WEBVTT 00:01.430 --> 00:03.780 Prof: Good morning everybody, hope you all had a 00:03.779 --> 00:04.649 wonderful weekend. 00:04.650 --> 00:09.240 I'm delighted today to be able to bring to you a guest speaker, 00:09.236 --> 00:13.376 Professor Stephen Teret from Johns Hopkins University. 00:13.380 --> 00:16.760 Stephen's been kind enough to come and speak to this class 00:16.756 --> 00:17.286 before. 00:17.290 --> 00:21.080 In return, I go down and speak to a large class that Stephen 00:21.083 --> 00:22.823 teaches at Johns Hopkins. 00:22.820 --> 00:25.090 It's always very interesting for me to do that, 00:25.090 --> 00:27.760 and I hope interesting for Stephen to come and speak to 00:27.755 --> 00:28.145 you. 00:28.150 --> 00:32.750 He's a pioneer in the application of the law to public 00:32.749 --> 00:33.529 health. 00:33.530 --> 00:36.210 As you can see from the slide there, 00:36.210 --> 00:39.320 he has training in the law, then went back to school at 00:39.315 --> 00:42.875 Johns Hopkins School of Public Health to get his Masters Degree 00:42.882 --> 00:44.092 in Public Health. 00:44.090 --> 00:49.070 He has a very interesting background in legal experience, 00:49.070 --> 00:52.470 having worked as a civil rights attorney in New York City for 00:52.472 --> 00:54.922 some time, practicing law in the state of 00:54.916 --> 00:58.156 New York and then coming to the world of public health law 00:58.159 --> 01:00.719 through his connection with Johns Hopkins. 01:00.719 --> 01:04.219 For many years he's been on the faculty at Johns Hopkins school 01:04.218 --> 01:05.288 of Public Health. 01:05.290 --> 01:09.360 There he is a Professor in the Department of Health Policy and 01:09.361 --> 01:10.231 Management. 01:10.230 --> 01:12.560 He's also the director, as you can see, 01:12.560 --> 01:15.660 of The Center for Law in the Public's Health at Johns Hopkins 01:15.656 --> 01:18.046 University, a collaborative venture between 01:18.045 --> 01:19.975 Hopkins and Georgetown University, 01:19.980 --> 01:23.770 and has made a real mark in the world of public health through 01:23.768 --> 01:25.568 the application of the law. 01:25.569 --> 01:28.969 I first got to know Stephen at a meeting with The Robert Wood 01:28.974 --> 01:31.764 Johnson Foundation put together on issues of diet, 01:31.757 --> 01:33.287 nutrition, and obesity. 01:33.290 --> 01:37.060 They brought in people who had used the law in other areas, 01:37.060 --> 01:40.250 and Stephen Teret had made a real mark in the area of gun 01:40.247 --> 01:44.737 control and violence prevention, and had a lot to say based on 01:44.741 --> 01:47.761 his experience there on the diet, 01:47.760 --> 01:52.030 nutrition, and obesity area, and has really had a phenomenal 01:52.031 --> 01:54.761 impact there, and national impact has been 01:54.756 --> 01:57.606 involved New York City's policies on gun control and 01:57.610 --> 02:00.580 violence and the like; and has more recently become 02:00.584 --> 02:04.054 interested in the area of diet, nutrition, and obesity and has 02:04.052 --> 02:07.332 really been powerful--a powerful ally in that fight as well. 02:07.328 --> 02:10.438 He's a remarkable person, creative, 02:10.438 --> 02:14.568 ingenious, interesting in the way he applies the law to issues 02:14.574 --> 02:17.394 of public health, particularly the issues that 02:17.387 --> 02:19.207 we're talking about in this class. 02:19.210 --> 02:22.480 I think you'll enjoy hearing from him. 02:22.479 --> 02:26.309 Let's please welcome Professor Stephen Teret. 02:26.310 --> 02:28.330 Prof: Thank you very much Kelly. 02:28.330 --> 02:33.850 02:33.848 --> 02:38.148 If I'm so creative and genius, how come I do lecture nineteen? 02:38.150 --> 02:43.640 02:43.639 --> 02:51.529 I guess one of the easiest ways is to state the relationship 02:51.525 --> 03:00.075 between gun violence and obesity would be to say eat well or I'll 03:00.078 --> 03:04.968 kill you, but that's not what I wanted to 03:04.972 --> 03:07.412 talk about to you today. 03:07.408 --> 03:14.668 What I was hoping to talk to you about is in general, 03:14.669 --> 03:17.389 public health and public health strategy, 03:17.389 --> 03:21.399 public health policy, and how strategies and policies 03:21.402 --> 03:25.962 that have been shown to work in other areas of public health 03:25.955 --> 03:30.425 might--and that's a question that you should explore--might 03:30.432 --> 03:34.912 work in trying to reduce the incidents of obesity worldwide 03:34.908 --> 03:38.458 or in the United States in particular. 03:38.460 --> 03:43.870 I think that I'll probably focus more on trying to address 03:43.872 --> 03:48.622 childhood obesity than obesity in general today. 03:48.620 --> 03:55.810 Kelly mentioned that I spent a portion of my career in working 03:55.807 --> 04:00.637 on the area of gun violence prevention. 04:00.639 --> 04:03.189 I'd like to use that as one of the examples, 04:03.189 --> 04:06.279 or perhaps the principle example, about which I'll be 04:06.275 --> 04:09.415 talking with you today, trying to draw parallels. 04:09.419 --> 04:14.219 Let me start by telling you about an incident that happened 04:14.223 --> 04:17.293 some time ago here in New England, 04:17.290 --> 04:23.140 where it was a Friday afternoon and a young boy whose name is 04:23.136 --> 04:29.176 Ross--he was about thirteen--was let out of school earlier than 04:29.177 --> 04:30.247 normal. 04:30.250 --> 04:33.630 School--not just Ross but everybody was let out, 04:33.627 --> 04:36.067 including Ross's friend Stephen. 04:36.069 --> 04:41.339 Ross and Stephen went to Ross' house where they were just 04:41.341 --> 04:46.521 hanging out, playing, goofing off and the phone rang. 04:46.519 --> 04:51.939 Ross answered it and it was his mother. 04:51.940 --> 04:57.440 His mother said to Ross, how are you doing? 04:57.440 --> 05:01.340 Fine, he said, I got out early. 05:01.339 --> 05:03.869 She said, so what are you up to? 05:03.870 --> 05:08.110 He said, I'm just hanging out here with Stephen, 05:08.107 --> 05:09.547 we're playing. 05:09.550 --> 05:15.150 Ross's mother said, you know Ross, 05:15.146 --> 05:23.966 I've told you this before, but I don't like you being 05:23.968 --> 05:27.868 alone with Stephen. 05:27.870 --> 05:31.750 There's just something about this kid Stephen--Ross's friend, 05:31.752 --> 05:33.892 that Ross's mother didn't like. 05:33.889 --> 05:38.509 Ross said to his mother, you're right, 05:38.514 --> 05:41.644 I'm sorry, we'll leave. 05:41.639 --> 05:49.469 So they left Ross's house and they went to Stephen's house. 05:49.470 --> 05:53.980 I want to point out that Johns Hopkins actually has desks that 05:53.975 --> 05:55.595 we provide students. 05:55.600 --> 05:59.500 05:59.500 --> 06:02.280 If any of you are thinking of graduate school, 06:02.281 --> 06:04.571 you might want to think of Hopkins. 06:04.569 --> 06:10.359 They went to Stephen's house and Stephen says to Ross, 06:10.355 --> 06:15.155 come with me I want to show you something. 06:15.160 --> 06:20.940 So they went upstairs to the bedroom that Stephen's parents 06:20.937 --> 06:25.917 shared and Stephen goes to his father's closet, 06:25.920 --> 06:32.080 opens the door and reaches up to the shelf in which Stephen's 06:32.077 --> 06:36.487 father has his sweaters or other things, 06:36.490 --> 06:43.430 and Stephen takes down a Beretta semi-automatic pistol. 06:43.430 --> 06:48.720 Now I don't know if you're familiar with a pistol; 06:48.720 --> 06:52.520 what a pistol is as opposed to a revolver? 06:52.519 --> 06:56.829 Do any of you not know the difference between a pistol and 06:56.834 --> 06:57.824 a revolver? 06:57.819 --> 07:02.549 Okay, a revolver if you watch old cowboy movies, 07:02.550 --> 07:07.370 a revolver is the thing that has six bullets in it and when 07:07.370 --> 07:11.780 the trigger is pulled the cylinder revolves--hence the 07:11.776 --> 07:16.596 name--so it lines up the next bullet with the barrel of the 07:16.598 --> 07:17.428 gun. 07:17.430 --> 07:22.480 A pistol is squarer in shape. 07:22.480 --> 07:25.970 A pistol--if you watch movies on HBO, 07:25.970 --> 07:30.400 you'd see pistols instead of revolvers--a pistol is square in 07:30.403 --> 07:34.023 shape and the bullets of a pistol are contained in 07:34.023 --> 07:38.063 something called the magazine, sometimes called the clip and 07:38.055 --> 07:40.995 it fits into the butt of the gun, the back end of the gun. 07:41.000 --> 07:49.670 Stephen takes down this Berretta. 07:49.670 --> 07:53.740 Beretta is an old company. 07:53.740 --> 07:56.930 It's a company that's more than five hundred years old, 07:56.930 --> 08:02.750 started in Italy, but they have a Maryland 08:02.750 --> 08:04.920 branch, Beretta U.S.A., 08:04.920 --> 08:07.470 which actually is in my state Maryland, in Accokeek, 08:07.470 --> 08:08.070 Maryland. 08:08.069 --> 08:14.969 Beretta is a popular gun, a popular pistol. 08:14.970 --> 08:21.180 Stephen pushes a button on the side of the Beretta, 08:21.180 --> 08:24.910 and that button discharges the magazine--remember that the 08:24.906 --> 08:28.626 magazine is what contains the bullet--and Stephen puts the 08:28.634 --> 08:32.594 magazine, the bullets back up so he now 08:32.591 --> 08:37.071 has the handgun, the pistol without the magazine 08:37.071 --> 08:39.261 in it, and he says to Ross, 08:39.255 --> 08:40.995 let's go out and play. 08:41.000 --> 08:45.830 They're outside, they're in the driveway of 08:45.827 --> 08:50.997 Stephen's family's home and horsing around. 08:51.000 --> 08:58.130 At some point Stephen says to Ross, 08:58.129 --> 09:02.289 he holds the gun like this--this is how people hold 09:02.285 --> 09:07.015 guns in movies now--and Ross is bent down a little bit and 09:07.024 --> 09:12.184 Stephen goes bang and pulls the trigger, but a bullet exits the 09:12.177 --> 09:13.007 gun. 09:13.009 --> 09:21.759 The bullet entered Ross's face just to the left of Ross's nose 09:21.760 --> 09:27.930 and traveled in a slightly downward path. 09:27.928 --> 09:34.408 So Ross is now in the driveway, laying down in the driveway 09:34.410 --> 09:39.440 exsanguinating, and Stephen is going crazy. 09:39.440 --> 09:47.580 He runs into the house because he's going to call 911, 09:47.580 --> 09:49.480 but actually the first thing that he does is he runs 09:49.481 --> 09:50.591 upstairs, goes to the closet, 09:50.586 --> 09:52.486 and puts the gun back in the closet, and he calls 911. 09:52.490 --> 10:01.490 You can listen to the tape, he's sort of nuts in fear and 10:01.489 --> 10:10.649 says to the 911 operator that his friend was just shot. 10:10.649 --> 10:14.119 That they were playing in the driveway and a shot came from 10:14.120 --> 10:18.070 the woods behind the house--he's scared, so he makes up a story. 