EP40 Pre-emption in Public Health with Jennifer Pomeranz

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I AM GPH EP40 Pre-emption in Public Health with Jennifer Pomeranz

EP40 Pre-emption in Public Health with Jennifer Pomeranz

Alexandra Arriaga: Did you know that state legislators across the political spectrum are increasingly supporting preemption of policies intended to improve community health and address social and economic disparities? Please join us on this new episode of I AM GPH in which we will discuss the role of preemption in public health and it's potential consequences with Dr. Jennifer Pomeranz. So, professor, could you please tell us about your background and what inspired you to pursue an MPH?

Jennifer Pomeranz: Sure. I went to law school and I thought I was going to be a civil rights attorney and go that route. And I ended up practicing law at a big firm and not doing anything related to civil rights, but actually pharmaceutical defense work for a company that made a diet drug. And I became really interested in the public health aspect of what was going on with all these plaintiffs who were obese. They were speaking to their doctors but they weren't really talking about their obesity. And I was taking depositions of these plaintiffs and learning a lot about obesity and comorbidities. And I really became very fascinated in the public health aspect of what was going on in our country with our increasing rates of obesity. I actually contacted a colleague who's a lawyer at the FDA, and I said, "How do I get a job in the FDA on the food side?" And she said, "Did you ever consider getting a master in Public health?" And I said, "What's that? What's public health?" I had never heard those terms before. And funny enough, I did some research and I looked at the websites and public health schools, and I thought, "This is my calling. This is exactly what's speaking to me." So I left the law and I got my master degree and then I ended up working in a food policy and obesity center. At the time it was at Yale, it's called the Rudd Center for Food Policy and Obesity. And I was the Director of Legal Initiatives. I was doing a lot of what I do now, a lot of academic research, thinking about how we can use the law to advance evidence-based policy, in terms of public health broadly, but also obesity and food. So that's how I ended up getting the Masters of Public Health. And then I really wanted to become a full professor and teach and have interactions with students. And so NYU has been the best career choice for that. I have great colleagues and there are a lot of collaboration among colleagues, which I think is really exciting and not at every school. We have amazing students and it's just such a cutting edge program. So it's been a perfect fit for me in terms of my career.

Alexandra Arriaga: Well, we're very happy that you're here. We're happy to have you. And so now that you chose the path of public health, what are some projects that you are currently working on?

Jennifer Pomeranz: I do a lot of work around the First Amendment, thinking about ways that government can increase information in the marketplace to ensure that consumers have valid, factual information about products and services that may cause harm. And then another thing I work on is this concept called preemption. And preemption is when a higher level of government withdraws or limits the authority of a lower level of government to act. I want to give a few examples so people understand what I'm talking about. So, a very common example of preemption where everyone agrees it makes sense is the federal government preempts, or it takes away the ability of states to have different laws over airline safety. So we have a plane traveling across the country, we clearly only have one law saying there's no smoking on planes. Everyone likes that-

Alexandra Arriaga: Right-

Jennifer Pomeranz: ... right? If we had laws over every state, they would be silly. They would pass over the states and then you could smoke, and not smoke, and that makes no sense. 

Alexandra Arriaga: That would be crazy. 

Jennifer Pomeranz: Right. So we need federal preemption to ensure uniformity that completely makes sense. In other areas we've agreed as a country that preemption makes sense. And the main area that is the case are product labels. So when companies make products that are sold throughout the country, food, dietary supplements, even warning labels on tobacco and alcohol, we have a uniform labeling requirement. If we didn't have that it would be difficult for companies to do business in all 50 states, if there were 50 different nutrition labeling requirements, for example. So we've come to accept that that makes sense for preemption. Where preemption becomes problematic is when, and what's increasing are states are actually blocking the ability of local government to enact evidence-based policies. And this is where my work is really focused. So states across the country have been preempting local control over many public health issues and they're not allowing local government to enact evidence-based policies. Now we're in New York City where our local government is very active. And we couldn't imagine a place where New York all a sudden took away our right to have a local government act. But this is what's happening across the country. So some examples, 43 states preempt the ability of local government to enact firearm safety laws. A large handful of states preempt the ability of local government to enact food policies. One of the most recent examples, California, Arizona and Michigan just preempted the ability, oh, and Washington state, to enact soda taxes. And this is an evidence-based policy, so it's very worrisome. And the examples are actually very far reaching, from civil rights, minimum wage, paid sick, even smoke-free air acts. So these are places where local governments are now not able to protect their citizens with evidence-based policy making. And so looking at the legal methods to address preemption has been an area that I've been working on a lot. 

Alexandra Arriaga: It seems very relevant and also very dangerous. What can be done to counteract this preemption?

