The committee believes that evidence-based public health strategies should infuse all departmental programs, including the reimbursement and research programs. This model would, for example: emphasize prevention in Medicare and Medicaid and in NIH, enabling these different types of programs to positively reinforce each other; recognize the importance of supporting services, such as the nutrition programs provided by the Administration on Aging that in the past 36 years have served seniors more than six billion meals, or the vital work of Head Start, which produces not just educational outcomes for participating children, but improvements in their health and beneficial effects on parents.

Attributes of an integrated public health agenda, in addition to helping create an aligned and coherent mission, as discussed above and in Chapter 2, would include the following:

  • Insistence that public health interventions, as well as medical services, create value—they should produce improvements or benefits for the greatest number of individuals, to the most vulnerable populations, to the greatest degree possible, and at the lowest cost.

  • Calculation of the full value of public health services—value should not be determined by just measuring the costs and benefits to the health sector, but should also include estimates of societal costs and benefits. For example, public health programs to urge the use of child car seats can prevent injuries that would not only require expensive medical care (health costs), but also special education (education costs) and lifelong disability payments (social welfare costs and lost productivity).

  • An emphasis on health behavior, disease prevention, and health literacy—health literacy requires that individuals have the capacity to obtain, process, and understand basic health information and services so they can make appropriate health decisions (HHS, 2000); at the same time, it requires that the information provided be culturally and linguistically appropriate.

  • Interdepartmental and cross-departmental approaches— representatives of diverse units of HHS—and in some cases, other departments5—should coordinate related activities to avoid


The Departments of Agriculture, Defense, Education, Energy, Homeland Security, Interior, Labor, Transportation, Treasury, Veterans Affairs, and the Environmental Protection Agency all play a role in some aspect of health policy (see Box 2-1).

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