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IOM recommends public health assessment of government policies
Local, state and federal agencies should consider the potential public health impacts of major legislation and regulations such as agriculture subsidies, zoning decisions and education policy, the Institute of Medicine argues in a new report.
The proposal is not unlike environmental assessments required since the 1969 National Environmental Policy Act. It's included in the second of two reports on public health strategies sponsored by the Robert Wood Johnson Foundation.
The recommendation comes as House Republicans are leading the charge to curtail regulations, but IOM experts defended their approach in a conference call with reporters.
"We … think it's worth looking at what the health implications are of different alternatives, so that they can inform the ultimate decision-making," said Steven Teutsch, the vice chairman of the IOM committee that wrote the report. "It's not a particularly pro-regulatory or anti-regulatory approach, but it's a balanced approach that needs to be applied. So whether you're in favor of school vouchers or whether you're in favor of increasing spending by local communities on education, you can evaluate the health impacts of these different modalities."
"This might be viewed as another level of regulatory activity," added committee member Leslie Beitsch, "but it might also be viewed as a common sense approach to make sure that things are considered together for their total impact on society in the larger sense."
And it calls for updating a number of public health statutes to give health agencies more power to address obesity, chronic diseases, injuries, substance abuse, immunization registries and surveillance systems.
Finally, the IOM recommends that state health agencies ensure they have enough funding and staffing to provide 10 "Essential Public Health Services. These include diagnosing community health hazards, enforcing public health laws and evaluating population-based services.
The recommendations face an uphill fight, given current budget woes facing state and local governments, however.
Rather than expanding their staffs, local health agencies cut 29,000 jobs nationwide — 19 percent of the total 2008 workforce — through layoffs and attrition between 2008 and 2010, according to the National Association of County and City Health Officials. A recent study found that:
• 44 percent of local health departments reported staff reductions in 2010;
• 42 percent had to make cuts to important programs such as maternal and child health, population-based primary prevention, clinical services and environmental health; and
• 44 percent report that their budget is lower in the current fiscal year as compared to last year, while half expect more reductions in the next fiscal year.
The IOM report acknowledges that fiscal reality urges federal officials to avoid any new unfunded mandates. Instead, it calls for more coordination among federal, state and local authorities, which might require legal and administrative changes such as contractual arrangements and delegations of authority.
