that question:

• When new facilities are opening. New facilities, particularly businesses that are hoping to attract customers, may be disposed to try limiting access to unhealthy products if people in the community request it.  A new neighborhood grocery store or supermarket may be willing to experiment with limiting shelf space for junk food, for example.  An industry newly locating in an area may also be open to requests to limit pollutants, use recycled materials, muffle or prevent noise, etc.
• When there’s a change in local administration.  Sometimes the difference between limiting and not limiting access to potential dangers lies in the person of a particular individual policy maker or in the makeup of a community governing body or board.  The Board of Health, the Town Council, the Conservation Commission – any of these and various other bodies may have some control over access to products and practices.  When a new official takes office, or when the character of a board shifts with the appointment or election of new members, it often creates an opportunity for change, especially if you’ve previously faced foot-dragging or outright opposition.
• When a community health problem that can be prevented or reduced by modifying access – obesity, smoking, substance use, etc. – is in the news.  When a health issue is already a matter of public discussion, people are more likely to be concerned about it and to support efforts to deal with it.  By the same token, policy makers, businesses, and others are more likely, because of public interest and public pressure, to be willing to put measures in place to limit or otherwise modify access to the factors that contribute to it.
• When a particular community health issue reaches a critical level.  When something becomes enough of a problem that people in the community are actually aware of it as a problem, public pressure generally forms to do something about it.  At that point, you can quickly be in the situation described above: the media takes hold of the issue, and suddenly it’s on everyone’s lips.  Officials often start proposing solutions – usually including modifying access to contributing factors – and it’s an ideal time to work to put those modifications in place.
• When there’s a community health-related campaign already under way.  Whether it’s related to smoking, health coverage for all, use of the local clinic, or water filtration in developing countries, a health-related campaign might present the opportunity to reach goals through changing access to undesirable products and practices.
• Before something becomes a problem.  The very best time to work to limit access to unhealthy products and practices is before they are common enough to pose a real threat to the community.  Unfortunately, an issue often has to reach crisis proportions before anyone is willing to do something about it, or before it’s studied enough so that people know what to do.  If you’re aware of an unhealthy product or practice that could become a problem – a steady, though still small, increase in heroin use among youth, for instance – and can alert the community and policy makers to it, you may be able to generate or support efforts to address it by modifying access before it reaches the crisis stage.

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

As with most situations discussed in the Community Tool Box, we recommend that the more stakeholders you involve, the more likely your effort is to succeed.  People who should be involved, depending upon the products or practices you’re concerned with, might include:

Policy makers at both public and private levels in the community.

• Local councils, Boards of Health, etc.
• Managers of markets, restaurants, bars, liquor and convenience stores
• CEO’s and/or board chairs of local corporations
• Managers of local industries

Health and other professionals.

• Doctors and medical personnel
• Public health officials
• Human service workers
• Educators at all levels
• Coaches, nutritionists

People affected by the product or practice.

• Consumers
• Parents
• Youth
• Retailers

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

Methods of modifying access

Before we get into just how you might go about modifying access, let’s discuss some different methods.  Some are direct – passing a law – and some quite indirect – public education.  Each of them can be effective in the right circumstances and/or in combination with one or more of the others.

Laws and ordinances. One common way to modify access is through laws and ordinances that specifically restrict the use of particular products or practices, or set an extra cost to them.  Some of the different ways that laws and ordinances operate:

• Forbidding the sale or possession of products outright. Most currently illegal drugs were once legal, for instance, until laws were passed banning their distribution and use.
• Restrictions on the distribution of products. It is illegal in the U.S. to sell alcohol to people under 21 or cigarettes to people under 18.
• Making specific practices illegal or requiring others. Many communities have laws against drinking in public, for example.  Exceeding the speed limit or not wearing a seat belt are both subject to fines (or worse, for repeat offenders) in the U.S.
• Restrictions on specific activities. In many places, smoking is not allowed in restaurants and/or bars.  It’s usually also forbidden on public transportation, and often in other indoor public spaces.

