U.S. spends too little on public health initiatives: report

(HealthDay) -- The United States needs to spend more on its chronically underfunded public health system and use that money more efficiently, according to an Institute of Medicine report released Tuesday.

The United States spends more on health than any other nation -- nearly $2.5 trillion in 2009 -- but has lower scores on life expectancy, infant survival and other indicators of population health than other wealthy nations, according to the report.

Public health department initiatives, services and expertise can help prevent or decrease rates of chronic diseases that account for the bulk of rising U.S. health spending, the authors report.

However, only 3.1 percent of U.S. health spending went to government-administered public health in 2009, according to the U.S. Centers for Medicare and Medicaid's National Health Expenditure Accounts. That works out to $251 per person in public health spending, compared with $8,086 per person in medical care spending.

The report calls for the U.S. Department of Health and Human Services to establish new goals for life expectancy and per-person health spending. The hope is that setting targets will motivate public health and medical care professionals to work together to maximize the value of health spending, and that public health skills and knowledge are used to address some of the biggest issues facing the larger health care system, such as the unnecessary use of medical procedures.

To achieve efficient use of public health dollars, the report recommended that the U.S. National Prevention, Health Promotion, and Public Health Council -- created by the Affordable Care Act -- should establish the minimum level of public health services every community should receive from its state and local health departments.

In addition, the council should create an expert panel to determine how much money is needed for every public health department to provide at least these minimum services, and to determine the proportion of federal health spending that needs to be spent in public health and medical care in order to get better value, the report said.

"Developing and implementing strategic population-based efforts to improve our health as a nation will increase the quality of life and productivity of Americans at the same time that it will contribute to moderating the expense of the clinical care system," report committee chair Dr. Marthe Gold, a professor and chair of the department of community health and social medicine at City College of New York, said in a National Academies news release.

"The country's failure to maximize the conditions in which people can be healthy continues to take a growing toll on the economy and on society. As the backbone of the health system, public health departments could help communities and other partners engage in efforts and policies that lead to better population health," Gold said.

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