The Future of the Public's Health in the 21st Century

The Future of the Public's Health in the 21st Century By the Committee on Assuring the Health of the Public in the 21st Century, National Academies Press, 2002, 536 pp., $39.00 (doth), $29.95 (paper). Also available at http://books.nap. edu/catalog/10548.hml. In The Future of the Public's Health in the 21st Century, experts from the national public health community present a framework for assuring the public's health in the coming decades. Convened through a collaborative agreement among the key federal agencies responsible for public health, the Committee on Assuring the Health of the Public in the 21st Century was charged with extending the scope of the landmark 1988 Institute of Medicine report, The Future of the Public's Health, to respond to a rapidly dianging national landscape. Demographic trends toward an older and more ethnically diverse population, shirts from acute to chronic disease as the more prevalent challenge, advances in biological science, and the growing importance of global health-all compel a reassessment of the nation's capacity to provide equal opportunities for optimal health to each of its citizens. The authors argue that while health has traditionally been recognized as a public good primarily under the purview of governmental public health agencies, thus approach is no longer appropriate. Rather, collaborations among many partners in the public and private sectors are required. Such partners include the public health infrastructure, the community, the healthcare delivery system, employers and business, the media, and academia. (The authors do not identify individuals as partners, it is interesting to note.) These partners, or constituencies, are used as an organizing framework for the book, with chapters devoted to the respective roles and responsibilities of each. The authors observe that despite substantial improvements in health status and life expectancy experienced in the twentieth century, current population health markers are profoundly troubling. The prevalence of certain conditions and chronic diseases such is obesity and diabetes is increasing, newly emerging infectious diseases pose major challenges, and life expectancies continue to tall snort of those in many other industrialized countries. Even more disturbing are the well-documented disparities in health outcomes and access to care that persist among citizens according to ethnic and racial backgrounds, sex, and socioeconomic status (Johnson and Smith, 2002). One of the book's more provocative discussions centers on the need to transform society's perception of health as an essentially individuallevel construct consisting of health status and access to medical care. The authors call for a more inclusive and multifaceted orientation that focuses on population-based health. This broader conceptualization recognizes multiple determinants of health, including genetic, behavioral, social, and environmental factors and has major implications for public health research and policy. To assure the public's health, the current disproportionate emphasis on biomedical research must be addressed, allowing more appropriate allocation of resources to investigate each of these contributing factors. Health policy must logically extend beyond the healthcare system to examine the roles of agriculture, housing, education, commerce, labor, and transportation. The authors distill their extensive recommendations into a national call to action comprising six overarching areas: First, they admonish, adopt a population health approach. second, strengthen the governmental public health infrastructure. Third, build "intersectoral" partnerships that engage diverse communities. Fourth, develop systems of accountability to assure the quality and availability of public health services. Fifth, make evidence the foundation of decision making and the measure of success. And, sixth, enhance communication within the public health system. …