policy in health care services. However, the health and well-being of the individual and the health of the population are interrelated and interdependent. Choucair (2011) suggests that “maintaining two disciplinary silos (public health and clinical medicine) is not the answer. Bridging the gap is critical if we are serious about improving the quality of life of our residents…. [W]e will not be successful unless we translate what we learn in research all the way into public policy.” Many public policies that improve health, especially for those with chronic illness, could be provided more effectively and efficiently in a more integrated, better aligned health system (Hardcastle et al., 2011). The committee discusses the need for a more integrated health system in detail in Chapter 6 and provides several examples of partnerships among clinical care, public health, and community organizations that promote health for those with chronic illness.

Barriers to Effective Health Policy

As expressed in the recent IOM report (2011), “now is a critical time to examine the role and usefulness of the law and public policy more broadly, both in and outside the health sector, in efforts to improve population health.” The report noted the need for improvements in public policy as a result of several factors, including but not limited to developments in the science of public health; the current economic crisis and severe budget cuts faced by local, state, and federal government; the lack of coordination of health policies and regulations; recent passage of federal health reform (the ACA); and increasing rates of obesity in the U.S. population.

Defining the appropriate role of government, however, is at the heart of public policy making in the United States. Although Americans value their health, many also value their ability to make individual choices about their health care, health behavior, and quality of life. Accordingly, many policy makers place high priority on individual liberties and, concomitantly, a limited role for government. Policy makers balance multiple competing public policy interests, made more challenging in the current economic climate in which competition for resources is high. For this reason, it is critical to integrate health care policy with public health policy and reframe them both to be consistent with other societal values, such as prosperity, economic development, long-term investment, and overall well-being. Reminding policy makers in all sectors of government that “businesses can rise and fall on the strength of their employees’ physical and mental health, which influence[s] levels of productivity and, ultimately, the economic outlook of employers” (IOM, 2011) will help to emphasize the economic implications of population health. Given that two-thirds of U.S. health care spending is consumed by just 28 percent of people who have two or more chronic illnesses (Anderson, 2010), the country can avoid unnecessary costs and



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