Policy Review: Birmingham Bus Rapid Transit System

May 16, 2022 | Anushree Gade, LHC Intern

Introduction

Public transit has emerged as a vital public service. Metropolitan cities across the world feature a multitude of rapid transit systems (subways, trams, buses, etc.). Such systems are also present in several cities across the United States including New York, Boston, Chicago, and Atlanta. Public transit is a means by which people are given access to various other services and facilities near where they live. The availability of public transit, such as the rapid transit systems, ensures that individuals in the community have the means by which they can obtain the services and experiences they need to improve their health and health outcomes. For many, public transit ensures access to education, employment, health care, and more.¹ Therefore, an affordable and cost-effective form of public transportation is crucial for cities to consider.
While extensive light rail systems like those seen in Chicago and other large cities are too expensive for smaller cities, Bus Rapid Transit (BRT) offers such cities an opportunity to provide fast and reliable public transportation to their residents. BRT systems are defined as a “high-quality bus-based system that delivers fast, comfortable, cost-effective services at metro level capacities.”² BRT systems have lanes of their own to ensure the performance and delivery of the service. They usually also have priority at signals and their own platforms.³ These components ensure that the system is an efficient and cost-effective method of transportation.
Several cities in the U.S. have their own Bus Rapid Transit systems, with Albuquerque’s BRT, seen as the gold standard.⁴ Albuquerque’s system was implemented to address connectivity and traffic congestion in the city. This system involves separate lanes just for the buses, which are centered in the middle of the road and are given priority at the signals. There are stations at the platform level throughout the city. The City of Albuquerque has implemented a pilot program that started in January 2022 and lasts until December 31, 2022, in which there are no fees associated with utilizing the Albuquerque Rapid Transit (ART) and ABQ RIDE, their original bus transit system.⁵

Benefits and Costs of Public Transit

With the population of cities growing, vehicle congestion and emissions are two severe consequences of personal transportation. There are increased numbers of cars on the road in metro areas, causing traffic congestion that delays travel times and greater fuel consumption as a result. These issues, in turn, contribute to the emission of greenhouse gasses into the atmosphere. With the implementation of public transit systems, either bus or rail, a decrease in congestion and improved air quality can be observed. Furthermore, public transit systems can provide disadvantaged populations such as the elderly, low-income, and disabled with a means of accessible transportation. This ensures that everyone has the opportunity to engage within the community.
Public transit provides several benefits for citizens; however, it is also important to consider the setbacks associated with it. One of the challenges that accompany the implementation of a public transit system is meeting optimal ridership. In order for public transit systems to operate effectively, there must be a sufficient reliance on them. Such systems can serve large capacities; however, the number of people that utilize the services is only a small fraction.⁶ As of 2018, the census indicated that only two thousand people depended on public transit in Birmingham.⁷ This represents about 1.0% of Birmingham’s total population. The COVID-19 pandemic has proven to be a challenge for public transit systems as well. Ridership decreased 73% across all public transit systems as a result of the pandemic.⁸ Public transit involves extensive human-human interactions and can contribute to the spread of infectious diseases, thus the pandemic negatively impacts ridership.