Regulations. There are two kinds of regulations. The first – regulations made by government agencies – often have the force of law.  Rather than setting out regulations, laws give agencies discretion in setting regulations in their areas, as well as the power to enforce them. These kinds of regulations might include:

• Labeling requirements for food and products that contain harmful chemicals or might cause harm if misused – solvents, cleaners, paint, bleach, etc.
• Inspection requirements at food packing plants, slaughterhouses, etc.
• Workplace safety regulations.
• Certification requirements for drugs and medications.
• Limits on the amounts of pollutants that industries can emit, as well as limits on waste disposal.

The second type of regulation is set by a business or other organization or institution to control its own internal functioning.  These may be similar to government regulations, but the major difference is that the regulating body has the final say on whether and how it is enforced.  There may or may not be an internal grievance procedure, but court is only an option if the regulation is illegal or unconstitutional.  Some examples:

• Employees must be non-smokers because of health care costs.
• The school district only allows vending machines with healthy food and drink – fruit, nuts, water, fresh juices – in school or other district buildings.
• Anyone working with certain tools or in certain places must wear safety equipment.
• Company drivers who are stopped for speeding a certain number of times will lose their jobs.

Taxes or other economic measures.  While similar to laws and government regulations, taxes and similar measures use economics to modify access to specific products or practices.  Sometimes, the money raised from such measures is used to further encourage health – a portion of cigarette taxes may be set aside for anti-smoking education in schools, or for health care, for example.  Sometimes, as in the case of the option of buying “pollution credits,” the measure can be designed to cause enough financial pain that the payer will simply meet the required standard.

Some examples of economic measures:

• Cigarette taxes are often used to discourage smoking.
• Gasoline taxes are sometimes used to encourage people to drive less, thus reducing pollution and, in some cases, encouraging travel by foot, bicycle, or public transportation.
• The current Massachusetts universal health care coverage law requires businesses of a certain size to provide health care plans for all employees or to pay a fixed cost per employee to cover state-sponsored health care for those who are uninsured.

Voluntary actions taken by retailers or other businesses and industries because of community pressure or because of corporate civic responsibility.  Many businesses – particularly those that deal directly with their customers, such as supermarkets and department stores – are responsive to public opinion.  When it’s clear that those customers are concerned about a product or business practice, these businesses often make adjustments.  Many supermarkets now label foods with their country of origin, for instance, and/or with some indication of their contribution to overall health.

Large corporations as well, concerned with profits, generally know that they have to be aware of their public image, and to address community health concerns.  By the same token, some large corporations have policies of displaying community-friendly and healthy corporate behavior.  These may apply both internally and community-wide, and extend to everything from the food in the employee cafeteria, to exercise opportunities available to employees, to corporate attitudes toward the global environment.

Some examples of voluntary actions businesses might take to modify access to unhealthy products and practices:

• Reducing shelf space for chips and soda in favor of healthier snacks, and/or stocking more organic foods.
• The elimination of  unhealthy food in employee cafeterias
• Employee assistance programs offering counseling and substance use treatment
• Recycling of waste and/or use of recycled and sustainable materials in their operations.
• Put a cap on the amount of overtime an employee is able (or asked) to work.
• Removing cigarette vending machines from bars, stores, etc.
• Ceasing to stock, or restricting access to products that are still legal, but whose safety is in question.
• Being meticulous about checking ages of buyers of alcohol and tobacco.

Physical barriers. Access to some unhealthy products or practices can be limited by actually placing physical obstacles in the way.  Some ways of obstructing access to unhealthy products and practices:

• Placing speed bumps on pass-through streets in residential neighborhoods.
• Placing candy above the reach and eye level of young children on “impulse-buy” shelves next to supermarket checkout lines, or eliminating candy on such shelves.
• Placing cigarettes behind the counter, where customers have to ask for them.

Enforcement of existing laws and regulations. Sometimes the most effective way of modifying access to unhealthy products and practices is simply to enforce what’s already on the books.  Underage drinking can be curbed at least somewhat by rigorous enforcement of the law.  Some existing laws whose vigorous enforcement can make for a healthier community:

• The sale of alcohol and tobacco to underage customers.
• Air- and water-pollution control laws.
• Ordinances against smoking in bars and restaurants or other public spaces.
• Food-inspection and -handling laws and regulations.
• Building codes, especially those regarding the use of unhealthy chemicals and VOC’s (Volatile Organic Compounds).

