has been worsening for decades leads us to recommend that the nation and its leaders act now in three areas: (1) intensify efforts to pursue existing national health objectives that already target the specific areas in which the United States is lagging behind other high-income countries, (2) alert the public about the problem and stimulate a national discussion about inherent tradeoffs in a range of actions to begin to match the achievements of other high-income nations, and (3) undertake analyses of policy options by studying the policies used by other high-income countries with better health outcomes and their adaptability to the United States.


RECOMMENDATION 4: The nation should intensify efforts to achieve established national health objectives that are directed at the specific disadvantages documented in this report and that use strategies and approaches that reputable review bodies have identified as effective.

Although the panel was not tasked with evaluating specific policies or programs that could address the U.S. health disadvantage we document in this report, the broad outlines are clear enough. The list of factors that may be responsible for the U.S. health disadvantage is daunting, but it is also very familiar to experts in public health and social policy. The list of specific health problems have been long-standing concerns: infant mortality, injuries, violence, adolescent pregnancy, sexually transmitted infections and HIV, drug abuse, obesity, diabetes, heart and lung disease, and disability. Similarly, the underlying contributors are familiar explanations: smoking and other unhealthy behaviors, education, poverty, and the physical and social environment. Many evidence-based strategies to address these specific public health challenges have been identified, and the United States has set national objectives to address them.

Indeed, the very areas in which the United States is deficient relative to other high-income countries are outlined in Healthy People 2020 (U.S. Department of Health and Human Services, 2012a) (see Table 10-1). The problem areas identified in this report align fully with the 12 priority areas in that report that were subsequently singled out as “critical to the nation’s health needs” (Institute of Medicine, 2011g, p. 2). For example, high U.S. transportation-related injury or violent deaths could be ameliorated by efforts that reduce traffic fatalities or homicides. The U.S. ranking as world leader in obesity and the high prevalence of diseases related to obesity (e.g., diabetes) could be helped by initiatives that succeed in lowering the average body mass index of the population.

Similarly, the national prevention strategy of the Surgeon General’s

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