BRT in Birmingham, AL

The city of Birmingham is one of the largest cities in the state with a population of 200,733 as of 2020.⁹ Birmingham spans 146.07 square miles in the center of Alabama. The Birmingham-Jefferson County Transit Authority (BJCTA) is the city’s publicly operated transit authority since 1972. The BJCTA organizes public transit services. Their main service, currently, is the MAX Transit services.
The MAX Direct is a feature of the MAX Transit services and is a micro-transit system that serves as the main form of public transportation in the city. As a micro-transit system, it is responsive to demand. The services are increased in areas with higher ridership density.¹⁰ The MAX Direct’s primary purpose is to provide transportation for commuters from the City of Mountain Brook and is an accessible transit option for people with disabilities. It travels around the city and provides transportation to the Birmingham Zoo, Bessemer, the Riverchase Galleria, and more significant Birmingham locations.¹¹
The municipality has made plans for Birmingham’s own Bus Rapid Transit system, known as the Birmingham Xpress or BX. This new system will provide better transit options for the 25 neighborhoods along its route and replace some MAX routes between those neighborhoods. The construction for BX began in December of 2020. Similar to the Albuquerque BRT system, BX will have dedicated bus lanes and signal priority at intersections and connect citizens to several significant employers across Birmingham including the University of Alabama at Birmingham (UAB), Brookwood Princeton Medical Center, and Integrated Medical Systems. The signal priority and dedicated lane features are currently lacking in the MAX system; with BRT features in place, BX will run more efficiently than MAX, incentivizing increased ridership.¹² Furthermore, Birmingham is hosting the 2022 World Games which will kick off on July 7th, 2022. This event has also seemed to have prompted the development of the BRT system.¹⁰ The construction of the BX is scheduled to be completed by July and before the World Games begin that same month.¹³
The existence of a transit system in Birmingham is integral to establishing and maintaining connectivity across the city and between neighborhoods. The Birmingham Xpress will enable residents to access healthcare, education, and employment. The transit system is expected to run through UAB, various health care facilities, and through the city itself where multiple large employers exist.
The Birmingham Xpress project was estimated to cost $58 million.¹⁴ The Birmingham City Council has had multiple items on its agenda relating to the BRT system. In March of 2021, the Council appropriated $9,037, 500 to the Birmingham Jefferson County Transit Authority (BJCTA) so that they can procure the buses for the BRT system.¹⁵ In August 2021, the Council provided the BJCTA with $5,000,000 for the BRT project. However, the exact reason for the funds was not mentioned.¹⁶ The Council also approved items involving the procurement of areas of land to build BRT platforms across the city.

Conclusion

Public transit is a crucial element in large metropolitan areas as it provides communities and neighborhoods with opportunities to connect with one another. Once the Birmingham Xpress starts to run, citizens will be able to easily access services. The BX will also provide more efficient transportation during the World Games. As Rio was confirmed to host the Olympics in 2016, they began work for their own Bus Rapid Transit. The public transit systems constructed in Rio served 2.2 million passengers during the Olympics alone and left a long-lasting impact on the city.¹⁷ Their public transit systems provided organized and efficient transportation that was otherwise lacking before the games. With the World Games approaching in Birmingham, the city’s public transit systems will be expected to see a marked increase in ridership.
Furthermore, the BX may also contribute to a decrease in missed medical appointments. A study that observed the effects of a new light rail line on the number of no-show appointments revealed that there is a correlation between public transit and the number of no-show appointments. Specifically, the analysis indicated that public transit systems contribute to a decrease in the number of missed medical appointments.¹⁸ As seen in this study, it can be expected that the BX will have a similar impact as it provides a connection to several medical facilities such as UAB and Brookwood Princeton Medical Center. Overall, the BX will play a vital role in improving Birmingham’s neighborhood connectivity and contributing to the city’s economic development.

