The Impact of Law on Coronary Heart Disease: Some Preliminary Observations on the Relationship of Law to “Normalized” Conditions

For the classic discussion of stigma and the factors that lead to it, see Goffman E. , Stigma: Notes on the Management of Spoiled Identity (Englewood Cliffs, New Jersey: Prentice Hall, 1963).

The HIV epidemic has many elements associated with stigma. It is a deadly infectious disease, spread by sexual activity, and especially prevalent in marginalized communities. See Sontag S. , AIDS and its Metaphors (New York: Farrar, Straus, Giroux, 1989): at 44.

Burris S. Kawachi I. , and Sarat A. , “Integrating Law and Social Epidemiology,” Journal of Law, Medicine & Ethics, 30, no. 4 (2002): 510–21.

Rose G. , The Strategy of Preventive Medicine (New York: Oxford University Press, 1992): at 53–64.

“Achievements in Public Health, 1900–1999: Decline in Deaths from Heart Disease and Stroke — United States, 1900–1999,” Morbidity and Mortality Weekly Report, 48 (1999): 649–56.

Thorn T.J. , “Incidence, Prevalence and Mortality of Cardiovascular Disease in the United States,” in Alexander R.W. , eds., Hurst's the Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 4.

“Achievements in Public Health,” supra note 5.

Thorn , supra note 6, at 6.

Bess C.J. , “Gender Bias in Health Care: A Life or Death Issue for Women with Coronary Heart Disease,” Hastings Women's Law Journal, 6 (1995): 41–64.

Thorn , supra note 6, at 8.

Mosca L. , “Cardiovascular Disease in Women: A Statement for Healthcare Professionals from the American Heart Association Writing Group,” Circulation, 96 (1997): 2468–82.

Herman A. , “Race, Law and Health,” paper presented at Health, Law and Human Rights: Exploring the Connections, 2001 Annual Meeting of the American Society of Law, Medicine & Ethics, Philadelphia, September 29, 2001.

Thorn , supra note 6, at 7.

American Heart Association, “Risk Factors and Coronary Heart Disease,” at <http://216.185.102.50/Heart_and_Stroke_A_Z_Guide/riskfact.html> (last visited June 30, 2002).

Kaplan G.A. and Keil J.E. , “Socioeconomic Factors and Cardiovascular Disease: A Review of the Literature,” Circulation, 88 (1993): 1973–88.

Terris M. , “The Development of Cardiovascular Disease Risk Factors: Socioenvironmental Influences,” Preventive Medicine, 29, suppl. (1999): S11–17.

Kaplan and Keil , supra note 17, at 1983.

See Friedewald W.T. , “Epidemiology of Cardiovascular Disease” in Friedewald W.T. and Wyngarden J.B.N. , eds., Cecil Textbook of Medicine (Philadelphia: W.B. Sender Co., 1996): at 171.

See Kaplan and Keil , supra note 17. Environmental exposure to cigarette smoking may also play a role. Otsuka R. , “Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults,” JAMA, 286 (2001): 436–41.

See “Achievements in Public Health,” supra note 5.

Friesinger G. II and Hurst J.W. , “The Natural History of Atherosclerotic Coronary Heart Disease,” in Alexander R.W. , eds., Hurst's the Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 1131; Syme S.L. , “Foreword,” in Berkman L. and Kawachi I. , eds., Social Epidemiology (New York: Oxford University Press, 2000): at xi.

Syme , supra note 23, at xi.

Terris , supra note 18, at S12.

Kaplan and Keil , supra note 17.

Id. at 1989; Bucher H.C. and Ragland D.R. , “Socioeconomic Indicators and Mortality from Coronary Heart Disease and Cancer: A 22-Year Follow-Up of Middle-Aged Men,” American Journal of Public Health, 85 (1995): 1231–36.

Diez-Roux A.V. , “Neighborhood of Residence and Incidence of Coronary Heart Disease,” N. Engl. J. Med., 345 (2001): 99–106.

Hall E. Johnson J.V. , and Tsou T.S. , “Women, Occupation and Risk of Cardiovascular Morbidity and Mortality,” Occupational Medicine, 8 (1993): 709–19; Theorell T. , “Working Conditions and Health,” in Berkman L.F. and Kawachi I. , eds., Social Epidemiology (New York: Oxford University Press, 2000): at 95–97.

Theorell , supra note 29, at 107–09.

Id. at 110–11.

Eliot R.S. , “The Heart, Emotional Stress and Psychiatric Behavior” in Alexander R.W. , eds., Hurst's The Heart, Arteries and Veins (New York: McGraw Hill, 1998): at 2352.

Id. at 2350.

Mosca , supra note 12.

Friedewald , supra note 20, at 170.

“Achievements in Public Health,” supra note 5.

E.g., Bess , supra note 10, at 44–55; Goldberg K. , “Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients,” JAMA, 267 (1992): 1473–77; Noah B.A. , “Racist Health Care,” Florida Law Review, 48 (1996): 357–72; Watson S.D. , “Race, Ethnicity & Hospital Care: The Need for Racial and Ethnic Data,” Journal of Health Law, 30, no. 2 (1997): 125–32.

