September 21, 2021 by Anushree Gade, LHC Student Assistant & Summer 2021 MPH Intern

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Introduction

Photo Courtesy of Getty ImagesThe field of public health aims to enhance and protect the health of individuals and the communities that those individuals are a part of (American Public Health Association [APHA], n.d.). The three core functions of Public Health include assessment, policy development, and assurance (Centers for Disease Control and Prevention [CDC], 2021). These core functions are broad categories that encompass the ten essential functions of public health. In recent times, policy surveillance has become a popular tool to assess and monitor policies and programs created by various levels of government and their effects on public health. Policy surveillance is defined as the “systematic, scientific collection and analysis of laws of public health significance” (Temple University Center for Public Health Law Research, n.d.).

Ongoing research, collection, and evaluation of laws relative to public health serve to identify trends and gaps in laws and how they impact the health of individuals and populations. Policy surveillance further promotes accurate evaluations of public health programs and enables accurate judgments on the viability of prevention measures that can be implemented. Policy surveillance also aligns itself with the three core functions of public health as it aids with assessment, policy development, and assurance. This literature review examines the implementation, outcomes, and impacts of various public health policy surveillance initiatives. Additionally, this literature review further discusses the magnitude of scholarship available regarding public health policy surveillance and its results.

Methods

The amount of literature available on each of the policy surveillance programs identified varied. The Public Health Law Research (PHLR) program has numerous papers published regarding the initiative itself and its contribution to policy surveillance. Similarly, the CDC’s Public Health Law Program (PHLP) has a significant amount of literature discussing their program available. The most comprehensive papers regarding both of these programs were published by Temple University’s Beasley School of Law due to its involvement with the PHLR program. Furthermore, both PHLR and PHLP were extensively used for various research purposes. Though their databases were not as frequently used as the ones mentioned previously, the Alcohol Policy Information System (APIS), State Tobacco Activities Tracking and Evaluation (STATE) system, and the Classification of Laws Associated with School Students (CLASS) databases were also employed to aid with advances in research.

Upon reviewing literature regarding policy surveillance initiatives, there seems to be a lack of literature surrounding the various initiatives covered in this literature review. Publications out of Temple University on PHLR and PHLP served as the primary sources of information. The author utilized Google Scholar to identify literature around these initiatives; initially, databases such as PubMed, Embase, and others failed to find literature related to policy surveillance initiatives. Various keywords were utilized to search through the databases, including “policy surveillance initiatives,” “policy surveillance programs,” “policy surveillance,” “LawAtlas,” “MonQcle,” “Temple University Beasley School of Law Public Health Law Research Program,” “Public Health Law Research Program,” “Public Health Law Program,” “APIS,” “STATE.” The databases did not yield any results to these keywords. Google Scholar, a search engine, efficiently identified scholarly articles related to the keywords used.

Overview of Policy Surveillance Initiatives

The Public Health Law Research Program (PHLR)

Founded by the Robert Wood Johnson Foundation (RWJF) and Temple University’s Beasley School of Law in 2009, the Public Health Law Research Program (PHLR) strives to establish policy surveillance as a scientific method for evaluating the impacts of laws on public health. Temple University provides technical and directional assistance to the PHLR program (Presley et al., 2015). Though it was not the first policy surveillance initiative, PHLR was the first to establish policy surveillance as a scientific study on the health impacts of laws. (Burris et al., 2016). The PHLR initiative identified which types of policies should be investigated concerning the topic of interest.

Furthermore, they established specific inclusion and exclusion criteria, described the laws and who they targeted, and established a search methodology (Burris et al., 2016). Due to a large amount of policy surveillance being conducted on various public health topics, PHLR developed LawAtlas, a software system designated to help with the dissemination of public health law research. LawAtlas provides the public with access to “Interactive Law Maps” as well as databases, codebooks, and protocols. Legal researchers at the Temple University Beasley School of Law manage LawAtlas and have developed similar software, MonQcle (Temple University Center for Public Health Law Research, 2012). MonQcle differs from LawAtlas in that it was created for more precise tracking of laws at various levels (local, state, national) on an international scale.

Furthermore, MonQcle allows researchers to edit, update, and share their research through the software system (Temple University Center for Public Health Law Research, n.d.). A significant amount of public health research has been conducted using LawAtlas and MonQcle; these software systems contain databases of various topics that greatly assist researchers. Using LawAtlas, two researchers identified differences in state laws regarding access, safety, and dispensing of medical marijuana. The study concluded that the effectiveness of the federal ban on marijuana is unknown (Klieger et al., 2017). The two software systems were additionally utilized to research Type 2 Diabetes, drugs and alcohol, youth sports concussion, distracted driving, and more.

