During public health emergencies (PHEs) involving chemical, biological, radiological, or nuclear threats or emerging infectious diseases, medical countermeasures (MCMs) (e.g., drugs, vaccines, devices) may need to be dispensed or administered to affected populations to help mitigate the human health impact of the threat. The optimal MCMs determined for use during an emergency might be U.S. Food and Drug Administration (FDA) approved but used in unapproved ways (e.g., in a new age group or against a new agent); FDA approved using animal models because human efficacy testing is not ethical or feasible; or not yet FDA approved for any indication. As part of the United States' scientific and research preparedness enterprise, there is an imperative to go "beyond the last mile" of MCM dispensing and administration to build and maintain a national capability to monitor and assess the use of MCMs (e.g., safety, compliance, clinical benefit) after they have been dispensed during PHEs. To further the discussion on this need, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop, Building a National Capability to Monitor and Assess Medical Countermeasure Use in Response to Public Health Emergencies. The workshop, sponsored by FDA, was held on June 6?7, 2017, in Washington, DC. Workshop participants discussed the roles and efforts of the federal government and of relevant stakeholders with an interest in building and maintaining a national PHE MCM active monitoring and assessment capability. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Setting the Stage: Defining Terminologies and Sharing Stakeholder Perspectives 3 Data Needs, Data Sources, and Collection Methodologies for Stakeholder Decision Making 4 Considerations for Conducting Rapid Clinical Research on MCMs During a PHE 5 Inspiring Collective Action: Perspectives from Federal Stakeholders and Reflections from Individual Workshop Participants Appendix A: References Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers and Moderators

On February 5, 2015, the Institute of Medicine Roundtable on Population Health Improvement hosted a workshop to explore the relationship between public health and health care, including opportunities, challenges, and practical lessons. The workshop was convened in partnership with the Association of State and Territorial Health Officials (ASTHO)-Supported Primary Care and Public Health Collaborative. Organized in response to the 2012 IOM report Primary Care and Public Health: Exploring Integration to Improve Population Health, this workshop focused on current issues at the interface of public health and health care, including opportunities presented by and lessons learned from the Centers for Medicaid and Medicare Services State Innovation Models program. The workshop featured presentations on several dimensions of the public health-health care relationship. Collaboration Between Health Care and Public Health summarizes the presentations and discussion of the event. Table of Contents Front Matter 1 Introduction 2 Collaborating to Advance Payment Reform 3 Million Hearts: A National Public Health and Health Care Collaborative 4 Collaboration Between Hospitals and Public Health Agencies 5 A Collaborative Community Approach to Asthma Care 6 Enhancing a Culture of Collaboration to Build a Culture of Health 7 Reflections on the Day Appendix A: References Appendix B: Workshop Agenda Appendix C: Speaker and Moderator Biographical Sketches

In October 2016, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement hosted a workshop to explore sustainable financing structures that reflect a recognition of the health and non-health factors that shape the well-being of U.S. communities. The goals of the workshop were to learn from the long-term, sustainable financing strategies used in other sectors, to explore how those approaches could be applied to population health, and to consider structures that work across sectors. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Sustainable Financing Structures for Population Health: Historical Patterns and Insights for the Future 3 Case Example 1: Justice Reinvestment 4 Case Example 2: Clean Energy Financing 5 Realigning Resources for Population Health: Small Group Conversations 6 Reflections on the Workshop Appendix A: References Appendix B: Workshop Agenda Appendix C: Sustainable Financing Structures for Population Health: Historical Patterns and Insights for the Future: Commissioned Paper Appendix D: Speaker Biographical Sketches

