By David A. Kindig, MD, PhD
I’ve been waiting with anticipation for last week’s IOM report on For the Public's Health: Investing in a Healthier Future, from the IOM Committee on Public Health Strategies to Improve Health. This is the third of three reports. The first report was released in December 2010 and focused on measurement of population health and related accountability at all levels of government. The second report was released in June 2011 and reflected the committee’s thinking about legal and public policy reform such as health departments’ powers, duties, and limitations as defined in enabling statutes and the use of legal and policy tools to improve the public’s health.
The third report addresses the critical issue, in a time of declining resources, of public health resource needs and approaches to addressing them in a “predictable and sustainable manner to ensure a robust population health system.” Given my many calls for dependable revenue streams for population health improvement, this clearly was a must-read for me.
This is a very important and thorough report with an excellent Executive Summary for those in a rush. Today I will simply give you a preview of several of the most important recommendations and next week I will blog on a fuller critique from a population health improvement perspective.
Recommendation: The Secretary of the Department of Health and Human Services should adopt an interim explicit life expectancy target, establish data systems for a permanent health-adjusted life expectancy target, and establish a specific per capita health expenditure target to be achieved by 2030. 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.
This would appear to be more of a measurement recommendation, and it does follow from the first report, but the call to set specific targets not only for broad outcomes but also for per capita healthcare expenditures is the kind of challenge we need to focus our improvement efforts. This would amount to adding an average of approximately 1.33 years to the life expectancies of 50 year old women and 0.90 years to the life expectancies of 50 year old men – which is no easy task. But the authors begin to address the investment aspect by observing that “excessive spending on medical care also presents opportunity costs — less funding remains for investment in other socially important activities, such as education. Bringing health expenditures more in line with other wealthy nations will free up resources that can support other US objectives that improve not only the health of Americans, but their quality of life.” This is a very clear population health resource perspective and challenge.
Several other recommendations deal with public health funding directly and also deserve attention, such as establishing a minimum package of public health services for every community and recommending that Congress double the current federal appropriation for public health -- and make periodic adjustments to this appropriation based on the estimated cost of delivering the minimum package of public health services.
Recommendation: The committee recommends that Congress authorize a dedicated, stable, and long-term financing structure to generate the enhanced federal revenue required to deliver the minimum package of public health services in every community. Such a financing structure should be established by enacting a national tax on all medical care transactions to close the gap between currently available and needed federal funds.
Not surprisingly, this was the only recommendation picked up by the Wall Street Journal, and certainly will be vigorously debated in the coming months or years regarding whether it is the best or most feasible potential source of such a needed funding stream.
These are only the highlights. They are extremely important considerations for a national population health improvement strategy and for enhancing public health. However, with the exclusive emphasis on governmental public health, the report falls short in advocating a broad population health strategy. Next week I’ll comment on how these recommendations could be made even more important and effective.
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.
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