Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T03:58:21.243Z Has data issue: false hasContentIssue false

The Impact of Law on Coronary Heart Disease: Some Preliminary Observations on the Relationship of Law to “Normalized” Conditions

Published online by Cambridge University Press:  01 January 2021

Extract

The relationship between law and a population’s health is complex and poorly understood. To the extent that scholarship exists on the subject, it has usually focused on epidemics that are concentrated in relatively vulnerable, marginalized communities. Often, individual behaviors are assumed to play a major role in the epidemiology of these diseases. Perhaps, as a result, these illnesses become stigmatized and the object of coercive laws, which in turn become the subject of litigation, legal debate, and ultimately scholarly analysis. Thus, to the extent that U.S. legal scholars have thought about public health in the last 30 years (and they seldom have), they have generally done so in the context of tuberculosis (TB), intravenous drug abuse, and a handful of similar conditions. Likewise, Jonathan Mann’s own appreciation of the importance of human rights to public health emerged in the wake of his work with HIV, which is perhaps the prototypical stigmatized disease.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

RERRENCES

For the classic discussion of stigma and the factors that lead to it, see Goffman, E., Stigma: Notes on the Management of Spoiled Identity (Englewood Cliffs, New Jersey: Prentice Hall, 1963).Google Scholar
The HIV epidemic has many elements associated with stigma. It is a deadly infectious disease, spread by sexual activity, and especially prevalent in marginalized communities. See Sontag, S., AIDS and its Metaphors (New York: Farrar, Straus, Giroux, 1989): at 44.Google Scholar
Burris, S. Kawachi, I., and Sarat, A., “Integrating Law and Social Epidemiology,” Journal of Law, Medicine & Ethics, 30, no. 4 (2002): 510–21.CrossRefGoogle Scholar
Rose, G., The Strategy of Preventive Medicine (New York: Oxford University Press, 1992): at 53–64.Google Scholar
“Achievements in Public Health, 1900–1999: Decline in Deaths from Heart Disease and Stroke — United States, 1900–1999,” Morbidity and Mortality Weekly Report, 48 (1999): 649–56.Google Scholar
Thom, T.J. et al., “Incidence, Prevalence and Mortality of Cardiovascular Disease in the United States,” in Alexander, R.W. et al., eds., Hurst’s the Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 4.Google Scholar
“Achievements in Public Health,” supra note 5.Google Scholar
Thom, et al., supra note 6, at 6.Google Scholar
Bess, C.J., “Gender Bias in Health Care: A Life or Death Issue for Women with Coronary Heart Disease,” Hastings Women’s Law Journal, 6 (1995): 4164.Google Scholar
Thom, et al., supra note 6, at 8.Google Scholar
Mosca, L. et al., “Cardiovascular Disease in Women: A Statement for Healthcare Professionals from the American Heart Association Writing Group,” Circulation, 96 (1997): 2468–82.CrossRefGoogle Scholar
Herman, A., “Race, Law and Health,” paper presented at Health, Law and Human Rights: Exploring the Connections, 2001 Annual Meeting of the American Society of Law, Medicine & Ethics, Philadelphia, September 29, 2001.Google Scholar
Thom, et al., supra note 6, at 7.Google Scholar
American Heart Association, “Risk Factors and Coronary Heart Disease,” at <http://216.185.102.50/Heart_and_Stroke_A_Z_Guide/riskfact.html> (last visited June 30, 2002).+(last+visited+June+30,+2002).>Google Scholar
Kaplan, G.A. and Keil, J.E., “Socioeconomic Factors and Cardiovascular Disease: A Review of the Literature,” Circulation, 88 (1993): 1973–88.CrossRefGoogle Scholar
Terris, M., “The Development of Cardiovascular Disease Risk Factors: Socioenvironmental Influences,” Preventive Medicine, 29, suppl. (1999): S1117.CrossRefGoogle Scholar
Kaplan, and Keil, , supra note 17, at 1983.CrossRefGoogle Scholar
See Friedewald, W.T., “Epidemiology of Cardiovascular Disease” in Friedewald, W.T. and Wyngarden, J.B.N., eds., Cecil Textbook of Medicine (Philadelphia: W.B. Sender Co., 1996): at 171.Google Scholar
See Kaplan, and Keil, , supra note 17. Environmental exposure to cigarette smoking may also play a role. Otsuka, R. et al., “Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults,” JAMA, 286 (2001): 436–41.Google Scholar
