Courting Health

In 1978, Stephen Teret was a trial lawyer turned MPH student when he first thought of using litigation to advance public health. He explored the idea in a paper for an injury prevention course taught by Health Policy and Management (HPM) professor and injury expert Sue Baker, MPH ’68. The published paper was the first in a series of reports connecting litigation and public health. In a provocative article for a trial lawyers’ magazine, Teret suggested that carmakers be held liable for failing to offer airbags as a safety option. Litigators eagerly took up the idea. By 1985, Ford Motor Company, facing $1.1 billion in airbag litigation claims, began offering airbags in cars.

Teret, JD, MPH ’79, has pursued the integration of public health and the law ever since. Now he’s launching the Johns Hopkins Clinic in Public Health Law and Policy, a first-of-its-kind initiative to teach students to use the law to solve public health problems. “I would hope that in years to come, all schools of public health develop similar clinics and that ours will be seen as the prototype,” says Teret, an HPM professor. He spoke this summer with writer Jackie Powder about the emerging discipline and his hopes for the new clinic.

How did the field develop after the airbag litigation?

We thought, here’s an example of where litigation actually seemed to be successful in changing the behavior of product manufacturers. We then expanded that to deal with litigation involving guns, and litigation involving other consumer products. With guns, we encouraged lawyers to sue gun makers for failing to use existing safety technologies that could prevent some shootings. Another example would be litigation against the maker of an outboard engine for a boat for failing to place a guard around the propeller. It’s work that was done at this School that developed the idea of using litigation as a tool to protect the public’s health and safety.

Is public health law a growth area within the legal arena?

There are a lot of people now who are interested in public health law, much more than there were 10, 20 or certainly 30 years ago. It’s a growth area in that foundations now are supporting work in public health law. For instance, the Robert Wood Johnson Foundation, one of the largest foundations with regard to health issues, has invested a great deal of money in the last few years in enhancing the quality of public health law and increasing the human capital, people who are working in public health law. Lawyers may not be the first group of people that one thinks about when one is thinking about public health, but now there’s widespread acceptance of the value of public health litigation as one of the most potent tools for enhancing the public’s health.

What’s the idea behind the new clinic?

When I graduated from this school a very long time ago, I didn’t really know well enough how I could solve actual public health problems in a practical way, and I think it’s still true for some students today. They’ve learned a lot about key elements of public health—epidemiology, biostatistics, health policy, health behavior, biological sciences—but they haven’t necessarily learned how to go out and solve a public health problem. We’ll present students with a public health problem and they’ll bring together what they’ve learned to actually solve it by the use of law and policy.

But to be effective in public health law, students would need a law degree, wouldn’t they?

No. Students don’t need a law degree. Students in the clinic are going to be fortunate in that they will have at least six faculty members working with them, all of whom have law degrees as well as an understanding of public health. The faculty will help with technical legal issues, although we hope that some of our students who are either lawyers getting their MPH degree or in a JD/MPH joint degree program will also participate and help their colleagues to understand how the law can be used as a tool in public health. 

Why did you select salt consumption as the clinic’s first issue?

It’s a compelling public health problem for which there is not a solution immediately in sight. Working on salt consumption will present our students with a problem that has interdisciplinary aspects to it—the biology of how the body deals with sodium, the epidemiology and the costs of hypertensive disease, the behaviors of individuals regarding sodium consumption and the behaviors of businesses that make and market foods.

Most of the salt that people get is not from a saltshaker. It’s the salt that’s already in prepared foods at restaurants and supermarkets. You can go to a fast food or chain restaurant and order a meal that may give you 7,500 mg of sodium (one of the elements of salt)—multiple times the recommended daily dietary allowance of sodium—and there’s no law or regulation that requires the restaurant to give you a warning that you might be placing yourself at risk: “Before you eat that, watch out, you’re getting 7,500 milligrams of sodium.”

What legal and policy solutions might the students propose for dealing with this issue?

They might decide that a regulatory agency like a health department should require restaurants to post how much sodium is in a given menu item, and write up a model regulation. They might draft model legislation that sets limits on how much salt is permissible in foods. If they think that litigation is going to be the most effective tool, then they could write up the documents necessary for the commencement of a lawsuit. We want our proposed solutions to actually be implemented, so, ultimately, we’ll work with legislators, regulators, litigators and other policy people to see how what we’ve developed can be used to address a problem that is estimated to cause 150,000 excess deaths a year in the U.S. from hypertension and related diseases.

What will determine whether the clinic is a success?

We have a wonderful group of dedicated public health lawyers who are all excited to teach in the clinic, and we have the best public health students in the world. I don’t foresee any barriers to success.