Informing the Future

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Informing the Future Critical Issues in Health FIFTH EDITION Advising the nation / Improving health

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INSTITUTE OF MEDICINE 500 Fifth Street, N.W. Washington, DC 20001 Funding: This document was produced using internal IOM funds. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on sci- entific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sci- ences the responsibility for advising the federal government. The National Academy of Engineer- ing also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters per- taining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to asso- ciate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is adminis- tered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. COVER: The nautilus shell is a marvel of the natural world. As the nautilus matures, its shell expands geometrically to accommodate the growing shell- fish, unfolding into a functional home as well as one of nature’s perfect loga- rithmic spirals. First expressed by Descartes, the logarithmic spiral under- lies not only the nautilus shell but also much of the natural world, including the human cochlea, the Milky Way, and a simple pinecone. Suggested citation: IOM (Institute of Medicine). 2009. Informing the Future: Critical Issues in Health, Fifth Edition. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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Contents The Institute of Medicine: Advising the Nation, Improving Health 1 Charting a Course for the Future of Health Care 5 Meeting the Unique Health Needs of Women and Children 17 Improving the Nation’s Health Care System 33 Stretching Across International Borders 53 Eating Right: Keeping America Healthy 67 Managing Threats and Ensuring Healthy Communities: Health of the Public 75 Taking Care of Those Who Take Care of Us: Military and Veterans 85 Advancing Knowledge and Shaping a Research Agenda 103 Convening and Collaborating: Forums and Roundtables 115 Producing Tomorrow’s Health Leaders: Fellowships at the Institute of Medicine 123 Recent and Upcoming Reports 127 Contact Us 163 

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