See “Achievements in Public Health,” supra note 5.Google Scholar
Friesinger, G. II and Hurst, J.W., “The Natural History of Atherosclerotic Coronary Heart Disease,” in Alexander, R.W. et al., eds., Hurst’s the Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 1131; Syme, S.L., “Foreword,” in Berkman, L. and Kawachi, I., eds., Social Epidemiology (New York: Oxford University Press, 2000): at xi.Google Scholar
Syme, , supra note 23, at xi.Google Scholar
Terris, , supra note 18, at S12.Google Scholar
Kaplan, and Keil, , supra note 17.Google Scholar
Id. at 1989; Bucher, H.C. and Ragland, D.R., “Socioeconomic Indicators and Mortality from Coronary Heart Disease and Cancer: A 22-Year Follow-Up of Middle-Aged Men,” American Journal of Public Health, 85 (1995): 1231–36.CrossRefGoogle Scholar
Diez-Roux, A.V. et al., “Neighborhood of Residence and Incidence of Coronary Heart Disease,” N. Engl. J. Med., 345 (2001): 99106.CrossRefGoogle Scholar
Hall, E. Johnson, J.V., and Tsou, T.S., “Women, Occupation and Risk of Cardiovascular Morbidity and Mortality,” Occupational Medicine, 8 (1993): 709–19; Theorell, T., “Working Conditions and Health,” in Berkman, L.F. and Kawachi, I., eds., Social Epidemiology (New York: Oxford University Press, 2000): at 95–97.Google Scholar
Theorell, , supra note 29, at 107–09.Google Scholar
Id. at 110–11.Google Scholar
Eliot, R.S. et al., “The Heart, Emotional Stress and Psychiatric Behavior” in Alexander, R.W. et al., eds., Hurst’s The Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 2352.Google Scholar
Id. at 2350.Google Scholar
Mosca, et al., supra note 12.Google Scholar
Friedewald, , supra note 20, at 170.Google Scholar
“Achievements in Public Health,” supra note 5.Google Scholar
E.g., Bess, , supra note 10, at 44–55; Goldberg, K. et al., “Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients,” JAMA, 267 (1992): 1473–77; Noah, B.A., “Racist Health Care,” Florida Law Review, 48 (1996): 357–72; Watson, S.D., “Race, Ethnicity & Hospital Care: The Need for Racial and Ethnic Data,” Journal of Health Law, 30, no. 2 (1997): 125–32.Google Scholar
Thom, et al., supra note 6, at 4–6.Google Scholar
Bess, , supra note 10, at 55 (discussing sex discrimination in the care of coronary heart disease patients).Google Scholar
Thom, et al., supra note 6, at 8.Google Scholar
“Achievements in Public Health,” supra note 5.Google Scholar
American Heart Association, supra note 16.Google Scholar
National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary, NIH Pub. No. 01-3670 (Bethesda: National Institutes of Health, 2001): at 2, available at <http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf>..>Google Scholar
Rose, , supra note 4, at 76.Google Scholar
See Burris, Kawachi, , and Sarat, , supra note 3.Google Scholar
In the 1950s, the National Heart Institute supported a study concerning the legal basis for awards in cardiac cases, which resulted in a book by McNiece, H.F., Heart Disease and the Law: The Legal Basis for Awards in Cardiac Cases (Englewood Cliffs, New Jersey: Prentice-Hall, 1961).Google Scholar
Branch, S., “Is Food the Next Tobacco?,” Wall Street Journal, June 13, 2002, at B1.Google Scholar
The strongest candidate for that title must fall to the National Heart Act of 1948, as amended, now codified at 42 U.S.C. §§ 218, 241, 287 et seq., which established the National Heart, Lung, and Blood Institute within the National Institutes of Health, and continues to provide resources for research in the area of heart disease.Google Scholar
For example, in 1999, the Centers for Disease Control and Prevention funded eleven states with high cardiovascular disease mortality rates to plan, develop, and implement state efforts. “Achievements in Public Health,” supra note 5. Earlier, the Heart Disease, Cancer & Stroke Amendments, Pub. L. No. 89–239, aimed to foster cooperative arrangements with state agencies to make available the latest advances in diagnosis and treatment. See also Pub. L. No. 89–0749, Comprehensive Health Planning and Public Health Services Amendments of 1966 (providing support for general health planning by states); Pub. L. 94–63, National High Blood Pressure Education Program (provides assistance to state and local programs aimed at reducing hypertension).Google Scholar