Public education. Public education may not seem like a method of modifying access to unhealthy products and practices, but it can be the first step toward making change.  Giving people information about the things they may have used without thinking can keep them healthy in any number of ways.  The health warning on cigarette packs, poison control directions on household substances, and TV programs that focus on the reasons for healthy eating and exercise all can affect what products people use and what they do.  Some other examples include:

• Contents and nutrition labeling on packaged food.
• Anti-smoking advertising campaigns.
• Trained peer sex educators and making condoms available to those at risk for HIV/AIDS and other sexually transmitted diseases.
• Investigative journalism that examines – in newspapers or on radio and TV – such issues as the nature of waste produced by certain industries or the effects of particular prescription drugs.

How to go about supporting efforts to limit access

There are really two ways you can go about supporting efforts to address unhealthy products and practices. One is to help with, and advocate for, a local effort already going on that’s spearheaded by a government body or an advocacy or other group.  The other is to mount an initiative yourself – as an existing organization, an existing community action group, a newly-formed community group specifically aimed at addressing this issue or health issues in general, or even as an individual (although only at first – no effort is likely to succeed if it involves only one person).  We’ll try to look at both cases, and discuss what you might do in each.

Supporting someone else’s effort

If another body has begun a push to regulate – legally or through formal or informal policy – unhealthy products or activities, you can join that effort, and work to make it a reality. There are a number of actions you can take.

Advocacy. Usually, the most effective way to help an ongoing effort along is through advocacy. There are several chapters of the Community Tool Box devoted specifically to setting up and running an advocacy campaign.

• Start with the group that is running the effort. What is their focus, and what can you do to strengthen their actions?  Make sure there’s coordination among all the groups and individuals involved in the effort, so that everyone’s working toward the same purpose at any given time.
• Involve as many stakeholders as possible. That might include all sectors of the community if the unhealthy product or practice affects the community as a whole.
• Establish relationships with the legislators, aides, policy makers, appointed and elected officials, agency people, and anyone else who can make the law, regulation, or policy a reality.
• Find a champion within the body that will have to institute and/or approve the proposed change who can help to guide it along. Coordinate your activities with that person so that she knows and approves of what you’re doing. Don’t embarrass or compromise the person who can actually get the job done.
• Do your homework, and make sure you know the facts, science, and other particulars of the issue.
• Be prepared to counter the arguments of opponents with facts, hard scientific evidence, and common sense.
• Use the media to get the message out.
• Inform the public about the issue, and bring public pressure to bear through the media, public meetings, messages from constituents to policy makers, etc.

Research. Your group or organization may be able to conduct research that’s helpful to the effort. That might include finding people with personal stories that illustrate why modifying access is necessary, or getting the scientific background on the issue. It might also involve finding organizations that can provide support and information, or other communities where a similar ordinance or policy has had good results.

Support and logistics. Even if you’re not directly engaged in advocacy, you may be able to produce a number of people for a rally or meeting, help to set up tables and chairs, provide food, stuff envelopes, provide child care and/or transportation, and otherwise support the events and actions that make up the substance of the effort.

Mounting an initiative

If you and/or your group take the lead in an effort to deal with unhealthy products or practices, what should you do in order to be successful?  Here are some brief guidelines, which should be added to those above for advocacy.  Nearly every effort has to include an advocacy component to be effective.  If no one understands what you’re concerned about, or realizes that there are other people concerned as well, you won’t get any action.

• Assemble a diverse group, with representatives of at least the sectors identified in the “who” part of the section, to plan and spearhead the effort.  The more of the community is represented, the more sectors you can bring into play, and the more everyone will feel that this is a community effort, and not one conceived by a small, elite group.  In addition, broad representation brings a range of ideas, and helps to ensure that the concerns of all elements of the community are addressed.
• Determine the readiness of the population to change behavior.  In several places in the Tool Box, we discuss the fact that people go through a series of stages in relation to behavior change.  In order to successfully change their behavior, they have to:
  • Know about the issue that the behavior concerns
  • Understand its importance
  • Believe they are capable of change
  • Desire to make the change
  • Implement the change
  • Maintain the change

Of course, maintaining lasting change is most likely to happen in an environment that is supportive of the change (and not in which previous alternative behaviors are readily supported and endorsed).

