• To provide transparent and easily understood information to members of communities and the public and private entities that serve them about health and the stakeholders that influence it locally and nationally.

  • To galvanize and promote participation and responsibility on the part of the public and institutional stakeholders (businesses, employers, community members, and others) that have roles to play in improving population health.

  • To foster greater accountability for performance in health improvement on the part of government health agencies, other government entities whose portfolios have direct bearing on the health of Americans, and private-sector and nonprofit-sector contributors to the health system.

The committee believes that analysis and use of health and relevant nonhealth data and measures are a necessary complement to and facilitator of other efforts in the transformation to healthier people, healthier community environments, and a strong, competitive national economy. Achieving those outcomes relies on an integration and building of synergy between the best evidence-based interventions at the population level and in the clinical setting. Measurement of health outcomes and performance can spur change—as demonstrated by communities that have been able to “move the needle” in their own local efforts to improve the conditions for health and in the clinical care system’s efforts to improve quality.

More complete, useful, timely, and geographically pertinent information is a necessary but not sufficient ingredient to facilitate heightened community engagement and improved performance by various stakeholders in the health system, defined as encompassing the “activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals” (IOM, 1988, 2003).

In Chapter 1, the committee constructs its case for change that will lead to a transformed health statistics and information system and to a more concrete framework for placing measurement in the service of accountability. The committee’s case includes an overview of the literature on the determinants of health and implications for the issues discussed in the remainder of the report.

In Chapter 2, the committee discusses the national health statistics and information enterprise. That enterprise is large and productive, but it lacks optimal coordination, it has gaps that impede its contributions to understanding of and improvement in population health outcomes, it does not shed sufficient light on the relevance of the determinants of health nationally or in communities, and it does not sufficiently inform about how the nation or communities can achieve improvements in health apart from



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