Assuring the
Public’s Health
in the
st
21 Century
Institute of Medicine
Washington, DC
HEALTH
TARGET OF
INTERVENTION
SOCIETY AND
INSTITUTIONS
COMMUNITY
INDIVIDUALS
INDIVIDUAL
ILLNESS
Clinical Care Health
Promotion/
Prevention
Public
Advocacy
TYPE OF INTERVENTION
Intersectoral
Working:
Jobs/Housing/
Education
Actual Causes of Death in the
United States in 1990
Deaths
Cause
Tobacco
Diet/activity patterns
Alcohol
Microbial agents
Toxic agents
Firearms
Sexual behavior
Motor vehicles
Illicit use of drugs
Total
Estimated
400,000
300,000
100,000
90,000
60,000
35,000
30,000
25,000
20,000
1,060,000
Percentage of
Total Deaths
19
14
5
4
3
2
1
1
<1
50
Causes of Premature Mortality
Environmental
Factors
20%
Genetic Factors
20%
Behavioral
Factors
50%
Inadequate
Access to
Medical Care
10%
The Core Function Project: U.S. Public Health Service, 1993
Public Health Expenditures As a
Percentage of Health Expenditures
Public Health
Expenditures
1%
Total Health
Expenditures
99%
The Core Function Project: U.S. Public Health Service, 1993
The Essential Public Health Services
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Monitor health status to identify community health problems.
Diagnose and investigate health problems and health hazards in the
community
Inform, educate and empower people about health issues
Mobilize community partnerships to identify and solve health problems
Develop policies and plans that support individual and community health
efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
Assure a competent public health and personal health care workforce
Evaluate effectiveness, accessibility, and quality of personal and
population-based health services
Research for new insights and innovative solution to health problems
Source: Public Health Function Steering Committee
The Public Health System
Community
Health care
delivery system
Governmental Public Assuring the Conditions
Health Infrastructure for Population Health
Academics
The National Academies
Advisors to the Nation on Science, Engineering and Medicine
Employers &
Business
The Media
INSTITUTE OF MEDICINE