The United States spends far more than any other nation on medical care, more than 17 percent of our gross domestic product. We are not getting our money’s worth, however: The life expectancy of Americans ranks 49th among all nations. Our infant mortality rates are higher than those of many less affluent countries. And we know little about our nation’s wellbeing and what we can do to improve our health.
Those were some of the sobering messages from the Institute of Medicine’s Committee on Public Health Strategies to Improve Health, which authored the recently released report, “For the Public’s Health: The Role of Measurement in Action and Accountability.” The committee, of which I’m a member, has been commissioned by the Robert Wood Johnson Foundation to examine three major topics that influence public health – measurement, laws and funding. In our first report on measurement, we concluded: “The United States lacks both a cohesive national strategy and the appropriate measurement tools to track and respond to the social and environmental factors that affect health outcomes.” In addition, we haven’t developed “reliable approaches to measuring the effectiveness of public health agencies and other organizations in improving the health of Americans.”
In other words, we have few clues on reversing our poor health outcomes because we don’t have effective ways to collect, analyze and communicate health information about our population.
That doesn’t mean we don’t do agood job of treating sick people. Infact, we have one of the best illness based clinical care systems in the world. But a glimpse of our nation’s rising rates of obesity and diabetes reveals a critical need to strengthen preventive care and wellness strategies. Our failure in these and other areas harms our quality of life, creates disparities and reduces our country’s ability to be competitive in the world marketplace.
For example, most health professionals recognize that the inabilityof residents in a community to buy healthy food or access safe parks can diminish health. But because factors like these are not routinely measured, they aren’t addressed. City planners, public transportation providers, law enforcement and others aren’t informed and mobilized to make changes that could improve health. Educators, health care providers and policy makers may not recognize a population’s need for information on, say, how to eat healthier or reduce one’s risk factors for diabetes.
Data-driven strategies and evaluation tools can help our communities, states and nation better inform policies, funding and actions both of individuals and organizations. To that end, our committee recommended these steps:
• Revamp the National Center for Health Statistics, the nation’s lead health statistics agency in the U.S. Department of Healthand Human Services (HHS), to improve coordination, integration and coherence of data in ways that suggest appropriate responses from public health agencies and their partners.
• Call on HHS to develop and implement a standardized, core set of health outcome and community health indicators that reflect national, state and local priorities and enable “apples to apples” comparisons of jurisdictions.
• Charge HHS with adopting a single, broad measuring tool, analogous to the gross domestic product, to track trends, mark progress and equip policy makers to better monitor health, make forecasts and set priorities.
• Urge HHS to begin reporting annually the social and environmental factors that influence a population’s health to educate individuals, health professionals and communities on ways to improve health.
• Facilitate greater collaboration between public health agencies and medical care systems to use data to set public health priorities and increase the effectiveness and efficiency of the clinical care system.
• Implement a framework of robust and available health indicators that provides the clear accountability needed to enable communities and policy makers to understand, monitor and improve the actions of various partners in our health system.
We believe these steps are critical for our nation and our citizens, who face rising health care costs and need information so they can take responsibility for their personal health. I believe the Affordable Care Act of 2010 will benefit Americans with its focus on insurance for all and health promotion and disease prevention. However, we also need the data – relevant, coordinated and communicated – that will guide us as we build a healthier population, environment and economy.
Mary Mincer Hansen, Ph.D., R.N., is director of DMU’s master of public health program with a joint appointment in its global health department. The former director of the Iowa Department of Public Health, Mincer Hansen has served on many national advisorycouncils and recently was appointed to the National Health Care Workforce Commission. The IOM committee report, “For the Public’s Health: The Role of Measurement in Action and Accountability,” is available online at www.nap.edu.
