communities that provide practical and service-oriented learning opportunities for students. Academia also assures workforce competence by providing high-quality education and training (ES 8), in addition to its substantial roles in evaluation and research (ESs 9 and 10). America’s businesses and employers have the opportunity to promote health and prevent disease and disability in their own workforces (ES 3). Employers are also a critical source of health care payment for personal health care services (ES 7). Furthermore, because businesses are closely involved with communities, they can collaborate in partnerships that monitor, identify, and address community health problems (ESs 1 and 4). Finally, the mass media can educate, inform, and thus empower (ES 3) communities with accurate and timely health communications.


The committee’s findings call attention to the fact that achieving the vision of healthy people in healthy communities is a difficult and complex task that cannot be accomplished through a single plan of action or by a single governmental agency or nongovernmental entity. Rather, broad societal action is required at every level; and such action needs to be better coordinated by all individuals, families and community members, businesses and workers, and health care providers and policy makers. Furthermore, responding to this vision requires a long-term public and political commitment to ensure that the policies, financial and organizational resources, and political and public wills are in place to assure the presence of the conditions necessary for all Americans to live longer, healthier lives. To support the creation of an effective intersectoral public health system, the committee identified six areas of action and change. These are reflected in the recommendations made to the potential public health system actors described in this report, but they are equally applicable to other components of the public health system not specifically addressed. Action and change are needed to:

  1. Adopt a population health approach that builds on evidence of the multiple determinants of health;

  2. Strengthen the governmental public health infrastructure—the backbone of any public health system;

  3. Create a new generation of partnerships to build consensus on health priorities and support community and individual health actions;

  4. Develop appropriate systems of accountability at all levels to ensure that population health goals are met;

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