The Institute of Medicine's newly released outline for how to improve the legal and regulatory framework to advance public health faces the usual obstacle of funding, but the public health community welcomed it as a valuable resource for the years to come.

The June 21 report, titled For the Public's Health: Revitalizing Law and Policy to Meet New Challenges, recommends 10 actions that could improve public health, all of which will take time and money. “It's a terrible financial environment” for this kind of report, says Robert Pestronk, executive director of the National Association of County and City Health Officials, Washington. “Some of the recommendations make good sense, but they are going to be difficult and complex to implement,” he said.

Nevertheless, the report is “really well done” and should prove useful for lawmakers and regulators over time as funding does eventually become available, Pestronk said. “It's important to have the report as a foundation,” though it may take years to have the recommendations adopted, he said. A recommendation that states pass laws with appropriate funding that mandate public health departments be able to deliver a set of 10 essential public health services is an example of a recommendation that is a good idea but will be difficult to implement, he said.

The report is the second of three on public health. The IOM will address the financial side in a third pending report. The first was released in December 2010 and examined the public health system's ability to measure the social and environmental factors that make Americans healthy or sick, finding several gaps (Dec. 13, p. 6). All three reports were sponsored by the Robert Wood Johnson Foundation.

The NACCHO supports several other of the report's recommendations, but it does not endorse its recommended mandatory accreditation of public health departments, and instead favors voluntary accreditation, Pestronk said. The committee included that recommendation in part because there is “increasing acceptance” that accreditation improves public health, said Dr. Leslie Beitsch, a member of the committee that wrote the report, speaking at a telephone news conference. Beitsch is director of the Center on Medicine and Public Health and associate dean for health affairs at Florida State University College of Medicine, Tallahassee.

Also in the report are recommendations calling for state and local governments to review and modernize public health laws, and to take into consideration the public health aspects of all major pieces of legislation, directly health-related or not. The report urges HHS to convene experts to improve methods for “assessing the strength of evidence regarding the health effects of public policies” and to provide guidance on standards on the process for translating evidence into policy.