10:18.070 --> 10:21.750 The police come, the helicopters overhead 10:21.745 --> 10:26.705 because there's a sniper somewhere in the woods and the 10:26.708 --> 10:30.998 ambulance comes, the fire department comes, 10:31.004 --> 10:34.554 and the police are talking to Stephen. 10:34.548 --> 10:38.888 They realize that this is a made up story, 10:38.889 --> 10:42.959 and Stephen quickly tells them the truth what had happened, 10:42.960 --> 10:46.280 but he said that he didn't know that there was a bullet in the 10:46.275 --> 10:48.935 gun because he took the bullets out of the gun. 10:48.940 --> 10:54.990 The ambulance takes Ross to the local hospital. 10:54.990 --> 11:00.460 Ross's parents are contacted, and they get there in time to 11:00.456 --> 11:05.916 sign the consent that allows the surgeons to harvest Ross's 11:05.923 --> 11:09.603 organs because Ross is brain dead, 11:09.600 --> 11:13.510 and they might as well do what they can for someone else, 11:13.509 --> 11:16.619 since there's nothing that they can do for their son anymore. 11:16.620 --> 11:21.330 How do things like that happen? 11:21.330 --> 11:26.380 When you read about things like that in the newspaper it says 11:26.383 --> 11:29.413 freak accident, but for people who work in 11:29.414 --> 11:32.854 public health--;and how many people here are students in The 11:32.854 --> 11:35.714 School of Public Health, The Yale School of Public 11:35.710 --> 11:36.410 Health? 11:36.408 --> 11:44.198 When you work in public health, you come to understand that 11:44.202 --> 11:51.862 these aren't freak accidents because there is a pattern to 11:51.860 --> 11:53.070 them. 11:53.070 --> 11:55.310 These boys were thirteen years of age, 11:55.308 --> 11:58.758 the highest age group--highest risk age group for something 11:58.758 --> 12:01.728 like this happening is about thirteen years of age, 12:01.730 --> 12:03.040 males not females. 12:03.038 --> 12:10.838 The pattern in public health is called the epidemiology of these 12:10.836 --> 12:11.946 events. 12:11.950 --> 12:16.390 There's a pattern as to what are the high risk guns, 12:16.393 --> 12:21.363 what are the high risk times of day, times of the year. 12:21.360 --> 12:25.930 Because there's this pattern, this epidemiology of these 12:25.927 --> 12:29.247 kinds of gun injuries and gun deaths, 12:29.250 --> 12:31.600 these gun injuries and gun deaths become, 12:31.597 --> 12:33.357 to some extent, foreseeable. 12:33.360 --> 12:38.290 It's not a freak accident in that this happens over and over 12:38.287 --> 12:43.547 again when you work in the field of gun violence prevention, 12:43.548 --> 12:47.148 one of the sad things is you come into work in the morning 12:47.153 --> 12:51.013 and someone you don't know has sent you an email or sent you a 12:51.009 --> 12:55.119 photocopy of a newspaper article with the same kind of story. 12:55.120 --> 12:57.590 Unfortunately, I'm in a position where I could 12:57.586 --> 13:01.076 tell you story after story, after story of thirteen year 13:01.080 --> 13:04.580 old boys who were playing together and one of them got 13:04.581 --> 13:05.971 killed by gunfire. 13:05.970 --> 13:12.870 You become the depository of these terribly sad stories. 13:12.870 --> 13:17.370 It's terribly sad on an individual basis, 13:17.370 --> 13:20.400 but it's terribly sad on a population basis, 13:20.399 --> 13:22.949 because I say that they're foreseeable, 13:22.950 --> 13:27.560 and if they're foreseeable then it seems that they also should 13:27.556 --> 13:28.836 be preventable. 13:28.840 --> 13:33.460 What we as public health people try to do then is to come up 13:33.458 --> 13:38.308 with ideas about how would you prevent something like this from 13:38.312 --> 13:39.412 happening? 13:39.408 --> 13:42.258 What prevention strategy--there's a world of 13:42.256 --> 13:46.156 prevention out there--so what prevention strategy might work 13:46.163 --> 13:49.143 best so that the next foreseeable event of one 13:49.144 --> 13:52.994 thirteen year old boy shooting and killing another thirteen 13:52.985 --> 13:55.365 year old boy doesn't happen? 13:55.370 --> 13:59.530 I know it's 9:00, I know that many of you are 13:59.525 --> 14:03.865 undergraduates, and therefore non-functional at 14:03.870 --> 14:05.100 9:00 a.m. 14:05.100 --> 14:08.860 on a Monday morning, but let me ask you just to see 14:08.864 --> 14:12.484 if you're responsive, or whether we should sign a 14:12.476 --> 14:14.356 consent form for you. 14:14.360 --> 14:17.730 Let me ask you: how would you go about 14:17.726 --> 14:20.726 preventing something like this? 14:20.730 --> 14:24.620 You don't want the next event like this to happen. 14:24.620 --> 14:26.070 What would you do? 14:26.070 --> 14:28.890 Do you think there's something that would work? 14:28.889 --> 14:30.119 Is there a strategy? 14:30.120 --> 14:32.340 Does anybody have a suggestion? 14:32.340 --> 14:36.250 I can go ahead if you don't have suggestions. 14:36.250 --> 14:37.360 Yes please. 14:37.360 --> 14:37.970 Student: > 14:37.970 --> 14:47.330 14:47.330 --> 14:49.090 Prof: That's a good idea. 14:49.090 --> 14:55.240 If you couldn't hear--was everybody able to hear 14:55.236 --> 15:00.056 that?--okay, the comment was we rarely see 15:00.061 --> 15:06.181 someone with a tie as attractive as the one that you have on. 15:06.178 --> 15:08.688 Thank you very much, that's very kind of you! 15:08.690 --> 15:18.330 Your second comment was--why doesn't Kelly wear these ties? 15:18.330 --> 15:20.120 I don't know. 15:20.120 --> 15:23.650 Your second comment was if people are going to have a gun 15:23.652 --> 15:26.052 and they have children in the home, 15:26.048 --> 15:29.628 then maybe there should be some permit for having the gun in the 15:29.634 --> 15:33.164 home that also has children, and the permit could be tied to 15:33.162 --> 15:36.172 some kind of educational intervention where the people 15:36.174 --> 15:37.714 learn about what's safe. 15:37.710 --> 15:41.490 Thank you, that's good. 15:41.490 --> 15:43.920 Anybody else have a suggestion. 15:43.919 --> 15:46.789 I won't make fun of you. 15:46.789 --> 15:47.649 Yes. 15:47.649 --> 15:51.069 Student: > 15:51.070 --> 15:53.260 Prof: Not allowing guns to be stored at home entirely. 15:53.259 --> 15:54.799 Good, thank you very much. 15:54.799 --> 15:56.329 One more, yes please. 15:56.330 --> 15:56.920 Student: > 15:56.919 --> 16:01.019 16:01.019 --> 16:04.139 Prof: Require the use of gun law so that ammo be stored 16:04.139 --> 16:07.309 separately from and require--and have ammo be stored separately 16:07.312 --> 16:08.542 from the gun itself. 16:08.539 --> 16:09.509 Good. 16:09.509 --> 16:10.829 All good suggestions. 16:10.830 --> 16:16.060 But not all suggestions are going to have equal 16:16.059 --> 16:17.879 effectiveness. 16:17.879 --> 16:21.719 I mean, that just stands to reason that not everything would 16:21.721 --> 16:23.221 be equally effective. 16:23.220 --> 16:27.410 So how do you figure out what's going to be the effective 16:27.408 --> 16:28.528 intervention? 16:28.528 --> 16:31.648 How do you figure out what's going to be the effective 16:31.653 --> 16:35.073 intervention for preventing childhood gun-related deaths or 16:35.073 --> 16:37.023 preventing childhood obesity? 16:37.019 --> 16:41.129 We need to come up with ideas or models. 16:41.129 --> 16:46.269 Let me present to you, or let me ask you if you will, 16:46.267 --> 16:51.897 to engage in a fiction with me for a minute about guns. 16:51.899 --> 16:56.429 Think of a gun, an individual gun as having a 16:56.429 --> 17:01.889 lifespan, and think of that lifespan as having certain 17:01.885 --> 17:03.735 markers in it. 17:03.740 --> 17:08.070 So the beginning of the lifespan of the gun would be the 17:08.065 --> 17:10.105 manufacturer of the gun. 17:10.108 --> 17:12.648 That's the birth of the gun, it's created, 17:12.653 --> 17:16.073 the manufacturer and the design of the gun by which it's 17:16.065 --> 17:17.115 manufactured. 17:17.118 --> 17:23.918 Then the next marker in this fictional lifespan of the gun 17:23.924 --> 17:31.094 would be when the gun is sold, or the purchase of the gun. 17:31.088 --> 17:36.308 Then the next marker in the lifespan--so think of there 17:36.311 --> 17:39.811 being a timeline here, and at the beginning of the 17:39.813 --> 17:41.903 timeline is the birth and manufacturer of the gun, 17:41.900 --> 17:45.190 then there's the sale of the gun--the next marker in this 17:45.192 --> 17:48.962 fictional lifespan of the gun is the possession of the gun or the 17:48.958 --> 17:50.368 carrying of the gun. 17:50.368 --> 17:54.378 Then let's have as the last marker in this fictional 17:54.383 --> 17:57.923 lifespan of the gun, the use of the gun or the 17:57.924 --> 18:00.054 pulling of the trigger. 18:00.048 --> 18:04.148 You could have policy that addresses these different 18:04.153 --> 18:07.133 markers in the lifespan of the gun. 18:07.130 --> 18:11.440 You could have policy that addresses the use of the gun, 18:11.442 --> 18:14.732 the last one, saying thou shalt not point a 18:14.734 --> 18:17.954 gun at somebody and pull the trigger. 18:17.950 --> 18:19.440 We do have policy. 18:19.440 --> 18:22.000 We have a lot of policy in the United States. 18:22.000 --> 18:25.770 There are federal laws, there are state laws in every 18:25.772 --> 18:28.972 one of our states, there are local laws about 18:28.965 --> 18:29.905 shooting. 18:29.910 --> 18:34.390 You could also have policy in each one of the other markers of 18:34.390 --> 18:36.300 the lifespan of the gun. 18:36.298 --> 18:39.968 But, those policies may not be equally effective, 18:39.973 --> 18:42.733 as I was mentioning to you before. 18:42.730 --> 18:50.610 What I would like to suggest to you is that if you thought about 18:50.606 --> 18:56.356 the lifespan of the gun with these markers, 18:56.358 --> 19:01.048 and you had effectiveness with high effectiveness and low 19:01.047 --> 19:04.837 effectiveness, if you plotted out the 19:04.835 --> 19:10.195 likelihood of effectiveness, my suggestion to you is that 19:10.202 --> 19:14.952 the effectiveness would be much higher at the early part of the 19:14.948 --> 19:19.458 lifespan of the gun than it would be down here at the use of 19:19.463 --> 19:20.463 the gun. 19:20.460 --> 19:25.850 Down here, we've already manufactured millions of guns. 19:25.848 --> 19:28.538 In the United States, we manufacture about three 19:28.542 --> 19:31.922 million new handguns every year, put them into the stream of 19:31.923 --> 19:32.673 commerce. 