U.S. Spends Too Little on Public Health Initiatives, Says New Institute for Medicine Report

The U.S. health system has failed to develop and deliver effective preventive strategies and this continues to take a growing toll on the economy and society, according to a new report from the Institute for Medicine (IOM).  The IOM report says America needs to improve its lackluster performance on health outcomes compared with its peer nations and to maintain its international competitiveness by investing more in its chronically underfunded public health system.  It also should spend public health dollars more efficiently. 

According to IOM, the United States spends more on health than other nations — almost $2.5 trillion in 2009 . Despite the big spend, the U.S. scores lower than other wealthy ations on life expectancy, infant mortality, and other indicators of population health.  The chronic diseases that contribute to the bulk of U.S. health spending are conditions that could be better controlled or prevented through public health initiatives, services, and expertise. Yet,, only 3.1 percent (2009 figures) of U.S. health dollars goes to government-administered public health, according to the Centers for Medicare and Medicaid's National Health Expenditure Accounts. This amounts to $251 per person in public health spending compared with $8,086 per person in medical care spending, IOM said in a press release.

The IOM committee that wrote the reportcalls on the U.S. Department of Health and Human Services to set new goals for U.S. life expectancy and per-person health spending as a critical first step in framing the nation's efforts to reach improved overall health outcomes. Setting these targets will engage public health professionals to maximize the value of the dollars invested in the nation's health system, the committee said. They also need to ensure that public health skills and knowledge are applied to medical care issues relevant to population health, such as the frequent overuse and misuse of medical procedures.

The IOM report concludes that federal spending on public health should at least be doubled from its current level of about $11.6 billion per year to approximately $24 billion as a starting point to meet the needs of public health departments and  the committee recommends ways to raise the extra funding.

Autism rates on the rise again, CDC reports

As the nation celebrated World Autism Awareness Day on April 2, we learned that new government estimates show autism on the rise among U.S. children.  About 1 in 88 children has been identified with an autism spectrum disorder (ASD), according to estimates from the Center for Disease Control's Autism and Developmental Disabilities Monitoring (ADDM) Network. This is a considerable increase over the 1 in 6 children identified with a developmental disability in 2006-2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.. Some experts have speculated that the increase in ASD cases is due to the improved diagnosis and expanded definition of autism and autism spectrum disorders.  Differences in record-keeping across different states also may account for the increasing numbers, the CDC notes, as the number of cases fluctuate from one state to another.  The CDC also found that ASDs are almost 5 times more common among boys (1 in 54) than among girls (1 in 252). ADDM Network investigators will continue to explore the factors surrounding ASDs, reports the CDC in a recent Morbidity and Mortality Weekly Report, with a focus on understanding disparities in the identification of ASDs among certain subgroups.  Researchers will also examine how these disparities have contributed to changes in the estimated prevalence of ASDs and will also take a look at risk factors that can contribute to these disorders.