While these patterns of investment have produced what is arguably the best biomedical research and specialty care system in the world, the nation has failed to balance its investments in primary care, public health, prevention, and the broader determinants of health, a problem clearly demonstrated by its low rankings in overall health status. McGinnis and Foege (1993) estimated that nearly half of all U.S. deaths that occurred in 1990 were attributable to behavioral and environmental factors. It has repeatedly been shown that such factors have a substantial influence on health outcomes, yet the current health system devotes most of its resources to treating disease and much less to the underlying causes of illness (CDC, 1992; Miller et al., 2012). Financial incentives and a medical culture focused overly on acute care and heroic cures encourage giving most attention to individuals who are already sick rather than promoting an effective balance of treatment and personal and community-based prevention. As a result, the current health system is inadequately equipped to provide critical health promotion and preventive services.

A number of relatively new developments have converged to create opportunities for improving the nation’s health. First, there is growing recognition that the status quo is unacceptable. The unsustainable rise in health care costs has created an urgent need for innovative ways to deliver health care more efficiently. This imperative has been evident not only in the activities of government health organizations but also in the private sector. As purchasers of health care, many employers have been exploring ways to reduce the growth in these costs. A recent survey by Towers Watson and National Business Group on Health (2010) found that many employers are incentivizing a number of healthy lifestyle activities for their employees, including weight management, smoking cessation, and screenings. The concern about health care expenditures has opened the door for innovative approaches to improving health and health care.

Adding momentum to the recognition that the status quo is unacceptable, health research continues to clarify the importance of social and environmental determinants of health (Marmot and Wilkinson, 2006; McMichael, 1999) and the limitations of the acute care medical system in addressing prevention and care needs in chronic illness. At the same time, the science with respect to primary prevention has grown and developed (The New York Academy of Medicine, 2009). As a result of these factors, a shift in the way health is approached in the United States is taking place.

Another development is the increased availability of health-related data. Advances in data collection techniques and health informatics have presented an opportunity to facilitate the utilization and sharing of data among health professionals. Recent endeavors have begun to capitalize on these opportunities. For instance, the Health Information Technology for Economic and Clinical Health (HITECH) Act encourages the collection



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