For your intervention to work, you’ll have to work with people where they are. If you’re trying to get a supermarket to change its display of snack food, for instance, the manager will have to understand that there’s a problem before you can convince her to do something about it.  The same is true for a community as a whole, as the Community Readiness section explains.  Understanding where targets of change are on the change scale will help you with the next of these guidelines.

• Decide what kind of modification you’re going to work for.  In addition to the question of change discussed above, this depends on a number of factors, including:

How dangerous is the product or practice to the user?  Eating large amounts of french fries may have a long-term negative effect on many people, but simply buying and eating an order of fries in a fast food restaurant is not likely to cause a calamity. Abusing alcohol, on the other hand, can have immediate and serious effects.

How dangerous is the product or practice to others?  This may be the more important question from the point of view of the community.  There are limits to how far you should go in a free society to protect people from their own desires, but no one has a right to endanger others for his own pleasure or advancement.

• Are the unhealthy effects generally known by users?  If not, have they only been recently discovered, or have they been covered up by producers or sellers?  If the latter, is a lawsuit or criminal prosecution appropriate? Is a social marketing campaign in order?
• Does the product or practice present important advantages, despite its threats to health?  Many dangerous products are used as medicines or pain relievers.  (Morphine – an addictive drug – is used for pain relief in hospitals.)  The way they’re regulated is meant to minimize the danger both to those for whom they’re prescribed and for others (potential addicts, for example). It makes little sense to try to modify access to the point where a product or practice can’t be used positively.
• Can the situation be changed without resorting to regulation or some other exercise of power?  Convincing a merchant to change policy – to give more shelf space to healthy foods, for instance – because it’s good for business and will be seen as a community service is ultimately far more effective than legislating the amount of shelf space, which is likely to make him resentful.  It’s almost always smarter to become a partner than to become an enemy.
• Who controls availability, distribution, and choice of use?  The producer?  The user?  The seller?  Someone else?  (In the case of baby formula in developing countries, the choice to use it is controlled not by the direct user – the baby – but by parents.  Their choices in turn are controlled to some extent by doctors or nurses.  Their choices are controlled to some extent by the distributor, who may offer them incentives to hand out and recommend the use of formula.)

The answers to these questions can tell you whom to target, and how.  That’s what we’ll cover in the rest of this section.

Target local lawmakers to pass laws and ordinances. The task here is largely advocacy, and most of the guidelines for that activity can be followed here. The difference is that you, rather than the lawmaker, are starting the effort.  You’ll have to demonstrate the need, and demonstrate that you have community support.  You may have to be willing to settle for a resolution that isn’t exactly what you wanted, but is a step in the right direction. Finding a champion from among lawmakers’ ranks is crucial, not only because that person can help you through the political minefield, but also because it gives you access, through her, to all the members of the lawmaking body.

Start by respecting those you’re trying to influence, and assuming they’re people of good will. The fact that they may not agree with you doesn’t necessarily mean that they don’t care. They may have other concerns that they consider more pressing, or disagree philosophically about how to go about building a healthy community. If you keep communication lines open and continue to press the issue, and if you have widespread support, the chances are that you’ll end up with an acceptable result.

If, on the other hand, there seems to be no chance of resolution, because of opponents’ lobbying or other reasons, you may have to be more assertive, using community organizing and/or direct action in order to get results.  If you’re sure you’re on the right side of the issue, you may have to fight to get what the community needs.

Approach agencies to institute or change policies or regulations. Most local, state, and federal agencies are empowered by law to set policy and sanctions which they or the local, state, or federal government will then enforce.  The guidelines here are similar to advocacy, in that you should:

• Establish personal relationships with people in the agency. When you call, you want to be able to ask for a specific person, and to have that person know you and be willing to return your calls.
• Learn the structure of the agency, so that you’ll know who makes the decisions, and whom you have to reach in order to get things done.  Sometimes, the decision-makers are influenced by particular people, and if you can find out who they are, you may be able to get results through them.
• Find an in-house champion to help you push the regulation and guide you through the bureaucracy.  This is sometimes even more important when dealing with an agency than with lawmakers, since agency bureaucracies can be mazes of unwritten rules that only those in the agency – and sometimes not all of them – know how to negotiate.
• Present the alternative that you want, with the understanding that it may be changed in the process of becoming policy.  Be prepared to settle for something acceptable, but not perfect.
• Know how to bring pressure to bear on the agency if you get no results.  That may mean calling in legislators or other elected officials, applying the force of public opinion, or even exposing agency incompetence or collusion with those it’s supposed to regulate, if those are the reasons for lack of change.

