Harvey Fineberg

Because people differ in gender, insurance status, geographical locations and other factors, it is not surprising that treatments vary, he said. The objective of a health care system should be to make outcomes less inequitable, not identical, he said.

AHRQ has been federally mandated to produce a series of annual reports on the variables that underpin health care in the U.S. The first report is expected to be released by the end of the year, he said. So far, data indicate that when quality of patient care increases, disparities narrow, he said.

In addition to addressing health disparities, public health faces other challenges, said Harvey Fineberg, president of the Institute of Medicine and former HSPH dean. Despite the enormous number of preventable deaths in the country each year, only five percent of the nation’s health care dollar is spent on population health and prevention; 95 percent is spent on personal health and treatment.

Why is prevention so hard to sell, he asked? When successful, prevention is invisible. No one counts the number of children who lived longer because they received a vaccine against pertussis. Prevention lacks the "drama of saving" that accompanies curative medicine, Fineberg noted. Organ transplantations, for example, still grab headlines.

Sheer numbers of people in need can be overwhelming to think about. Americans will rivet their attention on a single child stuck in a well but have a hard time thinking about millions of children trapped in poverty, he noted.

There are financial challenges as well. The return on investing in prevention can be a long time coming, Fineberg said, and those who benefit are not always the investors. Besides that, a double standard exists between preventive medicine and treatment. Prevention is expected to return a net savings for every $1 spent, whereas the same is not asked of treatment, he said.

In the future, Fineberg said that he would like to see a more universally accessible and person-centered, not provider-centered, public health system. The system should be evidence-based, integrated and quality-driven, he said, with a greater population and ecological perspective.

The IOM frequently publishes reports on aspects of public health and other health care issues. The reports can be accessed at http://www.iom.edu/.