taxes) on social security programs such as old-age, disability, and survivors insurance; public health or sickness insurance; workers’ compensation; unemployment insurance; and family allowance programs (U.S. Census Bureau, 1995).


Nine areas of health disadvantage are documented in Part I of this report:

•   adverse birth outcomes;

•   injuries, accidents, and homicides;

•   adolescent pregnancy and sexually transmitted infections;

•   HIV and AIDS;

•   drug-related mortality;

•   obesity and diabetes;

•   heart disease;

•   chronic lung disease; and

•   disability.

There are policy implications for each of these. Although much is still to be learned, for many of these public health issues there are evidence-based policies that could address them at the national, state, and local levels.

Policy is also relevant to the unfavorable social, economic, and environmental conditions identified in this report as potential contributors to the U.S. health disadvantage. A variety of policies can contribute to high poverty rates, unemployment, inadequate educational achievement, low social mobility, and the absence of safety net programs to protect children and families from the consequences of these problems. However, identifying and implementing policy solutions is a formidable challenge. For example, national health objectives to address many of the conditions listed above were adopted decades ago by the federal government but only some have been achieved, a problem that global initiatives to improve public health have also encountered. Although there have been important public health successes in the United States and elsewhere, such as the remarkable progress in reducing the rate of tobacco use (Brownson et al., 2006), a variety of barriers have impeded progress on other fronts, such as stemming the obesity epidemic or reducing smoking among adolescents.

Other high-income countries with better health status, lower rates of poverty, and more impressive advances in education may owe their success to creative policies or strategies that could find application in the United States. These suppositions, however, amount only to informed speculation and are without empirical evidence. This panel did not undertake a systematic

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