References

Wright L. Bus rapid transit. discovery.ucl.ac.uk. Published 2002. Accessed April 05, 2022. https://discovery.ucl.ac.uk/id/eprint/112/1/BRT_e-book.pdf.
Institute for Transportation and Development Policy. What is BRT?. itdp.org. Date unknown. Accessed April 05, 2022. https://www.itdp.org/library/standards-and-guides/the-bus-rapid-transit-standard/what-is-brt/.
Raleigh. What is bus rapid transit (BRT). Updated February 10, 2022. Accessed April 05, 2022. raleighnc.gov. https://raleighnc.gov/services/transit-streets-and-sidewalks/what-bus-rapid-transit-brt.
Institute for Transportation and Development Policy. Albuquerque, NM opens first USA gold standard BRT on historic route 66. itdp.org. Published November 27, 2017. Accessed April 6, 2022. https://www.itdp.org/2017/11/27/albuquerque-gold-standard-brt/.
City of Albuquerque. Zero fares pilot program. cabq.gov. Date Unkown. Accessed April 06, 2022. https://www.cabq.gov/transit/tickets-passes.
Gershon RRM. Public transportation: advantages and challenges. Journal of Urban Health. 2005; 82(1), 10.1093/jurban/jti003.
Liberation. Birmingham, AL: a victory for public transit. liberationnews.org. Published September 30, 2018. Accessed April 11, 2022. https://www.liberationnews.org/birmingham-al-a-victory-for-public-transit/.
Qi Y, Liu J, Tao T, Zhao Q. Impacts of COVID-19 on public transit ridership. International Journal of Transportation Science and Technology. 2021. https://doi.org/10.1016/j.ijtst.2021.11.003. Accessed April 13, 2022.
United States Census Bureau. Quick facts Birmingham city, Alabama. census.gov. Date unknown. Accessed April 14, 2022. https://www.census.gov/quickfacts/birminghamcityalabama.
Birmingham Times. MAX transit announces changes as the World Games 2022 nears. birminghamtimes.com. Published July 13, 2021. Accessed April 15, 2022. https://www.birminghamtimes.com/2021/07/max-transit-announces-changes-as-the-world-games-2022-nears/.
MAX Transit. Routes. maxtransit.org. Date unknown. Accessed April 13, 2022. https://maxtransit.org/routes/.
Birmingham City Council. Birmingham Xpress. birminghamal.gov. Date unknown. Accessed April 13, 2022. https://www.birminghamal.gov/brt.
WVTM 13. Birmingham Xpress construction almost complete. wvtm13.com. Date unknown. Accessed April 17, 2022. https://www.wvtm13.com/article/new-route-connects-five-points-west-with-woodlawn/39719728#.
Birmingham Times. MAX gets new leader as city council adds cash for bus rapid transit. Birminghamtimes.com. Published September 2, 2021. Accessed April 15, 2022. https://www.birminghamtimes.com/2021/09/max-gets-new-leader-as-city-council-adds-cash-for-bus-rapid-transit/.
Birmingham City Council. Summary of virtual pre-council meeting of the council of the city of Birmingham. Date unknown. Accessed April 6, 2022. https://docs.google.com/gview?url=https%3A%2F%2Fbhamal.granicus.com%2FDocumentViewer.php%3Ffile%3Dbhamal_32833bd813674f9eb079b619e2c6aaa4.pdf%26view%3D1&embedded=true.
Birmingham City Council. Regular meeting of the council. Date unknown. Accessed April 6, 2022. https://docs.google.com/gview?url=https%3A%2F%2Fbhamal.granicus.com%2FDocumentViewer.php%3Ffile%3Dbhamal_6d10040ec350872ae5d525f405389c3d.pdf%26view%3D1&embedded=true.
International Olympic Committee. Olympic games transport Rio to a new level. olympics.com. Published August 14, 2017. Accessed April 17, 2022. https://olympics.com/ioc/news/olympic-games-transport-rio-to-a-new-level.
Smith LB, Yang Z, Golberstein E, Huckfeldt P. The effect of a public transportation expansion on no-show appointments. Health Services Research. 2021. https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13899. Accessed April 17, 2022.

Local Initiatives to Reduce Food Insecurity in Birmingham Communities

November 22, 2021 | Kimberly Randall, LHC Program Coordinator

Food bank — Photo Courtesy of Getty Images | 2020

2021 marked the 80th anniversary of President Franklin D. Roosevelt’s Four Freedoms: Religion, speech, want, and fear. While religion and speech are constitutionally protected, many families in the Birmingham metropolitan area regularly suffer from food insecurity and are unable to provide for themselves and their families. The pandemic has worsened food insecurity nationwide, with food banks reporting 55% more people going to food banks, according to Feeding America. The US Department of Agriculture officially defines food insecurity as “a lack of consistent access to enough food for an active, healthy life” and affects an average of 1 in 8 Americans.

With Thanksgiving approaching, many families will turn to non-profit and charity organizations to access a holiday meal and offers an opportunity to evaluate the causes, effects, and resources related to food insecurity.

What causes food insecurity?

Food insecurity is differentiated by low and very-low access to nutritious food on a stable basis. 2008 saw a substantial jump in the number of families experiencing food insecurity with approximately 22% of children claiming food insecurity of some kind. While there are several nuances in terms of how families can become food insecure, the root of all food insecurity comes from financial instability. Geographical regions, such as the rural south, see higher numbers of impoverished families and, correspondingly, a higher number of families and individuals applying for food assistance.

However, wages alone aren’t the only deciding factor. One major issue with food insecure individuals comes with the lack of nutrition available in affordable food options. According to the USDA, fresh foods have seen an exponentially higher increase in cost compared to less nutritious alternatives. Between 1985 and 2000 a study found that “the retail price of carbonated soft drinks rose by 20%, the prices of fats and oils by 35%, and those of sugars and sweets by 46%, as compared with a 118% increase in the retail price of fresh fruits and vegetables.” Consequently, households often choose to purchase higher calorie, less nutritionally dense foods that are highly processed.

