For the Public's Health Investing in a Healthier Future (2012) / Chapter Skim
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to develop and deliver effective preventive strategies is taking a large and growing toll not only on health, but on the nation's economy. That is evident in the nation's poor health performance and high per capita health expenditures compared 1The health system, as envisioned in the committee's previous reports, comprises govern mental public health, medical care, and other actors that have the ability to influence health (IOM, 2011a,b)
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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.
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ESSENTIAL INGREDIENTS FOR A RENEWED PUBLIC HEALTH ENTERPRISE AND A HEALTHY NATION Solving the system challenges described in this report will empower public health to "bend the curve" on health risks, contributing to a decrease in the volume of people who require medical care for preventable conditions, and in a broader sense, leading to improved population health outcomes. Steps to renew the public health enterprise include • E nsuring adequate and sustainable funding for governmental public health, which is able to generate information about the influences on population health and lead or support interventions to address them.
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Reaching these targets should engage all health system stakeholders in actions intended to achieve parity with averages among comparable nations on healthy life expectancy and per capita health expenditures. REFORMING PUBLIC HEALTH AND ITS FINANCING To achieve a more effective national public health effort, the nation will have to change how it allocates health expenditures in general and public health funds specifically.
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. Although this package is built on the well-known and long-established concepts of the Three Core Public Health Functions and the Ten Essential Public Health Services, it is intended to make more specific the services that every community should receive from its state and local health departments and to inform public health funding decisions.
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Circumstances may make it more appropriate for public health agencies in some jurisdictions to provide specific kinds of clinical services directly. Examples might include specialized programs that have a population health component, such as tuberculosis or sexually transmitted disease control and specialized services delivered in community settings, such as nurse home visiting or community health worker health promotion activities, and in localities that do not have an infrastructure to serve at-risk (uninsured and underinsured)
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Recommendation 5: The committee recommends that a technical expert panel be established through collaboration among govern ment agencies and organizations that have pertinent expertise to develop a model chart of accounts for use by public health agencies at all levels to enable better tracking of funding related to program matic outputs and outcomes across agencies.4 The Affordable Care Act authorized a program of research related to many of the issues raised in this report,5 but funding and infrastructure development for this program is not yet available. The committee recommends steps to achieve a strengthened research infrastructure, including dedicated funding of up to 15 percent of total public health funding.
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As the minimum package of public health services is established and the resources required to deliver them are ascertained, the public will gain a deeper understanding of how and in what settings public health action at the population level can create greater value and efficiency than can clinical care. This also will inform investment in the public health system and the appropriate allocation between clinical care and population health.
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The newly available funds could be used to build data capacity and other essential public health services in localities. As coverage for health care is extended to the entire population in the course of implementing health care reform, public health departments need to be able to retain for their population-health mission general state and local resources that were previously used to cover clinical care.
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A national tax on medical care transactions, which exists in a number of states and has been used to raise funds to expand access to medical care in Minnesota and Vermont (Michael, 2011; PHPG, 2012) , meets the committee's three criteria for evaluating potential funding sources: ability to raise sufficient funds, pertinence or a link to population health, and low likelihood of deleterious economic effects.
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Second, the committee reiterates the finding in its first report that population-based prevention efforts are critical for improving population health and that the public health infrastructure of federal, state, and local health departments is qualified to implement or support such efforts. Third, the public health infrastructure is not funded adequately to carry out its mission, and the ways in which funding is allocated and used require retooling and the application of knowledge derived from better financial information and research.
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2010b. OECD health data 2010: How does the United States compare?
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