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HEALTHY COMMUNITIES
<br />PUBLIC HEALTH AND THE COMMUNITY
<br />In its discussions with community group representatives and public health
<br />officials, the committee heard of many innovative and effective approaches to
<br />community partnerships and collaboration that are consistent with widespread
<br />themes regarding community development and "reinventing government."
<br />Broader application and further development of these new approaches to
<br />collaboration within government (with legislators, boards of health, and nonhealth
<br />agencies) and with community partners to achieve public health goals should be
<br />encouraged
<br />Shared responsibility, however, requires careful management. The
<br />governmental.public health agency in each community needs to be capable of
<br />identifying and working with all of the entities that influence a community's
<br />health, especially those that are not directly health related. This function
<br />must be undertaken by public health agencies that understand the
<br />interactions of the full range of factors that influence the community's health.
<br />To address this, a companion IOM report proposes a "community health
<br />improvement process" that draws on performance monitoring concepts, an
<br />understanding of community development, and the role of public health consistent
<br />with the Committee on Public Health's discussions (IOM, in press). Public health
<br />professionals who must work with a community to improve its own health
<br />need to be trained and their roles need to be upgraded or enhanced.
<br />The committee's discussions showed that many functions essential to the
<br />public's health, such as immunizations and health education, can and are
<br />being performed by either public or private entities, depending on the
<br />historical context, community resources, and political dynamics of a
<br />particular area. Some functions, however, such as environmental regulation
<br />and enforcement of public health laws, must remain the responsibility of
<br />governmental public health agencies. There also needs to be a resource in each
<br />community to ensure that the health impact of multiple interventions in the
<br />community are understood and addressed. This remains an ideal function for
<br />governmental public health agencies and should not be delegated. Thus, the
<br />committee reasserts the critical findings of The Future of Public Health that
<br />governmental public health .agencies 'have a unique function in the
<br />community: "to see to It that vital elements are in place and that the [public
<br />health) mission is adequately addressed:' These elements include, assessment,
<br />policy development, and assurance. For a governmental agency to execute this
<br />responsibility effectively, there must be explicit legal authority, as well as health
<br />goals and functions, that the public understands and demands. A fundamental
<br />building block for this new approach to governance is public trust. With trust in
<br />public institutions at risk or at low levels in many communities, governmental
<br />EXECUTIVE SUMMARY
<br />public health agencies must find ways to improve their openness and their
<br />communication with the public to maintain and increase their trustworthiness.
<br />REVISITING THE FUTURE OF PUBLIC HEALTH
<br />Through its analysis of the interactions between managed care organizations
<br />and governmental public health agencies and the role of public health agencies to
<br />enhance the health of the community, and through its discussions about the many
<br />responses to The Future of Public Health, the committee found that the constructs
<br />of the mission and substance for public health agencies envisioned in that report
<br />have been extraordinarily useful in revitalizing the infrastructure and rebuilding
<br />the system of public health at all levels of government in the United States and
<br />continue to be viewed as the fundamental building blocks for the future. However,
<br />although clear progress has been made, some of the recommendations of that
<br />report have not yet been implemented In light of this, the committee's analysis
<br />shows that the concepts in The Future of Public Health remain vital and
<br />essential to current and future efforts to energize and focus the efforts of
<br />public health. These concepts need to be advanced, applied, and taught to all
<br />health professionals.
<br />The committee also found that the concepts of assessment, policy
<br />development, and assurance, while useful in the public health community itself,
<br />have been difficult to translate into effective messages for key stakeholders,
<br />including elected officials and community groups. These concepts need to be
<br />translated into a vernacular that these groups can understand.
<br />In conclusion, the committee found that the public health enterprise in the
<br />United States, as embodied in governmental public health agencies, is necessarily
<br />diverse in organization and function, but operates within the common framework
<br />set out in The Future of Public Health. The committee's discussions, however,
<br />revealed continuing evidence of inadequate support for governmental public health
<br />agencies in many communities. Now, as nearly a decade before, society must
<br />reinvest in governmental public health agencies, with resources,
<br />commitments, and contributions from government, private and non -profit
<br />sectors, and substantial legal authorities, if the public's health is to improve.
<br />The partnerships that are the focus of this report— between governmental public
<br />health agencies and managed care organizations, and between public health and
<br />the community—can provide both political - support and a vehicle for this
<br />reinvestment.
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