For the Public's Health

The Role of Measurement in Action and Accountability

The United States spends more money on health care than any other country in the world, but there's much more to good health than getting health care from doctors and hospitals. In fact, life expectancy in the United States ranks 49th among all nations, and infant mortality rates are higher in the United States than in many less-affluent nations. A new Robert Wood Johnson Foundation (RWJF)-commissioned Institute of Medicine (IOM) report argues that America’s less-than-stellar standing in these population health measures stems in part from inadequacies in the country’s system for gathering, analyzing and communicating health information that focuses not just on clinical care data but on the underlying factors that contribute to poor health, such as health behaviors and social determinants. The IOM report, For the Public’s Health: The Role of Measurement in Action and Accountability, reinforces the urgency to address health not just in the doctor’s office but where it starts—in our homes, schools, jobs and communities.

The report’s authors make specific recommendations for improved data collection and coordination by federal agencies such as the National Center for Health Statistics, making the case that better data can inform action to improve health in local communities. The County Health Rankings, first released in February 2010 by RWJF and the University of Wisconsin Population Health Institute, provided for the first time a standard measure of the overall health of each county in every state across the country. This collection of 50 reports—one per state—helps community leaders see that where we live, learn, work, and play influences how healthy we are and how long we live. In addition, the Rankings Web site provides resources to help county leaders—including public health professionals, government officials and business owners—identify and implement proven strategies to address the multiple factors that influence health.

Echoing the work of the RWJF Commission to Build a Healthier America, the report also calls for increased federal focus on the non-clinical factors that we know affect how healthy we are such as access to affordable, healthy foods; safe places for children to exercise; and access to high-quality education. The authors of the report recommend that the Department of Health and Human Services (HHS) develop and implement a standardized, core set of community health indicators that reflect these critical social determinants of health and enable true comparisons from one jurisdiction to another.

The report’s authors also recommend that HHS support the increased use of data-driven tools and models, such as health impact assessment (HIA), that can assess and predict potential health-related outcomes of policies, plans and projects that may impact the types of non-clinical health factors mentioned above. The Health Impact Project, a collaboration of RWJF and The Pew Charitable Trusts, is one of the nation’s leading resources on how HIAs can enable policy-makers in a range of sectors to factor health into their decision-making.

This is the first of three corresponding RWJF/IOM reports on strengthening the public health system that will be released between now and the end of 2011.

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