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.