ABSTRACT
The United States has made enormous progress during the past century in improving the health of its citizens, through aggressive public health action and signifi cant investments in biomedical research and healthcare. However, despite nearly $3.0 trillion in annual healthcare spending-more than twice as much as any other country in the world-the United States ranks 27th in the world in life expectancy, and relatively low in many other measures of health and wellbeing. 1 Worse yet, trends in increased life expectancy and quality of life in the United States have plateaued. 2 For the poor in this country, life expectancy is actually decreasing. 3
The Affordable Care Act (ACA) provided an opportunity to dramatically expand healthcare coverage; provide better, more affordable care; and support investments in prevention. This is a necessary step forward to improving health, but it is not suffi cient because the major drivers of morbidity and mortality today are non-medical: health-related behaviors, and environmental and social factors such as housing, education, economic opportunity, and the built environment. 4
Public health has a history of succeeding in improving quality of life and life expectancy by addressing such foundational determinants of health (clean water, safe food, etc.), and expanding into new prevention domains (e.g. vaccination) in keeping with new science and evolving health threats. 5 Given persistent and, in some areas, growing gaps in health status, we believe it is time to boldly expand the scope and reach of public health so that we can effectively address all aspects of life that promote health and well-being, including those related to economic development, education, transportation, food, environment, and housing. In short, it’s time for a major upgrade. We call this new era Public Health 3.0.
