Public Health Issues


Smoking is one of the leading causes of death among smokers and the dangers to the health of secondhand smokers – those who live and work in close proximity to smokers -- is well established. States regulate tobacco sales and use and are active in controlling the use of tobacco aimed at reducing the known negative health outcomes from its use on the general public and smokers. States differ on the degree to which they have implemented smoking bans, in workplaces, restaurants, and on public transit and other enclosed, non-residential spaces. In the U.S., 27 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands, plus hundreds of cities and counties, have enacted comprehensive smoke-free laws covering workplaces, restaurants, and bars. The states are: Arizona, California, Colorado, Delaware, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington and Wisconsin. Another 3 states and Guam have enacted strong smoke-free laws covering all restaurants and bars: Connecticut, New Hampshire, and North Carolina. Hundreds of cities and counties across the country have also taken action.

Climate change has led to more extreme-weather days, increased the number and intensity of natural disasters, and changes in infectious disease patterns. Older adults, people with disabilities, people of color, people with low incomes, and people with chronic illnesses bear the greatest burden of disease and death related to climate change. Extremely hot and cold days, which are increasing because of climate change, can be lift-threatening for older adults. Older adults and people with disabilities also face greater challenges in evacuating safely during a natural disaster (see also Chapter 13, Livable Communities: Disaster Planning and Recovery).



Pollution control

Public agencies should take specific and effective steps to control all forms of pollution (including biological and chemical agents) that threaten health, safety, and quality of life.

Smoking bans

Federal and state governments should enact legislation banning smoking in nonresidential public buildings, on public transportation, and in restaurants.

Preference for allocating government revenues from tobacco company settlements should be given to programs designed to improve public health, including Medicaid and Medicare, antismoking and smoking-cessation programs, and efforts to expand access to long-term care and other health care services. Tobacco settlement funds should not replace existing federal or state funding in these areas.

To promote government accountability, states should develop a public process for deciding how tobacco settlement funds should be spent. Those expenditures should be disclosed annually. The information should be brought to the attention of the general public.

State governments should ensure that their public health infrastructures are adequate, strong, and sustainable over the long term before using tobacco settlement funds to balance state budgets.

Public health effects of climate change and extreme weather conditions

Policymakers should mitigate the immediate effects of climate change events on the health of older adults and other vulnerable populations. This includes ensuring affordable access to heating and cooling, particularly during extreme temperature days, which are more common because of climate change (see also Sustainable Energy).

During extreme weather or climate-related events, policymakers should:

  • provide immediate assistance to vulnerable populations, particularly those with chronic health conditions that are exacerbated by climate change; and
  • address the needs of people with disabilities, who may have greater difficulty evacuating or otherwise seeking aid during an emergency (see also Assistance Programs).

Policymakers should devise plans for the environmental, socioeconomic, and infrastructural impacts of climate change on the health of older adults and other vulnerable populations. Those plans should include ways to prevent and mitigate adverse impacts.

Federal, state, and local governments should work to mitigate the effects of climate change and extreme weather conditions by:

  • expanding (and simplifying) eligibility and increasing funding for weatherization programs and affordable energy programs including but not limited to the Low Income Energy Assistance Program (LIHEAP),
  • prioritizing home weatherization programs that target the medically frail,
  • identifying and implementing best practices for educating people about the risks,
  • facilitating weather protection and operating emergency alert systems, and
  • identifying and maintaining emergency locations for heating and cooling for displaced people in extreme weather.

To prevent and mitigate the potentially adverse health effects of climate change on older people, all levels of government should:

  • expand categorical eligibility for LIHEAP, weatherization services, and other affordable energy programs in order to target groups identified as most at risk of adverse health outcomes—possible participants can be identified through eligibility for state Medicaid waiver programs and the Medicare Part D Low-Income Subsidy or other programs (see also Affordability for details on Low Income Energy Assistance programs);
  • make referrals for LIHEAP, weatherization, and other affordable energy programs;
  • support education and outreach efforts to increase awareness about weatherization programs—both within the health care community and among older adults, their families, and caregivers—of resources that can help people maintain access to healthy and comfortable temperatures;
  • give priority to in-home repair or modification programs that serve medically frail participants (such as under a state Medicaid waiver) so they can have access to cost-effective energy efficiency measures that protect health and safety, such as special coatings for flat-roofed row houses that lower indoor temperatures in summer (see also Affordability for details on Low Income Home Energy Assistance programs); and
  • identify and implement best practices for communicating with the public—especially older adults, their families, and their caregivers—about the risks of heat waves and cold temperatures, links between temperature and health, and the most effective prevention, education, and response efforts.