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Informing the Future: Critical Issues in Health, Fourth Edition The Institute of Medicine: Advising the Nation, Improving Health The story of human civilization is the story of knowledge: its pursuit and application. Nowhere is this more evident than in efforts to improve people’s health and well-being. The detailed observations of the ancient Egyptians led to cultural practices of hygiene and diet that would place them ahead of many developing nations today. The Grefi medical schools of the fifth century B.C. began paving the way for the modern scientific pursuit of medicine and put the fundamentals of human biology on paper. Louis Pasteur’s work on germ theory in the 1800s ushered in the era of antiseptics, antibiotics, vaccination, and pasteurization—innovations that have saved untold millions of lives and improved the quality of life for nearly every person on the planet. The efforts of James Watson and Francis Crick, who deciphered the structure of DNA in the 1950s, laid the groundwork for a deeper understanding of how the human body works, fails, and fights. In each age of medicine, an increase in knowledge has led to improved public health. The work of great scientific minds has been bolstered, supported, and amplified by public policy, public opinion, and national action. Without massive infrastructure investments during World War II, for example, penicillin would have remained an interesting lab experiment. The decisions that guide and shape these advances are profoundly important and often politically charged. Today, health care sits at the top of the nation’s agenda. Issues such as the rising cost of health care and emerging threats such as avian flu and bioterrorism have created new challenges to the health care system. Meanwhile, advances in stem cells, nanotechnology, and genomics have brought the ethics of medicine further into the arena of politics, creating increasingly complex challenges for policy makers and scientists alike.
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Informing the Future: Critical Issues in Health, Fourth Edition Against this backdrop, the need for independent, evidence-based information and analysis has become even more important. The Institute of Medicine (IOM), the health arm of the National Academies, meets this need. Standing outside government, the IOM serves as adviser to the nation to improve health. As an independent, scientific authority, the IOM strives to provide advice that is unbiased, based on evidence, and grounded in science. The mission of the IOM embraces the health of people everywhere. The IOM commitment to public service is locked into the words of its charter, where the IOM is described as [A] national institution, composed of individuals of distinction and achievement, committed to the advancement of the health sciences and education and to the improvement of health care. In addition to IOM members, more than 2,000 other experts—scientists, health professionals, legal experts, organizational executives, engineers, humanists, civic leaders, patient advocates, and others—volunteer to help the IOM answer the world’s most challenging health questions: from AIDS to vaccine safety, from breast cancer to childhood obesity, and from the quality of medical care to public health preparedness. Members and other experts all serve without compensation by conducting studies, participating in workshops and roundtable discussions, serving as reviewers, and supporting the IOM’s many activities designed to improve health. The IOM adheres to strict standards to avoid conflicts of interest for the tasks assigned to its committees, and it benefits from the breadth of perspective brought by the diversity of backgrounds and expertise of its volunteers. The IOM regularly undertakes studies to provide authoritative and scientifically balanced recommendations to Congress, to government agencies at all levels, to health professionals and institutions, to community organizations, and to the public. The IOM convenes roundtables, workshops, and symposia that provide an opportunity for public- and private-sector experts to discuss contentious issues in a neutral, open environment, which facilitates an evidence-based dialogue. Although many of its studies and other activities are requested and supported by the federal government, the IOM itself, private industry, foundations, and state and local governments may also advance and support ideas for studies or other activities that promote the public’s health.
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Informing the Future: Critical Issues in Health, Fourth Edition In addition, the IOM is home to several fellowship programs. For more than three decades, the IOM has managed the Robert Wood Johnson Health Policy Fellowships Program, which is designed to develop the capacity of outstanding mid-career health professionals in academic and community-based settings to assume leadership roles in health policy and management. Another hallmark of the IOM process is its rigorous peer review. Every report that the IOM produces must first undergo extensive review and evaluation by a group of experts who are anonymous to the authoring committee, and whose names are revealed only when the study is published. The results of these peer-reviewed deliberations have been relied upon for nearly 40 years to provide policy makers and the American people with objective advice that is grounded in evidence. The ultimate goal of all of these activities is to inform decision making and to improve health. By identifying scientifically sound evidence and presenting it in a well-reasoned and rational context, the IOM has become recognized as a trustworthy and apolitical national resource on topics related to biomedical science, medical care, and human health. IOM studies can be quite focused, as evidenced by the Review of NASA’s Space Flight Health Standards-Setting Process: Letter Report (2007). They can also be sweeping in both scope and impact, spanning multiple academic disciplines, industries, and even international borders. For example, Congress asked the IOM to evaluate the implementation of the President’s Emergency Plan for AIDS Relief, resulting in PEPFAR Implementation: Progress and Promise (2007), which offered evidence-based recommendations for improving the program. Leveraging knowledge to improve health can have a lasting impact on the lives of everyday people: Since 1998, the IOM’s ongoing work on nutrition has been represented in its Dietary Reference Intakes (DRI) series, a complete and thorough analysis of human nutrition that examines every nutrient in thousands of applications and variations. The DRIs form the basis for nearly all state and federal nutrition policy and serve as the scientific foundation for industry efforts to improve health through the removal of trans fats from foods and the education of consumers about nutritional issues. The IOM’s Crossing the Quality Chasm series (2000–2007) has identified the unacceptable costs of medical errors and the challenges faced by the health care community in raising the overall standard of care for all Americans. The series
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Informing the Future: Critical Issues in Health, Fourth Edition has been instrumental in guiding state-level patient safety centers to track and analyze medical error data. Reports and summits in the series have put forth actionable, real-world advice for practitioners and administrators at both the local and the national levels. The IOM’s work on childhood obesity has been groundbreaking and influential. The 2005 report Preventing Childhood Obesity: Health in the Balance outlined the nature and scope of the childhood obesity crisis and offered a blueprint for action. The Robert Wood Johnson Foundation requested that the IOM continue this work, which resulted in Progress in Preventing Childhood Obesity: How Do We Measure Up? (2006). This renewed call for accountability again galvanized the debate and has kept the pressure on government and industry alike. It also provided meaningful measurements of the concrete work that has been done since 2005 and highlighted the tremendous efforts that are still necessary to improve the health of America’s children. These are just a few examples of the IOM’s impact. This booklet opens a window into the broader work of the IOM and highlights some of the policy areas that will be critical to the nation’s well-being in the years to come. The main section of this booklet illustrates the work that IOM committees have done in several topic areas. There follows a description of IOM’s convening and collaborative activities—those cases in which the IOM’s unique position has brought people together in a common place and time to share ideas and discuss possible solutions. The last section provides a compr›ensive bibliography of IOM reports published since 2005.