For the Public’s Health: Investing in a Healthier Future

The poor performance of the United States in life expectancy and other major health outcomes, as compared with its global peers reflects what the nation prioritizes in its health investments. It spends extravagantly on clinical care but meagerly on other types of population-based actions that influence health more profoundly than medical services. The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society.

In 2009, the IOM formed a committee to consider three topics related to population health: data and measurement, law and policy, and funding. In this final report, the IOM assesses both the sources and adequacy of current government public health funding and identifies approaches to building a sustainable and sufficient public health presence going forward, while recognizing the importance of the other actors in the health system, including clinical care, governmental public health, and others. In order for health outcomes to improve in the U.S., we will need to transform the way the nation invests in health to pay more attention to population-based prevention efforts; remedy the dysfunctional manner in which public health funding is allocated, structured and used; and ensure stable funding for public health departments.

Solutions that have been proposed include

  • Controlling administrative waste by harmonizing records and rationalizing insurance.
  • Remedying sources of excess cost and other inefficiencies in clinical care, while improving quality (IOM, 2011b).
  • Achieving universal coverage (this involves increased cost for basic services but also savings achieved by intervening earlier and broadening coverage) (CBO, 2009; IOM, 2003).
  • Implementing population-based health improvement strategies (including action on nonhealth factors that are known to influence health outcomes).

The first three solutions have bee discussed in detail by prior IOM committees, the IOM Roundtable on Value and Science-Driven Health Care, and many others (IOM, 2004; {IOM, 2011 #3509}; CBO, 2009; Berwick et al., 2008). The present committee has examined the fourth solution, although focusing mostly on the governmental public health enterprise and its contributions to population health.

Briefing Slides (PDF)

Press Release (HTML)

Report Brief (PDF, HTML)

Institute of Medicine. For the public’s health: investing in a healthier future. Washington, DC: National Academies Press; 2012. Available from