1 Assuring the Public’s Health in the 21 st Century: A Research Agenda Congressional Briefing May 19,2004 Jo Ivey Boufford, MD

2 The Committee’s Vision Healthy People in Healthy Communities

3 Causes of Premature Mortality The Core Function Project: U.S. Public Health Service, 1993

4 Public Health Expenditures As a Percentage of Health Expenditures The Core Function Project: U.S. Public Health Service, 1993

5 Actual Causes of Premature Death in the United States in 1990 Deaths CauseEstimated % of total Deaths Tobacco400,00038% Diet/activity patterns300,00028% Alcohol100,00010% Microbial agents 90,0008% Toxic agents 60,0006% Firearms 35,0004% Sexual behavior 30,0002% Motor vehicles 25,0002% Illicit use of drugs 20,0001% Source: McGinnis & Foege, JAMA 1993

6 The Essential Public Health Services 1.Monitor health status to identify community health problems. 2.Diagnose and investigate health problems and health hazards in the community 3.Inform, educate and empower people about health issues 4.Mobilize community partnerships to identify and solve health problems 5.Develop policies and plans that support individual and community health efforts 6.Enforce laws and regulations that protect health and ensure safety 7.Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8.Assure a competent public health and personal health care workforce 9.Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10.Research for new insights and innovative solution to health problems Source: Public Health Function Steering Committee

7 The Public Health System Community Health care delivery system Employers & Business Governmental Public Health Infrastructure Academics The Media Assuring the Conditions for Population Health INSTITUTE OF MEDICINE

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ASPH (Spencer 2000)9 Population-based Prevention Research Addresses health problems that affect large numbers of people; Involves a definable population; Evaluates the application and impact of new discoveries on the actual health of the population; and Focuses on behavioral or environmental factors associated with primary and secondary prevention of disease in populations; or behavioral, biological, or clinical variations among populations; or integration of behavioral, biological, and environmental factors

10 Congress and CDC Recommendation 31 Increase funding to support CDC investigator-initiated prevention research and maintain a strong program of Centers, Institutes, and Offices (CIO) generated research, and Recommendation 32 Determination of effective funding levels for Prevention Research Centers

11 NIH Recommendation 33 NIH should increase the portion of its budget allocated to population- and community- based prevention research and report this annually to the public

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