Keeneland Conference: A Conversation with IOM's Harvey Fineberg
In 2009, the Robert Wood Johnson Foundation, requested the Institute of Medicine (IOM) to convene a committee to consider three major topics in public health: measurement, law and policy, and funding. The last of these reports, which recommends new health targets and changes in how public health is funded and organized, was released last week and has been a key topic of discussion at this week’s Keeneland Conference.
Harvey Fineberg, MD, president of the IOM, delivered a keynote address on these three reports, as well as another recent report on the potential for collaboration between public health and primary care. NewPublicHealth spoke to Dr. Fineberg about the reports and next steps.
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NewPublicHealth: How will the findings from the three-report series on public health be helpful to public health service delivery going forward?
Dr. Harvey Fineberg: I think of these reports as the contemporary trilogy of public health. They each stand on its own and yet are also connected in a vital way.
The first report looks at how we can know where we stand in public health. It emphasizes the importance of a standard core set of indicators. The aim is to make them a guide for policy and practice of public health, and to monitor where we are and what needs to be done.
The second report was on the legal foundation that provides the authority for health agencies to protect the public’s health. It turns out that many of the statutes have been on the books for decades and don’t necessarily have the specifics for dealing with contemporary needs such as the challenge of dealing with obesity or emerging infectious diseases or bioterrorism. The report pointed to the ten essential services of public health which set a standard of practice, and spoke to what state laws would be needed to make the ten core functions operable.
The third report dealt with essentially the resources that would be needed to carry out public health services. And the committee found that we grossly under-invest in public health. They recommended a conservative estimate of doubling the national investment and proposed a fee on dollars that flow through the medical system to be captured and reinvested in prevention, which they said would ultimately protect and improve health.
NPH: How important was the evidence base to the committee in producing the reports?
Dr. Fineberg: I think the key to all three of these report is that they begin with the thorough and critical analysis of the state of play currently. Each report combines the evidence base with pragmatic and creative ways to move from where we are to where the committees said we need to go.
NPH: How much do you think public health departments do and should rely on the evidence base for determining services and delivery?
Dr. Fineberg: I would say that when you are facing a restrained resource environment, being ever more prudent with the ways you use your precious dollars is very important. Being guided by how to use that money is much more important than when budges are more generous. Today and in the future, those health departments that look carefully at the evidence and shape their programs to where needs are, will return more value in public health services.
NPH: Another related report, requested by the Centers for Disease Control and Prevention (CDC), and the Health Services Resources Administration, looked at the integration of primary care and public health. How does this report fit in with the other three?
Dr. Fineberg: It’s a very important extension. The recent report is talking about a crucial underutilized mechanism to promote the public’s health, by integrating primary care and public health more collegially and effectively. Public health, for example, has a perspective on the needs of the community—where the problems exist, where primary care can offer service—and can help bring together surveillance and delivery. That’s a tremendous way of expanding every available dollar for both primary care and public health.
>>Keeneland Update: A plenary panel at this week’s Keeneland Conference reviewed the findings of all four reports, moderated by Robert Pestronk, executive director of the National Association of County and City Health Officials. Paul Jarris, MD, executive director of the Association of State and Territorial Health Officials, was invited to comment as part of a reactor panel on the reports and called them “bold,” particularly with respect to a call for a minimum package of public health services, proposed in the financing of public health report. But Jarris called the reports “incomplete” because they don’t call for health equity. “We have got to improve our measure of fairness,” Jarris told the conference attendees.
Judith Monroe, MD, head of the CDC’s Office of State, Tribal, Local and Territorial Support, called the integration of primary care and public health a “sweet spot” and said that “the challenge is making it happen,” but added that there is already work underway at CDC based on that new report. Monroe said she also appreciated that the report acknowledged that “there are different needs across the country, and one size fits won’t always fit all.”