States' Voters Resolved Wide Range of Public Health Issues


BOSTON — Voters in several states made their voices heard last month on public health issues ranging from smoking bans to restrictions on abortion to the minimum wage.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA). The following is a sample of the some of the issues that appeared on the ballot on Nov. 7:

Reproductive Health

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban that was passed by the South Dakota legislature earlier this year.

The controversial South Dakota law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where the abortion is necessary to preserve the woman's health or in cases of rape or incest. After the law was signed by the governor earlier this year, opponents began a petition to force the issue onto the November ballot. If voters had approved the ballot measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by the voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the life or health of the woman.

In Oregon and California, voters rejected measures that would have required physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state's constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. This is not the first time that California voters have dealt with this issue. Last year they defeated the same measure in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board. “Good family communication unfortunately cannot be imposed by the government,” she said.

Smoking Restrictions

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed statewide smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax increases while California and Missouri rejected them.

“I think the United States has made great progress,” said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University in Baltimore.

Social norms around smoking are starting to change but that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs.

Despite the number of states moving toward smoking bans, Ms. Stillman does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country. “They can't be everywhere at once,” she said.

If there is a single effort at the federal level it should be for the Food and Drug Administration to regulate tobacco, said Dr. Georges Benjamin, executive director of the APHA.

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act, which prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The proposition also imposes an increase on cigarette taxes.

Arizona voters also passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products. The voters also rejected a ballot initiative that prohibited smoking in many public places but would have exempted bars and parts of restaurants that have a separate ventilation system.

Nevada voters passed a ballot question to ban smoking in a number of indoor areas including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants. Exceptions include stand-alone bars, casinos, strip clubs or brothels, and retail tobacco stores. This initiative allows cities and towns to adopt stricter laws.

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