Jennifer Pomeranz: From a legal standpoint, there are a few times that lawsuits have been successful. It's actually quite rare that there is a real legal case. An example of a successful lawsuit was when Cleveland passed a trans-fat ban, which is an evidence-based policy. The state of Ohio did not like that. Yeah, this happens a lot, it snuck into legislation that's already been down the pipe. And so this clause of preempting trans-fat bans was snuck into legislation very far into the process. And because of the procedural method that they did that, Ohio, Cleveland sued and won. Now this is rare. Usually the states can preempt local control. And the reason is that local governments are actually a creation of the state. And so, though local governments have been in existence since the constitution was ratified, and as our population has increased, and of course, the different aspects of what local governments would need to control given increasing population and complexity involved, local governments are needed to take an increasingly active role, especially in public-health policy making. But even though that's the case, states still have the authority to preempt a lot of laws. And so that's where it becomes really problematic. So from a legal standpoint, it's actually less easy. And so a lot of people use grassroots organizing to alert legislators and voters of the real issues. And I have to say that the number one way to address it is voting, is actually having people vote for legislators that care about public health. And so getting elected officials in office that are interested in furthering evidence-based policy is really a huge issue and one of the main ways to win for public health.

Alexandra Arriaga: Obviously this topic is incredibly important. What motivates you to keep pushing through it? It seems like there's so many obstacles throughout going through this, so how do you keep going?

Jennifer Pomeranz: I actually love public health, and I feel very strongly that everyone has a right to experience the best health that they can. And what's kind of funny is even though I didn't end up being a civil rights lawyer, I try to funnel that feeling into this. In fact, one of the papers I wrote had to do with the removal of civil rights action. Arkansas actually preempted the ability of local governments to enact civil rights laws, specifically, unfortunately, in response to Fayetteville, Arkansas passing an LGBTQ protection of civil rights. So, an Arkansas state legislator didn't like that and they actually preempted it. And even just last week, the state's highest court upheld that. So I think, personally, there's a federal case to be made here. But this is what drives me, that this is taking away civil rights from people. And that's already a social determinant of health. Discrimination clearly causes health disparities. And so I still am thinking with that hat but really, thinking through how we can ensure evidence-based policy making so all people have the best possible way to be healthy. And some of the other areas are paid sick leave, paid family leave. This country is one of the very few in the world that doesn't really have strong policies. Minimum wage, all these things are really pressing issues that the preemption is taking away. So, you know, I'm very passionate about it as you can tell.

Alexandra Arriaga: No, I can definitely tell. And so what advice would you give to two types of people? First, what advice would you give to MPH students who just graduated and are listening to you and they're like, "Wow, I also want to work in this"? And then, what advice would you give, maybe people who looked at your trajectory from, maybe being a JD to going for an MPH route? And what would you tell them if it's someone that is on the brink of changing directions or making that switch, what would you say?

Jennifer Pomeranz: I think that a few things. You want to find your passion on what really interests you. I love my work and I feel very lucky. I love my work, I love everything about it. So if you can find that you're very lucky. But please don't get discouraged about a bad job or a bad position. There's something important about learning what you like, and then where you should be. And sometimes, bad jobs bring you to that place. And as you said earlier, do something scary every day. It's really good. Learn something new every day. So if you're at a job that's not the place for you, try to learn from it. Learn something new everyday and then find your direction. And I think that's really key. I did not find this job overnight. I was a practicing attorney for several years, not doing what I wanted to do. And I'm doing what I want to do now. So it takes time to get there. And I loved law school, I would never suggest anyone not pursue law school if that is the passion. But public health school is just an amazing education, and I think a really amazing view on the world and life. And it's really about community, which in America is sometimes undervalued. When you think about individualism and individual strengths, that's important but sometimes we forget about community, and about the public and the population as a whole. And so I do like that about public health, that we're thinking about how to improve things for a community and not just for individuals. And so I would urge going in that direction, for sure. And then, JD-MPH is always great. But, yeah, those would be my answers.

Alexandra Arriaga: Yeah. And so, lastly, for your students, if you have any current students watching, or maybe prospective students, what is the biggest message you would like for them to take away?

Jennifer Pomeranz: Well, current students, please do your reading and I want you to keep up with the reading. That's really important because that's how you learn. But I would say that the topic that's going to excite you, it'll be different for every single one of you. Everyone's going to have a different thing that's exciting for them. And you don't need to let it go. Sometimes it's something you're going to do on the side and sometimes it's something you'll be doing as your career. And then you'll meld the two together and get there. But I really think, follow your passion. And I also say, I think it's amazing that you're in public health school because that is, I think it's a great experience. And as you know, I'm very fond of NYU as a place to get the MPH. And so that, and do your homework.

Alexandra Arriaga: Oh, yeah, do your reading, do your homework, find your passion. Very important. Well, Jennifer, it's been such a pleasure having you here. Please keep us posted about any other big, encouraging research that you find yourself doing. And thank you so much everyone, for watching. It's been such a pleasure having you.

Jennifer Pomeranz: Thank you so much.