Not only is it easier to pass a local measure than at the federal level, but successful state policies can provide a roadmap for national ones: Massachusetts' 2006 health care reform law served as one of the blueprints for 2010's Affordable Care Act.   

With the help of Columbia University's Mailman School of Medicine faculty and the online resource Ballotopedia, Transmission, the Public Health news source takes a look at some of the initiatives citizens across the country will vote on this year:

A Legalized High? In total, 82 million US residents could see a change in their state's marijuana laws after November 8. Following in the footsteps of Oregon, Colorado, and Washington, five states will vote on legalizing recreational marijuana use this year:  Arizona, California, Maine, Massachusetts, and Nevada. And, Arkansas, Florida, Montana, and North Dakota, could be the latest states to legalize medical marijuana use — it's already legal in 25 states and the District of Columbia. Even while the country moves toward looser marijuana laws, full understanding of the benefits and harms of legalization has yet to be achieved. As Silvia Martins, associate professor of Epidemiology, notes: "There are several potential pros and cons of legalized recreational marijuana. More years of data are needed for researchers to truly be able to estimate the public health impact of these policies."  

Gun Control. Despite thousands of deaths caused by guns every year, the US Congress remains steadfastly divided on measures to control how they are sold. Even in the wake of the Orlando massacre in June, a measure to expand background checks and ban those on the FBI's terrorist watch list from buying guns was voted down. In November, four states will attempt to pass gun control measures: California votes on a ban on large-capacity ammo magazines; Maine and Nevada will decide on stricter background checks; and Washington advocates seek to restrict an individual's access to guns through the power of a court order.

Should Condoms Be Required in Pornography? A proposal in California would mandate condom use in pornography — a measure that sounds simple at first, but is more complicated when one dives into the details. Research by Eric Schrimshaw, associate professor of Sociomedical Sciences, suggests that condom use in pornography encourages safe sex by those who view it. "From a public health standpoint, the argument for condom use is a solid one — both from an occupational health perspective for pornography actors and, as our studies suggests, for the health and safety of the resulting consumers." But, as written, California's proposition has caused people on both sides of the aisle to question how the law will deal with specific monitoring, enforcement, and litigation mechanisms, as well as guarantee the rights of actors.       

Upping the Minimum Wage. As research from the Mailman School and the National Center for Children in Poverty recently showed in Florida, too often, a full-time job at minimum wage isn't enough to support the basic needs of their family, including food, shelter, or utilities like heat or electricity. As Congress stymies efforts to raise the federal minimum wage, several states are taking matters into their own hands. Arizona, Colorado, Maine, and Washington ballots will include proposals to raise the minimum wage to $12 or higher by 2020. Arizona and Washington go one step further, asking voters to decide whether employers must offer paid time off and paid sick leave. On the other hand, South Dakota voters will consider a proposal to lower the minimum wage for workers under age 18, from $8.50 to $7.50.

Life, Death, and Improving Health Through Taxes. Cities and states often put so-called 'sin taxes' on vices from gambling to liquor. 2016 is no exception. After a successful passage in Philadelphia and encouraging early results from Mexico and Berkeley, CA, more cities are attempting to pass taxes on sugary beverages in an effort to reduce obesity. Voters in Oakland, San Francisco, and Boulder, Colorado, will all have the chance to weigh in on proposed soda taxes. Additionally, in California, Colorado, North Dakota, and Missouri, ballots will include tax increases on tobacco products.

From sexual health to gun violence, cities and states are attempting to pass a variety of new policies that could eventually make their way to other states or the federal level. It's public health and democracy in action: while the media focuses on the top of the ticket, many citizens have the chance to weigh in on measures that could have a real impact on their day-to-day lives — and on the health of their communities.