NATIONAL ACADEMY PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this study was provided by the John D. and Catherine T. MacArthur Foundation, but the support of this organization does not imply that it takes responsibility for any statements or views expressed in this report.
Additional copies of this report are available in limited quantities from:
Committee on Health and Human Rights
Institute of Medicine (FO 3037)
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Washington, DC 20418
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Copyright 1994 by the National Academy of Sciences. All rights reserved.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo-type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.
COMMITTEE ON HEALTH AND HUMAN RIGHTS
ROBERT S. LAWRENCE, M.D., * Chair, Director,
Health Sciences, The Rockefeller Foundation
MARY ELLEN AVERY, M.D., * Thomas Morgan Rotch Professor of Pediatrics,
Harvard Medical School
CHRISTINE K. CASSEL, M.D., * Professor of Medicine and Professor of Public Policy Studies,
University of Chicago Medical Center
CASWELL A. EVANS, Jr., D.D.S., M.P.H., * Assistant Director of Health Services, Director of Public Health Programs and Services,
County of Los Angeles
CLAIRE FAGIN, Ph.D., R.N., * Dean and Professor,
School of Nursing, University of Pennsylvania
WILLIAM C. HSIAO, Ph.D., * Professor of Economics and Health Policy,
Harvard School of Public Health
GEORGE I. LYTHCOTT, M.D., * Assistant Commissioner (Retired),
School of Health and Adolescent Medicine, New York City Department of Health
ALICIA H. MUNNELL, Ph.D., * Assistant Secretary for Economic Policy,
U.S. Department of the Treasury
PAUL GRANT ROGERS, J.D., * Partner,
Hogan and Hartson
JANE G. SCHALLER, M.D., * David and Leona Karp Professor and Chairman,
Department of Pediatrics, Tufts University School of Medicine,
Pediatrician-in-Chief,
New England Medical Center Hospitals
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Member, Institute of Medicine |
ADVISORY GROUP ON THE ANNUAL LECTURE PROGRAM
ELENA O. NIGHTINGALE, M.D., Ph.D., * Chair, Senior Program Officer and Special Advisor to the President,
The Carnegie Corporation of New York
SOLOMON R. BENATAR, M.D., * Professor of Medicine and Head,
Department of Medicine, University of Cape Town and Groote Schuur Hospital
DON E. DETMER, M.D., * Vice President and Provost for Health Sciences,
University of Virginia
CLAIRE FAGIN, Ph.D., R.N., * Dean and Professor,
School of Nursing, University of Pennsylvania
ROBERT S. LAWRENCE, M.D., * Director, Health Sciences,
The Rockefeller Foundation
GEORGE I. LYTHCOTT, M.D., * Assistant Commissioner (Retired),
School of Health and Adolescent Medicine, New York City Department of Health
ROBERT F. MURRAY, Jr., M.D., * Professor of Pediatrics,
Medicine, and Genetics, Howard University College of Medicine
ADAM YARMOLINSKY, LL.B., * Regents Professor of Public Policy,
University of Maryland, Baltimore County
INSTITUTE OF MEDICINE STAFF
JOSEPH S. CASSELLS, M.D., Study Director,
Committee on Health and Human Rights
CONSTANCE M. PECHURA, Ph.D., Study Director,
Annual Lecture Advisory Group
ROSEMARY CHALK, Editor
TERRI BARBA, Project Assistant
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Member, Institute of Medicine |
Preface
Societies can be judged to a significant extent by the manner in which they deal with their vulnerable citizens—the elderly, those who are sick or disabled, and children. The future of any society literally depends on the future of its children. James P. Grant has dedicated his life to these issues. In this volume, he communicates both the wisdom and the caring for which he is so well known and to which we would hope all leaders aspire. The Institute of Medicine (IOM) is deeply indebted to Elena Nightingale, chair of the IOM Human Rights Lecture Program, and Robert Lawrence, chair of the IOM Committee of Health and Human Rights, which sponsored Mr. Grant's address. The Institute is committed to the protection of human rights and to the improvement in the well-being of children in the United States and around the world.
Kenneth I. Shine, M.D.
President
Institute of Medicine
