Assuring the Public’s Health in the st Century 21
Institute of Medicine
Washington, DC
TARGET OF INTERVENTION SOCIETY AND INSTITUTIONS
HEALTH
COMMUNITY
INDIVIDUALS
INDIVIDUAL ILLNESS
Clinical Care Health Promotion/ Prevention Public Advocacy Intersectoral Working: Jobs/Housing/ Education
TYPE OF INTERVENTION
Actual Causes of Death in the United States in 1990
Deaths
Cause Tobacco Diet/activity patterns Alcohol Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs Total Estimated 400,000 300,000 100,000 90,000 60,000 35,000 30,000 25,000 20,000 1,060,000 Percentage of Total Deaths 19 14 5 4 3 2 1 1 <1 50
Causes of Premature Mortality
Environmental Factors 20% Behavioral Factors 50%
Genetic Factors 20%
Inadequate Access to Medical Care 10%
The Core Function Project: U.S. Public Health Service, 1993
Public Health Expenditures As a Percentage of Health Expenditures
Public Health Expenditures 1%
Total Health Expenditures 99%
The Core Function Project: U.S. Public Health Service, 1993
The Essential Public Health Services
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community Inform, educate and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solution to health problems Source: Public Health Function Steering Committee
The Public Health System
Community
Health care delivery system
Governmental Public Assuring the Conditions Health Infrastructure for Population Health
Employers & Business
Academics
The Media
The National Academies
Advisors to the Nation on Science, Engineering and Medicine
INSTITUTE OF MEDICINE