19:32.670 --> 19:37.590 Again, down here at possession and use, we've already 19:37.592 --> 19:39.772 manufactured the gun. 19:39.769 --> 19:43.659 We've already figured out, or someone has figured out what 19:43.660 --> 19:46.800 they want to do about the design of the gun. 19:46.798 --> 19:52.668 The person is already carrying the gun or possessing the gun. 19:52.670 --> 20:00.380 What we would say in terms of policy for the use of the gun 20:00.382 --> 20:02.692 is, you know the gun that you have 20:02.685 --> 20:04.585 in your hand, that the gun that you have in 20:04.593 --> 20:05.113 your pocket? 20:05.108 --> 20:08.598 We always want you to act kindly and prudently with that 20:08.604 --> 20:12.294 gun even though sometimes you may be filled with alcohol or 20:12.288 --> 20:15.058 other drugs, sometimes you may be filled 20:15.058 --> 20:17.348 with rage, sometimes you may be filled 20:17.354 --> 20:21.014 with rage for very good reasons, because we live in an unfair 20:21.013 --> 20:24.693 world and there are things that do engender rage in an unfair 20:24.688 --> 20:26.838 world; but when you are filled with 20:26.836 --> 20:29.226 rage and with alcohol or something else, 20:29.230 --> 20:33.090 we want you when you have this gun on you, 20:33.088 --> 20:38.008 we want you not to use the gun in a violent way against someone 20:38.013 --> 20:38.573 else. 20:38.569 --> 20:41.809 That's foolish in my mind. 20:41.808 --> 20:44.258 If you really want success, if you want 20:44.255 --> 20:47.595 effectiveness--defining effectiveness is reducing the 20:47.602 --> 20:51.662 incidence of gun violence in the United States--then you need to 20:51.656 --> 20:53.456 shift your focus back. 20:53.460 --> 20:55.960 We can have laws about possession. 20:55.960 --> 20:59.280 Most of our laws in the United States about possession have 20:59.277 --> 21:02.937 been making it easier to possess a gun, concealed carry laws that 21:02.938 --> 21:04.538 many states have passed. 21:04.539 --> 21:11.109 We can have laws about sale; we do have laws about sale. 21:11.108 --> 21:15.938 I don't know if any of you have gone and bought a gun, 21:15.940 --> 21:20.210 some of you are too young to buy a handgun under federal law, 21:20.210 --> 21:25.910 but we have laws about sale or purchase of guns. 21:25.910 --> 21:29.240 Until recent times, the law about sale of gun is 21:29.243 --> 21:33.363 the person who wants to go in and buy a gun--and I just got 21:33.358 --> 21:37.758 contacted by a lawyer recently who is representing a man who is 21:37.759 --> 21:42.349 a quadriplegic, because an eighteen year old 21:42.346 --> 21:46.666 person went into a pawn shop, bought a gun, 21:46.674 --> 21:51.184 the gun was illegally sold to the eighteen year old person. 21:51.180 --> 21:54.590 The eighteen year old person then went to a shopping center 21:54.590 --> 21:58.240 and with that gun and one other gun shot up the shopping center 21:58.237 --> 22:01.887 in Salt Lake City, Utah killing a number of people 22:01.892 --> 22:04.122 and severely wounding others. 22:04.118 --> 22:08.448 So there's a lawsuit against the pawn shop for violating the 22:08.451 --> 22:12.051 laws or the policy regarding the sale of a gun. 22:12.048 --> 22:15.398 What we've relied upon with regard to policy for the sale of 22:15.404 --> 22:18.764 a gun is a person--like this eighteen year old who went into 22:18.759 --> 22:22.399 the pawn shop--a person comes into a place that sells guns, 22:22.400 --> 22:27.210 looks in the display case of a gun--of guns and says to the 22:27.210 --> 22:29.450 clerk, I'd like that one. 22:29.450 --> 22:34.800 So the clerk has a pad, and tears off the top page of 22:34.795 --> 22:39.725 Form 4473 of the Bureau of Alcohol, Tobacco & 22:39.730 --> 22:44.150 Firearms--now it's called Bureau of Alcohol, 22:44.151 --> 22:48.981 Tobacco, Firearms & Explosives--and asks the 22:48.981 --> 22:54.741 intended purchaser to please fill out Form 4473. 22:54.740 --> 23:00.970 The person looks at Form 4473 and it says, hey are you a 23:00.971 --> 23:03.691 fugitive from justice? 23:03.690 --> 23:09.890 The person thinks and no I don't recall that and checks no. 23:09.890 --> 23:13.350 It says, are you a convicted felon? 23:13.349 --> 23:16.399 No. 23:16.400 --> 23:20.060 Have you been adjudicated mentally incompetent? 23:20.058 --> 23:26.318 How many people are going to--thank you for reminding me, 23:26.318 --> 23:30.118 I remember the adjudication now; 23:30.118 --> 23:32.248 yes, you ought not to sell me the gun. 23:32.250 --> 23:34.620 I have a friend, Clark Deets, 23:34.616 --> 23:39.856 who is a forensic psychiatrist to the stars in Los Angeles, 23:39.858 --> 23:43.728 who before he did that was a Professor at University of 23:43.728 --> 23:47.448 Virginia and he went to the Virginia Hospital for the 23:47.453 --> 23:50.753 criminally insane or some name like that, 23:50.750 --> 23:54.040 where everyone by definition had been adjudicated mentally 23:54.040 --> 23:54.850 incompetent. 23:54.848 --> 23:57.838 He passed out a questionnaire saying to each person, 23:57.837 --> 24:00.707 have you been adjudicated mentally incompetent? 24:00.710 --> 24:04.530 75% of the people said no; I mean they're mentally 24:04.525 --> 24:05.785 incompetent, why would they say yes? 24:05.788 --> 24:10.858 We relied upon self-reporting as our policy for trying to keep 24:10.864 --> 24:15.024 guns out of the hands of people who we thought were 24:15.023 --> 24:17.773 disproportionately dangerous. 24:17.769 --> 24:21.259 But instead, we can look at the manufacturer 24:21.255 --> 24:24.045 of the gun, and the design of a gun, 24:24.050 --> 24:28.000 and make decisions as a public about whether we want three 24:27.997 --> 24:32.217 million new handguns made every year in the United States; 24:32.220 --> 24:36.520 and if we do want three million new handguns made every year in 24:36.515 --> 24:39.905 the United States, how do we want those guns to be 24:39.909 --> 24:40.809 designed? 24:40.808 --> 24:44.288 There are certain things on guns called magazine disconnect 24:44.288 --> 24:46.748 devices and loaded chamber indicators, 24:46.750 --> 24:52.170 that might have prevented this kind of tragedy from happening 24:52.172 --> 24:53.892 to this boy Ross. 24:53.890 --> 24:58.170 A loaded chamber indicator is a kind of thing on the gun that 24:58.169 --> 25:01.449 tells you whether there's a bullet in a gun. 25:01.450 --> 25:06.050 What happened with Stephen's father's gun is Stephen took out 25:06.053 --> 25:10.353 the clip but there was this thing called the round in the 25:10.348 --> 25:11.268 chamber. 25:11.269 --> 25:14.599 There was still a bullet contained in the gun that wasn't 25:14.597 --> 25:17.687 in the clip or the magazine that Stephen took out. 25:17.690 --> 25:23.960 That situation so frequently results in injury or death to 25:23.963 --> 25:30.353 others, because people didn't know there was a round in the 25:30.348 --> 25:31.668 chamber. 25:31.670 --> 25:34.550 But you can have a device on a gun that's called a loaded 25:34.548 --> 25:37.108 chamber indicator, a little piece of metal that 25:37.108 --> 25:40.278 sticks out or it could be more sophisticated like a red light 25:40.279 --> 25:42.859 that comes on, that tells you that there's a 25:42.855 --> 25:43.915 bullet in the gun. 25:43.920 --> 25:47.210 Would you buy a camera that didn't tell you whether there 25:47.210 --> 25:48.680 was film in the camera? 25:48.680 --> 25:51.330 Would you buy a car that wouldn't tell you whether you 25:51.328 --> 25:52.678 had gas in your gas tank? 25:52.680 --> 25:55.500 I don't think so, but everyday people buy guns 25:55.500 --> 25:59.260 that don't tell them that there's a round in the chamber, 25:59.259 --> 26:02.059 a bullet in the gun, even though the device that 26:02.063 --> 26:05.883 would tell you is something that was patented more than a century 26:05.880 --> 26:09.340 ago and would cost less than a dollar to put on guns, 26:09.338 --> 26:13.158 and some guns have it so it's imminently technologically 26:13.163 --> 26:13.933 feasible. 26:13.930 --> 26:18.950 Or there's something called a magazine disconnect device, 26:18.950 --> 26:22.610 where if you take out the magazine as Stephen did, 26:22.608 --> 26:25.118 even though there's still a round in the chamber, 26:25.118 --> 26:29.758 without the magazine in the gun, you can't pull the trigger 26:29.759 --> 26:31.919 and discharge the bullet. 26:31.920 --> 26:35.670 So Ross would not have been killed had this gun had a 26:35.666 --> 26:38.186 magazine disconnect device on it. 26:38.190 --> 26:43.090 Again, the patent for magazine disconnect device is more than a 26:43.085 --> 26:46.315 century old, and the cost is less than a 26:46.319 --> 26:49.609 dollar again, and it exists on a very small 26:49.609 --> 26:52.799 percentage of guns, but it's technologically 26:52.798 --> 26:53.688 feasible. 26:53.690 --> 26:58.180 It doesn't exist on most handguns, and it doesn't exist 26:58.175 --> 27:02.995 on most handguns because we don't regulate them as to their 27:02.996 --> 27:03.906 design. 27:03.910 --> 27:08.660 We don't look all the way back here at the point of manufacture 27:08.661 --> 27:12.971 for formulating our policy, even though that would be the 27:12.970 --> 27:15.120 most effective kind of policy. 27:15.118 --> 27:22.818 So what, if anything, does this teach you about food? 27:22.818 --> 27:27.148 I'm not sure that I know the answer and I won't know the 27:27.148 --> 27:30.768 answer to a lot of the comparisons here between 27:30.769 --> 27:34.789 firearms and food, because I'm not as smart about 27:34.788 --> 27:39.278 food policy as Dr. Brownell is or many of the other people who 27:39.278 --> 27:42.368 will come lecture you in this course. 27:42.368 --> 27:45.978 But it seems to me that if we say, 27:45.980 --> 27:50.410 let's regulate eating--if you think of there being a lifespan 27:50.405 --> 27:53.795 with regard to food being the manufacturer, 27:53.798 --> 27:55.928 or the growing, or the processing of the food, 27:55.930 --> 27:58.430 the marketing of the food, the purchase of the food, 27:58.430 --> 28:02.970 the eating of the food--if we put our policy investment down 28:02.971 --> 28:07.361 here at the end of the lifespan of the food for eating. 28:07.358 --> 28:10.308 You can walk into the supermarket, 28:10.308 --> 28:12.428 you can walk into the convenience store, 28:12.430 --> 28:15.910 you can buy whatever garbage you want no matter how 28:15.910 --> 28:19.460 obesigenic the food is, but we're saying to the people 28:19.464 --> 28:22.814 once they've done that, but please be careful about 28:22.808 --> 28:26.098 eating the food, that just doesn't make sense to 28:26.098 --> 28:26.518 me. 28:26.519 --> 28:30.129 We can try to regulate the purchase of the food, 28:30.132 --> 28:34.442 but it may be that that too is of relatively low yield in 28:34.435 --> 28:35.815 effectiveness. 