Thorn , supra note 6, at 4–6.

Bess , supra note 10, at 55 (discussing sex discrimination in the care of coronary heart disease patients).

Thorn , supra note 6, at 8.

“Achievements in Public Health,” supra note 5.

American Heart Association, supra note 16.

National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary, NIH Pub. No. 01-3670 (Bethesda: National Institutes of Health, 2001): at 2, available at <http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf>.

Rose , supra note 4, at 76.

See Burris Kawachi , and Sarat , supra note 3.

In the 1950s, the National Heart Institute supported a study concerning the legal basis for awards in cardiac cases, which resulted in a book by McNiece H.F. , Heart Disease and the Law: The Legal Basis for Awards in Cardiac Cases (Englewood Cliffs, New Jersey: Prentice-Hall, 1961).

Branch S. , “Is Food the Next Tobacco?,” Wall Street Journal, June 13, 2002, at B1.

The strongest candidate for that title must fall to the National Heart Act of 1948, as amended, now codified at 42 U.S.C. §§ 218, 241, 287 et seq., which established the National Heart, Lung, and Blood Institute within the National Institutes of Health, and continues to provide resources for research in the area of heart disease.

For example, in 1999, the Centers for Disease Control and Prevention funded eleven states with high cardiovascular disease mortality rates to plan, develop, and implement state efforts. “Achievements in Public Health,” supra note 5. Earlier, the Heart Disease, Cancer & Stroke Amendments, Pub. L. No. 89-239, aimed to foster cooperative arrangements with state agencies to make available the latest advances in diagnosis and treatment. See also Pub. L. No. 89-0749, Comprehensive Health Planning and Public Health Services Amendments of 1966 (providing support for general health planning by states); Pub. L. 94-63, National High Blood Pressure Education Program (provides assistance to state and local programs aimed at reducing hypertension).

Medicare, 42 U.S.C. §§ 1395–1395ggg (2002); Medicaid, 42 U.S.C. §§ 1396–1396v (2002).

See Kaplan and Keil , supra note 17.

Alcohol, Tobacco, and Certain Other Excise Taxes, I.R.C. § 5701–63 (2002).

See Grossman M. and Chaloupka F.J. , “Cigarette Taxes: The Straw to Break the Camel's Back,” Public Health Reports, 12 (1997): 290–97.

Tobacco Price Support Program, 7 U.S.C. §§ 1445-1445-3 (2002). For a discussion of the impact of this program, see Zhang P. and Husten C. , “The Impact of the Tobacco Support Program on Tobacco Control in the United States,” Tobacco Control, 7, no. 2 (1998): 176–82.

Cigarette Labeling and Advertising Act, 15 U.S.C. §§ 1331–1341 (2002).

Lorillard Tobacco Co. v. Reilly , 533 U.S. 525 (2001).

Food and Drug Administration v. Brown & Williamson Tobacco Corp. , 529 U.S. 120 (2000).

There are limited exceptions; for example, federal law prohibits smoking in airplanes. 14 C.F.R. 252.3 (2002).

“Reducing Tobacco Use: A Report of the Surgeon General — Executive Summary,” Morbidity and Mortality Weekly Report, 49, RR-16 (2000): 1–27.

See note 21, supra.

Federal Food, Drug, and Cosmetic Act, 21 U.S.C. §§ 301–397 (2002).

Nutrition Labeling and Education Act of 1990, Pub. L. 101–535, 104 Stat. 2353 (1990).

Food Labeling Regulations, 21 C.F.R. §§ 101.1–101.108 (2002); Ernst N. , “Health Promotion Roles of the Federal Government and Food Industry in Nutrition and Blood Pressure,” Hypertension, 17, suppl. 1 (1991): 196–200.

Nestle M. , Food Politics: How the Food Industry Influences Nutrition and Health (Berkeley: University of California Press, 2002): passim.

See National School Lunch Program, 7 C.F.R. § 210.10 (regulations pertaining to school lunches).

For a discussion of the authority granted to local public health agencies, see Gostin L.O. , Public Health Law: Power, Duty, Restraint (Berkeley. University of California Press, 2000): at 246–47.

Jacobson M.F. and Brownell K.D. , “Small Taxes on Soft Drinks and Snack Foods to Promote Health,” American Journal of Public Health, 90, no. 6 (2000): 854–57.

Lorillard Tobacco Co. , 533 U.S. at 587–88.

Pollard M. and Brennan J. , “Disease Prevention and Health Promotion Initiatives: Some Legal Considerations,” Health Education Monographs, 6, no. 2 (1978): 211–22.

In 2000, the National Heart, Lung, and Blood Institute was allocated $2,029,424. See NIH Almanac — Appropriations, at <http://www.nih.gov/about/almanac/appropriations/index.htm> (last reviewed November 8, 2001). It should be noted that the federal government supports research not only directly through grants for coronary heart disease research, but also indirectly through federal health insurance programs and programs that fund academic medicine. For purposes of this discussion, these programs are not considered laws about coronary heart disease.

