time to examine the role and usefulness of the law and public policy more broadly, both in and outside the health sector, in efforts to improve population health. This sense of urgency is due to recent and evolving developments in the following areas: the sciences of public health; the economy (i.e., the economic crisis and the great uncertainty and severe budget cuts faced by governmental public health agencies); the social and legislative arenas (e.g., the Affordable Care Act); the functioning of public health (e.g., fragmentation of government response to public health issues, lack of interstate and intersectoral coordination of policies and regulations); and the health of the population (e.g., data on the increasing prevalence of obesity and poor rankings in international comparisons of major health indicators).
In the report’s second chapter, the committee examines the laws that codify the mission, structure, duties, and authorities of public health agencies. The chapter also examines the loci—federal, state, and local—of government action to manage different types of health risk, as well as the interaction among the levels of government. In the third chapter, the committee discusses statutes, regulations, and court litigation as tools specifically designed to improve the public’s health. In the fourth chapter, the report explores non-health laws and policies that are enacted or promulgated in other sectors of government, but have potentially important impacts on the public’s health. These include public policy in areas such as transportation, agriculture, and education. Numerous examples of policies adopted in various sectors of government have had unintended consequences for health. These include (1) agricultural subsidies that spurred the development of inexpensive sweeteners, which are a key component of nutrient-poor foods and beverages, and (2) a national education policy that has led to diminished and even nonexistent physical education in schools.1 The chapter discusses the intersectoral nature of the influences on the public’s health, and refers to structured ways to consider health outcomes in all policymaking—a “Health in All Policies” (HIAP) approach. This approach takes into account health-producing or health-harming activities in all parts of government, as well as those of private sector actors. In this chapter, the committee also continues its discussion of the broad determinants of health begun in its first report, but now in the context of legal and policy interventions, many located outside the health sector or involving multiple sectors. The chapter ends with a discussion of the evidence needed for “healthy” policymaking.
The report’s key messages focus on three major areas. First, the committee finds that laws and public policies that pertain to population health warrant systematic review and revision, given the enormous transformations in the practice, context, science, and goals of public health agencies
1 For a discussion of the effect of the No Child Left Behind policy on physical education in schools, see http://sports.espn.go.com/espn/otl/news/story?id=4015831.