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Informing the Future
Critical Issues in Health
SIXTH EDITION
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INSTITUTE OF MEDICINE 500 Fifth Street, N.W. Washington, DC 20001
Funding: This document was produced using internal IOM funds.
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon
the authority of the charter granted to it by the Congress in 1863, the Academy has a man-
date that requires it to advise the federal government on scientific and technical matters.
Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of
the National Academy of Sciences, as a parallel organization of outstanding engineers.
It is autonomous in its administration and in the selection of its members, sharing with
the National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Charles M. Vest is president of the National Academy of
Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examina-
tion of policy matters pertaining to the health of the public. The Institute acts under the
responsibility given to the National Academy of Sciences by its congressional charter to
be an adviser to the federal government and, upon its own initiative, to identify issues of
medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute
of Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy’s
purposes of furthering knowledge and advising the federal government. Functioning in
accordance with general policies determined by the Academy, the Council has become
the principal operating agency of both the National Academy of Sciences and the National
Academy of Engineering in providing services to the government, the public, and the sci-
entific and engineering communities. The Council is administered jointly by both Acad-
emies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are
chair and vice chair, respectively, of the National Research Council.
For more information about the Institute of Medicine, visit the IOM home page at: www.
iom.edu.
Copyright 2011 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cul-
tures and religions since the beginning of recorded history. The serpent adopted as a logo-
type by the Institute of Medicine is a relief carving from ancient Greece, now held by the
Staatliche Museen in Berlin.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe
Advising the Nation. Improving Health.
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Contents
Forging Connnections in a Disconnected World 1
Building a Sustainable, High-Quality Healthcare System 5
Improving Food Safety, Nutrition, and Health 21
Strengthening the Healthcare Workforce 35
Measuring America’s Health 49
Military and Veterans: Protecting the Protectors 59
Public Health: Protecting the Population 73
Shaping Research Priorities 97
The Persistence of Chronic Diseases 109
Advancing Health Around the World 121
Fostering Leadership: Fellowships at the Institute of Medicine 135
The Value of Collaboration: IOM’s Role as a Convener 139
Recent and Upcoming Reports 149
Contact Us 195
v
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