California sets trends in health regulation

Californians tend to rank higher in physical fitness and diet rich in fruits and vegetables.

Story highlights

  • California led several public health efforts in tobacco control, air quality
  • Residents tend to be health-conscious because of culture, environment
  • Critics say the state over-regulates, stifling freedom and economy
  • Several metrics show laws don't translate into healthy population
Beyond skateboards, Silicon Valley and hippies, California has a trendsetting streak of a different kind.
The state has been first to pass major public health initiatives that have spread throughout the country. California was first to require smog checks for clean air, pass anti-tobacco initiatives and bike helmets laws.
While these laws were met with skepticism and ridicule, they've often become standard practice in other states. The Golden State was first to ban smoking in workplaces, bars and restaurants in 1998. Now similar rules exist throughout the country.
Some advocates tout the state as a forward-thinking vanguard in which its health and safety laws are routinely emulated by other states.
"There have been progressive legislations in tobacco, environment and obesity prevention," said Mark Horton, a lecturer at the University of California Berkeley School of Public Health. "In some respect, the rest of the country looks to California as a laboratory for moving forward with those various types of initiatives."
But some critics liken the Golden State to a nanny state. California has 151,002 health and safety laws.
"It never ends," said Laer Pearce, who works in public affairs in Orange County. "Every year, several hundred bills come through and dozens of them tell us how to live our lives."
Starting in January, 760 new California laws went into effect -- for example, the importing of shark fins is prohibited, student athletes are required to have medical clearance after suffering a head injury, teens are banned from using tanning booths and the sale of caffeinated beer is forbidden.
There's a perception that California has "more folks who are health-oriented and more health-minded," said Horton, former director of the California Department of Public Health.
It's not just workout fanatics hanging out at Muscle Beach, Sierra Club members hiking mountains or the uber-health-conscious touting organic foods. Californians in general tend to have healthier habits, ranking 10th for physical activity, fourth for healthy blood pressure and fifth for a diet high in fruits and vegetables compared with other states, according to America's Health Rankings.
Californians have a stake in their health and the environment, because they want to enjoy the state's natural landscape, said several people interviewed for the article.
"What brings many people to California is the climate and the culture," said Matt Rodriquez, California's Secretary for Environmental Protection. "That means people who do come here have an interest in preserving ... a beautiful environment, clean air and clean water."
The willingness to innovate in health laws is part of the California's culture, said Marice Ashe, founder and executive director of Public Health Law & Policy in Oakland, California.
"You see that in technology innovation in Silicon Valley, there's a lot of sharing of ideas and resources that lead to major breakthroughs." A similar vibe exists in public health because there is a high concentration of medical, public health and law schools and organizations exchanging ideas, she said.
Since California started allowing ballot initiatives in 1911, its voters have swept in many several pioneering health laws.
In 1986, the state's voters passed a ballot initiative requiring information on products if they contain chemicals known to cause cancer, birth defects or reproductive harm. Products like electrical cords and Tiffany-style lamps carry statements: "WARNING: This product contains lead, a chemical known to the State of California to cause cancer and birth defects or other reproductive harm. Wash hands after handling."
One of California's biggest examples of its influence on public health law is tobacco regulation. In 1988, voters approved a proposition to become the first state to tax cigarettes to fund a tobacco control program. Ten years later, California banned smoking in public places such as trains, planes, buses, workplaces and restaurants. Now, about half of the states have similar policies about smoking in public places.
California became a guide for developing anti-smoking policies, said Lawrence Green, who formerly served as the acting director of the Centers for Disease Control and Prevention's Office on Smoking and Health.
The state also has a long history of limiting air pollution. California was the first state to ban a chemical used in laundromats called perchloroethylene, prohibit leaded gasoline, require smog checks and reduce carbon dioxide and other greenhouse gases. The state's air resource board passed another rule in January requiring reductions in greenhouse gas emissions and putting more zero-emission vehicles on the road.
California, home to more than 37 million people and the world's ninth-largest economy, has major clout.
"It's a large and powerful state, it can challenge national industries and has done so," said Green, professor of epidemiology and biostatistics at the University of California at San Francisco School of Medicine.
In certain cases, California laws have gone too far, according to the courts. Last year, the