BILL ANALYSIS                                                                                                                                                                                                    Ó






                              SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       SB 747
          AUTHOR:        DeSaulnier
          AMENDED:       January 6, 2014
          HEARING DATE:  January 15, 2014
          CONSULTANT:    Diaz

           SUBJECT  :  Public Health Impact Assessments.
           
          SUMMARY  :  Permits the California Department of Public Health, if  
          it determines that a product contributes to a public health  
          epidemic, as specified, to request that the contributing  
          product's largest manufacturers, as specified, submit a written  
          response to Department of Public Health's determination.  

          Existing law: Requires Department of Public Health (DPH) to  
          regulate various consumer products, including food and drugs.

          This bill:
          1.Permits DPH, if it determines that a product contributes to a  
            public health epidemic, as specified, to request that the  
            contributing product's largest manufacturers, representing 80  
            percent of the costs identified in 2 b) below, submit a  
            written response to DPH's determination. Requires the written  
            response to include, but not be limited to:

                  a.        A written risk assessment analysis that  
                    identifies the public health impacts resulting from  
                    the sale of the product in this state; and,

                  b.        A list of mitigation strategies sufficient to  
                    reasonably reduce adverse public health impacts  
                    identified in the risk assessment.

          2.Defines "contributing product" as a manufactured product  
            intended for consumer consumption in this state for which DPH  
            has credible evidence that use of the product significantly  
            contributes to a public health epidemic and that meets both of  
            the following criteria:

                  a.        The public health epidemic to which the  
                    product contributes is one recognized by the federal  
                    Centers for Disease Control and Prevention (CDC), the  
                    United States Department of Health and Human Services,  
                                                         Continued---



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                    the Surgeon General, or the United States Food and  
                    Drug Administration; and,

                  b.        The adverse impact on public health from use  
                    of the product in this state would have a fiscal  
                    impact of $50 million or more annually on the state  
                    public health system, including, but not limited to,  
                    public hospitals and overall Medi-Cal expenditures.

          3.Defines "credible evidence" as peer-reviewed research, data,  
            and studies currently available to DPH.

          4.Permits DPH to charge the manufacturer of the contributing  
            product an amount not exceeding $20,000 for the reasonable  
            costs of reviewing the risk assessment and mitigation  
            document. Requires fees to be placed in the Public Health  
            Fund, which is established under this bill. Permits DPH to use  
            these fees, upon appropriation by the Legislature, for the  
            implementation of this bill.

          5.Prohibits this bill from being interpreted to affect any  
            authority of the Department of Toxic Substances Control  
            (DTSC).

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal  
          committee.

           COMMENTS  :  
           1.Author's statement. California faces a growing burden of  
            largely preventable chronic illnesses, including heart  
            disease, cancer, stroke, obesity, and diabetes. The Center for  
            Disease Control and Prevention reports that chronic diseases  
            and obesity-associated chronic diseases are among the most  
            widespread and costly of all health problems, but they are  
            also the most preventable. These conditions account for 70  
            percent of all deaths in the U.S., and more than 75 percent of  
            health care costs are due to chronic conditions. Common causes  
            leading to death and disability from chronic conditions  
            include poor nutrition, lack of physical activity, tobacco  
            use, excessive alcohol consumption, and substance abuse and  
            addiction.

            SB 747 allows DPH to request that leading manufacturers, who  
            produce and sell products that contribute significantly to a  
            public health epidemic or impose a substantial fiscal burden  
            on the state, generate a public health risk assessment on the  




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            product, including any mitigation strategies necessary to  
            reasonably reduce the public health impact and submit the  
            assessment to DPH. SB 747 is a necessary step in fighting  
            serious chronic disease, improving public health, and reducing  
            healthcare costs.

