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For the Public's Health: Investing in a Healthier Future

In 1914, New York City Health Commissioner Herman M. Biggs remarked that " public health is purchasable, " adding that " within natural limitations, a community can determine its own death rate. " That powerful idea resonates today. The poor performance of the United States in life expectancy and other major health outcomes, as compared with its global peers (see Figure), reflects what the nation prioritizes. It spends extravagantly on clinical care but meagerly on other types of population-based actions that influence health more profoundly than medical services. At the request of the Robert Wood Johnson Foundation, the Institute of Medicine (IOM) convened a committee in 2009 to consider three topics of relevance to population health: data and measurement, law and policy, and funding. In this final report, For the Public's Health: Investing in a Healthier Future, the IOM committee assesses both the sources and adequacy of current governmental public health funding and identifies approaches to building a sustainable and sufficient public health presence going forward, while recognizing the importance of the other actors in the health system, including clinical care and others. In its new report, the committee continues arguments it introduced in its first report that, to its detriment, society's fixation on clinical care, its delivery , and its financing overshadows population-based activities that more efficiently and effectively improve the nation's health. Population-based prevention efforts can improve Americans' health more efficiently than clinical care alone, according to the committee. The health system's failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.