with those of its high-income peers (Commonwealth Fund Commission on a High Performance Health System, 2011; OECD, 2010b).
Data collection, reporting, and action—including public policy and laws informed by data and quality metrics—are needed to support activities that will alter the physical and social environment for better health. In the present report, For the Public’s Health: Investing in a Healthier Future, the committee continues the arguments presented in its first report: to the detriment of society, its fixation on clinical care and its delivery eclipses attention to population-based activities that offer efficient and effective approaches to improving the nation’s health.
Viewing U.S. health problems through a funding lens reveals two issues: (1) insufficient funding for public health and (2) dysfunction in how the public health infrastructure is funded, organized, and equipped to use its funding.2 The solutions that the committee proposes in this report are intended to address both issues. Chapter 1 provides an introduction and context for the report. In Chapter 2, the committee describes how the governmental public health system and its financing can be reformed. The two-part Chapter 3 discusses the administrative changes needed to facilitate more efficient and rational allocation and use of funds in public health, and the research needed to help the public health infrastructure to become more knowledgeable about and effective in its use of funding. Chapter 4 offers recommendations for providing funding that is sufficient, stable, and sustainable to permit optimal functioning of the public health infrastructure. Although the report focuses largely on the funding of governmental public health activities, the committee recognizes that a far broader societal approach to improving population health is necessary. It would extend to an array of stakeholders and societal strategies to improve the conditions and environments that influence health (such as education, employment, and housing). Stakeholders, some described in the committee’s other reports as actors in a multi-sectoral health system, include non-health government agencies, businesses, philanthropic organizations, and community-based organizations. Their contributions to health improvement include policy actions, financial support, and a variety of interventions. First, however, the nation’s health investments require change to achieve better value for money. Solutions that have been proposed include
• Controlling administrative waste.
• Remedying sources of excess cost and other inefficiencies in clinical care, while improving quality (IOM, 2011c).
2In Chapter 2, the committee revisits the multi-sector health system that it described in its first report and describes the evidence-based solutions that will help the nation to achieve better health outcomes and realize greater value from its investments in health.