The US Congress needs to establish a national public health council to advise the government on public health issues and to review the policies of other agencies for their impact on the national health, says a new report from the Institute of Medicine.
More reliable funding, improved organisation, and better coordination with other government agencies are needed, says the report. It urges public health agencies to develop public and private sector partnerships to work with the present system and devise new public health strategies.
"We have tried to marshal the evidence and argue why these other factors should be involved," said Dr Jo Ivey Boufford, dean at the Robert F Wagner Graduate School of Public Health, New York University, and co-chairwoman of the committee that produced the report.
Compared with 1900, "by every measure we are healthier, live longer and enjoy lives less likely to be marked by injury, ill health or premature death," says the report.
But in terms of life expectancy the United States lags behind most other comparable nations. And the country ranks 28th in infant mortality among 39 industrialised nations. Compared with 30 other countries, the United States has the highest incidence of all cancers. In the World Health Organization's assessment of health systems around the world the United States is ranked 37th.
Recent events in the United States, such as the anthrax scare and the threat of bioterrorism, have shown up weaknesses in the public health system. In 1988 the Institute of Medicine issued a report on the public health, saying that it was "in serious disarray." The latest report shows that 14 years later this is still the case.
The report cites a long list of inadequacies in the health system: a vulnerable and outdated health information system, an insufficient and inadequately trained public health workforce, and antiquated laboratory capacity, among others. This not only leaves the nation vulnerable to exotic diseases and bioterrorism but risks the public's health when there are social and environmental conditions that undermine health, including toxic water and air, poor housing, poverty, and uneven access to health care.
Dr Boufford says that the solution lies in organising "public policies and political will, and we have not yet been able to mobilise these effectively. We know what the problems are. We haven't done anything about them."
The Future of the Public's Health in the 21st Century is available for purchase at the institute's website,http://www.iom.eduwww.iom.edu