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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