          2.Let's Get Healthy California Task Force. On May 3, 2012,  
            Governor Jerry Brown established the Let's Get Healthy  
            California Task Force to develop a 10-year plan for improving  
            the health of Californians, controlling health care costs,  
            promoting personal responsibility for individual health, and  
            advancing health equity. The Governor's Executive Order  
            directed the Task Force to issue a report by mid-December 2012  
            with recommendations for how the state can make progress  
            toward becoming the healthiest state in the nation over the  
            next decade. The Executive Order identified a number of issues  
            to be considered, including asthma, diabetes, childhood  
            obesity, childhood vaccinations, and hypertension, as well as  
            hospital readmissions and sepsis-related mortality. The report  
            identified a range of private sector efforts and public sector  
            programs that seek to improve one or more of the Task Force's  
            priorities. Although the Task Force officially ended with the  
            report, a Web site will be created to serve as a repository  
            for the report and to promote information sharing, facilitate  
            collaboration, and enable progress to be collectively tracked.

            According to the Task Force Final Report issued on December  
            19, 2012, many unhealthy behaviors with a life-long impact on  
            health-smoking, poor diet, and inactivity-begin in childhood  
            and adolescence. Though Californians engage in higher rates of  
            physical activity and the state's current adult obesity  
            rate-approximately one in four-is one of the lowest in the  
            country, obesity rates could increase substantially by 2030 if  
            current trends continue. Numerous studies have demonstrated  
            that surrounding environment heavily influences quality of  
            health, from the level of air pollution to the availability of  
            parks or green space, to availability of fresh produce. More  
            than 23 million Americans, including 6.5 million children,  
            live in food deserts-neighborhoods that lack access to stores  
            where affordable, healthy food is readily available. According  
            to the Task Force report, prevention and better management of  
            chronic disease and redesigning the health delivery system to  
            be more efficient and effective are critical to controlling  
            costs. 





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            In California, nine percent of adult women are smokers,  
            compared to 15 percent of men. Asians have the lowest rates of  
            smoking-nine percent overall-while the rate of African  
            Americans is twice as high. According to the Task Force  
            report, by focusing on where the disparities are the greatest  
            and on those populations and communities with the poorest  
            health outcomes, California can lead the way in improving the  
            overall health of its population. Efforts to address many of  
            the goals and indicators, such as infant mortality, asthma, or  
            diabetes, will need to reach beyond the boundaries of the  
            traditional health and health care sectors and take a  
            multi-sectoral approach.

          3.California Center for Public Health Advocacy Report. In June  
            2012, the California Center for Public Health Advocacy (CCPHA)  
            and the UCLA Center for Health Policy Research released data  
            on the childhood obesity epidemic in California cities.  
            Overweight and Obesity among Children by California City -  
            2010 shows the health of California's children varies widely  
            based on locale. Over 250 California cities were analyzed for  
            the study and revealed that while 38 percent of the state's  
            children are overweight or obese, the numbers range from 11  
            percent (Manhattan Beach) to 53 percent in the state's poorest  
            performing city (Huntington Park).

            On October 17, 2013, CCPHA and the UCLA Center for Health  
            Policy Research released the report Still Bubbling Over:  
            California Adolescents Drinking More Soda and Other  
            Sugar-Sweetened Beverages. This study shows that while  
            consumption of soda and other sugary drinks among young  
            children in California is declining, there is an alarming  
            spike among adolescents, the biggest consumers of these  
            beverages. The study found that sugar-sweetened beverage  
            consumption decreased by 30 percent among 2- to 5-year-olds  
            and 26 percent among 6- to 11-year-olds. Conversely,  
            consumption increased by 8 percent among adolescents ages  
            12-17. Additionally, major disparities now exist between  
            races/ethnicities. Seventy-four percent of African-American  
            adolescents drink at least one sugary drink each day, compared  
            to 73 percent of Latinos, 63 percent of Asians, and 56 percent  
            of whites. Adolescents in all ethnic groups, except whites,  
            consumed more sugary drinks in 2011-12 than in 2005-07. Soda  
            consumption rates also varied significantly from county to  
            county. 
            
