Public health services and systems research: Building the science of public health practice

Despite spending far more resources on health care than any other nation on earth, the United States continues to lag behind many other industrialized nations in population health outcomes ranging from life expectancy at birth and infant mortality to the incidence of preventable chronic diseases.1 Although many factors contribute to this gap between investment and outcome, one likely explanation is the limited resources and attention devoted to public health-that is, the activities designed to promote health and prevent disease and disability on a population-wide basis.2-4 These activities include monitoring and reporting on community health status, investigating and controlling disease outbreaks, educating the public about health risks and prevention strategies, developing and enforcing laws and regulations to protect health, and inspecting and ensuring the safety and quality of water, food, air, and other resources necessary for health.5 The vast majority of the $2.7 trillion spent on health in the United States each year supports the organization, financing, and delivery of medical care services, with less than 3 percent allocated to population-based public health strategies.6, 7 Meanwhile, the nation's health research enterprise focuses primarily on discovering new medical interventions and better ways of delivering these interventions to patients, with comparatively little attention given to uncovering new and better ways of preventing disease through public health.