Additionally, a policy research report commissioned by The Future of Children determined that non-income factors can influence food insecurity, such as a caretaker’s poor mental and physical health. The report states that “children living with a disabled adult are three times as likely to experience very-low food insecurity” compared to children with similar income levels who are not living with a disabled adult.

What are the long-term impacts of food insecurity?

According to Feeding America, hunger and health are very closely related. A 20140 study found that food insecurity can increase the likelihood of chronic conditions such as diabetes, hypertension, and obesity (Seligman and Schillinger, 2010), ultimately leading to a cycle of higher healthcare expenditures and reducing income even further. It is estimated that food-insecure households account for nearly $60 billion in healthcare costs annually. Additionally, many families have to choose between many other necessities such as utilities in order to provide food.

In addition to the health disadvantages of food insecurity, food-insecure children and teens see a direct impact on their education. Research shows that food insecurity prevents youth from fully participating in social and school settings and have difficulty engaging in daily activities, assignments, and social interactions during school while also having greater difficulty in creating peer relationships. According to No Kid Hungry, by the time most food-insecure children reach high school, they are twice as likely to have been diagnosed with a mental health problem such as depression, anxiety, and behavioral problems by a psychologist and are significantly more likely to have been suspended from school. With all other factors accounted for, food insecurity also decreases a child’s chances of graduating from high school, ultimately affecting their income-earning ability later in life and continuing the poverty cycle.

What can be done about food insecurity?

Solving or mediating food insecurity has been a priority for many organizations and policymakers for years. The child tax credit, a part of the American Rescue Plan, was partially intended to reduce food insecurity by providing extra income to families. According to the Household Pulse Survey, an experimental tool utilized by the US Census Bureau to evaluate the economic and social impacts of the pandemic, there was a 3-point drop in the number of households with children reporting food insecurity from 11% to 8.4%.

Future policy changes are possible as well. Lawmakers have declared their intention to make the child tax credit a permanent fixture in the Internal Revenue Code, as well as expanding SNAP (Supplemental Nutrition Assistance Program) benefits by 15%. However, community organizations are often the first point of contact for individuals experiencing food insecurity.

Currently, there are eight food banks in the state of Alabama with one, the Community Food Bank of West Alabama, serving the Birmingham Metro. Operating primarily as a food distribution center, the Food Bank purchases food through industry connections and distributes it to a series of community agencies, over 250 of them, to be administered to local individuals and families in need. Information regarding food distribution events can be found on the Community Food Bank of West Alabama’s website. Information regarding volunteer opportunities, events, and a donation page can be found here.

Recently re-opened Blazer Kitchen, operated on UAB’s campus, provides resources for students experiencing food insecurity. In order to abide by COVID-19 regulations, the center is offering online appointment timesfor students and employees to collect pre-packaged parcels of food. Blazer Kitchen operates out of the Hill Student Center and the 1613 Building. A donation portal, volunteer opportunities, and more information can be found on the official Blazer Kitchen website.

Food banks and local pantries are integral toward mitigating food insecurity in communities and are considered the first line of defense in the fight against hunger. According to the University of Vermont, 85% of food pantry users reported a good or very good experience with them. While some individuals surveyed complained of the long lines and limited selection, the overwhelming majority stated that they were positively impacted by food banks. Food banks are vital to improving food security in communities.

Policy Watch: Top Public Health Issues in the 2022 Alabama Legislative Session

February 7, 2022 | Kimberly Randall, LHC Program Coordinator

Montgomery Capital Sign

Montgomery CapitalPhoto Courtesy of Getty Images

Legislatures have spoken about various agendas, and points of interest as the Alabama House of Representatives and Senate reconvene for the official 2022 session. The Alabama House Republican Caucus has dubbed its plan “Standing Tall for Alabama” and includes legislation banning Critical Race Theory, allowing concealed weapons to be carried without a permit, and increasing technology access to rural areas of the state. Meanwhile, state democratic lawmakers have declared that social issues such as reducing or eliminating grocery sales tax, expanding Medicaid, and prison reform to be their top priorities. Here is a look at the leading public health issues expected to come up for debate over the next few months and the corresponding bills filed in the Alabama legislative directory.