28:35.818 --> 28:39.818 Marketing may buy you some more, we market food to kids--I 28:39.821 --> 28:43.831 don't know if you've already have lectures on marketing of 28:43.825 --> 28:47.865 food to kids, but that seems like something 28:47.868 --> 28:53.138 that's imminently well regulated or could be--isn't well 28:53.141 --> 28:57.551 regulated now, but could be well regulated. 28:57.548 --> 29:00.178 There are people like Jennifer Pomeranz--have you met Jennifer 29:00.175 --> 29:00.645 Pomeranz? 29:00.650 --> 29:02.530 Jennifer Pomeranz is raising her hand now, 29:02.528 --> 29:06.988 and Jennifer Pomerantz is the Director of Legal Studies and 29:06.990 --> 29:11.140 Legal Initiatives at The Rudd Center and Jennifer works 29:11.144 --> 29:15.474 on--among other issues, she works on the area of 29:15.465 --> 29:21.145 marketing of food to children as a means of reducing the risk of 29:21.153 --> 29:23.053 childhood obesity. 29:23.048 --> 29:25.568 You can look also at the manufacturer, 29:25.568 --> 29:29.888 the processing of food about how much high fructose corn 29:29.888 --> 29:33.658 syrup is going to go into food unnecessarily, 29:33.660 --> 29:37.320 perhaps how much salt is going to be in the food which may be 29:37.320 --> 29:39.640 only indirectly related to obesity, 29:39.640 --> 29:43.070 but salt is said to kill 150,000 people in the United 29:43.066 --> 29:46.946 States unnecessarily from the kinds of hypertensive diseases 29:46.952 --> 29:50.782 and renal diseases that come from eating too much salt that 29:50.775 --> 29:52.945 doesn't have to be in food. 29:52.950 --> 29:58.310 We need to think about how do we want to invest our regulatory 29:58.311 --> 30:03.501 efforts and our legal efforts with regard to food policy. 30:03.500 --> 30:09.180 One way of doing that might be this type of thing similarly to 30:09.176 --> 30:12.896 how I discussed about this with guns, 30:12.900 --> 30:16.350 with the public health principle here being it's better 30:16.349 --> 30:19.669 to provide the population with some kind of automatic 30:19.673 --> 30:23.063 protection where they don't have to do something. 30:23.058 --> 30:25.848 They don't have to make a decision every time they want to 30:25.852 --> 30:29.142 put something in their mouth, every time they get into a car 30:29.137 --> 30:32.517 they don't have to make the decision about how they're going 30:32.518 --> 30:34.178 to give themselves safety. 30:34.180 --> 30:38.010 We put airbags in cars, which are automatic protection, 30:38.009 --> 30:41.019 we want people to buckle up also, but we put airbags in 30:41.022 --> 30:43.922 cars--I may talk about that a little more in a couple 30:43.923 --> 30:47.493 minutes--because we want them to be automatically protected where 30:47.494 --> 30:50.684 they don't have to do something to avail themselves of the 30:50.675 --> 30:52.345 benefit of the airbag. 30:52.348 --> 30:55.448 We want to do something automatically for people which 30:55.453 --> 30:58.793 is best done at the time of manufacture so that they don't 30:58.794 --> 31:02.254 always have to be considering what should they be doing when 31:02.250 --> 31:05.180 they're making decisions about what to eat, 31:05.180 --> 31:07.360 and how much to eat, and what are the contents of 31:07.356 --> 31:10.606 the things that they're eating, particularly if they're in a 31:10.614 --> 31:14.294 restaurant and they don't know what the content of the things 31:14.288 --> 31:15.878 is that they're eating. 31:15.880 --> 31:22.950 I want to talk to you about another public health model that 31:22.950 --> 31:28.940 deals again with guns, but I think is applicable to 31:28.942 --> 31:30.982 other issues. 31:30.980 --> 31:33.910 Think of the universe of people. 31:33.910 --> 31:38.300 Do you remember venn diagrams in high school? 31:38.298 --> 31:41.358 When you were in high school you learned about venn diagrams, 31:41.355 --> 31:44.205 is there anybody who didn't learn about venn diagrams? 31:44.210 --> 31:46.630 Should we explain venn diagrams to somebody? 31:46.630 --> 31:49.480 When I was in high school I had a great math teacher. 31:49.480 --> 31:53.760 He was a great math teacher, but not withstanding his 31:53.759 --> 31:57.709 greatness, I was a uniquely poor math student. 31:57.710 --> 32:01.850 But, one of the few things that I do--lawyers don't have to be 32:01.851 --> 32:06.131 good math students--all lawyers have to know how to do is divide 32:06.128 --> 32:08.838 by three, because your contingency fee is 32:08.844 --> 32:11.354 one-third of what you get for your client, 32:11.348 --> 32:15.978 and so we're genetically--we're very good at dividing by three 32:15.982 --> 32:19.712 but we don't do other quantitative things quite as 32:19.705 --> 32:20.385 well. 32:20.390 --> 32:25.150 This math teacher taught us about--he said think of the 32:25.154 --> 32:26.924 Triborough Bridge. 32:26.920 --> 32:29.010 You're going over the Triborough Bridge, 32:29.009 --> 32:32.199 which is in New York City if you're not from there, 32:32.200 --> 32:41.070 and there is a big sign that says Bronx two right lanes, 32:41.068 --> 32:46.258 Manhattan three left lanes, but there are only four lanes. 32:46.259 --> 32:49.199 This is a venn diagram. 32:49.200 --> 32:55.590 Think of the beginning of a venn diagram as being the 32:55.588 --> 32:58.168 universe of people. 32:58.170 --> 33:01.490 People, some of whom may want to have guns, 33:01.493 --> 33:06.163 and maybe from a policy point of view, it's okay for some of 33:06.164 --> 33:10.304 these people to have guns; but maybe it's not okay for 33:10.301 --> 33:12.001 some people to have guns. 33:12.000 --> 33:18.670 Then think of--I once was debating somebody about guns and 33:18.674 --> 33:25.124 this man was saying that all we have to do to reduce the 33:25.115 --> 33:31.905 incidence of gun deaths--this was at an American Academy of 33:31.907 --> 33:37.997 Pediatrics meeting and this was a famous yet perverse 33:37.998 --> 33:44.908 pediatrician--and what he was saying is all we have to do to 33:44.906 --> 33:51.106 reduce the incidence of gun deaths is teach people the 33:51.114 --> 33:55.334 safety rules about guns. 33:55.328 --> 33:58.448 He would say, and as you can see on my next 33:58.446 --> 34:02.006 slide--this is before there were PowerPoints, 34:02.009 --> 34:05.959 they were slides and they were remote control things--but he 34:05.962 --> 34:09.852 would turn it and point it at the screen, instead of at the 34:09.849 --> 34:11.189 slide projector. 34:11.190 --> 34:14.050 Which here is a man who is saying all we have to do is 34:14.045 --> 34:17.165 teach people the basics about gun safety, and he's pointing 34:17.172 --> 34:19.062 his gun in the wrong direction. 34:19.059 --> 34:25.149 Let me point my gun in the right direction here. 34:25.150 --> 34:31.990 You also have a universe of guns. 34:31.989 --> 34:38.859 It may be that there are some guns which it's okay for people 34:38.860 --> 34:43.020 to have, and some guns for which it's 34:43.016 --> 34:48.996 not okay for people to have, so the key area becomes this 34:49.001 --> 34:53.121 area, the overlap in the venn diagram, 34:53.119 --> 34:59.769 this area which were it shaded, I could say the shaded 34:59.768 --> 35:04.258 area--being the people, certain people, 35:04.260 --> 35:09.110 who are allowed to have certain guns but then there are some 35:09.106 --> 35:12.066 people, the felons, the adjudicated 35:12.072 --> 35:15.512 mentally incompetent, the fugitives from justice, 35:15.505 --> 35:19.225 etc.--there are some people who should have no guns and there 35:19.231 --> 35:22.731 are some guns, 50 caliber guns for example, 35:22.730 --> 35:25.110 that no people should have. 35:25.110 --> 35:32.280 The point of view with regard to gun policy is that what we 35:32.282 --> 35:39.332 want to do is we want to move those circles away from each 35:39.333 --> 35:47.253 other so that we're minimizing this non-shaded shaded area, 35:47.250 --> 35:51.640 so that there are more people who are in the proscribed 35:51.643 --> 35:54.053 category, like maybe it's not only 35:54.054 --> 35:57.644 felons, but maybe it's people who were convicted of a violent 35:57.643 --> 36:00.993 act that would have been a felony but the courts were too 36:00.992 --> 36:03.182 crowded, so it was reduced to a 36:03.175 --> 36:06.045 misdemeanor so they're misdemeanants rather than 36:06.047 --> 36:07.957 felons; but maybe they shouldn't be 36:07.956 --> 36:09.056 allowed to have a gun. 36:09.059 --> 36:11.999 Or maybe there are more guns like Saturday Night 36:11.996 --> 36:15.306 Specials--the cheap handguns that are sort of like the 36:15.306 --> 36:18.176 starter guns for someone launching his criminal 36:18.181 --> 36:21.431 career--that no one should be allowed to have. 36:21.429 --> 36:26.949 As a policy means, what we want to do is move 36:26.949 --> 36:34.099 those circles away from each other so we're narrowing that 36:34.099 --> 36:35.229 area. 36:35.230 --> 36:39.350 What if instead we had nutrition circles? 36:39.349 --> 36:44.199 Again, you have people and here you have foods, 36:44.199 --> 36:48.129 different kinds of foods so in the people category you have 36:48.132 --> 36:49.882 adults, you have kids, 36:49.878 --> 36:53.768 you have people who have predilection for obesity. 36:53.768 --> 36:56.068 In the food categories you have good foods, 36:56.070 --> 36:59.290 you have unhealthy foods, you have foods that are 36:59.289 --> 37:01.819 obesigenic, foods that are high in sugars, 37:01.815 --> 37:03.345 foods that are high in salt. 37:03.349 --> 37:08.019 You also have places, places being things like 37:08.016 --> 37:14.446 schools--why don't we just leave it at schools if we're dealing 37:14.445 --> 37:20.355 with children--and if you look at what the policy is about 37:20.355 --> 37:23.925 food, it's essentially that anyone 37:23.929 --> 37:26.509 can eat any food in any place. 37:26.510 --> 37:30.740 We don't have policies with regards to foods that regulate 37:30.739 --> 37:33.929 who should be eating what in what places. 