Nearly half of all causes of mortality in the United States are linked to social and behavioral factors such as smoking, diet, alcohol use, sedentary lifestyle, and accidents.  Yet, less than five percent of the approximately $1 trillion spent annually on healthcare in the United States is devoted to reducing risks posed by these preventable conditions. 

As chronic disease rates continue to escalate and the social and cultural diversity in the United States continues to grow, public health campaigns must  employ the most effective strategies for enhancing health behaviors, beliefs, and outcomes among targeted communities.  Effective actions must be to taken by public health leaders to ensure that technological advances in science and health do not give rise to a disproportionate growth of poorer health outcomes for selected American communities.

Given these challenges, the Institute of Medicine has convened several expert committees to review the status and promotion of public health in the United States.  In addition, these committees have provided recommendations focused on conducting successful public health campaigns.  Collectively, these reports create a comprehensive national strategy to address existing and emerging public health needs by enabling healthcare professionals, patients, families, community activists, and policy makers to understand the complex relationship between health and behavior.

Understanding interactions between health and behavior
An individual's interplay between biological, behavioral, and societal influences on  health and behavior ultimately shape health status and outcomes.  Understanding this relationship offers insight to health professionals regarding the construction of successful intervention campaigns that improve health through modifying behaviors. Behavior is not simply an individual choice.  Multiple forces such as families, social networks, workplaces, schools, religious affiliations, or community and societal structures shape how an individual makes health decisions.  The report, Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences,  provides tools to researchers, practitioners, program developers, and policy makers  to understand the links between health and behavior, potential behavioral influences by social environments, and improved intervention methods to modify these behaviors.

Addressing intervention strategies at the community level
Fundamental social and behavioral influences offer considerable benefits to communities that actively participate during the design, implementation, and evaluation of health promotion interventions.  Multiple settings, such as educational institutions, social support structures, and behavioral programs are needed to effectively promote health behaviors and outcomes among multiple target audiences.  Promoting Health: Intervention Strategies from Social and Behavioral Research is a collection of 12 commissioned papers authored by the nation's leading experts that identifies promising areas in social and behavioral research that address public health needs and improve population health outcomes.

Exploring the potential of health communication strategies
Despite efforts to reduce or eliminate health disparities across America's diverse populations, challenges in health behaviors and health outcomes continue to exist.  The 21st century has offered many advancements in communication technology that may lead to a potentially better informed and presumably healthier population; however, little research has been conducted on how these new technologies are being utilized within communities.  Given the dynamic nature of social and cultural diversity in the United States, public health campaigns must consider the most effective communication strategies  for enhancing health behaviors, beliefs, and outcomes among targeted populations.  Speaking of Health: Assessing Health Communication Strategies for a Diverse Population explores the fundamental question of whether scientifically integrating diversity factors into health communication approaches is a valuable influence on populations and their health outcomes

Confronting racial and ethnic disparities in healthcare
Despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of morbidity and mortality when compared to non-minority populations.  African Americans, for example, experience the highest rates of mortality from heart disease, cancer, cerebrovascular disease, and HIV/AIDS. These disparities are complex and poorly understood, but largely may reflect socioeconomic differences, differences in health-related risk factors, environmental degradation, and direct and indirect consequences of discrimination.  Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare assesses the variation in the quality of healthcare services provided to individuals of different racial and ethnic backgrounds regardless of a patients' insurance status, education, income, or other factors that are known to affect access to care.  The recommendations offered in this report are intended to contribute to the elimination of health disparities by enhancing healthcare delivery mechanisms and reducing potential sources of bias, discrimination, and stereotyping.

Strengthening the public health infrastructure
Future public health efforts in the United States will require collective support by public and private organizations focusing on the improvement of population health by making strategic investments to address the multiple health needs of America.  These investments have the capacity to broadly impact populations through "healthy" prevention policies that support education, adequate housing, a living wage, or clean air.  Further, they may address some of the pervasive socio-economic inequities that appear to be associated with profound disparities in health status, access, and outcomes.  The Future of the Public's Health in the 21st Century reviews the nation's health achievements in recent decades, examines hidden vulnerabilities that undercut current health potential, which, if not addressed, could produce a decline in the future health status of the American people.  The report recommendations address a number of present and future challenges facing the nation's public health infrastructure, partnerships, and population health approaches.

Enhancing the role of public health professionals
Education efforts directed toward public health professionals in the U.S. must undergo considerable change in order to enhance skills among professionals to meet the growing diversity of health needs among America's population. To address this myriad of issues, a broader focus on multiple determinants of health, strengthening of the public health infrastructure, building partnerships, developing accountability, emphasizing evidence, and improving communication must be achieved. Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century provides a framework of action for health professionals and offers recommendations that will enhance public health education, research, and practice.  It also focuses on the governmental public health infrastructure and several potential partners in the public health system, namely, the community, the healthcare delivery system, employers and business, the media, and academia. 

Improving Health Literacy in the United States
Nearly half of all American adults-- 90 million people-- have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy, says a report from the Institute of Medicine titled Health Literacy: A Prescription to End Confusion. Limited health literacy may lead to billions of dollars in avoidable health care costs.

More than a measurement of reading skills, health literacy also includes writing, listening, speaking, arithmetic, and conceptual knowledge. Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. At some point, most individuals will encounter health information they cannot understand. Even well educated people with strong reading and writing skills may have trouble comprehending a medical form or doctor's instructions regarding a drug or procedure.

A concerted effort by the public health and health care systems, the education system, the media, and health care consumers is needed to improve the nation's health literacy, the report says. If patients cannot comprehend needed health information, attempts to improve the quality of care and reduce health care costs and disparities may fail.