For the Public's Health The Role of Measurement in Action and Accountability (2011) / Chapter Skim
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as the intersectoral system that comprises the government public health agencies and various partners, including communities, the health care delivery system, employers and business, the media, and academia. In the present report, the system has been redefined as simply "the health system." The modifiers public and population are poorly understood by most people other than public health professionals and may have made it easier to misinterpret or overlook the collective influence and responsibility that all sectors have for creating and sustaining the conditions necessary for health.
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This report contains four chapters that offer seven recommendations relevant to public health agencies, other government agencies, decision-makers and policy-makers, the private sector, and the American public. The national preoccupation with the cost of clinical care evident in the lead-up to the passage of the Affordable Care Act of 2010 is well founded, and changes in the system's pricing, labor, processes, and technology are essential and urgent (see Chapter 1)
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Measurement of health outcomes and performance can spur change -- as demonstrated by communities that have been able to "move the needle" in their own local efforts to improve the conditions for health and in the clinical care system's efforts to improve quality. More complete, useful, timely, and geographically pertinent information is a necessary but not sufficient ingredient to facilitate heightened community engagement and improved performance by various stakeholders in the health system, defined as encompassing the "activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals" (IOM, 1988, 2003)
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The chapter's other recommendations are for the development and adoption of three types of measures that could better inform the public, decision-makers, public health practitioners, and their many partners about health outcomes and their determinants; an annual report on the socioeconomic determinants of health; modeling for predictive and systems use; data-sharing between public health agencies and medical care organizations; and public health agency reporting on clinical care performance pertinent to population health. In Chapter 4, the committee uses the lens of measurement to examine and discuss system performance.
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The committee finds that the nation's population health statistics and information enterprise lacks three types of measures that could support the information needs of policy-makers, public health officials, health system partners, and communities. These are: a standardized set of measures that can be used to assess the intrinsic health of communities in and of themselves; a standardized set of health outcome indicators for national, state, and local use; and a summary measure of population health that can be used to estimate and track health-adjusted life expectancy (HALE)
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and input from other relevant stakeholders, including other agencies and organizations that collect, analyze, and report data; communitylevel public health practitioners; and the public health research community. Because the summary measure of population health in part (c)
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Recommendation 3 The committee recommends that the Department of Health and Human Services produce an annual report to inform policy-makers, all health-system sectors, and the public about important trends and disparities in social and environmental determinants that affect health. The committee was asked to consider the implications of health care reform for population health and for the public health infrastructure in the context of measurement.
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However, much more could be communicated to the public in an easy-to-understand format and in the context of a broader effort to inform and educate the public about effectiveness and efficiency in clinical care and to improve patients' decision-making. Recommendation 5 The committee recommends that state and local public health agen cies in each state collaborate with clinical care delivery systems to assure that the public has greater awareness of the appropriateness, quality, safety, and efficiency of clinical care services delivered in their state and community.
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. Chapter 4 highlights two types of accountability: contract accountability, referring to the financial and statutory relationships between government public health agencies (and to a smaller extent nonprofit public health organizations)
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range from technical assistance, training, and mentorship to direct oversight and assumption of responsibilities and from consolidation with other jurisdictions (or regionalization) to pooling of resources or sharing of specific resources and expertise to increase agency capacity and meet performance standards to ensure that every person in every jurisdiction has access to a full set of public health services.
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1988. The Future of Public Health.
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