37:33.929 --> 37:37.359 Again, we could change that. 37:37.360 --> 37:41.520 We could move the places circle down so that for instance in 37:41.523 --> 37:45.623 schools there are some foods that you can eat but there are 37:45.619 --> 37:49.289 some foods that you ought not to be able to eat; 37:49.289 --> 37:54.299 move the foods circle out, move the people out so that 37:54.297 --> 37:59.207 ultimately this area over here is--doesn't have to be 37:59.211 --> 38:02.231 minimized, but we want to make sure that 38:02.228 --> 38:05.478 some people who shouldn't be eating certain foods in certain 38:05.480 --> 38:07.740 places like schools, are not doing so. 38:07.739 --> 38:19.809 Let me talk to you about one more area of conceptual models. 38:19.809 --> 38:23.219 I want to talk to you about something called The Haddon 38:23.221 --> 38:23.791 Matrix. 38:23.789 --> 38:28.679 Bill Haddon was a genius of a man and he's now deceased. 38:28.679 --> 38:31.719 He was a physician, he was trained in public 38:31.722 --> 38:34.322 health, he went to college, 38:34.320 --> 38:40.090 to a school--I can't remember what's the school that begins 38:40.092 --> 38:44.772 with an "H", he went to where Jennifer went, 38:44.766 --> 38:47.456 he went to Harvard, and he went to MIT. 38:47.460 --> 38:55.210 He was a health officer in New York State, 38:55.210 --> 38:59.110 a county health officer in Westchester County and he became 38:59.106 --> 39:02.866 the first administrator of what's now called The National 39:02.867 --> 39:06.157 Highway Traffic Safety Administration which is the 39:06.159 --> 39:10.259 Federal Government Agency that controls the design of vehicles 39:10.259 --> 39:14.419 and a number of other things to try to reduce the 42,000 deaths 39:14.423 --> 39:19.063 that occur on the highways in the United States every year. 39:19.059 --> 39:22.509 Bill Haddon, who is also the father of the 39:22.507 --> 39:27.527 field of injury prevention said, if we're thinking of ways to 39:27.525 --> 39:32.355 address a problem, why don't we think of there 39:32.362 --> 39:35.222 being certain factors. 39:35.219 --> 39:44.559 The factors being over here that are pre-event, 39:44.556 --> 39:51.036 event, and post-event; I'll explain those to you in a 39:51.039 --> 39:51.469 second. 39:51.469 --> 39:54.279 Let's also--I'm sorry, the factors being here, 39:54.282 --> 39:56.532 human, vehicle, physical environment, 39:56.534 --> 40:00.554 social, legal environment; and the phases being pre-event, 40:00.545 --> 40:02.125 event, and post-event. 40:02.130 --> 40:07.170 What Haddon meant by this is for the phases, 40:07.170 --> 40:10.200 if you think of injuries occurring during motor vehicle 40:10.202 --> 40:12.312 crashes, and he created this matrix 40:12.313 --> 40:14.613 principally for motor vehicle crashes, 40:14.610 --> 40:17.130 but then realized that it was widely applicable to other 40:17.126 --> 40:18.266 public health problems. 40:18.268 --> 40:22.008 The event would be the actual crash of the car, 40:22.010 --> 40:26.550 but there are things that can be done that reduce the 40:26.547 --> 40:30.907 likelihood of an injury before the car crashes, 40:30.909 --> 40:34.529 and after the car crashes, as well as at the time the car 40:34.532 --> 40:35.182 crashes. 40:35.179 --> 40:40.719 Those things can deal with humans who are involved in this, 40:40.719 --> 40:44.529 they can deal with the vehicle--that would be the car 40:44.534 --> 40:49.084 in this case--or they can deal with the physical environment or 40:49.083 --> 40:52.463 the social cultural and legal environment. 40:52.460 --> 40:57.170 The reason--one of the reasons that Haddon came up with this 40:57.168 --> 41:00.358 matrix is because most interventions, 41:00.360 --> 41:05.390 the knee-jerk reaction to interventions are interventions 41:05.389 --> 41:09.879 that occupy this cell: the pre-event human cell. 41:09.880 --> 41:14.060 The pre-event human cell is characterized by educational 41:14.063 --> 41:15.283 interventions. 41:15.280 --> 41:20.150 Now, I don't want to bad mouth educational interventions too 41:20.150 --> 41:23.620 much, because sometimes they might work. 41:23.619 --> 41:27.909 Somewhere there might have been an educational intervention that 41:27.907 --> 41:28.517 worked. 41:28.518 --> 41:31.738 I recognize that I'm basically in a psychology class, 41:31.739 --> 41:35.329 so I don't want to say that educational interventions never 41:35.331 --> 41:35.891 work. 41:35.889 --> 41:38.139 I'm an educator, I don't want to say that 41:38.137 --> 41:40.327 educational interventions never work. 41:40.329 --> 41:46.819 But we would be misplacing our policy capital if we only looked 41:46.815 --> 41:51.415 to that one cell of a multi-celled matrix. 41:51.420 --> 41:56.160 I'm sure you each have your own personal stories that you could 41:56.155 --> 41:56.685 tell. 41:56.690 --> 41:59.390 Let me tell you one of mine. 41:59.389 --> 42:02.499 Kelly said I used to be a lawyer, I was a plaintiff's 42:02.503 --> 42:06.103 trial lawyer in New York State and I decided that I wanted to 42:06.097 --> 42:09.507 go to public health school and work in the field of injury 42:09.510 --> 42:10.530 prevention. 42:10.530 --> 42:15.270 I went to Johns Hopkins School of Public Health, 42:15.268 --> 42:18.348 the largest, the oldest, the number one 42:18.347 --> 42:23.527 rated school of public health in case any of you were thinking of 42:23.532 --> 42:28.502 post-graduate or graduate work, a school of public health 42:28.503 --> 42:32.123 where--I don't know if I said this before, 42:32.119 --> 42:34.689 but where we actually have desks for students. 42:34.690 --> 42:39.340 I went to the school of public health and I sat at the feet of 42:39.342 --> 42:42.092 the goddess of injury prevention, 42:42.090 --> 42:46.010 a woman named Susan Baker, and I was learning everything 42:46.007 --> 42:47.857 about injury prevention. 42:47.860 --> 42:52.740 I was living in a row house, this is what in other areas 42:52.742 --> 42:57.362 that are not Baltimore would be called townhomes, 42:57.360 --> 43:00.630 but in Baltimore they're still called row houses which are 43:00.625 --> 43:03.495 connected, single family houses that are 43:03.496 --> 43:06.406 all connected, so you have a wall that 43:06.409 --> 43:11.019 separates you from the adjoining row house housing a different 43:11.023 --> 43:11.783 family. 43:11.780 --> 43:19.000 One day I was downstairs in the basement with my son Michael, 43:19.000 --> 43:23.820 who must have been six or seven years old, 43:23.820 --> 43:31.240 and my wife and my daughter were out away from the house. 43:31.239 --> 43:36.159 My then youngest child Christopher was upstairs in his 43:36.155 --> 43:40.975 crib taking his nap, and I was playing with Legos. 43:40.980 --> 43:44.900 I don't know if people know what Legos are anymore--you know 43:44.898 --> 43:48.018 what Legos are--so we're playing with Legos, 43:48.018 --> 43:50.608 these little building blocks that you put together, 43:50.610 --> 43:56.380 and I go, Michael do you smell something burning? 43:56.380 --> 44:01.420 Michael--no, so I said, I'm going to go 44:01.416 --> 44:06.186 upstairs and check, you stay here. 44:06.190 --> 44:08.820 I run upstairs, nothing on the first floor, 44:08.822 --> 44:12.522 I run up one more floor where Christopher is taking his nap, 44:12.521 --> 44:15.531 don't smell anything, okay I made a mistake. 44:15.530 --> 44:19.270 I come back down to the basement and there's a crack in 44:19.268 --> 44:23.838 the wall that separates our row house from the other row house, 44:23.840 --> 44:26.500 and I see black smoke coming through the crack and I say, 44:26.503 --> 44:28.173 Michael there's a fire next door. 44:28.170 --> 44:33.020 Michael you go outside and don't cross the street or 44:33.018 --> 44:35.568 anything, but walk to the end of the 44:35.572 --> 44:37.912 block and just stand there on the corner, 44:37.909 --> 44:40.699 I'm going to go get Christopher, I'll meet you there 44:40.704 --> 44:42.024 in less than a minute. 44:42.018 --> 44:44.518 He does that, I go upstairs, 44:44.519 --> 44:49.519 I grab tiny baby Christopher, run out--who's now almost 44:49.521 --> 44:55.451 thirty--and run out of the house with tiny baby Christopher. 44:55.449 --> 44:59.969 I see the house next door now is engulfed in flames that have 44:59.969 --> 45:04.039 broken the windows and the flames are lapping up on the 45:04.036 --> 45:08.476 outside of the house and now everyone in the whole community 45:08.480 --> 45:12.020 has gathered because you could smell it, 45:12.018 --> 45:15.748 you could hear it, that a row house is burning, 45:15.750 --> 45:19.290 it's frightening, so I get to the corner, 45:19.289 --> 45:24.409 there are a bunch of people there and I say to a neighbor, 45:24.409 --> 45:28.739 you take Christopher, here I've got to go back in to 45:28.740 --> 45:30.440 get the valuables. 45:30.440 --> 45:35.030 Oh God, well how stupid, I'm an injury control student, 45:35.025 --> 45:39.355 I know this kind of stuff, you never enter a burning 45:39.356 --> 45:42.156 building or a smoky building. 45:42.159 --> 45:46.509 I give Christopher to a neighbor, I go back in--the 45:46.507 --> 45:50.507 house now is filled with black sooty smoke, 45:50.510 --> 45:57.160 it's clawing at your throat, I make my way in the darkness, 45:57.159 --> 46:00.189 it's the middle of the day but the house is filled with black 46:00.186 --> 46:03.236 smoke, I grope my way upstairs to the 46:03.235 --> 46:08.205 bedroom to get the valuables, and it was at that point that I 46:08.213 --> 46:11.103 realized that I'm a graduate student, 46:11.099 --> 46:14.259 and by definition, therefore, I have no valuables. 46:14.260 --> 46:16.360 I mean what am I going to get? 46:16.360 --> 46:18.210 There's nothing there. 46:18.210 --> 46:22.910 But I also recognize that the street is filled now with scores 46:22.913 --> 46:24.073 of neighbors. 46:24.070 --> 46:27.650 I'm not going to come out empty handed and look stupid in front 46:27.652 --> 46:32.192 of the neighbors, so I grabbed the toothbrushes 46:32.193 --> 46:36.863 and I come out--I got the toothbrushes. 46:36.860 --> 46:40.090 I mean, what a dumb thing to do. 46:40.090 --> 46:42.510 You don't do that, I'm supposed to be an expert, 46:42.510 --> 46:45.390 or a budding expert in injury control, 46:45.389 --> 46:48.139 I have learned, I've been the subject of 46:48.137 --> 46:52.357 educational interventions that tell me that you don't enter a 46:52.364 --> 46:55.644 building; but people aren't always smart. 46:55.639 --> 47:01.039 If you invest all of your effort in this cell of educating 47:01.039 --> 47:06.849 humans to always act prudently, you're going to miss a whole 47:06.849 --> 47:11.659 lot of other opportunities that you shouldn't miss. 47:11.659 --> 47:17.969 With regard to going back to Ross and Stephen and guns, 47:17.969 --> 47:21.919 with regard to what can you do to prevent these kinds of things 47:21.922 --> 47:24.412 from happening, you can have educational 47:24.409 --> 47:25.239 programs. 