By David A. Kindig, MD, PhD
A few weeks ago I wrote about the first report in the Institute of Medicine For the Public’s Health series on The Role of Measurement in Action and Accountability. The second report, Revitalizing Law and Policy to Meet New Challenges was released last week. Its overall purpose is to review how statutes and regulations “prevent injury and disease, save lives, and improve the health of populations.” This post will focus on the third chapter, “Intersectoral Action for Health.”
There is growing consensus around the idea that multisectoral solutions are needed to address broad population health challenges. Various conceptual approaches have been suggested, such as Health Outcome Trusts, Accountable Health Communities (by Sanne Magnan, former Minnesota Commissioner of Health), and my own “Super Integrator” concept. The opportunity for the federal government to coordinate across all departments is also the charge and the promise of the new National Prevention Council. The IOM chapter on intersectoral action provides an excellent and concise summary of the evidence and arguments for such an approach, and includes three important recommendations (the report has nine recommendations altogether):
The committee recommends:
- that states and the federal government develop and employ a Health in All Policies (HIAP) approach to consider the health effects—both positive and negative—of major legislation, regulations, and other policies that could potentially have a meaningful impact on the public’s health.
- that state and local governments create health councils of relevant government agencies convened under the auspices of the chief executive; engage multiple stakeholders in a planning process; and develop an ongoing, cross-sector, community health improvement plan informed by a HIAP approach. Stakeholders will advise in plan development and in monitoring its implementation.
- that state and federal governments evaluate the health effects and costs of major legislation, regulations, and policies that could have a meaningful impact on health. This evaluation should occur before and after enactment.
If carefully and strategically implemented, these three recommendations should provide strong momentum for multisectoral collaboration for population health improvement. A report section entitled “The Role of Policy as a Determinant of Health” points out that “although many socioeconomic and environmental factors affect health, only some are under the personal control of individuals and families….in corporate boardrooms, legislatures, and the executive branches of government, decisions that ultimately affect the public’s health emerge from policies that few view as health decisions.” Moving to such approaches at state and local levels will be critical; whether primary responsibility for this should rest with state and local government or some broader multisectoral structure remains an open question.
The report wraps up with an appropriate warning that implementation will not be easy and that many challenges await. The report underscores that multisectoral action “cannot operate effectively without hard work to build relationships and solve interagency barriers that impede communication, collaboration, and the sharing of resources.” From my perspective, the most critical task of these is a population health business model with new and realigned resources across all determinants.
Population health advocates will eagerly await the final report in this series which promises to address these serious resource challenges.
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.
For further reading:
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