IOM calls for more U.S. public health spending

To improve America's lackluster performance on health outcomes compared with its peer nations and to maintain its international competitiveness, the United States needs to invest more in its public health system and spend public health dollars more efficiently, says a new report from the Institute of Medicine.

In the report, “For the Public’s Health: Investing in a Healthier Future,” the IOM found that the United States spends more on health than other nations – almost $2.5 trillion in 2009 – and yet scores lower than other wealthy nations on life expectancy, infant mortality and other indicators of population health.

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The chronic diseases that drive the bulk of U.S. health spending are conditions that could be decreased or prevented through the initiatives, services and expertise that public health departments provide, according to the report, which also notes that 3.1 percent of U.S. health dollars go to government-administered public health. The U.S. invests $251 per person per year in public health spending compared with the $8,086 that is spent per person on medical care.

In the report, the IOM:

• calls upon the U.S. Department of Health and Human Services to set new goals for U.S. life expectancy and per-person health spending as a first step in framing the nation's efforts to achieve better overall health outcomes; 
• advises the National Prevention, Health Promotion, and Public Health Council to oversee the development of a minimum package of public health services that specifies the services every community should receive from its state and local health departments; 
• suggests the federal government should double its spending on public health to approximately $24 billion per year as a starting point to meet the needs of public health departments; and 
• recommends instituting a transaction tax on medical care services to raise the funds necessary to improve environmental and social conditions that promote health and prevent diseases such as obesity that are largely outside the medical care system's ability to influence.

“Developing and implementing strategic population-based efforts to improve our health as a nation will increase the quality of life and productivity of Americans at the same time that it will contribute to moderating the expense of the clinical care system,” said the committee that wrote the report, in a press release. “The country's failure to maximize the conditions in which people can be healthy continues to take a growing toll on the economy and on society. As the backbone of the health system, public health departments could help communities and other partners engage in efforts and policies that lead to better population health.”

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