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In its 2012 report For the Public’s Health: Investing in a Healthier Future, the Institute of Medicine (IOM; now the National Academy of Medicine and the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine) recommended that the secretary of the US Department of Health and Human Services adopt an explicit life expectancy target and establish a specific per capita health expenditure target to be achieved by 2030. The report stated that efforts to reach these targets “should engage all health system stakeholders in actions intended to achieve parity with averages among comparable nations on healthy life expectancy and per capita health expenditures.”1(p4) In a recent analysis, Kindig et al. explored the plausibility of meeting the life expectancy target by 2030.2 They found that to achieve parity with the United Nations’ projected 2030 mortality estimates for Western Europe, US life expectancy would have to increase by 0.32% per year between 2016 and 2030.2 Although this rate is high, it does have at least some historical precedent among Organization for Economic Co-operation and Development (OECD) nations and US states. Similar analyses have not been undertaken to determine the plausibility of achieving the IOM’s health care spending parity target. This is a significant evidence gap given.
The 3 National Academies oversee programmatic activities conducted under the auspices of the National Research Council, the operating arm of the National Academies. These programmatic activities convene experts in many ways to suit different purposes.2 If we need definitive recommendations on a subject matter or controversy, we undertake a consensus study. A consensus study brings together a diverse committee of 10 to 20 leading experts to agree on the most practical, wise, and substantiated solutions to a problem. The committee’s work is guided by a formal statement of task that outlines the scope and objectives of the study. The committee, aided by staff, conducts extensive research and detailed analysis of available data and evidence, followed by extensive deliberation that results in specific recommendations for relevant stakeholders, which are captured in a detailed report. The report undergoes a rigorous peer-review process and is then released to the public. Our consensus reports have influenced the trajectory of health and shaped the direction of biomedical research. Some of our most influential pieces include Mapping and Sequencing the Human Genome (1988), Guidelines for Human Embryonic Stem Cell Research (2005), four and Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease (2011).
Before the COVID-19 pandemic, our most recent experience with a public health crisis was with the terrorist attacks of 9/11 and the anthrax bioterrorism that closely followed. The immediate reaction to these attacks was a substantial infusion of funding for public health preparedness and response through the Centers for Disease Control and Prevention (CDC), beginning with the Public Health Emergency Preparedness Cooperative Agreement with states and the Hospital Preparedness Program.[ 1] This immediate response, though, preceded any overarching public health planning and was followed by our human tendencies to forget: the peak funding for public health emergency preparedness was the fiscal year (FY)2002 ($940 million), and for the Hospital Preparedness Program, FY2003 ($515 million), and both have been on a steady decline since.[ 1] During this 2001 through 2020 time frame, we have seen the establishment and dismantling of a long list of emergency preparedness and response initiatives, including the Centers for Public Health Preparedness, Preparedness and Emergency Response Learning Centers, and the Preparedness Emergency Response Research Centers.[ 2] The United States seems incapable of keeping the memory alive enough to influence the mundane work of maintaining preparedness, even when we fully accept the truth that another event will come. And then came COVID-19. Has our immediate response differed from previous crises such as 9/11, and, perhaps more importantly, how will we respond over the long term?

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