Missing the Public Health Forest in the Trees -- Lessons from California's Environmental Health Initiatives

California has long been a national leader in public health and environmental law, including its laws designed to protect its citizens from both acute and chronic health threats. Recent examples include its groundbreaking global warming initiative, and the soon-to-be-released Green Chemistry regulation, which is intended to ensure that chemical exposure risk from consumer products is reduced to the absolute minimum. Of course, California's most famous environmental health law is Proposition 65 -- a ballot initiative that provides for warnings to consumers prior to exposures to "chemicals known to the State of California to cause cancer, birth defects and other reproductive harm." Proposition 65 has several important victories under its belt, but recent cases and issues have higlighted the conflict between reducing trace exposures to chemicals and promoting other health behaviors proven to reduce the risk of chronic disease. A famous example confronted by the California Supreme Court involved efforts to place a reproductive harm warning on nicotine patches -- potentially preventing pregnant women from using smoking cessation devices. Recent examples include attempts to place warnings on everything from cereal to applesauce. This presentation will discuss the often difficult conflict between environmental health efforts and other health promotion priorities in an era of scarce public health funding.