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.
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