and/or disability. The recent Institute of Medicine (IOM) report For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges (2011) describes these policies and makes detailed recommendations about the need to review and revise various public health policies and laws in order to improve population health. Many of these policies and laws are designed to prevent illness in the general population and to help prevent further morbidity in those already chronically ill—for example, clean indoor air laws and smoking cessation interventions.

Extending through the tip of Frieden’s pyramid, the chapter concludes with policies that impact health care delivery and self-care, also important in supporting those with chronic illness to live well. Recently passed federal health reform, the Affordable Care Act (ACA), represents the most significant changes to health care policy since the passage of Medicare and Medicaid in 1965. Given the numerous provisions targeted to improving health care delivery and population health, the chapter describes aspects of the ACA that are particularly relevant to the well-being of those with chronic illness.

Finally, in order to promote synergistic improvements in public policies that have the potential to impact health, the chapter describes a broad Health in All Policies (HIAP) strategy that seeks to assess the health implications from both health and nonhealth public- and private-sector policies.

Defining Health Care (Clinical Medicine) and Public Health Policy

In general, public policy refers to the “authoritative decisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others” (Longest and Huber, 2010). Health policy is the subset of public policies that impacts health care delivery (clinical medicine) and public health (population health).

Most health policy in the United States is health care (clinical medicine) policy, aimed at regulating or funding the loosely coordinated mechanisms for the financing, insurance, and delivery of individual-level health care services (Hardcastle et al., 2011; IOM, 2011; Shi and Singh, 2010). Whereas public health focuses on the health status of broad populations across generations, clinical care focuses on individuals. The committee discussed the need to expand beyond this fairly simplistic view of health and in Chapter 1 provides a framework (Figure 1-1) for considering the relationship among determinants of health, the spectrum of health, and policies and other interventions that help those with chronic illness to “live well.”

To the extent that Americans often think in terms of their individual health status rather than in terms of population health, it may be understandable why policy makers focus on allocating resources and regulating



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