Negotiate with business or industry for changes in their internal or external policies or practices. You may be concerned with a business’s internal policies, and try to encourage it to shield employees from unhealthy practices by sponsoring healthy ones – healthy food in the cafeteria and vending machines, free gym memberships, no-smoking policies, etc. Or you may be more focused on the business’s relationship to the community, and advocate for better waste disposal, recycling, or pollution controls. You may be asking retailers to change where and how they display certain items, or to stop stocking some things altogether.

The ideal here is to make businesses and industries partners in your effort.  Include them in the planning team.  Give them credit and public praise at every opportunity for their civic responsibility – pictures in the paper and on TV, stories in community newsletters, acknowledgment in public presentations.  Encourage supporters of the effort to patronize those businesses that take part in it, so they’ll be willing to continue the partnership when other issues arise.  Do all you can to show them that civic responsibility is not only the right stance to take, but the most profitable one.

Offer your assistance.  If you’re trying to persuade an industrial plant, for instance, to make a major change, try to help managers come up with a plan for how to do so.  Research government programs that provide support for installing anti-pollution equipment, for instance. Connect businesses with concerned academics and scientists to find innovative ways of reducing waste and pollution...and saving money.

When dealing with business and industry, just as with agencies, it’s important to understand the structure of the operation.  For a smaller, locally-owned business, the structure may essentially consist of one person, the owner: all transactions and negotiations should be with him, because he’s the lone decision-maker.  A business or plant that’s part of a large corporation may be controlled by the local manager, or may be managed from a distance.  You should find out whom you actually have to talk to in order to initiate action, and how to get to that person or group.

Conduct a public education campaign. A public education campaign might stand on its own, if information is the only issue here, but is more likely to be part of a larger effort and to be combined with other activities listed here.  Its purpose is usually both to inform the public about an unhealthy product or practice, and to gain public support in modifying access to it.  Consumer groups were able to convince the government to require nutrition labels on food in the U.S. at least partially because citizens became concerned about what was in the food they were putting on their tables.

There is a good deal of material in the Tool Box about or related to conducting public information campaigns. An abbreviated list of guidelines for running a public education campaign might include:

• Assemble a diverse group, from all sectors of the community, to plan and sponsor the campaign.
• Make sure you fully understand the issue and all the facts relating to it.  The better your grasp of the science, politics, and other elements involved, the better you’ll be able to explain how the product or practice in question affects the community, and why people should care.  It’s also important that you have the facts of the matter correct, or your opponents will try to use your mistakes to discredit everything you say.
• Put your message in language that your target audience will understand – plain English, the languages of particular populations, etc.
• Make your message straightforward and truthful.  The information you’re passing on should speak for itself.  Trying to scare people or infuriate them often backfires – the emotional level is too high, and they’ll turn the message off entirely, unless they’re already true believers.
• Choose channels for your message that will reach your intended audience.  Depending on the nature of the community, Spanish-language or hip-hop radio stations, service clubs, supermarket and laundromat bulletin boards, houses of worship, and health and human service agencies might all be good options, in addition to the mainstream media.
• If possible, choose spokespersons the community can identify with and/or believe.  These might include people actually affected by the products or practices in question, respected community leaders, sports figures, doctors, etc.
• Hold public events of various kinds – public forums, press conferences, demonstrations – to advertise your message and your presence in the community.
• Use the media as much as possible.
• Use social networks and word-of-mouth to spread your message.
• Use e-mail and the Web.  A YouTube video is worth a thousand – or several thousand – hits. Your message can be spread incredibly quickly through the use of e-mail lists, which often are passed on from one list to another almost automatically.

Conduct a social action campaign. The best course is nearly always to accomplish your goals by persuasion and finding common ground with policy makers and/or opponents. When that’s simply not possible, you may need to mobilize the community to apply enough pressure to get movement on modifying access.