47:25.239 --> 47:28.049 You can have them if you want, but I don't know how much 47:28.050 --> 47:29.790 you're going to get out of them. 47:29.789 --> 47:33.649 You could have humans wear bulletproof vests; 47:33.650 --> 47:38.290 you could have humans have physical resilience so if 47:38.286 --> 47:41.396 they're in a car crash, if they get shot, 47:41.402 --> 47:44.582 if they're healthy and strong, then maybe they're not going to 47:44.583 --> 47:46.293 die from that kind of injury. 47:46.289 --> 47:49.809 You could change the vehicle, in this case the vehicle being 47:49.811 --> 47:52.501 a gun by having loaded chamber indicators, 47:52.500 --> 47:55.850 which before the event--before the trigger is pulled--would 47:55.849 --> 47:58.389 tell you that there's a bullet in the gun. 47:58.389 --> 48:01.589 You could have these magazine disconnect devices that I 48:01.590 --> 48:04.260 mentioned to you so the trigger is pulled, 48:04.260 --> 48:06.390 the event occurs, but a bullet doesn't come out 48:06.387 --> 48:08.877 of the gun; I'm not going to go over all 48:08.876 --> 48:09.816 these things. 48:09.820 --> 48:13.140 You could change the environment, the physical 48:13.141 --> 48:16.241 environment, have gun safes--this is not 48:16.244 --> 48:20.164 meant to be a safe gun--but a gun safe in the home, 48:20.159 --> 48:22.749 so that people store their guns, change the physical 48:22.753 --> 48:24.843 environment of how they store the guns. 48:24.840 --> 48:28.220 You could have emergency medical services with easy 48:28.219 --> 48:32.339 access changing the environment, so people have easy access to 48:32.344 --> 48:34.444 emergency medical services. 48:34.440 --> 48:38.250 You can--in the social and legal environment you could, 48:38.248 --> 48:42.408 have trauma systems which would be a post-event strategy. 48:42.409 --> 48:47.039 You could legally ban guns were it not for a recent decision by 48:47.036 --> 48:51.136 the United States Supreme Court which would be pre-event 48:51.139 --> 48:52.109 strategy. 48:52.110 --> 48:57.760 I don't think I'm going to take the time to discuss what that 48:57.755 --> 49:02.175 means but there are things that can be done, 49:02.179 --> 49:07.089 if you think about what does The Haddon Matrix offer you. 49:07.090 --> 49:10.720 It's a tool for thinking about prevention. 49:10.719 --> 49:15.399 It shows you that you don't have to focus solely on that one 49:15.400 --> 49:19.050 human pre-event cell for your interventions; 49:19.050 --> 49:22.610 you should expand your mind and think about other things, 49:22.610 --> 49:25.040 and you don't have to fill in every single cell when you're 49:25.043 --> 49:27.313 trying to do a Haddon Matrix, nor do you really have to 49:27.309 --> 49:27.729 worry. 49:27.730 --> 49:32.630 One of the ways that The Haddon Matrix gets ruined in 49:32.632 --> 49:38.192 discussions is people will have endless talmudic debate over 49:38.193 --> 49:43.103 which cell does a particular intervention or proposed 49:43.096 --> 49:45.826 intervention belong in. 49:45.829 --> 49:46.909 Who cares? 49:46.909 --> 49:50.449 The purpose of The Haddon Matrix is to allow you to think 49:50.447 --> 49:52.847 through all kinds of interventions, 49:52.849 --> 49:57.629 and it doesn't really matter if Kelly says it goes in one cell, 49:57.630 --> 50:01.680 I say it goes in another cell, what matters is that we thought 50:01.679 --> 50:03.139 of the intervention. 50:03.139 --> 50:08.569 You could think of trying to make a Haddon Matrix with the 50:08.567 --> 50:13.257 event not being a car crash, or the event the event the 50:13.255 --> 50:17.415 pulling of a trigger, but the event being excessive 50:17.418 --> 50:18.868 caloric intake. 50:18.869 --> 50:23.219 You could think of how would you feel this in. 50:23.219 --> 50:28.069 We won't have time or opportunity in our short time 50:28.074 --> 50:31.964 today about how you would fill it in, 50:31.960 --> 50:35.060 but there are things that you could do, 50:35.059 --> 50:39.199 and again, the purpose of doing this is to give you an 50:39.199 --> 50:42.949 opportunity to expand your fields of interest. 50:42.949 --> 50:47.159 For the--and the other thing about The Haddon Matrix you're 50:47.161 --> 50:50.501 allowed to say stupid things and then just say, 50:50.501 --> 50:53.481 all right but we would never do that. 50:53.480 --> 50:58.200 For the human factor, you could educate people in the 50:58.195 --> 51:01.455 pre-event phase, you could have bariatric 51:01.460 --> 51:05.510 surgery that makes your stomach much smaller so you can only eat 51:05.505 --> 51:08.005 a little bit during the event phase. 51:08.010 --> 51:13.060 Bulimia, you ought not to do that, that's a very, 51:13.056 --> 51:19.466 very bad idea but that would be a post-eating event way of not 51:19.471 --> 51:22.311 having so much obesity. 51:22.309 --> 51:25.579 But again, let me stress this is a very bad idea. 51:25.579 --> 51:29.669 With regard to the vehicle or vector--those are epidemiologic 51:29.672 --> 51:33.702 terms, in this case it would be the food that you're talking 51:33.697 --> 51:34.377 about. 51:34.380 --> 51:36.450 Food is the vehicle, or the vector, 51:36.452 --> 51:39.872 vector is a living thing, sometimes we eat living things, 51:39.867 --> 51:42.547 sometimes some people eat living things. 51:42.550 --> 51:47.490 In the pre-event phase, you could have food that's low 51:47.492 --> 51:52.532 in calories, you could have smaller portions during the 51:52.527 --> 51:54.017 event phase. 51:54.018 --> 51:58.358 All of these slides will be made available to you so you 51:58.356 --> 52:00.796 don't need to copy this down. 52:00.800 --> 52:06.340 Again, I want to stress that you don't have to fill in every 52:06.344 --> 52:07.664 ', its okay. 52:07.659 --> 52:10.849 You may have ideas for what goes in the cells; 52:10.849 --> 52:14.109 when I was trying to make these slides I didn't have such good 52:14.112 --> 52:14.542 ideas. 52:14.539 --> 52:16.839 With regard to the physical environment, 52:16.840 --> 52:21.400 you can have something that allows for stores to exist in 52:21.398 --> 52:24.978 inner city areas that sell healthy foods, 52:24.980 --> 52:27.220 rather than foods that are unhealthy. 52:27.219 --> 52:31.919 You could have menu labeling, change in physical environment, 52:31.920 --> 52:35.800 so you walk into a fast food store and there's menu--there's 52:35.797 --> 52:39.677 a sign that tells you how much calories are in the item that 52:39.675 --> 52:41.775 you're considering ordering. 52:41.780 --> 52:48.850 Or you can change the social or the legal environment and--as a 52:48.847 --> 52:54.317 law you could eliminate the subsidy for corn, 52:54.320 --> 52:58.300 which would result in perhaps less use of high fructose corn 52:58.302 --> 53:01.182 syrup, and perhaps less calorie dense 53:01.179 --> 53:01.709 foods. 53:01.710 --> 53:05.060 As a result, you could regulate the sale of 53:05.061 --> 53:09.691 foods: something that we don't think about a whole lot, 53:09.690 --> 53:12.800 but should children be allowed to buy any food they want? 53:12.800 --> 53:17.850 Should a young child be allowed to go into a convenience store 53:17.851 --> 53:22.661 and buy a majorly large bag of potato chips or a soft drink 53:22.655 --> 53:25.135 containing a lot of sugar? 53:25.139 --> 53:29.979 You could also as a post-event legal intervention, 53:29.980 --> 53:33.240 you could engage in litigation. 53:33.239 --> 53:36.729 Not only litigation suing McDonald's, 53:36.730 --> 53:41.590 etc., for making people fat but engage in litigation for other 53:41.588 --> 53:45.648 things that maybe you'll discuss in this course, 53:45.650 --> 53:50.110 like the possibility that some food manufacturers may be 53:50.110 --> 53:55.220 actually trying to make their food have an addictive quality. 53:55.219 --> 53:59.549 The point with regard to The Haddon Matrix is: 53:59.548 --> 54:05.228 don't allow yourself to take a myopic view of policy by only 54:05.226 --> 54:11.766 focusing on that human pre-event educational intervention cell, 54:11.768 --> 54:17.898 you should look at a lot of different kinds of policies. 54:17.900 --> 54:21.370 My school of public health is called The Johns Hopkins 54:21.371 --> 54:24.781 Bloomberg School of Public Health because a man named 54:24.777 --> 54:27.317 Bloomberg, who is the mayor of New York 54:27.324 --> 54:30.624 City happened to give in the hundreds of millions of dollars 54:30.621 --> 54:33.641 to then find his name on the side of the building, 54:33.639 --> 54:36.179 for which we're very, very grateful, 54:36.179 --> 54:40.589 but Mike Bloomberg when he was a student at Johns Hopkins, 54:40.590 --> 54:44.960 was very much influenced by an article that was published. 54:44.960 --> 54:47.670 He was interested in business back, then even though he was an 54:47.670 --> 54:48.650 engineering student. 54:48.650 --> 54:52.440 There was an article that was published in the early 60s in 54:52.440 --> 54:55.970 The Harvard Business Journal called Marketing 54:55.969 --> 54:56.949 Myopia. 54:56.949 --> 54:59.689 It was written by a man named Theodore Levitt. 54:59.690 --> 55:03.710 What Levitt said in this article, which is a classic--and 55:03.710 --> 55:07.870 Theodore Levitt unfortunately just passed away a few months 55:07.873 --> 55:12.323 ago--what Theodore Levitt wrote was that sometimes companies do 55:12.324 --> 55:14.914 poorly because they're myopic. 55:14.909 --> 55:19.259 He gave, as an example, the train industry, 55:19.259 --> 55:21.329 railroad industry. 55:21.329 --> 55:26.209 At one time the railroad industry was considered the very 55:26.208 --> 55:29.778 best investment that anyone could make. 55:29.780 --> 55:34.450 There were rulers of countries outside of the United States who 55:34.452 --> 55:38.602 would invest in the United States railroad industry, 55:38.599 --> 55:42.089 but the railroad industry has not done well, 55:42.090 --> 55:44.340 as is the case with many other industries, 55:44.340 --> 55:48.440 and Levitt's argument was because the railroad industry 55:48.442 --> 55:49.432 was myopic. 55:49.429 --> 55:53.579 The railroad industry thought that it was in the business of 55:53.577 --> 55:57.297 trains, when Levitt suggests it was in the business of 55:57.304 --> 55:58.644 transportation. 