ABSTRACT

This case takes students behind the scenes in the world of public health policymaking. Students follow the New York City Department of Health and Mental Hygiene, and the process it went through to craft a policy to reduce public consumption of trans fats in restaurants. In 2005, the department’s Bureau of Chronic Disease Prevention and Control elected after considerable internal negotiations to launch a public awareness campaign aimed equally at consumers, restaurants and their suppliers. But after a year, the awareness campaign had not budged the rate of trans fat use in restaurants. In 2006, the department decided to resort to regulation, despite the risks of triggering protests of a “nanny state,” not to mention pushback from industry. Staff have to craft regulations that treat restaurants fairly, while still obtaining the desired reduction in public trans fat consumption.

Use this case to promote student discussion about the compromises required between scientific evidence and political realities. Dr. Lynn Silver, who led the trans fat campaign, has to consider what is affordable, feasible and sensible before embarking on a campaign that can be expected to attract criticism as well as support. Students begin to understand the complexities of operating in the public sector, as well as the tools that a public health official has at his/her disposal. They can debate whether trans fats are the best subject for a public health campaign; whether the department has the capacity to monitor either a voluntary or regulatory restriction of trans fats; and how much effect this can be expected to have on cardiac disease in New York City. You might ask students to draft their own set of regulations, taking into account the science on trans fats, their use in the restaurant industry, and the likely reaction from constituents.

The case is suitable for courses/classes about public health policy, public awareness campaigns, or regulating public health.