Compliance with the recommendations of the Institute of medicine report, The Future of Public Health: a survey of local health departments.

In 1989 a survey of state health officials was conducted to ascertain the extent that the recommendations of the 1988 Institute of Medicine's report, The Future of Public Health, were in place. We applied a similar survey in 1996 to assess the level of implementation of the IOM recommendations at the local health department level. Agreement with the specific IOM recommendations at the local level was, in almost all cases, greater than 90%. However, when one views the extent of these recommendations in place, nearly half fall below 50%. While there have been improvements in areas such as education of the public and outreach towards legislators and voluntary health organizations, our results show that there are still major short-comings when it comes to implementing the recommendations. Lack of resources at the local level appears to be the predominant cause of the low level of implementation, with restricted authority and lack of support also contributing to the problem. We feel the IOM recommendations can provide a strong foundation for our public health system, and hope these results help serve as a benchmark for further study.