According to the Institute of Medicine, 70% of the causes of avoidable death are attributable to our behavior and environment. The top three causes of premature death are associated with tobacco, diet and inactivity, and alcohol. Investments in public education and public health infrastructure can reduce tobacco use, obesity and alcohol consumption, yet we spend less than one percent of our health care dollars on public health interventions.
For many years, public health has been considered separately from insurance and health care financing issues. Now, as the cost of preventable chronic diseases is rising at an unsustainable rate, consensus around a holistic approach to health and health care is growing. This vision, which was articulated by the Institute of Medicine’s The Future of the Public’s Health in the 21st Century,1 rests on the idea that public health should no longer be thought of as solely a government responsibility. Businesses, schools, and communities all have a role to play in keeping Americans healthy.
Evidence-based community, workplace, and school-based programs have shown positive returns on investment in prevention and control of the prevalence of chronic disease. Programs like those detailed in the chapter on “Disease Prevention” are widely regarded as important components of the nation’s public health effort, disease prevention components of a modernized health care system that would increase the cost effectiveness and clinical effectiveness of 21st century health care.