55:58.639 --> 56:01.859 If it realized that it was in the business of transportation, 56:01.860 --> 56:06.570 the railroad industry could have become also the automotive 56:06.565 --> 56:08.155 industry, the airline 56:08.161 --> 56:11.271 industry--parenthetically neither one of those are doing 56:11.268 --> 56:14.378 too well right now--but they were when Levitt wrote this 56:14.375 --> 56:15.105 article. 56:15.110 --> 56:20.780 He was saying don't be myopic about what your business is 56:20.780 --> 56:21.590 about. 56:21.590 --> 56:25.650 Our business in public health is about saving lives millions 56:25.646 --> 56:28.386 at a time, and we shouldn't be myopic 56:28.393 --> 56:32.463 about what our opportunities are with regard to prevention 56:32.456 --> 56:33.166 policy. 56:33.170 --> 56:37.180 They're far more than just trying to tell people to always 56:37.182 --> 56:40.842 act prudently when they're making decisions that will 56:40.844 --> 56:45.284 affect their publics--their health and the public's health. 56:45.280 --> 56:50.800 I want to go through now quickly ten questions that I 56:50.795 --> 56:56.625 would like to suggest to you for considering when you're 56:56.630 --> 57:03.420 selecting policies to protect the well-being of populations. 57:03.420 --> 57:07.300 The first question--and again you'll get these questions on 57:07.302 --> 57:10.322 the slides, so you don't need to write this 57:10.322 --> 57:14.092 down--the first question is to identify what's the public 57:14.085 --> 57:17.105 health goal that you're seeing to achieve? 57:17.110 --> 57:21.240 You need to keep that public health goal in mind. 57:21.239 --> 57:23.329 I think that what we're talking about, 57:23.329 --> 57:26.799 other than the guns and the other examples I've given you, 57:26.800 --> 57:30.680 is that we're talking about reducing the incidence and the 57:30.681 --> 57:32.861 severity of childhood obesity. 57:32.860 --> 57:36.140 It's important to keep your public health goal in mind, 57:36.139 --> 57:40.589 because you can get pulled away into political goals or other 57:40.590 --> 57:45.110 types of goals that may not lead you to the same place as your 57:45.114 --> 57:46.824 public health goal. 57:46.820 --> 57:52.530 It's also to keep in mind that if we are public health people, 57:52.530 --> 57:55.120 and I know that many of you are not yet public health people, 57:55.119 --> 57:58.779 but when you come to Johns Hopkins that actually has desks 57:58.782 --> 58:01.912 for students, you will become public health 58:01.909 --> 58:02.489 people. 58:02.489 --> 58:06.749 Public health people have public health in mind, 58:06.750 --> 58:10.920 not everyone else has public health in mind. 58:10.920 --> 58:13.640 When we come up with public health interventions, 58:13.637 --> 58:16.517 policy interventions, they may be interventions that 58:16.523 --> 58:18.113 other people don't like. 58:18.110 --> 58:20.690 We say for example, there ought to be a law that 58:20.686 --> 58:24.026 requires motorcyclists to wear helmets when they ride on their 58:24.030 --> 58:25.730 motorcycles on the highway. 58:25.730 --> 58:29.890 We do that because we don't like the idea of traumatic brain 58:29.893 --> 58:32.883 injury, but motorcyclists like feeling 58:32.876 --> 58:37.656 the wind through their hair and they may have an interest that's 58:37.657 --> 58:41.977 higher in their mind that the pleasure of feeling the wind 58:41.983 --> 58:46.163 through their hair than what we think of as the foremost 58:46.159 --> 58:50.029 interest, which is a public health interest. 58:50.030 --> 58:54.580 So we should keep that in mind to remain adequately humble 58:54.583 --> 58:56.743 about what we want to do. 58:56.739 --> 59:02.899 The second question is, if you've addressed your public 59:02.898 --> 59:06.488 health goal, then what policy objective if 59:06.485 --> 59:09.845 any, will help you achieve that public health goal? 59:09.849 --> 59:13.139 Again, as I've said to you already, not all policy 59:13.141 --> 59:16.301 objectives are going to be equally effective. 59:16.300 --> 59:20.210 So you could have as your policy objective educating the 59:20.213 --> 59:24.203 person who feeds the child if you want to, as your public 59:24.201 --> 59:25.341 health goal. 59:25.340 --> 59:27.750 You want to reduce the incidence and severity of 59:27.751 --> 59:30.331 childhood obesity, you could regulate marketing to 59:30.327 --> 59:32.757 children, you could regulate the caloric 59:32.757 --> 59:36.727 density of the food, and you need to think again 59:36.731 --> 59:42.381 through this process of what best allows you to achieve your 59:42.375 --> 59:47.535 public health goal because there'll be differences. 59:47.539 --> 59:50.439 I'm not sure if that's a question or a stretch; 59:50.440 --> 59:52.010 it was a stretch, okay. 59:52.010 --> 59:58.810 The third of these three questions would be, 59:58.807 --> 1:00:08.607 by what tool is that policy that you've chosen best created? 1:00:08.610 --> 1:00:10.230 There are different tools. 1:00:10.230 --> 1:00:12.820 There's legislation, there's regulation, 1:00:12.815 --> 1:00:16.055 there's litigation, there are tools that deal with 1:00:16.063 --> 1:00:18.453 collaborative voluntary efforts. 1:00:18.449 --> 1:00:22.669 I think you already had Dr. Derek Yach talk with you 1:00:22.668 --> 1:00:27.128 about things that maybe collaboratively people could do 1:00:27.134 --> 1:00:32.514 with industry to try to reduce how calorie-dense foods are. 1:00:32.510 --> 1:00:35.680 There're programmatic efforts, but you should think through 1:00:35.677 --> 1:00:36.987 these different tools. 1:00:36.989 --> 1:00:40.019 It's not that you have to devote yourself to only one 1:00:40.021 --> 1:00:40.431 tool. 1:00:40.429 --> 1:00:42.889 These are not mutually exclusive categories; 1:00:42.889 --> 1:00:46.579 you could be doing legislation at the time same time you're 1:00:46.579 --> 1:00:49.509 doing regulation, at the same time you're doing 1:00:49.505 --> 1:00:50.455 litigation. 1:00:50.460 --> 1:00:56.870 I mentioned earlier that maybe I would take just a minute and 1:00:56.873 --> 1:01:03.293 say something about airbags in cars to you, so let me do that 1:01:03.286 --> 1:01:04.246 here. 1:01:04.250 --> 1:01:08.050 When I first came to the field of public health, 1:01:08.050 --> 1:01:11.190 in injury control, motor vehicle related injuries 1:01:11.193 --> 1:01:15.193 were the worst problem--there were 52,000 deaths a year in the 1:01:15.190 --> 1:01:19.580 United States rather than the present 42,000 that we have now, 1:01:19.579 --> 1:01:22.919 and we wanted to reduce the incidence of motor vehicle 1:01:22.920 --> 1:01:25.190 deaths and one way of doing that, 1:01:25.190 --> 1:01:27.890 people were convinced--correctly so--would 1:01:27.887 --> 1:01:29.727 be to get airbags in cars. 1:01:29.730 --> 1:01:33.870 We tried to get airbags in cars by having Congress mandate it. 1:01:33.869 --> 1:01:36.579 Politically that was very difficult to do. 1:01:36.579 --> 1:01:40.909 We tried getting airbags in cars by having the regulatory 1:01:40.914 --> 1:01:42.754 agency, the one that I mentioned 1:01:42.751 --> 1:01:45.321 earlier, National Highway Traffic Safety Administration, 1:01:45.320 --> 1:01:48.510 make a regulation requiring airbags in cars. 1:01:48.510 --> 1:01:52.140 That, too, was very politically difficult to do. 1:01:52.139 --> 1:01:56.139 We turned to a third tool, we turned to litigation. 1:01:56.139 --> 1:01:59.289 There was an article that was published in a magazine called 1:01:59.293 --> 1:02:02.233 Trial Magazine, the magazine of what was then 1:02:02.231 --> 1:02:05.161 called The Association of Trial Lawyers of America, 1:02:05.159 --> 1:02:09.279 an organization of about 60,000 plaintiff's trial lawyers. 1:02:09.280 --> 1:02:11.630 These are the lawyers bringing lawsuits. 1:02:11.630 --> 1:02:15.810 The article said to these 60,000 plaintiff trial lawyers, 1:02:15.809 --> 1:02:18.709 when you have a client come into your office, 1:02:18.710 --> 1:02:21.910 a client who has been in a car crash, 1:02:21.909 --> 1:02:26.099 a client who has suffered paralysis as a result of that, 1:02:26.099 --> 1:02:31.969 or who has brain damage; or who has facially disfiguring 1:02:31.967 --> 1:02:37.607 scarring as a result of a frontal collision; 1:02:37.610 --> 1:02:41.110 don't think only of suing the driver of the other car. 1:02:41.110 --> 1:02:44.610 Think about suing the car manufacturer for failing to 1:02:44.605 --> 1:02:48.575 offer an airbag in cars, because for decades the car 1:02:48.579 --> 1:02:53.379 manufacturers knew and proved that airbags would be extremely 1:02:53.380 --> 1:02:57.460 effective in reducing the incidence of morbidity and 1:02:57.460 --> 1:03:02.020 mortality that results from frontal or frontal oblique car 1:03:02.018 --> 1:03:03.218 crashes. 1:03:03.219 --> 1:03:07.609 As a result of that article, a lawyer in Birmingham, 1:03:07.610 --> 1:03:12.260 Alabama had a client whose name was Rebecca Burgess. 1:03:12.260 --> 1:03:14.760 Rebecca Burgess was eighteen years of age, 1:03:14.760 --> 1:03:16.680 she had just graduated high school, 1:03:16.679 --> 1:03:19.909 she'd been a cheerleader, she was going on for some 1:03:19.911 --> 1:03:21.401 additional education. 1:03:21.400 --> 1:03:26.690 She was driving a Ford and she was in a frontal collision. 1:03:26.690 --> 1:03:29.070 If you look at pictures of Ms. 1:03:29.065 --> 1:03:32.545 Burgess before the crash and after the crash, 1:03:32.552 --> 1:03:36.992 you couldn't recognize them as being the same person. 1:03:36.989 --> 1:03:40.169 In the crash, she was rendered a brain 1:03:40.172 --> 1:03:42.842 damaged spastic quadriplegic. 1:03:42.840 --> 1:03:48.540 The lawsuit was brought against Ford saying you should have put 1:03:48.536 --> 1:03:50.646 an airbag in the car. 1:03:50.650 --> 1:03:56.160 Ten days into the trial, the lawsuit was settled by the 1:03:56.157 --> 1:04:00.747 payment of Ford of $1.8 million dollars to Ms. 1:04:00.746 --> 1:04:01.966 Burgess. 1:04:01.969 --> 1:04:05.049 I told you before that lawyers are good at dividing by three; 1:04:05.050 --> 1:04:10.870 $1.8 million divided by three is some large number--told you 1:04:10.869 --> 1:04:17.279 that I'm not good at math--so lawyers know that's a hefty fee, 1:04:17.280 --> 1:04:19.800 so as a result of that and the publicity, 1:04:19.800 --> 1:04:23.320 there was publicity among lawyers, there was publicity 1:04:23.320 --> 1:04:26.020 among the public, I got to go on The Today Show 1:04:26.016 --> 1:04:28.696 because I was the person who wrote the article in Trial 1:04:28.704 --> 1:04:30.594 Magazine, and talk about this kind of 1:04:30.590 --> 1:04:31.110 thing. 