V. Conclusion

Healthy People 2020 is an ambitious project with broad goals, including the elimination of health disparities and the achievement of health equity. However, HP 2020 fails to fully incorporate the principles of health equity because it generally does not acknowledge the distributive consequences of policy options on the most critical health issues facing the country today, including universal insurance coverage, taxes on unhealthy foods, or regulation of carbon emissions. In many instances, there are clear and predictable distributive effects on disparities when comparing coercive legal mechanisms such as regulation and taxation with voluntary initiatives such as educational campaigns or industry-led efforts. To better serve its self-stated, overarching goal of achieving health equity, the nation's “master blueprint for health” should advocate for the mechanisms--which may often be coercive in nature--that are most likely to achieve the desired population health objective while also reducing disparities. That HP 2020 does so in the case of less controversial mechanisms such as school nutrition, helmet laws, and tobacco control demonstrates that HP 2020 is not entirely apolitical. By taking a position as to the desirability and effectiveness of certain coercive legal measures, HP 2020 (and by implication HHS) has inserted itself into the policy debate, as indeed it should--Who better than HHS to opine on the effectiveness of policy options? Having shown that it is willing to advocate for some coercive legal mechanisms, HHS and HP 2020 should more fully incorporate the principles of health equity by advocating for even those politically controversial but demonstrably effective coercive legal mechanisms that could help reduce health disparities on today's most pressing health concerns. As demonstrated herein, law is an essential tool for reduction of health disparities, and in many instances, coercive legal mechanisms are the only effective means of addressing disparities. HP 2020 serves an invaluable purpose in setting evidence-based objectives for improving health, but to truly advocate for health equity, HP 2020 must also acknowledge and advocate for those evidence-based coercive legal interventions that will contribute to reductions in disparities. In so doing, HP 2020 will move the U.S. further down the path toward elimination of health disparities and full realization of health equity.

. Law Fellow, O'Neill Institute for National and Global Health Law, Georgetown University Law Center.