Infrastructure

Infrastructure packages have been proposed at nearly every level of government over the last year. H.R.3684 – the Infrastructure Investment and Jobs Act passed through the US Congress in November, authorizing $65 billion to improve passenger railways, rebuild or repair roads and bridges, upgrade airports and improve public transportation in various metro areas across the country. Alabama seems to be following in the trend, as HB1 advocates the use of $225,000,000 to “improve access to clean water to the citizens of Alabama through investments in water and sewer infrastructure projects.”

The bill allocates:

Up to $120,000,000 in water and sewer systems grants for emergency or high need projects previously identified for participation in the Clean Water State Revolving Fund or the Drinking Water State Revolving Fund.
Up to $100,000,000 in matching grants to public water and sewer systems for water or sewer infrastructure projects.
Up to $5,000,000 provided as grants to install clustered decentralized wastewater system demonstrations utilizations utilizing a collection system known as Septic Tank Effluent Pump (STEP) or other demonstration systems in the Alabama Black Belt areas of low population density, rural poverty, and/or soils with poor perc characteristics, where there is a finding of discharge of raw sewage onto the ground due to the utilization of straight pipes, failing septic systems, or similar circumstances.

In addition to the improvements to water and sewer systems, the bill also allocates $85 million for statewide improvements to broadband internet access, particularly in rural communities. The Federal Communications Commission found that while broadband service is accessible to roughly 75% of the state’s population, some rural areas, such as Greene County, had fewer than 2% of residents subscribed to the service. According to SpeedMatters.org, high-speed internet access in rural communities is vital to economic growth and development in these areas. Additionally, as more services such as telehealth and online pharmacies become more prevalent, broadband internet can impact the healthcare of rural citizens.

Gender-Affirming Medical Treatment

In 2021, the Alabama Senate passed SB10, also called the Vulnerable Child Compassion and Protection Act, which made the administration of gender-affirming medical treatment a felony in Alabama. At the time, the Southern Poverty Law Center released a statement in opposition to the bill:

“We are disappointed that, despite reservations expressed by committee members, House Bill 1 is moving forward, particularly after the heart-wrenching testimony during last week’s public hearing by Sgt. David Fuller. This legislation disregards the medical needs of transgender children and the hard choices that their families make in their best interest. It would criminalize the very doctors that so many families turn to in their times of need. The last place for governmental overreach is at the bridge of personal medical decisions and the advice of trained professionals.”

While SB10-2021 ultimately never went to a vote in the house, failing, similar legislation has been proposed this year as HB150 was filed by Representative Wes Allen and SB5 was filed by Senator Shelnutt.

Did you know: The Lister Hill Center published a testimonial from a UAB student on SB10. Read it here.

The bill works to “prohibit the performance of a medical procedure or the prescription or issuance of medication, upon or to a minor child, that is intended to alter the appearance of the minor child’s gender or delay puberty … [and] establish criminal penalties for violations.”

Prison Reform

Following a special session in October 2021, critical pieces of legislation were passed to address prison reform. Overcrowding, a significant contributor to the spread of COVID-19 in prison systems, inspired a bill that funded the construction of new prison facilities. Additionally, legislation was passed that retroactively applied a mandated probationary period to individuals sentenced before 2015. However, in the 2022 general session, SB87 has been filed in the general session, which looks to roll back some of the granted probation initiatives.

The legislation reads: “Under existing law, certain prisoners in the physical custody of the Department of Corrections are eligible for correctional incentive time. This bill would provide that any person who enters into a plea agreement would not be eligible for correctional incentive time.”

The United States legal system has come underfire in recent years for a trend referred to as “coercive plea bargaining,” where prosecutors can use a wide variety of techniques to convince defendants to accept a guilty plea rather than going to trial. According to a report by the Pew Research Center, over 90% of convictions at the state level come from a plea rather than a jury, even though trial by jury is a constitutionally protected right. While it has not been passed, SB87 could remove the protections granted in the special session last year related to the mandated probationary period to those who plead guilty, a large percentage of current inmates in the Alabama Department of Corrections.

HB28 looks to approach prison reform from a different angle. Pre-filed by Representatives Hollis and Hall, the bill offers protections for women who are pregnant or up to six weeks postpartum who are incarcerated. The legislation reads:

“This bill would provide for prohibited practices relating to a pregnant female inmate or a female inmate who is in the immediate postpartum period. This bill would also specifically prohibit certain actions relating to strip searches, restraints, examinations, labor and delivery, solitary confinement, and transfer.”

