among states and localities. However, government 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 that are formed when nonprofit hospitals and health insurers became privatized (such as the California Wellness Foundation). Funds for population health and medical care activities are also provided by community-based organizations that have substantial resources, by not-for-profit clinical care providers, and by stakeholders in other sectors.
The subjects addressed in the committee’s 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 by, 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 governmental public health agencies, grant them their authority, drive partnerships with other sectors, and influence policy.
In its three reports, the committee has made the case for increased accountability of all sectors that affect health—including the clinical care delivery system, the business sector, academe, nongovernment organizations, communities, the mass media, and various government agencies—with coordination, wherever possible, by the governmental public health agency that is 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 second report, released in June 2011, reflected the committee’s thinking about legal and public policy reform on three levels: the public health departments’ powers, duties, and limitations as defined in enabling statutes (that establish their structure, organization, and functioning); the use of legal and policy tools to improve the public’s health; and other sectors of government at the national, state, and local levels and diverse private and not-for-profit sector actors. This third report on funding, in a time of declining resources, considers resource needs and approaches to addressing them in a predictable and sustainable manner to ensure a robust population health system.