E.g., “Reducing Tobacco Use: A Report of the Surgeon General — Executive Summary,” supra note 62; Soldz S. , “Tobacco Use Among Massachusetts Youth: Is Tobacco Control Working?,” Preventive Medicine, 31 (2000): 287–95.

Lorillard Tobacco Co. , 533 U.S. at 526; Cipollone v. Liggett Group, Inc., 505 U.S. 504, 520 (1992).

Kristal A.R. , “Trends in Food Label Use Associated with New Nutrition Labeling Regulations,” American Journal of Public Health, 88 (1998): 1212–15.

See note 23, supra.

Sarat A. and Kearns T.R. , “Beyond the Great Divide: Forms of Legal Scholarship and Everyday Life,” in Sarat A. and Kearns T. R. , eds., Law in Everyday Life (Ann Arbor: University of Michigan Press, 1993): 27–33.

Gully v. First National Bank, 299 U.S. 109, 117 (1936).

Earned Income Tax Credit, I.R.C. § 32 (2002).

Occupational Safety and Health Act (OSHA), 29 U.S.C. §§ 651–78 (2002).

Id. § 652(8).

Ziskind D. and Fadem J. , “Law and Quality of Working Life,” Comparative Labor Law, 2 (1997): 122–35. See 29 U.S.C. § 654(a)(i) (general duty clause). See also 29 U.S.C. § 651(b)(5)–(b)(7) (congressional findings regarding the intentions behind OSHA).

National Occupational Research Agenda, Organization of Work, at <http://www.cdc.gov/niosh/nrworg.html> (last updated June 11, 1999).

In general, federal law gives workers little ability to enforce their rights under OSHA. See McGarity T.O. , “Reforming OSHA: Some Thoughts for the Current Legislative Agenda,” Houston Law Review, 31 (1994): 99–117.

Larson A. and Larson L.K. , Larson's Workmen's Compensation (New York: Matthew Bender, 1952 & Supp. 1999): §§ 207–08.

Berry A.S. , “The Reality of Work-Related Stress: An Analysis of How Mental Disability Claims Should Be Handled Under the North Carolina Workers' Compensation Act” (Comment), Campbell Law Review 20 (1998): 321–45.

Larson and Larson , supra note 86, at § 52.04 [3] n.28.

“Police Officer's Heart Disease Was Presumptively Work-Related,” National Public Employment Reporter, 4, no. 11 (April 4, 2001): 15–16.

In general, workers' compensation laws provide compensation only for diseases that are considered unusual to the trade and do not commonly occur. Larson and Larson , supra note 86, § 52.03. The “typical” stresses that induce the all-too-common coronary heart disease would appear to fall outside the purview of most workers' compensation laws.

See text accompanying notes 29–31, supra.

Americans with Disabilities Act, 42 U.S.C. §§ 12101–12213 (2002).

Discrimination has been posited as a source of stress affecting coronary heart disease in the social epidemiological literature. E.g., Krieger N. and Sidney S. , “Racial Discrimination and Blood Pressure: The CARDIA Study of Young Black and White Adults,” American Journal of Public Health, 86 (1996): 1370–78; Krieger N. and Sidney S. , “Prevalence and Health Implications of Anti-Gay Discrimination: A Study of Black and White Women and Men in the CARDIA Cohort,” International Journal of Health Services, 27 (1997): 157–76.

42 U.S.C. § 12112(b)(5)(a).

Parmet W.E. , “Plain Meaning and Mitigating Measures: Judicial Interpretations of the Meaning of Disability,” Berkeley Journal of Employment and Labor Law, 21 (2000): 53–90.

Sutton v. United Air Lines , 527 U.S. 471 (1999).

Id. at 512 (Stevens, J., dissenting).

Parmet W.E. , “Individual Rights and Class Discrimination: The Fallacy of an Individualized Determination of Disability,” Temple Political & Civil Rights Law Review, 9 (2000): 283–301.

Some of these studies appear in Blanck P. , ed., Employment, Disability and the Americans with Disabilities Act: Issues in Law, Public Policy and Research (Evanston, Illinois: Northwestern University Press, 2000).

E.g., Higginbotham A.L. Jr. , Shades of Freedom: Racial Politics and Presumptions of the American Legal Process (New York: Oxford University Press, 1996) (arguing that the law has advanced racial justice); Rosenberg G. , The Hollow Hope: Can Courts Bring About Social Change? (Chicago: University of Chicago, 1991) (arguing that judicial decisions did not substantially improve the conditions of black Americans); Ackerman S. , “The White Supremacist Status Quo: How the American Legal System Perpetuates Racism as Seen Through the Lens of Property Law,” Hamline Journal of Public Law and Policy, 21 (1999): 137–75 (arguing that U.S. law continues to support racism); Turner R. , “Thirty Years of Tide VII's Regulatory Regime: Rights, Theories and Realities,” Alabama Law Review, 46 (1995): 375–485 (concluding that Title VII had an immediate but limited impact on job discrimination).