Specifically, the bill details specific instances in which pregnant or postpartum women would or would not be restrained through the use of wrist cuffs or placed in solitary confinement. The ACLU has declared that ending the shackling of pregnant inmates is a priority in the coming year. The United States is the only remaining industrialized nation to partake in this practice due to the abundance of evidence pointing to the mental and physical health implications to both the mother and child.

Health Insurance Reform

Healthcare and insurance reform have been a growing state and national politics trend. The Department of Health and Human Services enacted new federal guidelines on “surprise” hospital bills effective January 1, 2022. The new rules work to shield Americans from unexpected bills from an out-of-network provider, out-of-network facility, or out-of-network air ambulance provider. However, legislation has been proposed at the state level to help patients receive the proper medical treatment approvals from their insurance providers. SB27, proposed by Senator Butler, enacts a timeline for insurance providers to approve or deny a request for prescription drug coverage. The legislation reads:

“This bill would require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, within three business days of receiving a request for insurance coverage of a prescription drug benefit, that the request is approved, denied, or requires supplemental documentation. This bill would also require a health insurer to communicate to a physician or other health care professional with authority to prescribe drugs, regarding the approval or denial of the request, within three business days of receiving sufficient supplemental documentation.”

This legislation will work to streamline the authorization process in Alabama, hopefully increasing the speed at which patients receive their medications. According to a report by HPI, 66% of first-time prescriptions are rejected at pharmacies due to required authorizations, causing a bureaucratic battle for patients who may be waiting for weeks. Only 29% of patients end up with their initially prescribed medication when authorizations are required.

Policy Surveillance and Public Health

September 21, 2021 by Anushree Gade, LHC Student Assistant & Summer 2021 MPH Intern

Click here for a PDF version of this literature review

Introduction

Stethescope i the shape of scales of justice — Photo Courtesy of Getty Images

The field of public health aims to enhance and protect the health of individuals and the communities that those individuals are a part of (American Public Health Association [APHA], n.d.). The three core functions of Public Health include assessment, policy development, and assurance (Centers for Disease Control and Prevention [CDC], 2021). These core functions are broad categories that encompass the ten essential functions of public health. In recent times, policy surveillance has become a popular tool to assess and monitor policies and programs created by various levels of government and their effects on public health. Policy surveillance is defined as the “systematic, scientific collection and analysis of laws of public health significance” (Temple University Center for Public Health Law Research, n.d.).

Ongoing research, collection, and evaluation of laws relative to public health serve to identify trends and gaps in laws and how they impact the health of individuals and populations. Policy surveillance further promotes accurate evaluations of public health programs and enables accurate judgments on the viability of prevention measures that can be implemented. Policy surveillance also aligns itself with the three core functions of public health as it aids with assessment, policy development, and assurance. This literature review examines the implementation, outcomes, and impacts of various public health policy surveillance initiatives. Additionally, this literature review further discusses the magnitude of scholarship available regarding public health policy surveillance and its results.

Methods

The amount of literature available on each of the policy surveillance programs identified varied. The Public Health Law Research (PHLR) program has numerous papers published regarding the initiative itself and its contribution to policy surveillance. Similarly, the CDC’s Public Health Law Program (PHLP) has a significant amount of literature discussing their program available. The most comprehensive papers regarding both of these programs were published by Temple University’s Beasley School of Law due to its involvement with the PHLR program. Furthermore, both PHLR and PHLP were extensively used for various research purposes. Though their databases were not as frequently used as the ones mentioned previously, the Alcohol Policy Information System (APIS), State Tobacco Activities Tracking and Evaluation (STATE) system, and the Classification of Laws Associated with School Students (CLASS) databases were also employed to aid with advances in research.

Upon reviewing literature regarding policy surveillance initiatives, there seems to be a lack of literature surrounding the various initiatives covered in this literature review. Publications out of Temple University on PHLR and PHLP served as the primary sources of information. The author utilized Google Scholar to identify literature around these initiatives; initially, databases such as PubMed, Embase, and others failed to find literature related to policy surveillance initiatives. Various keywords were utilized to search through the databases, including “policy surveillance initiatives,” “policy surveillance programs,” “policy surveillance,” “LawAtlas,” “MonQcle,” “Temple University Beasley School of Law Public Health Law Research Program,” “Public Health Law Research Program,” “Public Health Law Program,” “APIS,” “STATE.” The databases did not yield any results to these keywords. Google Scholar, a search engine, efficiently identified scholarly articles related to the keywords used.

