budgets must balance a variety of needs, programs, and policies, and the budgets draw on different sources (including different types of taxes and fees), depending on jurisdiction. Therefore, the funds allocated to public health depend heavily on how the executive and legislative branches set priorities. Other funding sources support public health activities in the community, including “conversion” foundations formed when nonprofit hospitals and health insurers became privatized (such as The California Wellness Foundation). Additionally, funds for population health and medical care activities may be provided by community-based organizations with substantial resources, not-for-profit clinical care providers, and stakeholders in other sectors.
The subjects addressed in the three reports are not independent of each other and, indeed, should be viewed together. For example, measurement of health outcomes and of progress in meeting objectives can provide evidence to guide the development and implementation of public health laws and the allocation of resources for public health activities. Laws and policies often require the collection of data and can circumscribe the uses to which the data are put, for example, prohibiting access to personally identifiable health information. Similarly, statutes can affect funding for public health through such mechanisms as program-specific taxes or fees. And laws shape the structure of public health agencies, grant them their authority, and influence policy.
In the three reports, the committee will make a case for increased accountability of all sectors that affect health—including the clinical care delivery system, the business sector, academe, nongovernment organizations, communities, and various government agencies—wherever possible, with coordination by the government public health agency leading or coordinating activities and sectors. The committee’s first report, released in December 2010, focused on measurement of population health and related accountability at all levels of government. The present report reflects the committee’s thinking about legal and public policy reform on three levels: first, pertaining to the public health agencies’ powers, duties, and limitations as defined in enabling statutes (i.e., that establish their structure, organization, and functioning); second, the use of legal and policy tools to improve the public’s health; and third, pertaining to other sectors of government at the national, state, and local levels, and the role of a diverse set of private and not-for-profit sector actors. The committee’s final report on funding, will consider resource needs and approaches to addressing them in a predictable and sustainable manner to ensure a robust population health system.