          4.Double referral. This bill is double referred.  Should it pass  




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            out of this committee, it will be referred to the Senate  
            Committee on Environmental Quality.
               
          5.Prior legislation. AB 2246 (John A. Pérez), Chapter 446,  
            Statutes of 2012, requires the California Healthy Food  
            Financing Initiative (CHFFI) Council to establish and maintain  
            a Web site that provides specified information by March 31,  
            2013, to include, but not be limited to, prescribed  
            information, including actions that the council has taken and  
            funding sources that are available to support access to  
            healthy foods.
            
            AB 581 (John A. Pérez), Chapter 505, Statutes of 2011, creates  
            the CHFFI, the CHFFI Fund, and the CHFFI Council for the  
            purpose of expanding access to healthy foods in underserved  
            communities. AB 581 requires the California Department of Food  
            and Agriculture (CDFA) Secretary, by July 1, 2012, to prepare  
            recommended actions to be taken to promote food access within  
            California.  This authority remains in effect until January 1,  
            2017.

            AB 152 (Fuentes), Chapter 503, Statutes of 2011, established  
            the State Emergency Food Assistance Program (SEFAP) in statute  
            and allows for federal contributions to SEFAP for the purchase  
            of California-grown fresh fruits or vegetables.  Provides a  
            tax credit to California growers for the costs of fresh fruits  
            or vegetables donated to California food banks. AB 152 directs  
            CDPH to apply for specified federal funding for obesity  
            prevention and promotion of healthy eating.
            
            AB 70 (Monning) of 2011 would have allowed DPH to apply, in  
            conjunction with another eligible applicant as specified, for  
            federal community transformation grants under the Patient  
            Protection and Affordable Care Act and the Healthy,  
            Hunger-Free Kids Act of 2010, as specified.  AB 70 failed in  
            the Senate Health Committee.

            AB 727 (Mitchell) of 2011 would have required at least 50  
            percent of food and beverages offered in vending machines and  
            all food offered in cafeterias located on state property to  
            meet specified nutritional guidelines by 2014. AB 727 failed  
            in the Senate Appropriations Committee.
            
            AB 2720 (John A. Pérez) of 2010 was substantially similar to  
            AB 581. AB 2720 was vetoed by Governor Schwarzenegger, who  




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            stated that while his Administration shared the same goals as  
            the author when it comes to promoting healthy and affordable  
            food access for low-income communities in California, the  
            CHFFI had not yet been acted on by Congress, and unless and  
            until those important federal funding details were known, AB  
            2720 was both premature and unnecessary.

            AB 2384 and AB 2726 (Leno), Chapters 236 and 466, Statutes of  
            2006 and 2008, required CDPH, in consultation with CDFA, to  
            develop a Healthy Food Purchase pilot program to increase the  
            sale and purchase of fresh fruits and vegetables in low-income  
            communities, as specified, until January 1, 2011, and extended  
            the repeal date of the Healthy Food Purchase pilot program  
            from January 1, 2011, to January 1, 2013, respectively.
            
          6.Support. The California Primary Care Association (CPCA) writes  
            in support of this bill and argues that the conditions for  
            which community clinics and health centers often treat  
            patients-diabetes, obesity, heart disease, poor nutrition, and  
            substance and drug abuse-are often preventable or can be  
            mitigated if patients are adequately informed about products  
            that can pose health risks. CPCA further argues that reducing  
            or eliminating the medically underserved population's risk of  
            chronic diseases and conditions not only would improve overall  
            public health, it also would reduce medical costs borne by  
            taxpayer-funded programs.

            The Health Officers Association of California (HOAC) writes in  
            support that the leading causes of death in the state-heart  
            disease, cancer, and stroke-are largely preventable conditions  
            that contribute to high health care costs for public and  
            private payers and decrease workforce productivity. HOAC  
            states that this bill would create a tool for the state to  
            combat leading causes of chronic disease and that collecting  
            this type of information is a vital first step in combating  
            the burden of chronic disease.
            
