Photo credit: George Morina
by Daniel Fink, MD, Chair, The Quiet Coalition
I have long thought that rational evidence-based public policies affecting human behavior lead to better health outcomes, although sometimes the evidence that these policies work is hard to find. The two best examples of public policies dramatically reducing morbidity and mortality in the U.S. may be the concerted efforts at state and federal levels to reduce motor vehicle crash mortality and to reduce illness and death from cigarette smoking.
A variety of changes in vehicle design, vehicle safety features like airbags and seatbelts, mandatory seatbelt laws, reduced allowable blood alcohol concentrations, and changes in highway design, have led to dramatic reductions in motor vehicle crash fatalities since data first began to be collected in 1913.
After publication of the Surgeon General’s report on Smoking and Health in 1964, smokers began quitting. Laws limiting smoking in restaurants, workplaces, airplanes, trains, and buses were implemented in the 1990s. Cigarette advertising was banned, warning labels were required on cigarette packages and cartons, and tobacco manufacturers were fined. The percentage of smokers decreased, with dramatic reductions in tobacco-related illness and death.
The current issue of JAMA Open Network contains two articles providing more evidence that rational evidence-based public policies affecting human behavior lead to better health outcomes. Both studies follow what is called a natural experiment design; i.e., the researchers looked at the outcomes of government policies affecting human behavior rather than conducting a randomized controlled trial. One examined state policies regulating guns with gun-related mortality, finding that the state with the strictest gun laws had 20% lower gun-related mortality. The other, from a study of Kaiser Permanente members in northern and southern California living in cities with or without taxes on sugar sweetened beverages (colloquially known as soda taxes), showed that children living in cities with soda taxes didn’t gain as much weight as those living in cities without soda taxes.
As best as I can tell, there are no federal, state, or local laws or regulations governing nonoccupational noise exposure in the United States. There are no warning labels on personal listening devices, earbuds, or headphones, stating WARNING: USE OF THIS PRODUCT CAN CAUSE HEARING LOSS, TINNITUS, AND HYPERACUSIS. There are no warning labels at rock concert venues or sports stadiums or arenas. We accept hearing loss in old age as part of normal aging, when it is largely caused by noise exposure. In 2017 I wrote that the only evidence-based safe noise exposure level to prevent hearing loss was a time-weighted average of 70 decibels for 24 hours, but a more recent analysis suggests that the actual safe noise level is only 55 A-weighted decibels* for a single noise event and a daily average of 55-60 decibels.
We are exposed to too much noise every day. It’s long past time for the Consumer Product Safety Commission to require warning labels on personal listening devices, earbuds, and headphones. I will boldly predict that in 20 years today’s young people will be as hard of hearing as today’s seniors. It’s long past time for some city somewhere to require quiet restaurants, or at least quiet rooms in restaurants. It’s long past time for the EPA’s Office of Noise Abatement and Control to fulfill its Congressional mandate to protect Americans from dangerous levels of noise.
A quieter world will be a better and healthier world for all.
