Informing the Future

Critical Issues in Health

SIXTH EDITION

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES



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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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