Date: Nov. 11, 2002
Contacts: Christine Stencel, Media Relations Officer
Andrea Durham, Media Relations Assistant
(202) 334-2138; e-mail <>

Publication Announcement

Overhaul of Government Public Health Infrastructure,
New Partners Needed to Address Nation's Health Challenges

As the recent spread of West Nile virus and the anthrax scare of 2001 dramatically illustrate, America faces a variety of new health challenges in the 21st century, along with a number of persistent problems, such as racial disparities in health status and care delivery. Promoting and protecting health also has been made increasingly complex by the growing prevalence of chronic conditions influenced by multiple factors, including social, environmental, and behavioral determinants, as well as biological risk factors.

Improving America's health in the 21st century requires major overhauls in the funding, organization, and coordination of the government public health infrastructure to ensure that it has the technology, work force, and other resources needed to promote and protect health, says a new report from the Institute of Medicine of the National Academies. However, public health should no longer be thought of as just those functions historically provided by government public health agencies. Multiple public- and private-sector partners must engage with government agencies to develop innovative strategies to change the environments -- social, physical, and political -- that shape the public's health, the report says.

The Future of the Public's Health in the 21st Century reviews the nation's capabilities in this area and presents a comprehensive framework for how the government public health agencies, working with partners from the public and private sectors, can better assure the health of people and communities. Only a well-integrated public health system supported by political will, public and private partnerships, and other necessary resources can meet new and ongoing health challenges.

Traditionally, the government has been responsible for providing public health services through a network of federal, state, local, and tribal health departments and clinics. Even as demands on the public health infrastructure have increased, support for public health has languished in recent decades. Unlike personal health care, which directly and visibly affects individuals, the roles that government public health agencies and their private-sector partners play in preventing injuries and illness and keeping communities healthy often are less obvious or take place behind the scenes -- and consequently tend to get less attention and funding. According to some estimates, as much as 95 percent of the nation's spending on health -- roughly $1.3 trillion in 2000 -- goes to personal medical care and biomedical research. Only 1 percent to 2 percent of the health care budget is spent on prevention.

The nation cannot rely on biomedical research and personal health care alone for answers to all health issues, the report says. The United States spends more per capita on health care than any other country -- $4,637 in 2000 -- yet ranks 37th in a World Health Organization assessment of global health systems. It is also clear that government alone should not carry sole responsibility for protecting public health. The report recommends a new approach to public health in which the health care delivery system, academia, community organizations, businesses, the media, individual members of society, and others all work as partners with government public health agencies to promote and protect the nation's overall health. This approach addresses the multiple factors that determine health and capitalizes on the different impacts these partners can have in promoting health.

Among specific recommendations are:

Build a new generation of partnerships. Real improvements in the nation's health will depend on breaking down traditional barriers and building and sustaining partnerships across the public and private sectors. For instance, employers and community organizations, such as faith-based and nonprofit groups, create environments that influence individuals' outlooks and behaviors, and shape the conditions for good health in communities. They should work jointly with state and local health departments and health care organizations to develop and promote workplace and community health education programs and support research into the effectiveness of health-related interventions. Universities must increase their support for faculty and students to engage with communities in addressing health problems as part of their teaching, learning, and research. The private sector could be encouraged to invest in work-based and community health through creation of a corporate investment health award sponsored by the federal government and business leaders.

Invest in the public health infrastructure. Even with new partnerships, the government public health infrastructure -- its professionals, information systems, and organizations -- will remain the backbone of the nation's efforts to create the conditions that promote health. Every community should have access to certain essential public health services, such as the monitoring of health status to identify and address community health problems, and the enforcement of laws and regulations that protect health and ensure safety. Federal, state, and local governments must provide adequate and sustained funding for the public health system. The U.S. Department of Health and Human Services must develop a comprehensive investment plan to support the nation's public health infrastructure at federal, state, and local levels.

Enhance communication. The anthrax incidents of 2001 highlighted the failure of government and its public health officials to communicate clearly and effectively with the public. The federal government should facilitate the development of an enhanced health information infrastructure to improve the public health system's ability to gather, process, and share information. In addition, broadcast media have a significant influence on audiences' behaviors and attitudes. The media should donate more time to public service announcements during prime time TV hours, a step that the Federal Communications Commission should encourage by reviewing its regulations for serving the public. Moreover, to help Congress and the public become more informed about the capacity of the public health system, DHHS should issue an annual, publicly available assessment of the state of the nation's government public health infrastructure.

Reform health care availability. A significant obstacle in achieving the best possible health for the nation is the lack of health insurance for more than 41 million Americans. The report calls for the federal government to lead a national effort to examine options and develop plans for making comprehensive and affordable health insurance available to everyone.
The report was sponsored by the Centers for Disease Control and Prevention; National Institutes of Health; Health Resources and Services Administration; Substance Abuse and Mental Health Services Administration; DHHS Office of the Secretary, Assistant Secretary for Planning and Evaluation; and DHHS Office of Disease Prevention and Health Promotion. The Institute of Medicine is a private, nonprofit organization that provides advice on health policy issues under a congressional charter to the National Academy of Sciences. A committee roster follows.

Read the full text of The Future of the Public's Health in the 21st Century for free on the Web as well as more than 2,500 other publications from the National Academies Press; tel (202) 334-3313 or 1-800-624-6242 or order on the Internet at Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).

Board on Health Promotion and Disease Prevention

Committee on Assuring the Health of the Public in the 21st Century

Jo Ivey Boufford, M.D.* (co-chair)
Robert F. Wagner Graduate School of Public Service
New York University
New York City

Christine Cassel, M.D.* (co-chair)
School of Medicine
Oregon Health and Science University

Kaye W. Bender, Ph.D., M.S., R.N., F.A.A.N.
Deputy State Health Officer
Mississippi State Department of Health

Lisa Berkman, Ph.D.*
Department of Health and Social Behavior, and
Thomas Cabot Professor of Public Policy and Epidemiology
Harvard School of Public Health

Judyann Bigby, M.D.
Associate Professor of Medicine, and
Community Health Programs
Harvard Medical School

Thomas A. Burke, Ph.D., M.P.H.
Associate Professor of Environmental Health Policy
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health

Mark Finucane
Leadership Development Solutions
Health Sciences Advisory Services
Ernst & Young LLP
Los Angeles

George R. Flores, M.D., M.P.H.
Public Health Advisor
California Endowment

Lawrence O. Gostin, J.D.*
Professor of Law
Georgetown University, and
Professor of Public Health
Johns Hopkins University, and
Center on Law and the Public's Health
Georgetown University Law Center
Washington, D.C.

Pablo Hernandez, M.D.
Wyoming Mental Health Division

Judith R. Lave, Ph.D.*
Professor of Health Economics
Department of Health Services and Administration
Graduate School of Public Health
University of Pittsburgh

John Lumpkin, M.D., M.P.H.
Illinois Department of Public Health

Patricia A. Peyser, Ph.D.
Department of Epidemiology
School of Public Health
University of Michigan
Ann Arbor

George Strait, M.S.
Chief Executive Officer
MedComm Inc.
Belmont, Calif.

Thomas W. Valente, Ph.D.
Associate Professor, and
Preventive Medicine Director
Master of Public Health Program
Department of Preventive Medicine
School of Medicine
University of Southern California
Los Angeles

Patricia Wahl, Ph.D.
School of Public Health and Community Medicine
University of Washington


Rose Marie Martinez, Sc.D.
Study Director

* Member, Institute of Medicine