Medicare, 42 U.S.C. §§ 1395–1395ggg (2002); Medicaid, 42 U.S.C. §§ 1396–1396v (2002).Google Scholar
See Kaplan, and Keil, , supra note 17.Google Scholar
Alcohol, Tobacco, and Certain Other Excise Taxes, I.R.C. § 5701–63 (2002).Google Scholar
See Grossman, M. and Chaloupka, F.J., “Cigarette Taxes: The Straw to Break the Camel’s Back,” Public Health Reports, 12 (1997): 290–97.Google Scholar
Tobacco Price Support Program, 7 U.S.C. §§ 1445-1445-3 (2002). For a discussion of the impact of this program, see Zhang, P. and Husten, C., “The Impact of the Tobacco Support Program on Tobacco Control in the United States,” Tobacco Control, 7, no. 2 (1998): 176–82.CrossRefGoogle Scholar
Cigarette Labeling and Advertising Act, 15 U.S.C. §§ 1331–1341 (2002).Google Scholar
Lorillard Tobacco Co. v. Reilly, 533 U.S. 525 (2001).Google Scholar
Food and Drug Administration v. Brown & Williamson Tobacco Corp., 529 U.S. 120 (2000).Google Scholar
There are limited exceptions; for example, federal law prohibits smoking in airplanes. 14 C.F.R. 252.3 (2002).Google Scholar
“Reducing Tobacco Use: A Report of the Surgeon General — Executive Summary,” Morbidity and Mortality Weekly Report, 49, RR-16 (2000): 127.Google Scholar
See note 21, supra.Google Scholar
Federal Food, Drug, and Cosmetic Act, 21 U.S.C. §§ 301–397 (2002).Google Scholar
Nutrition Labeling and Education Act of 1990, Pub. L. 101–535, 104 Stat. 2353 (1990).Google Scholar
Food Labeling Regulations, 21 C.F.R. §§ 101.1–101.108 (2002); Ernst, N., “Health Promotion Roles of the Federal Government and Food Industry in Nutrition and Blood Pressure,” Hypertension, 17, suppl. 1 (1991): 196200.CrossRefGoogle Scholar
Nestle, M., Food Politics: How the Food Industry Influences Nutrition and Health (Berkeley: University of California Press, 2002): passim.Google Scholar
See National School Lunch Program, 7 C.F.R. § 210.10 (regulations pertaining to school lunches).Google Scholar
For a discussion of the authority granted to local public health agencies, see Gostin, L.O., Public Health Law: Power, Duty, Restraint (Berkeley. University of California Press, 2000): at 246–47.Google Scholar
Jacobson, M.F. and Brownell, K.D., “Small Taxes on Soft Drinks and Snack Foods to Promote Health,” American Journal of Public Health, 90, no. 6 (2000): 854–57.Google Scholar
Lorillard Tobacco Co., 533 U.S. at 587–88.Google Scholar
Pollard, M. and Brennan, J., “Disease Prevention and Health Promotion Initiatives: Some Legal Considerations,” Health Education Monographs, 6, no. 2 (1978): 211–22.CrossRefGoogle Scholar
In 2000, the National Heart, Lung, and Blood Institute was allocated $2,029,424. See NIH AlmanacAppropriations, at <http://www.nih.gov/about/almanac/appropriations/index.htm> (last reviewed November 8, 2001). It should be noted that the federal government supports research not only directly through grants for coronary heart disease research, but also indirectly through federal health insurance programs and programs that fund academic medicine. For purposes of this discussion, these programs are not considered laws about coronary heart disease.+(last+reviewed+November+8,+2001).+It+should+be+noted+that+the+federal+government+supports+research+not+only+directly+through+grants+for+coronary+heart+disease+research,+but+also+indirectly+through+federal+health+insurance+programs+and+programs+that+fund+academic+medicine.+For+purposes+of+this+discussion,+these+programs+are+not+considered+laws+about+coronary+heart+disease.>Google Scholar
E.g., “Reducing Tobacco Use: A Report of the Surgeon General — Executive Summary,” supra note 62; Soldz, S. et al., “Tobacco Use Among Massachusetts Youth: Is Tobacco Control Working?,” Preventive Medicine, 31 (2000): 287–95.CrossRefGoogle Scholar
Lorillard Tobacco Co., 533 U.S. at 526; Cipollone v. Liggett Group, Inc., 505 U.S. 504, 520 (1992).Google Scholar
Kristal, A.R. et al., “Trends in Food Label Use Associated with New Nutrition Labeling Regulations,” American Journal of Public Health, 88 (1998): 1212–15.Google Scholar
See note 23, supra.Google Scholar
Sarat, A. and Kearns, T.R., “Beyond the Great Divide: Forms of Legal Scholarship and Everyday Life,” in Sarat, A. and Kearns, T. R., eds., Law in Everyday Life (Ann Arbor: University of Michigan Press, 1993): 2733.CrossRefGoogle Scholar