The first step in any social action campaign is organizing the community.  You can’t do anything unless you have strong community backing, and that means establishing a strong and wide community political base, as well as a communication network, large numbers of people willing to take action, and people willing and able to coordinate and monitor actions and events.  Community organizing takes time and patience – it doesn’t happen overnight – and requires a huge amount of personal contact.  It can help if there’s an issue of mutual concern to mobilize around, but organizing still may involve reconciling competing or opposing factions within the community, and putting aside disagreements over other matters to focus on the one in question.

The trick here is to try to get action with the least pressure possible. The less confrontation you engage in, the fewer enemies you’ll make, and the more likely policy makers will be to deal respectfully with you the next time – and there’s almost always a next time.  Always start at the most reasonable level possible. If you’ve already been put off more than once, that might be simply renewing your efforts, and making it clear that you have strong backing from the community. If you meet with disrespect, continued resistance, and/or outright hostility, be prepared to go to the next level, which may be a media campaign, or may be showing your public support through a barrage of phone calls to officials or corporate headquarters.

If that level of action fails to get a response, then direct action may be called for.  That can involve anything from demonstrations to lawsuits, depending on the situation and the need.  Save your strongest actions for last.  If you start with your best weapons, then you have nothing left if they don't work, and you may label your group as extremist.  Try to maintain the moral high ground, only going to direct action when it’s clear to the public that you’ve tried everything else.

Keep at it. Regardless of what kind of modification you’re seeking, and of how you go about it, one thing is sure: whether or not you get what you’re aiming for, your work isn’t over.  If you’re successful, you’ll need to maintain your success, and not let your gains slide. If you don’t succeed, you’ll need to try a different strategy, and to keep up the pressure either until modifications are in place, or until it becomes clear the community doesn’t want what you’re asking for.

This last is an important point.  You might simply be on the wrong side of the issue, trying to limit something that a vast majority of the public wants, and is willing to take risks in order to have.  On the other hand, you may simply be early in the process.

In the late 1950’s, when the first scientific reports of the dangers of smoking began to surface, most people paid no attention, and a smoking ban of any kind would have been inconceivable.  In the U.S. today, only about a quarter of the population smokes (as opposed to more than half of the population 50 years ago), and smoking bans in public buildings, restaurants, and bars are common and largely accepted.  Early crusaders for limits on smoking because it was unhealthy for everyone, however, were doomed to frustration.  It was only because they and others who followed didn’t give up that the Surgeon General’s office began placing warnings on cigarette packs, and Americans finally realized the real dangers of tobacco. Many smoking ordinances have been created in communities because concerned people at the grassroots level brought the issue to their legislators.

There may be a moral component here as well. Some elements of a healthy community are simply right, and need to be fought for. The majority of segregated communities in the American South didn’t want integration.  The leaders of the Civil Rights Movement and their allies were right to keep pushing until they got results, no matter how long it took.  It’s important, however, to understand when there’s a legitimate disagreement about points of view, and your effort is merely an attempt to force your opinion on others, rather than a true road to a healthier community.

Once changes in access are made, you’ll have to work to maintain them.  If your ultimate goal is a healthy community, you can’t stop working toward it.

In Summary

Among the tools for building a healthy community is the option of discouraging people from using unhealthy products and engaging in unhealthy practices.  In a free society, the government or some other entity can’t treat everyone as a child and simply forbid the use of anything that might be harmful.  In some situations – where a product or practice is immediately and severely harmful, or where it threatens others who aren’t using it – a ban may be legitimate.   In others, however – where reasonable use of a product causes no ill effects, and it’s only overuse or improper use that’s harmful – a ban may not only be inappropriate, but may itself be harmful physically as well as politically.  (Most important medications are dangerous if taken in large quantities, for example, but banning them would put health and lives at risk.)

In addition to legally restricting unhealthy products and practices where that makes sense, there are a number of other ways to modify people’s access to them.  Some are physical – less, and less visible, shelf space for unhealthy snacks; keeping cigarettes behind the counter – some are informational – media stories about the dangers of particular products, limits on advertising – and some involve policy changes on the part of government, businesses and industries, or institutions.  The goals in all cases are to make sure that people understand their choices to the best of their capacity (children may not be able to project the consequences of their choices into the future as well as adults can), and are encouraged to make the healthiest choices possible.