CDC’s Public Health Law Program (PHLP)

The Center for Disease Control and Prevention’s (CDC) Public Health Law Program (PHLP), launched in 2000, is one of the first policy surveillance initiatives. One of PHLP’s goals is to stimulate extensive legal research on the impacts of laws on public health; additionally, it strives to disseminate public health law research to various professional communities. PHLP essentially focuses on taking a law-based approach to address multiple public health outcomes (Goodman et al., 2006). As the PHLP got involved in other projects, it magnanimously contributed to further establishing policy surveillance as a scientific approach to studying the impacts of laws on public health (Presley et al., 2015). The CDC PHLP has been conducting legal research on “electronic health information, prescription drug abuse, and state coroner/medical examiner systems” (Burris et al., 2016). Additionally, the CDC has also contributed to determining criteria, competencies, and methods for policy surveillance.

Other Policy Surveillance Initiatives: STATE, APIS, and CLASS

The CDC launched the State Tobacco Activities Tracking and Evaluation (STATE) system. Its purpose is to initiate research on state tobacco policies while also promoting awareness of tobacco policies. The STATE system, an application created by the CDC, contained a database with information similar to what was written in the CDC’s State Tobacco Control Highlights (1996). When it was initially launched, it lacked depth; however, a 2004 update and redesign of the STATE system included more detail on state laws regarding tobacco. The system became more interactive for users after the redesign (Burris et al., 2016). Data from the STATE system was further used to study state laws directed towards selling tobacco to minors and using electronic nicotine delivery systems (i.e. vape, hookah, e-cigarettes, etc.) indoors (Marynak et al., 2014).

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) launched the Alcohol Policy Information System (APIS). This initiative aims to measure the impact of public policies on alcohol-related behaviors and develop a resource that promotes additional scientific endeavors regarding the effects of alcohol-related policies (Bloss, 2011). APIS launched its first public website in 2003 (Burris et al., 2016). Furthermore, the National Cancer Institute’s Classification of Laws Associated with School Students (CLASS) is an example of another policy surveillance initiative; it exclusively focuses on examining how state laws regarding school physical education and nutrition impact student health. They evaluate the impacts of these laws by observing student’s body mass index (BMI), their activity levels, and food choices (“About CLASS,” n.d.).

Commonalities and Differences Between the Policy Surveillance Initiatives

Each of the policy surveillance initiatives discussed possess databases that are downloadable for users. The Robert Wood Johnson Foundation’s Public Health Law Research (PHLR) program has databases on policies encompassing various topics. The PHLR is unique because they utilize two software systems, LawAtlas and MonQcle, to publicize the databases and provide an interactive experience for users. Other policy surveillance initiatives have downloadable databases; however, unlike PHLR, they did not develop their software systems. Furthermore, APIS, STATE, and CLASS focus primarily on state-level policies. By monitoring relevant policies at the state level, these programs more effectively determine the impacts of policies on target areas. The PHLR program encompasses laws at local, state, and federal levels. This allows for comparisons of policies between different countries.

Moreover, each policy surveillance initiative differs in terms of its methods for policy surveillance and their purposes. Each of them has different topics that they focus on. For example, APIS focuses on alcohol-related laws, STATE focuses on tobacco-related laws, and CLASS looks at nutrition and physical education laws for schools. PHLR and PHLP are broader in terms of what they focus on compared to APIS, STATE, and CLASS.

Conclusion/Discussion

Policy surveillance is becoming an increasingly important practice in public health as professionals have come to realize the magnitude of impact laws have on the lives of individuals and communities. It is critical for public health professionals to understand the details of that magnitude. Furthermore, laws can also be implemented to prevent and address health issues. Understanding and monitoring policies at the local, state, and federal levels will allow professionals to identify which laws would be essential to promoting public health.

Though policy surveillance is becoming increasingly common in the recent decades through various initiatives, there is limited information on the specifics of these initiatives (i.e., methods, database organization, contributions to policy creation). There is a lack of recognition of the gift of policy surveillance to policy development; this is most likely attributable to the fact that policy surveillance is only a recently emerging practice. However, policy surveillance continues to be used as a tool to identify and fill gaps in policies that can further contribute to enhancing public health outcomes and initiatives.

Get Informed:

Want to know more? Here are a few of our favorite social media accounts you can follow to get the latest updates.

• Alliance for Health Policy
• American Public Health Association
• Health Affairs
• Kaiser Family Foundation

Get Involved:

Health policy changes happen all the time! If you want to get involved in local policy changes, keep an eye on the Birmingham City Council agendas, minutes, and recordings can be found here: https://www.birminghamalcitycouncil.org/council-meeting-video-archives/

A full list of references is available in the PDF version of this literature review.