Policy and environmental change: new directions for public health.

Solving major, persistent public health problems requires new policies and more aggressive, sweeping interventions that affect large populations. We need well-conceived health policies and effective interventions for environmental change, but are we likely to get them? To find out, the Directors of Health Promotion and Education and the U.S. Centers for Disease Control and Prevention initiated a study of state and local public health agencies in the United States from 1996 through 1999. Data were collected by peer- and non-peer-reviewed literature searches, key informant interviews, reviews of Internet sites, and a nationwide survey. Study conclusions found confusion about the legitimacy of advocacy, lack of priority and funding for interventions that take more time versus quick fixes, variable leadership, reluctance to take risks, and a political climate that often discourages government agencies to take on these interventions. There are successes, yet more can be done.