The State of U.S. Public Health: Challenges and Trends

By: Howard Koh and Pamela Yatsko and Rosabeth Moss Kanter

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Synopsis: The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." For many Americans, the World Health Organization's definition of true health seems unattainable, given the multitude of complex problems plaguing the U.S. health system. The United States over the last 50 years has focused most of its health resources on providing medical care for individuals after they fall ill. It has placed far less emphasis on the non-medical determinants of health and the prevention of disease for the lives of its citizens. The result: an infamously expensive "sick care system" that does not perform as well as other wealthy countries across key measures. Americans of all socioeconomic stripes experience poorer health outcomes than their rich country peers. Such trends undermine U.S. international competitiveness. This background note digs deeper into these trends and their origins, the barriers hindering change, and past and current reforms, including the 2010 Affordable Care Act. If fully implemented, the controversial act will help the United States push beyond its myopic sick care focus towards the WHO's true health vision by creating a health system that integrates medical care with public health and prevention for all Americans.