National Academy of Medicine’s Vital Directions initiative calls for better health at lower cost
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* Elizabeth Rasmussen

As opponents continue to attack the Affordable Care Act, experts worry that without intervention, health care shortfalls will continue to impact Americans.

“Vital Directions for Health and Health Care,” a series of discussion papers released by the National Academy of Medicine, details the fundamental challenges and health priorities crucial to improving national health and reducing costs. A new summary of the papers, released March 21, assembled guidance from over 150 scientists, researchers and policymakers and focused on 19 crucial issues regarding U.S. health care. Those issues fall into three subcategories — better health and well-being, high-value health care and strong science and technology — and include topics such as chronic disease prevention, payment reform, data mining and targeted research. The issues are the most important ones for the nation to address, the summery said. Experts worry, however, that policymakers are getting caught up in complicated insurance debates and neglecting new insights that will have a greater impact on the population’s health.

“In the midst of all of this debate, we cannot afford to lose focus on the ultimate goal of achieving better health for all through an effective health care system — one that not only helps people prevent and treat their ailments, but also helps every American to reach their very best health and well-being,” said NAM President Victor Dzau, MD, at a March 21 symposium at the National Academy of Sciences in Washington, D.C.

The 18-member steering committee assembling Vital Directions also summarized some of the greatest fundamental challenges to the current American health care system, including persisting health disparities, a rapidly aging population and lack of public health preparedness.

A key action priority for policymakers included in the report was “paying for value” – designing health financing strategies for the best results for individuals and populations.

“While we’ve made enormous progress in health care in many ways, the central challenge still remains to find the best value for our health care dollars,” said APHA Executive Director Georges Benjamin, MD, at the symposium.

Benjamin co-authored a paper released in the series, “Advancing the Health of Communities and Populations,” which discusses integrating social services such as housing, food and transportation with medical services to improve health outcomes and reduce inequalities.

“Moving our health care upstream into prevention and figuring out ways we can leverage that across sectors is extremely important,” Benjamin said.

In the summary, experts called for policy reform that achieves better health outcomes, reduces waste and reduces an “unsustainable” $3.2 trillion annual cost of health care.

The *Journal of the American Medical Association* published a review to accompany Vital Directions, detailing health care waste and inefficiencies.

“It is not only the nation’s health but its fiscal capacity that is at risk, as health care spending reduces investments in education, infrastructure and other arenas important to the daily lives of U.S. residents,” the review said.

According to the *JAMA* review, the U.S. has the largest discrepancy between health care spending and the population’s health status. This could be caused by a lack of preventive and cross-sector care, the review suggested. In most developed countries, about $2 is spent on social services for every dollar spent on health care. In the U.S., only 50 cents per dollar spent on health care is spent on social services. Redirecting a portion of health care expenses to high-priority investments — such as social services — would cause “health and productivity benefits (to) ripple far beyond the health sector.”

Other action priorities of the initiative involve engaging, educating and empowering patients as well as activating communities to take greater control of their health care.

For more information, visit [https://nam.edu/initiatives](https://nam.edu/initiatives) or [http://jamanetwork.com/journals/jama](http://jamanetwork.com/journals/jama).

*   Copyright The Nation’s Health, American Public Health Association