Gully v. First National Bank, 299 U.S. 109, 117 (1936).Google Scholar
Earned Income Tax Credit, I.R.C. § 32 (2002).Google Scholar
Occupational Safety and Health Act (OSHA), 29 U.S.C. §§ 651–78 (2002).Google Scholar
Id. § 652(8).Google Scholar
Ziskind, D. and Fadem, J., “Law and Quality of Working Life,” Comparative Labor Law, 2 (1997): 122–35. See 29 U.S.C. § 654(a)(i) (general duty clause). See also 29 U.S.C. § 651(b)(5)–(b)(7) (congressional findings regarding the intentions behind OSHA).Google Scholar
National Occupational Research Agenda, Organization of Work, at <http://www.cdc.gov/niosh/nrworg.html> (last updated June 11, 1999).+(last+updated+June+11,+1999).>Google Scholar
In general, federal law gives workers little ability to enforce their rights under OSHA. See McGarity, T.O., “Reforming OSHA: Some Thoughts for the Current Legislative Agenda,” Houston Law Review, 31 (1994): 99117.Google Scholar
Larson, A. and Larson, L.K., Larson’s Workmen’s Compensation (New York: Matthew Bender, 1952 & Supp. 1999): §§ 207–08.Google Scholar
Berry, A.S., “The Reality of Work-Related Stress: An Analysis of How Mental Disability Claims Should Be Handled Under the North Carolina Workers’ Compensation Act” (Comment), Campbell Law Review 20 (1998): 321–45.Google Scholar
Larson, and Larson, , supra note 86, at § 52.04 [3] n.28.Google Scholar
“Police Officer’s Heart Disease Was Presumptively Work-Related,” National Public Employment Reporter, 4, no. 11 (April 4, 2001): 1516.Google Scholar
In general, workers’ compensation laws provide compensation only for diseases that are considered unusual to the trade and do not commonly occur. Larson, and Larson, , supra note 86, § 52.03. The “typical” stresses that induce the all-too-common coronary heart disease would appear to fall outside the purview of most workers’ compensation laws.Google Scholar
See text accompanying notes 29–31, supra.Google Scholar
Americans with Disabilities Act, 42 U.S.C. §§ 12101–12213 (2002).Google Scholar
Discrimination has been posited as a source of stress affecting coronary heart disease in the social epidemiological literature. E.g., Krieger, N. and Sidney, S., “Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults,” American Journal of Public Health, 86 (1996): 1370–78; Krieger, N. and Sidney, S., “Prevalence and Health Implications of Anti-Gay Discrimination: A Study of Black and White Women and Men in the CARDIA Cohort,” International Journal of Health Services, 27 (1997): 157–76.CrossRefGoogle Scholar
42 U.S.C. § 12112(b)(5)(a).Google Scholar
Parmet, W.E., “Plain Meaning and Mitigating Measures: Judicial Interpretations of the Meaning of Disability,” Berkeley Journal of Employment and Labor Law, 21 (2000): 5390.Google Scholar
Sutton v. United Air Lines, 527 U.S. 471 (1999).Google Scholar
Id. at 512 (Stevens, J., dissenting).Google Scholar
Parmet, W.E., “Individual Rights and Class Discrimination: The Fallacy of an Individualized Determination of Disability,” Temple Political & Civil Rights Law Review, 9 (2000): 283301.Google Scholar
Some of these studies appear in Blanck, P., ed., Employment, Disability and the Americans with Disabilities Act: Issues in Law, Public Policy and Research (Evanston, Illinois: Northwestern University Press, 2000).Google Scholar
E.g., Higginbotham, A.L. Jr., Shades of Freedom: Racial Politics and Presumptions of the American Legal Process (New York: Oxford University Press, 1996) (arguing that the law has advanced racial justice); Rosenberg, G., The Hollow Hope: Can Courts Bring About Social Change? (Chicago: University of Chicago, 1991) (arguing that judicial decisions did not substantially improve the conditions of black Americans); Ackerman, S., “The White Supremacist Status Quo: How the American Legal System Perpetuates Racism as Seen Through the Lens of Property Law,” Hamline Journal of Public Law and Policy, 21 (1999): 137–75 (arguing that U.S. law continues to support racism); Turner, R., “Thirty Years of Tide VII’s Regulatory Regime: Rights, Theories and Realities,” Alabama Law Review, 46 (1995): 375–485 (concluding that Title VII had an immediate but limited impact on job discrimination).Google Scholar