Overview of Policy Surveillance Initiatives

The Public Health Law Research Program (PHLR)

Founded by the Robert Wood Johnson Foundation (RWJF) and Temple University’s Beasley School of Law in 2009, the Public Health Law Research Program (PHLR) strives to establish policy surveillance as a scientific method for evaluating the impacts of laws on public health. Temple University provides technical and directional assistance to the PHLR program (Presley et al., 2015). Though it was not the first policy surveillance initiative, PHLR was the first to establish policy surveillance as a scientific study on the health impacts of laws. (Burris et al., 2016). The PHLR initiative identified which types of policies should be investigated concerning the topic of interest.

Did you know?

Health policy goes far beyond pharmecuticals or procedures. Health policy research has influenced recent legislature on evictions, paid time off for employees, and even taxes!

Check out these examples:

Evictions and Health
Promoting Health and Cost Control in States
Earned Income Tax Credit Laws

Furthermore, they established specific inclusion and exclusion criteria, described the laws and who they targeted, and established a search methodology (Burris et al., 2016). Due to a large amount of policy surveillance being conducted on various public health topics, PHLR developed LawAtlas, a software system designated to help with the dissemination of public health law research. LawAtlas provides the public with access to “Interactive Law Maps” as well as databases, codebooks, and protocols. Legal researchers at the Temple University Beasley School of Law manage LawAtlas and have developed similar software, MonQcle (Temple University Center for Public Health Law Research, 2012). MonQcle differs from LawAtlas in that it was created for more precise tracking of laws at various levels (local, state, national) on an international scale.

Furthermore, MonQcle allows researchers to edit, update, and share their research through the software system (Temple University Center for Public Health Law Research, n.d.). A significant amount of public health research has been conducted using LawAtlas and MonQcle; these software systems contain databases of various topics that greatly assist researchers. Using LawAtlas, two researchers identified differences in state laws regarding access, safety, and dispensing of medical marijuana. The study concluded that the effectiveness of the federal ban on marijuana is unknown (Klieger et al., 2017). The two software systems were additionally utilized to research Type 2 Diabetes, drugs and alcohol, youth sports concussion, distracted driving, and more.

CDC’s Public Health Law Program (PHLP)

The Center for Disease Control and Prevention’s (CDC) Public Health Law Program (PHLP), launched in 2000, is one of the first policy surveillance initiatives. One of PHLP’s goals is to stimulate extensive legal research on the impacts of laws on public health; additionally, it strives to disseminate public health law research to various professional communities. PHLP essentially focuses on taking a law-based approach to address multiple public health outcomes (Goodman et al., 2006). As the PHLP got involved in other projects, it magnanimously contributed to further establishing policy surveillance as a scientific approach to studying the impacts of laws on public health (Presley et al., 2015). The CDC PHLP has been conducting legal research on “electronic health information, prescription drug abuse, and state coroner/medical examiner systems” (Burris et al., 2016). Additionally, the CDC has also contributed to determining criteria, competencies, and methods for policy surveillance.

Other Policy Surveillance Initiatives: STATE, APIS, and CLASS

The CDC launched the State Tobacco Activities Tracking and Evaluation (STATE) system. Its purpose is to initiate research on state tobacco policies while also promoting awareness of tobacco policies. The STATE system, an application created by the CDC, contained a database with information similar to what was written in the CDC’s State Tobacco Control Highlights (1996). When it was initially launched, it lacked depth; however, a 2004 update and redesign of the STATE system included more detail on state laws regarding tobacco. The system became more interactive for users after the redesign (Burris et al., 2016). Data from the STATE system was further used to study state laws directed towards selling tobacco to minors and using electronic nicotine delivery systems (i.e. vape, hookah, e-cigarettes, etc.) indoors (Marynak et al., 2014).

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) launched the Alcohol Policy Information System (APIS). This initiative aims to measure the impact of public policies on alcohol-related behaviors and develop a resource that promotes additional scientific endeavors regarding the effects of alcohol-related policies (Bloss, 2011). APIS launched its first public website in 2003 (Burris et al., 2016). Furthermore, the National Cancer Institute’s Classification of Laws Associated with School Students (CLASS) is an example of another policy surveillance initiative; it exclusively focuses on examining how state laws regarding school physical education and nutrition impact student health. They evaluate the impacts of these laws by observing student’s body mass index (BMI), their activity levels, and food choices (“About CLASS,” n.d.).

