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Summary and Recommendations
Pages 1-18

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From page 1... ... This study was undertaken to address a growing perception among the Institute of Medicine membership and others concerned with the health of the public that this nation has lost sight of its public health goals and has allowed the system of public health activities to fall into disarray. Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy. Read the entire page →
From page 2... ... It has examined demographic and epidemiologic statistics, agency budgets, organization charts, program plans, statutes, and regulations. It has visited localities in six states and spoken with more than 350 people: state and local health officers, public health nurses, sanitarians, legislators, citizen activists, public administrators, voluntary agency personnel, private physicians, and many others. Read the entire page →
From page 3... ... At the same time, advances such as the discovery of bacteria and identification of better ways to control and prevent communicable disease made possible effective community action under the auspices of increasingly professional public health agencies. THE PUBLIC HEALTH MISSION Knowledge and values today remain decisive elements in the shaping of public health practice. Read the entire page →
From page 4... ... in only 25 years. Too frequently during its investigations, the committee heard legislators and members of the general public castigate public health professionals as paper-shufflers, out of touch Read the entire page →
From page 5... ... Perhaps because they view their professional knowledge and skills as effective and therefore obviously valuable, public health professionals appear to have been slow in developing strategies to demonstrate the worth of their efforts to legislators and the public. Public health crises, not public health successes, make headlines. Read the entire page →
From page 6... ... Management of a public health agency is a demanding, high-visibility assignment requiring, in addition to technical and political acumen, the ability to motivate and lead personnel, to plan and allocate agency resources, and to sense and deal with changes in the agency's environment and to relate the agency to the larger community. Progress in public health in the United States has been greatly advanced throughout its history by outstanding individuals who fortuitously combined all these qualities. Read the entire page →
From page 7... ... THE GOVERNMENTAL ROLE IN PUBLIC HEALTH � The committee finds that the core functions of public health agencies at all levels of government are assessment, policy development, and assurance. Assessment � The committee recommends that every public health agency regularly and systematically collect, assemble, analyze, and make available information on the health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems. Read the entire page →
From page 8... ... They bear primary public sector responsibility for health. ~ The committee recommends that the public health duties of states should include the following: lion; state; -assessment of health needs in the state based on statewide data collec assurance of an adequate statutory base for health activities in the -establishment of statewide health objectives, delegating power to localities as appropriate and holding them accountable; assurance of appropriate organized statewide effort to develop and maintain essential personal, educational, and environmental health services; provision of access to necessary services; and solution of problems inimical to health; -guarantee of a minimum set of essential health services; and Read the entire page →
From page 9... ... � The committee recommends the following functions for local public health units: - assessment, monitoring, and surveillance of local health problems and needs and of resources for dealing with them; policy development and leadership that foster local involvement and a sense of ownership, that emphasize local needs, and that advocate equitable distribution of public resources and complementary private activities commensurate with community needs; and assurance that high-quality services, including personal health services, needed for the protection of public health in the community are available and accessible to all persons; that the community receives proper consideration in the allocation of federal and state as well as local resources for public health; and that the community is informed about how to obtain public Read the entire page →
From page 10... ... These include modification of public health statutes, changes in the organizational structure, special linkages, strategies for building agency capacity, and improvements in education for public health. STATUTES � The committee recommends that states review their public health statutes and make revisions necessary to accomplish the following two objectives: -clearly delineate the basic authority and responsibility entrusted to public health agencies, boards, and officials at the state and local levels and the relationships between them; and -support a set of modern disease control measures that address contemporary health problems such as AIDS, cancer, and heart disease, and incorporate due process safeguards (notice, hearings, administrative review, right to counsel, standards of evidence) Read the entire page →
From page 11... ... Provisions for tenure in office, such as a specific term of appointment, should promote needed continuity of professional leadership. � The committee recommends that each state establish standards for local public health functions, specifying what minimum services must be offered, by what unit of government, and how services are to be financed. Read the entire page →
From page 12... ... � The committee recommends the establishment of a task force to consider what structure or programmatic changes would be desirable to enhance the federal government's ability to fulfill the public health leadership responsibilities recommended in this report. SPECIAL LINKAGES The committee finds that environmental health and mental health activities are frequently isolated from state and local public health agencies, resulting in disjointed policy development, fragmented service delivery, lack of accountability, and a generally weakened public health effort. Read the entire page →
From page 13... ... � The committee finds that, until adequate federal action is forthcoming, public health agencies must continue to serve, with quality and respect and to the best of their ability, the priority personal health care needs of uninsured, underinsured, and Medicaid clients. STRATEGIES FOR CAPACITY BUILDING To equip public health agencies to fulfill adequately their assessment, policy development, and assurance functions, it is necessary to go beyond reorganization to build agency competence. Read the entire page →
From page 14... ... In addition to conducting research directly, the federal government should support research by states, localities, universities, and the private sector. Political � Public health agency leaders should develop relationships with and educate legislators and other public officials on community health needs, on public health issues, and on the rationale for strategies advocated and pursued by the health department. Read the entire page →
From page 15... ... � Salaries and benefits should be improved for health department managers, especially health officers, and systems should be instituted so that they can carry retirement benefits with them when they move among different levels and jurisdictions of government. Programmatic � The committee recommends that public health professionals place more emphasis on factors that influence health-related behavior and develop comprehensive strategies that take these factors into account. Read the entire page →
From page 16... ... In addition, most public health workers have no formal training in public health, and their need for basic grounding may not be appropriately met by the degree programs appropriate to prepare people for middle- and upperlevel positions. To these ends the committee recommends: � Schools of public health should establish firm practice links with state and/or local public health agencies so that significantly more faculty members may undertake professional responsibilities in these agencies, conduct research there, and train students in such practice situations. Read the entire page →
From page 17... ... In addition, short course offerings should provide opportunities for previously trained public health professionals, especially health officers, to keep up with advances in knowledge and practice. � Because the schools of public health are not, and probably should not try to be, able to train the vast numbers of personnel needed for public health work, the schools of public health should encourage and assist other institutions to prepare appropriate, qualified public health personnel for positions in the field. Read the entire page →
From page 18... ... The committee intends not to prescribe one best way of rescuing public health, but to admonish the readers to get involved in their own communities in order to address present dangers, now and for the sake of future generations. Read the entire page →

From page 1...

... This study was undertaken to address a growing perception among the Institute of Medicine membership and others concerned with the health of the public that this nation has lost sight of its public health goals and has allowed the system of public health activities to fall into disarray. Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.

Summary and Recommendations Pages 1-18

Summary and Recommendations
Pages 1-18