          7.Opposition. The California Chamber of Commerce (CCC) writes in  
            opposition to this bill on behalf of numerous organizations.  
            CCC states that this program is burdensome, duplicative of  
            other state regulatory programs, and poses a direct threat to  
            thousands of jobs in California. CCC argues that DPH would  
            have the authority to target virtually any manufacturer of any  
            consumer product it deems harmful and require a detailed  
            report. CCC claims that it is unclear why DPH would require  
            reports from manufacturers when the department is only  




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            required to review the report. CCC further argues that  
            consumer products are already subject to regulation through  
            Proposition 65 administered by Office of Environmental Health  
            Hazard Assessment and, soon, by the Safer Consumer Products  
            regulations of the DTSC, making this program duplicative. CCC  
            states that food preparation safety is already regulated by  
            local public health directors and inspectors, who coordinate  
            with DPH's Food and Drug Branch; that the CDC's Web site  
            identifies 11 diseases and conditions that could be implicated  
            by this program; and that there is nothing in the language of  
            the bill to indicate how DPH should, or even could, accurately  
            identify the state public health system costs of a single  
            consumer product.
            
          8.Policy comments:
             a.   Unclear use of risk assessment and mitigation document.  
               The author may wish to consider what actions DPH would take  
               after reviewing the risk assessments and the purpose in  
               receiving mitigation strategies as the bill does not  
               require DPH to take a particular action. Additionally, the  
               bill does not require manufacturers to comply with or  
               respond to DPH's request.

             b.   "Contributing product" may be too broadly defined.  
               Although the definition of "contributing product" appears  
               broad and includes any product intended for consumer  
               consumption for which DPH has credible evidence that use of  
               the product significantly contributes to a public health  
               epidemic, the author contends that the focus is on products  
               that lead to preventable chronic diseases, such as tobacco,  
               alcohol, and food/beverages that lead to obesity. The  
               author may wish to consider adding a list of such products  
               or possible ingredients of products to the definition of  
               "contributing products" as opponents have argued that this  
               bill is duplicative of Proposition 65 and the jurisdiction  
               of the DTSC. 
            
             c.   Clarify that bill affects current market products. The  
               bill includes in the definition of "contributing product"  
               any product for which the adverse impact on public health  
               from use of the product in this state would have a fiscal  
               impact of $50 million or more annually (emphasis added).  
               The author has stated that the intent is for this bill to  
               apply to both current products on the market and any future  
               products. The author may wish to consider clarifying that  




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               this bill would affect current products that have a fiscal  
               impact of $50 million or more annually and any future  
               manufactured products that would have a fiscal impact of  
               $50 million or more on the state public health system. 

             d.   List of federally recognized public health epidemics. It  
               is unclear whether or not the federal agencies specified in  
               the bill keep a list of recognized public health epidemics  
               and the products responsible for those epidemics.

          1.Technical amendment. 

               On page 4, line 4, strike out (1) and insert:

          (a)

           SUPPORT AND OPPOSITION  :
          Support:  California Primary Care Association
                    Health Officers Association of California

          Oppose:   American Chemistry Council
                   California Chamber of Commerce
                   California Association of Winegrape Growers
                   California Grocers Association
                   California Independent Grocers Association
                   California Manufacturers and Technology Association
                   California Nevada Soft Drink Association
                   California Restaurant Association
                   California Retailers Association
                   California Specialty Products Association
                   California Taxpayers Association
                   Civil Justice Association of California
                   Consumer Specialty Products Association
                   Distilled Spirits Council of the United States
                   Family Winemakers of California
                   Grocery Manufacturers Association
                   Industrial Environmental Association
                   National Federation of Independent Businesses
                   Western Plant Health Association
                   Wine Institute



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