Health policy implications of emerging infections.

The solutions to emerging disease problems involve politics and policy issues, as well as solid science. The National Academy of Sciences’ Institute of Medicine (IOM), whose mission is to “improve the health of people of the nation and the world,” draws upon the expertise of elected members as well as others in the United States and other nations to make policy recommendations. Groups convene to debate contentious issues and publish evidence-based reports with recommendations to government, academia, industry, and the public. Evidence-based reports are the foundation upon which policy can be built. In this last decade, IOM has produced several documents that have focused on emerging infections and provided a springboard for policy on a local, nationwide, and international scale. The U.S. Capacity to Address Tropical Infectious Disease Problems (1987) (1) concluded that U.S. capacity was barely adequate and that improvement in policies and modest additional funding could make a substantially stronger contribution to the field. Required efforts included sustained support for basic and applied research; accelerated development and testing of new preventive, therapeutic, and diagnostic technologies; sustainable career structures for tropical disease professionals; increased capacity to train U.S. tropical disease professionals and those from developing countries in research and public health service; development of disease surveillance capabilities; strengthened institutional capabilities in developing countries; and flexible, responsive administration of programs. The Future of Public Health (1988) (2) report made three basic recommendations regarding the mission of public health and defined its core functions to be assessment, policy development, and assurance. It also included guidance for the government’s role in fulfilling the public health mission and the responsibilities unique to each level of government. The report has been a useful blueprint for the past decade. Emerging Infections: Microbial Threats to Health in the United States (1992)(3) identified significant emerging infectious diseases, determined what might be done to deal with them, and recommended how similar future threats might be confronted to lessen their impact on public health. The document focused on factors contributing to disease emergence, not the diseases themselves: human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, microbial adaptation and change, and the breakdown of public health measures. Sexually Transmitted Diseases: The Hidden Epidemic (1997) (4) focused on the need for a new social norm of healthy sexual behavior. The small investment in prevention efforts was contrasted with the very high costs of care for treating sexually transmitted diseases (STDs) (Figure 1). The report also examined the obstacles and opportunities presented by managed care. Limitations include the low priority for STD prevention, emphasis on short-term cost savings, Health Policy Implications of Emerging Infections