On June 21, 2011 the Institute of Medicine (IOM) released a prepublication version of For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges (Report), a report by the IOM Committee on Public Health Systems to Improve Health (Committee) and sponsored by the Robert Wood Johnson Foundation. In this Report the Committee discusses how laws may be used to optimize health outcomes.
The Report is organized in three major parts. In the first part, the Committee recommends that antiquated state public health statues be revisited and revised to provide specific powers for chronic diseases, include protections for individual rights and optimize the structure of state and local public health authority. The second part examines the ways laws can be used as tool to improve the public’s health. The third part, which is the focus of this blog, recommends broad evaluation of “Health in All Policies” (HIAP) to engage non-health actors to consider the health outcomes of their policies.
The recommendation for HIAP stems from the fact that non-health government policies such as agricultural subsidies or zoning requirements often substantially affect determinants of health. Yet most decision-makers in non-health sectors do not consider the public health dimensions of policies because they do not have a traditional or statutory responsibility to do so. The HIAP approach promotes the coordinated and routine consideration of health outcomes by decision-makers in non-health sectors such as housing, agriculture or transportation.
The Affordable Care Act (ACA) of 2010 created the highest-profile example of HIAP by establishing the National Prevention, Health Promotion and Public Health Council, which assembles the heads of major agencies and cabinet secretaries to provide coordination of leadership with respect to national health priorities from an interdepartmental perspective. The approach, however, contemplates not only federal, state and local policies, but also engagement of private sector actors to adopt practices that consider or promote health, such as “green” building standards or employer-based health and safety policies. The Report envisions establishment of state and local interdisciplinary councils modeled after the ACA’s National Prevention, Health Promotion and Public Health Council to advise a range of governmental and private-sector actors to use the HIAP approach to evaluate policies and programs. Toward this effort, state and local public health agencies may facilitate HIAP by systematizing their role as reporters about a community’s health and conveners of collaborative action by other organizations.
The Report distinguishes HIAP from its closely related cousin, Health Impact Assessments (HIAs). This distinction appears to be more a matter of degree and depth of treatment rather than conceptual. HIAP refers to a broader consideration of health in public policy and uses intersectoral consultation and collaboration, whereas HIAs (like the methodology in environmental impact reports) involve an extensive protocol for policymakers to gather, evaluate and report health impact data and alternatives for a specific program or policy. As conceived by the Report, HIAP requires fewer resources than HIAs and thus is appropriate for a broader range of policies that may have more negligible or ancillary effects on health. The Report recommends government agencies perform the more in-depth HIA when assessing the health impacts of major legislation with substantial potential health impacts, such as the federal farm bill or transportation bill or large-scale local or regional development projects.
In a Dissemination Workshop hosted by IOM on July 14, 2011, stakeholders discussed the Report’s recommendations and paths to implementation. Included among a wide variety of stakeholders invited by IOM to participate in the Workshop were the Network’s Dan Stier, PHLR’s Scott Burris, Marice Ashe from the Public Health Law and Policy Program, and the Public Health Law Center’s Doug Blanke. Committee member Lawrence O. Gostin summed up the discussion by noting that “HIAP may the most important concept in health policy full stop.”
The Report’s recommendation of the HIAP approach addresses the fact that determinants of health are affected by non-health policies. It looks beyond traditional public health policy and thus fills a gap in the field of public health law by recommending the use of HIAP to engage all decision-makers in considerations of health impacts of their policies.
This blog was developed by Erin Fuse Brown, J.D., M.P.H., deputy director, Network for Public Health Law - Western Region and Siena Smith, J.D. candidate and legal researcher, Sandra Day O’Connor College of Law at Arizona State University.
 Report, P-1.
 Report, 1-5.
 Report, 2-1.
 Report, S-7.
 Report, 3-5.
 The Patient Protection and Affordable Care Act (PPACA), Pub. L. 111-48, 124 Stat 219 (2010), § 4001; Report, 3-7.
 Report, 3-5.
 Report, 3-15.
 Report, 3-20.
 Report, 3-20.