First, disease risk is currently conceived of as a continuum rather than a dichotomy. Three realities are central to the development of effective population-based prevention strategies.
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To modify these, the nation and the intersectoral public health system must identify and exploit the full potential of new options and strategies for health policy and action. Personal health care is only one, and perhaps the least powerful, of several types of determinants of health, among which are also included genetic, behavioral, social, and environmental factors (IOM, 2000 McGinnis et al., 2002). This concept was best articulated by Rose (1992), who noted that “medical thinking has been largely concerned with the needs of sick individuals.” Although this reflects an important mission for medicine and health care, it is a limited one that does little to prevent people from becoming sick in the first place, and it typically has disregarded issues related to disparities in access to and quality of preventive and treatment services. This approach identifies key determinants of the nation's health and presents evidence for their consideration in developing effective national strategies to assure population health and support the development of a public health system that blends the strengths and resources of diverse sectors and partners (IOM, 1997).įor nations to improve the health of their populations, some have cogently argued, they need to move beyond clinical interventions with high-risk groups. This chapter describes the rationale behind a transformed approach to addressing population health problems. Furthermore, the efforts of the public health system must be supported by political will-which comes from elected officials who commit resources and influence based on evidence-and by “healthy” public policy-which comes from governmental agencies that consider health effects in developing agriculture, education, commerce, labor, transportation, and foreign policy. As has been outlined in the preceding pages, what is needed is the creation of an effective intersectoral public health system. To best address the social, economic, and cultural environments at national, state, and local levels, the nation's efforts must involve more than just the traditional sectors-the governmental public health agencies and the health care delivery system. Approaching health from a population perspective commits the nation to understanding and acting on the full array of factors that affect health. Such repositioning will affirm and expand existing commitments to reflect a broader perspective.
Given these issues, the committee believes that it is necessary to transform national health policy, which traditionally has been grounded in a concern for personal health services and biomedical research that benefits the individual. The work of assuring the nation's health also faces dramatic change, systemic problems, and challenging societal norms and influences. As noted in Chapter 1, America's health status does not match the nation's substantial health investments. Assuring the health of the public, however, goes beyond focusing on the health status of individuals it requires a population health approach.
For most people, thinking about health and health care is a very personal issue.
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