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From the Editor |
Influences On The Health Of Populations: A Closer Look
The American health care system, like those of every industrialized nation, is built around the medical model at the expense of public health. An estimated 95 percent of the U.S. health care economy ($1.3 trillion in 2000) is allocated every year for direct medical care, while only 5 percent of these resources are invested in populationwide approaches to health improvement. This mismatch of resources underscores both the value that industrialized societies attach to modern medicine and the distance they must travel to actually target those measures that have such a great influence on the health status of populations.
The potential to change this ratio has perhaps never been greater, given the events of last September 11 and their aftermath. Suddenly, many health policymakers have awakened to the reality that the nation’s public health enterprise is badly in need of repair. Given these developments—plus the rising tide of interest in improving the health status of the entire citizenry—we are devoting this issue to papers that cover the major societal and environmental influences that shape the health of a population.
The volume is composed of several papers from individuals who are giants in this field, among them Princeton economist Angus Deaton and Sir Michael Marmot, the noted epidemiologist from University College London. We are grateful for their contributions and confident that their insights will enlighten thinking on this topic and spur debate in an area that many feel has been neglected by the policy establishment. In addition to the solicited papers that form the core of the volume, we are gratified to offer two other papers that fit into the theme. One, by Paul Chung and Craig Garfield and colleagues of the University of Chicago, examines youth targeting by tobacco manufacturers after the Master Settlement Agreement; the other, by RAND economist Roland Sturm, is an eye-opening comparative analysis of the health effects of obesity, substance abuse, and aging.
We greatly appreciate the financial support of the Robert Wood Johnson Foundation and the counsel of J. Michael McGinnis, its senior vice-president for health; James R. Knickman, vice-president for research and evaluation; and Kim Lochner, program officer. When the Johnson foundation opened its doors in 1971, its mission was clearly articulated: to improve the health and health care of all Americans. Yet for much of its first two decades the foundation concentrated its resources on the health care component of its mission. Over the past decade its program emphasis began to change as the foundation focused on some of the critical non–medical care factors that influence a person’s health: smoking, diet, exercise, and environmental exposures.
Today the foundation consists of two distinct and roughly equivalent program groups—health and health care. The health group, which McGinnis oversees, is built around five teams that deal with tobacco; alcohol and illegal drugs; health and behavior, with a special emphasis on physical activity; community health, with an emphasis on social connectedness; and population health science and policy.
As we announced with publication of our January/February 2002 issue, Health Affairs has unveiled a redesigned Web site (at our same Web address, <www.HealthAffairs.org>) that includes new features and, at the beginning, a few bugs that required technical fixes. For all of those readers who encountered problems that needed quick solutions, we appreciate your patience. We have been pleasantly surprised at the sharp increase in the number of people who are visiting the site, signing in, downloading papers, and taking advantage of the twenty-year archive that dates to the very beginning of Project HOPE’s journal. The response to papers that we have begun to publish as Web exclusives also has been gratifying. These papers are subject to the same external peer review process as applies to all manuscripts we consider. In an effort to make certain these papers are not lost in the Internet shuffle, we are publishing abstracts of them in the journal, including them in our Table of Contents, and publishing an annual volume containing the Web exclusives from each year.
Founding Editor
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