1:04:31.110 --> 1:04:34.350 As a result of all of that there was a tidal wave of 1:04:34.349 --> 1:04:37.159 litigation, so much so that at the end of 1:04:37.155 --> 1:04:40.985 1985 when Ford Motor Company had to file its forms with the 1:04:40.989 --> 1:04:43.699 Securities & Exchange Commission, 1:04:43.699 --> 1:04:47.629 as corporations do, it said to the Securities & 1:04:47.632 --> 1:04:52.112 Exchange Commission that for that year 1985 it had pending 1:04:52.114 --> 1:04:56.524 against it an airbag litigation claims the amount of $1.1 1:04:56.518 --> 1:04:58.248 billion dollars. 1:04:58.250 --> 1:05:02.110 That, coincidentally or not, was also the year that Ford 1:05:02.105 --> 1:05:05.465 decided to offer airbags as an option in cars. 1:05:05.469 --> 1:05:10.449 Litigation can be a potent tool in protecting the health of the 1:05:10.454 --> 1:05:12.584 public, whether you're talking about 1:05:12.576 --> 1:05:14.546 cars, whether you're talking about guns, 1:05:14.550 --> 1:05:17.640 or actually whether you're talking about food. 1:05:17.639 --> 1:05:21.919 One of the things that The Rudd Center is making a real mark on 1:05:21.922 --> 1:05:26.272 is understanding how litigation can be used as an effective tool 1:05:26.273 --> 1:05:30.073 in reducing the incidence of obesity, particularly among 1:05:30.072 --> 1:05:31.112 children. 1:05:31.110 --> 1:05:35.150 The next question is, you need to know: 1:05:35.152 --> 1:05:42.072 what the major barriers are to achieving your policy objective? 1:05:42.070 --> 1:05:44.960 There are going to be barriers that deal with legality, 1:05:44.960 --> 1:05:46.760 there are going to be barriers that deal with costs, 1:05:46.760 --> 1:05:49.120 there are going to be barriers that deal with personal 1:05:49.123 --> 1:05:51.403 freedoms, there are going to barriers 1:05:51.396 --> 1:05:52.616 about bad science. 1:05:52.619 --> 1:05:57.909 I said to you that one of the things public health people try 1:05:57.905 --> 1:06:03.185 to do was to get legislatures at the state level to pass laws 1:06:03.193 --> 1:06:07.073 requiring motorcyclists to wear helmets. 1:06:07.070 --> 1:06:10.660 I used to go to a lot of motorcycle helmet hearings and 1:06:10.657 --> 1:06:12.317 legislative committees. 1:06:12.320 --> 1:06:14.920 They're great theatre. 1:06:14.920 --> 1:06:19.960 My favorite thing was listening to a motorcyclist testifying 1:06:19.956 --> 1:06:25.076 once saying that you don't want motorcyclists to have to wear 1:06:25.077 --> 1:06:30.027 helmets because they interfere with peripheral vision. 1:06:30.030 --> 1:06:34.020 He said that what he, as a safe motorcyclist does, 1:06:34.018 --> 1:06:35.908 whenever he's riding down the highway, 1:06:35.909 --> 1:06:40.429 is he has one eye looking straight ahead at the roadway 1:06:40.427 --> 1:06:44.777 and the other scanning the periphery--perhaps kind of 1:06:44.780 --> 1:06:47.960 lizard life capable of doing that. 1:06:47.960 --> 1:06:51.700 But you look at the legislators who were listening to this and 1:06:51.695 --> 1:06:54.385 going, yes sure you would want to do that. 1:06:54.389 --> 1:06:59.819 So bad science is one of the issues that you sometimes have 1:06:59.824 --> 1:07:04.794 to deal with as a barrier to achieving your policy. 1:07:04.789 --> 1:07:09.659 You need to learn how you can overcome those barriers. 1:07:09.659 --> 1:07:12.219 One way is by appealing to children. 1:07:12.219 --> 1:07:15.209 It's always easier to get policy made if you're dealing 1:07:15.210 --> 1:07:17.870 with children than if you're dealing with adults, 1:07:17.869 --> 1:07:20.529 because everybody wants to protect children. 1:07:20.530 --> 1:07:23.720 You can have exemptions to policy so that your most 1:07:23.715 --> 1:07:26.325 stringent critics are exempted from it. 1:07:26.329 --> 1:07:30.179 This happens with things like vaccine policy where you leave a 1:07:30.184 --> 1:07:33.664 little loophole in mandatory childhood immunization laws 1:07:33.661 --> 1:07:37.201 saying you don't have to have your child vaccinated if it 1:07:37.201 --> 1:07:41.501 violates your religious beliefs or your philosophical beliefs. 1:07:41.500 --> 1:07:43.980 So sometimes these exemptions are useful. 1:07:43.980 --> 1:07:48.320 You will be relying upon the police powers of the states. 1:07:48.320 --> 1:07:51.390 Those are the powers reserved by the United States 1:07:51.387 --> 1:07:54.827 Constitution to the states, to protect the well being of 1:07:54.829 --> 1:07:55.769 the public. 1:07:55.768 --> 1:08:01.268 You can try to rebut bad science with good science. 1:08:01.268 --> 1:08:07.798 The next question is that of is there adequate science to 1:08:07.804 --> 1:08:11.544 support your policy objective? 1:08:11.539 --> 1:08:15.509 Sometimes the decision makers, legislators don't care about 1:08:15.507 --> 1:08:17.967 whether there's adequate science, 1:08:17.970 --> 1:08:22.600 like with the lizard life being able to look in all directions. 1:08:22.600 --> 1:08:26.720 Sometimes you can act in the absence of science, 1:08:26.720 --> 1:08:30.310 sometimes you can simultaneously to advocating for 1:08:30.306 --> 1:08:33.546 policy create the science, do small studies, 1:08:33.551 --> 1:08:37.111 do studies that are very scientifically relevant as The 1:08:37.113 --> 1:08:39.623 Rudd Center is committed to doing, 1:08:39.618 --> 1:08:41.598 and sometimes even the science can come afterwards, 1:08:41.600 --> 1:08:42.910 after the policy has been made. 1:08:42.908 --> 1:08:51.298 A very difficult issue is, how do you deal with opposition 1:08:51.300 --> 1:08:54.980 from within your field? 1:08:54.979 --> 1:08:59.239 That's tough to deal with, but it always come up whether 1:08:59.237 --> 1:09:02.717 you're talking about environmental policy, 1:09:02.720 --> 1:09:04.420 whether you're talking about public health, 1:09:04.420 --> 1:09:06.210 whether you're talking about anything. 1:09:06.210 --> 1:09:09.160 Fortunately for academics, we live in a field of great 1:09:09.159 --> 1:09:12.439 freedom where we're all allowed to voice our opinions and we 1:09:12.444 --> 1:09:14.564 like to disagree with each other, 1:09:14.560 --> 1:09:18.000 so you frequently will have opposition from within your 1:09:17.997 --> 1:09:20.547 field, you can compromise when 1:09:20.545 --> 1:09:24.405 necessary, you can try to achieve consensus. 1:09:24.408 --> 1:09:29.038 If that doesn't work you have to have the courage of your own 1:09:29.038 --> 1:09:33.508 convictions in the field of trying to protect children from 1:09:33.514 --> 1:09:34.444 obesity. 1:09:34.439 --> 1:09:38.819 We have an example of that happening right now with regard 1:09:38.818 --> 1:09:43.198 to a difficult legal issue called preemption where part of 1:09:43.197 --> 1:09:47.807 the public health community says we don't care if the federal 1:09:47.805 --> 1:09:52.795 government preempts states from making more stringent laws. 1:09:52.800 --> 1:09:55.990 Other people within the public health community say we do care 1:09:55.988 --> 1:09:58.548 about that, and you have to try to figure 1:09:58.551 --> 1:10:02.531 out a way to either resolve that or go ahead with the courage of 1:10:02.533 --> 1:10:04.053 your own convictions. 1:10:04.050 --> 1:10:06.830 Not only will you have opposition from within the 1:10:06.828 --> 1:10:09.218 field, but you'll have oppositions 1:10:09.219 --> 1:10:13.299 that's external to your field that you can expect compromise 1:10:13.302 --> 1:10:14.552 when necessary. 1:10:14.550 --> 1:10:16.970 Just be smarter, work harder, 1:10:16.965 --> 1:10:19.635 be willing to play hard ball. 1:10:19.640 --> 1:10:26.300 There's a quotation from Goethe that I like which says, 1:10:26.300 --> 1:10:31.170 "Be bold and mighty forces will come to your aid," 1:10:31.171 --> 1:10:35.961 so rely on the fact that if you're bold about pursuing in a 1:10:35.960 --> 1:10:39.180 strong way your policy objectives, 1:10:39.180 --> 1:10:46.010 sometimes you'll be lucky and some mighty forces may come to 1:10:46.011 --> 1:10:50.991 your aid like what happened last Tuesday. 1:10:50.988 --> 1:10:57.628 You also need to be able to assure that you'll have proper 1:10:57.625 --> 1:11:01.345 implementation of your policy. 1:11:01.350 --> 1:11:06.230 If implementation goes awry, then everything that you were 1:11:06.230 --> 1:11:08.630 trying to do will go awry. 1:11:08.630 --> 1:11:11.950 It's not enough to put the policy in place, 1:11:11.948 --> 1:11:16.528 but the implementation of the policy is of great matter. 1:11:16.529 --> 1:11:21.469 And lastly, you need to remember that you're going to 1:11:21.472 --> 1:11:24.422 have to evaluate your policy. 1:11:24.420 --> 1:11:26.990 You should plan on that from the beginning. 1:11:26.988 --> 1:11:28.668 You should have unbiased evaluators, 1:11:28.670 --> 1:11:33.270 you should evaluate both process and outcome--you can 1:11:33.268 --> 1:11:38.568 learn about those when you come to Hopkins--and based on your 1:11:38.573 --> 1:11:43.523 evaluation you also should ultimately revise your initial 1:11:43.524 --> 1:11:47.244 strategies or your initial policies. 1:11:47.238 --> 1:11:56.038 Here you have a number of different ways of thinking 1:11:56.037 --> 1:11:59.217 about, as public health people tend to 1:11:59.216 --> 1:12:01.146 do, of thinking about how do I 1:12:01.145 --> 1:12:04.525 formulate policies, how do I choose among competing 1:12:04.527 --> 1:12:07.637 policies, how do I get policy put in 1:12:07.637 --> 1:12:10.667 place, and implemented properly? 1:12:10.670 --> 1:12:15.020 We need to think about these things. 1:12:15.020 --> 1:12:18.110 We need to think about these things because we have so many 1:12:18.113 --> 1:12:18.703 problems. 1:12:18.698 --> 1:12:21.698 We don't only have the problem of childhood obesity, 1:12:21.698 --> 1:12:25.468 we have a problem of obesity in general at the same time that we 1:12:25.472 --> 1:12:28.492 have a problem of obesity, we have problems of 1:12:28.492 --> 1:12:30.992 undernutrition, we have problems of emerging 1:12:30.993 --> 1:12:33.463 infectious diseases, we have problems of violence. 1:12:33.460 --> 1:12:39.270 The world is beset with problems. 1:12:39.270 --> 1:12:43.820 What the world needs ultimately are public health heroes to 1:12:43.819 --> 1:12:45.779 address these problems. 1:12:45.779 --> 1:12:47.869 These problems can be solved. 1:12:47.868 --> 1:12:51.128 It takes long time to solve these problems, 1:12:51.130 --> 1:12:55.940 but they're not going to be solved without these kinds of 1:12:55.944 --> 1:13:00.934 public health heroes and those public health heroes I hope, 1:13:00.934 --> 1:13:02.314 will be you. 1:13:02.310 --> 1:13:03.770 Thank you very much. 1:13:03.770 --> 1:13:09.000