WASHINGTON -- Because strong evidence indicates that policies beyond the health sector have substantial effects on people's health, all levels of U.S. government should adopt a structured approach to considering the health effects of any major legislation or regulation, says a new report by the Institute of Medicine. In addition, federal and state policymakers should review and revise public health laws so that they adequately address current health challenges.
"The law has been an essential factor for improving the public's health through policies such as decreasing tobacco use, increasing road safety, and ensuring the greater healthfulness of our food and water," said Marthe Gold, chair of the committee that wrote the report and Arthur C. Logan Professor and Chair of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York City. "Our report recommends several actions that will ensure that federal, state, and local public health agencies make full use of a broad array of proven legal tools that can improve population health."
Policies and regulations that lie outside the health sector can have a significant impact on people's health, including, for example, government agricultural subsidies that influence the availability and affordability of certain foods, zoning policies that create green space, and education policies that support intellectual and physical growth of America's youth. The report recommends that laws and policies that cross sectors be examined critically for potential positive and negative effects on public health. To address these concerns, government agencies should collaborate to anticipate and evaluate the health effects of major legislation. And because private-sector actions can also have major impacts on the public's health, state and local governments should form health councils to engage other public agencies and private and nonprofit stakeholders in community health improvement plans.
The report says that many public health statutes defining the roles and authorities of government health agencies have not been updated in decades and lack specific power to address current needs. Public health laws need to provide health agencies the authority to address concerns such as obesity and other chronic diseases, injuries, substance abuse, immunization registries, and surveillance systems that could help detect bioterrorist attacks or disease outbreaks.
States should also require health agencies to provide 10 Essential Public Health Services as the standard of practice and make certain that adequate funding and staffing are in place to provide these services, the report says. Previously developed by a consortium of public health groups, the list of services includes basic functions such as monitoring the health status of communities, diagnosing and investigating community health hazards, mobilizing community action, enforcing laws that protect health, and evaluating population-based services. State laws also should require public health accreditation to ensure a uniform standard of public health practice, says the report, and every health agency should have adequate access to attorneys with public health expertise.
Whenever possible, federal and state governments should set minimum public health standards and develop regulations to allow lower levels of government to enact further restrictions when necessary. For example, the Affordable Care Act requires calorie labeling on chain restaurant menus but prevents states and localities from enacting stricter regulations than the federal government in the area of menu labeling.
The report, sponsored by the Robert Wood Johnson Foundation, is the second in a series on public health strategies to improve health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. For more information, visit http://national-academies.
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Report in Brief
Pre-publication copies of For the Public's Health: Revitalizing Law and Policy to Meet New Challenges are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.
INSTITUTE OF MEDICINE
Board on Population Health and Public Health Practice
Committee on Public Health Strategies to Improve Health
Marthe R. Gold, M.D., M.P.H. (chair)
Arthur C. Logan Professor and Chair
Department of Community Health and Social Medicine
City University of New York Medical School
New York City
Steven M. Teutsch, M.D., M.P.H. (vice chair)
Chief Science Officer
Los Angeles County Public Health
Leslie Beitsch, M.D., J.D.
Center for Medicine and Public Health
Florida State University College of Medicine
Joyce D. Essien, M.D., M.B.A.
Center for Public Health Practice
Rollins School of Public Health
David W. Fleming, M.D.
Department of Public Health
Seattle and King County
Thomas Getzen, Ph.D.
Professor of Risk, Insurance, and Healthcare Management
Fox School of Business
Lawrence O. Gostin, J.D.
Professor of Public Health
Johns Hopkins University;
Linda and Timothy O'Neill
Professor of Global Health Law
Georgetown University; and
O'Neill Institute on National and Global Health Law
Georgetown University Law Center
George J. Isham, M.Sc., M.D.
Medical Director and Chief Health Officer
Robert M. Kaplan, Ph.D.
Office of Behavioral and Social Sciences Research, and
Office of the Director
National Institutes of Health
Wilfredo Lopez, J.D.
Current Counsel Emeritus
New York City Department of Health
Glen P. Mays, Ph.D.
Inaugural Associate Professor and Associate Professor
Department of Health Policy and Management
College of Public Health
University of Arkansas School for Medical Sciences
Phyllis D. Meadows, Ph.D., M.S.N., R.N.
Office of Public Health Practice
Department of Health Management and Policy
University of Michigan School of Public Health
Mary Mincer Hansen, Ph.D., R.N.
M.P.H. Program and Global Health Department
Des Moines University
Des Moines, Iowa
Poki S. Namkung, M.D., M.P.H.
Santa Cruz County Health Services Agency
Santa Cruz, Calif.
Margaret E. O'Kane, M.S.
National Committee for Quality Assurance
David A. Ross, Sc.D.
Public Health Informatics Institute
Martin Jose Sepulveda, M.D., M.P.H.
Vice President for Integrated Health Services
International Business Machines Corp.
Steven H. Woolf, M.D., M.P.H.
Center on Human Needs, and
Professor of Family Medicine, Epidemiology, and Community Health
Virginia Commonwealth University
Alina Baciu, Sc.M.