and to inform advocacy for public health policies and practices.”1 At the committee’s first meeting, the sponsor clarified the intent of the reference to the “public health system” to mean the multisectoral system described in the 2003 IOM report rather than the government public health infrastructure alone (IOM, 2003).

This report is the committee’s response to its first task and hence focuses on measurement and on the US health statistics and information system, which collects, analyzes, and reports population health data, clinical care data, and health-relevant information from other sectors. However, data and measures are not ends in themselves, but rather tools to inform the myriad activities (programs, policies, and processes) developed or undertaken by governmental public health agencies and their many partners, and the committee recognizes that its later reports on the law and funding will complete its examination of three of the key drivers of population health improvement.

The committee finds that the United States lacks a coherent template for population health information that could be used to understand the health status of Americans and to assess how well the nation’s efforts and investments result in improved population health. The committee recommends changes in the processes, tools, and approaches used to gather information on health outcomes and to assess accountability. This report contains four chapters that offer seven recommendations relevant to public health agencies, other government agencies, decision-makers and policy-makers, the private sector, and the American public.

The national preoccupation with the cost of clinical care evident in the lead-up to the passage of the Affordable Care Act of 2010 is well founded, and changes in the system’s pricing, labor, processes, and technology are essential and urgent (see Chapter 1). However, improving the clinical care delivery system’s efficiency and effectiveness will probably have only modest effects on the health of the population overall in the absence of an ecologic, population-based approach to health improvement. Unhealthy communities and unfavorable socioeconomic environments will continue to facilitate unhealthy choices and unhealthy environments.

The expected reform of the clinical care delivery system and the committee’s understanding of the centrality of socioenvironmental determinants of health led it to view measures of health outcomes (often presented as indicators for public or policy-maker consumption and conveying statistical data directly or in a composite form) as serving three primary functions:


Although the committee uses clinical care system in the report to refer to the health care or medical care delivery system, the language in this quotation comes directly from the sponsor’s charge to the committee, so it was not changed.

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