Commonalities and Differences Between the Policy Surveillance Initiatives

Each of the policy surveillance initiatives discussed possess databases that are downloadable for users. The Robert Wood Johnson Foundation’s Public Health Law Research (PHLR) program has databases on policies encompassing various topics. The PHLR is unique because they utilize two software systems, LawAtlas and MonQcle, to publicize the databases and provide an interactive experience for users. Other policy surveillance initiatives have downloadable databases; however, unlike PHLR, they did not develop their software systems. Furthermore, APIS, STATE, and CLASS focus primarily on state-level policies. By monitoring relevant policies at the state level, these programs more effectively determine the impacts of policies on target areas. The PHLR program encompasses laws at local, state, and federal levels. This allows for comparisons of policies between different countries.

Moreover, each policy surveillance initiative differs in terms of its methods for policy surveillance and their purposes. Each of them has different topics that they focus on. For example, APIS focuses on alcohol-related laws, STATE focuses on tobacco-related laws, and CLASS looks at nutrition and physical education laws for schools. PHLR and PHLP are broader in terms of what they focus on compared to APIS, STATE, and CLASS.

Heads Up!
The Lister Hill Center for Health Policy teamed up with the Office of Public Health Practice to implement a policy surveillance project of our own. We’ve been tracking municipal-level policies, programs, and initiatives since October 2019 and will publish our database soon! If you’re interested in getting involved, email us at lhc@uab.edu

Conclusion/Discussion

Policy surveillance is becoming an increasingly important practice in public health as professionals have come to realize the magnitude of impact laws have on the lives of individuals and communities. It is critical for public health professionals to understand the details of that magnitude. Furthermore, laws can also be implemented to prevent and address health issues. Understanding and monitoring policies at the local, state, and federal levels will allow professionals to identify which laws would be essential to promoting public health.

Though policy surveillance is becoming increasingly common in the recent decades through various initiatives, there is limited information on the specifics of these initiatives (i.e., methods, database organization, contributions to policy creation). There is a lack of recognition of the gift of policy surveillance to policy development; this is most likely attributable to the fact that policy surveillance is only a recently emerging practice. However, policy surveillance continues to be used as a tool to identify and fill gaps in policies that can further contribute to enhancing public health outcomes and initiatives.

Get Informed:

Want to know more? Here are a few of our favorite social media accounts you can follow to get the latest updates.

Get Involved:

Health policy changes happen all the time! If you want to get involved in local policy changes, keep an eye on the Birmingham City Council agendas, minutes, and recordings can be found here: https://www.birminghamalcitycouncil.org/council-meeting-video-archives/

A full list of references is available in the PDF version of this literature review.

Birmingham Policy Surveillance Initiative

February 28, 2020, by Tessa Graham (Program Coordinator II, Office of Public Health Practice) and Sean McMahon (LHC Outreach Coordinator)

Two Ambitious Projects…

Policy Surveillance Project

While much public health policy is enacted at the state or federal level, US cities play a crucial role in implementing programs and polices that impact population health. Despite playing this role, there are few systems that track and seek to understand practices at this level. In 2017, the Urban Health Collaborative at the Drexel University Dornsife School of Public Health initiated a Policy Surveillance Project (UHC PSP) that focused on urban centers with active policy debate.

Drexel Live HealthSmart

Live HealthSmart Alabama

According to America’s Health Rankings, Alabama ranks 46th in obesity, 48th in diabetes, and 49th in high blood pressure, among other poor health ranking metrics. This was the impetus for the winner of UAB’s Grand Challenge: Live HealthSmart Alabama. This initiative, led by Dr. Mona Fouad (Director, Minority Health & Health Disparities Research Center), works “with businesses, schools, faith-based organizations, and non-profits in order to make changes to policies, systems, and build environment impacting the health of Alabamians.” Dr. Lisa McCormick (Associate Dean of Public Health Practice, UAB School of Public Health) is a collaborator on the Live HealthSmart team and assists them in their goals of transforming Alabama’s health and moving us out of the bottom ten in national health rankings. Live HealthSmart has chosen a team of collaborators from disciplines all across campus, allowing them to assess complex factors detrimental to the health of Alabamians.