The emerging multidisciplinary field of regenerative engineering is devoted to the repair, regeneration, and replacement of damaged tissues or organs in the body. To accomplish this it uses a combination of principles and technologies from disciplines such as advanced materials science, developmental and stem cell biology, immunology, physics, and clinical translation. The term "regenerative engineering" reflects a new understanding of the use of tissue engineering for regeneration and also the growing number of research and product development efforts that incorporate elements from a variety of fields. Because regenerative engineered therapies rely on live cells and scaffolds, there are inherent challenges in quality control arising from variability in source and final products. Furthermore, each patient recipient, tissue donor, and product application is unique, meaning that the field faces complexities in the development of safe and effective new products and therapies which are not faced by developers of more conventional therapies. Understanding the many sources of variability can help reduce this variability and ensure consistent results. The Forum on Regenerative Medicine hosted a public workshop on October 18, 2018, in Washington, DC, to explore the various factors that must be taken into account in order to develop successful regenerative engineering products. Invited speakers and participants discussed factors and sources of variability in the development and clinical application of regenerative engineering products, characteristics of high-quality products, and how different clinical needs, models, and contexts can inform the development of a product to improve patient outcomes. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Sources of Variability Associated with Regenerative Therapies: Lessons from Case Studies 3 Factors Contributing to Patient Variability 4 Addressing Variability in Donor Tissues and Cells 5 Addressing Variability and Meeting Quality Expectations in the Manufacturing Setting 6 Exploring Variability and Its Impact on Product Regulation and Outcomes 7 Potential Next Steps to Consider for Addressing Variability References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task Appendix D: Registered Attendees

Genomic applications are being integrated into a broad range of clinical and research activities at health care systems across the United States. This trend can be attributed to a variety of factors, including the declining cost of genome sequencing and the potential for improving health outcomes and cutting the costs of care. The goals of these genomics-based programs may be to identify individuals with clinically actionable variants as a way of preventing disease, providing diagnoses for patients with rare diseases, and advancing research on genetic contributions to health and disease. Of particular interest are genomics- based screening programs, which will, in this publication, be clinical screening programs that examine genes or variants in unselected populations in order to identify individuals who are at an increased risk for a particular health concern (e.g., diseases, adverse drug outcomes) and who might benefit from clinical interventions. On November 1, 2017, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to explore the challenges and opportunities associated with integrating genomics-based screening programs into health care systems. This workshop was developed as a way to explore the challenges and opportunities associated with integrating genomics-based programs in health care systems in the areas of evidence collection, sustainability, data sharing, infrastructure, and equity of access. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Evidence Considerations for Integrating Genomics-Based Programs into Health Care Systems 3 Financial Considerations for Implementing Genomics-Based Screening Programs 4 Exploring Approaches to Optimize Data Sharing Among Early Implementers of Genomics-Based Programs 5 Understanding Participant Needs and Preferences and Improving Diversity and Equity 6 Improving Health Through the Integration of Genomics-Based Programs: Potential Next Steps References Appendix A: Workshop Agenda Appendix B: Speaker Biographies Appendix C: Statement of Task Appendix D: Registered Attendees

In September 2015, the National Academies of Sciences, Engineering, and Medicine hosted a workshop to explore the basic and translational research needs for population health science, and to discuss specific research priorities and actions to foster population health improvement. The workshop was designed to provide frameworks for understanding population health research and its role in shaping and having an effect on population health, identify individual and institutional facilitators and challenges regarding the production, communication, and use of research for population health improvement, and identify key areas for future research critical to the advancement of population health improvement. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Setting the Context 3 Research in Practice: Opportunities and Challenges 4 Building a Population Health Research Agenda: Views from the Field 5 Population Health Research Priorities: Perspectives from Users of Research 6 Toward a Research Agenda for Population Health Appendix A: References Appendix B: Workshop Agenda Appendix C: Suggested Readings for Krieger Presentation (Chapter 2) Appendix D: Results from a University of Michigan Survey Regarding Priorities for Population Health Research Appendix E: Speaker Biographies

Those involved in the drug development process face challenges of efficiency and overall sustainability due in part to high research costs, lengthy development timelines, and late-stage drug failures. Novel clinical trial designs that enroll participants based on their genetics represent a potentially disruptive change that could improve patient outcomes, reduce costs associated with drug development, and further realize the goals of precision medicine. On March 8, 2017, the Forum on Drug Discovery, Development, and Translation and the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine hosted the workshop Enabling Precision Medicine: The Role of Genetics in Clinical Drug Development. Participants examined successes, challenges, and possible best practices for effectively using genetic information in the design and implementation of clinical trials to support the development of precision medicines, including exploring the potential advantages and disadvantages of such trials across a variety of disease areas. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Overarching Considerations for Implementing Successful Genetics-Enabled Drug Development 3 Case Studies in Precision Drug Development 4 Integrating Genetics into the Drug Development Pathway for Complex Diseases 5 Finding Innovative Ways to Integrate Genetic Research into the Drug Development Process 6 Reflecting Back and Looking Forward: Key Themes and Potential Next Steps in Genetics-Enabled Drug Development Appendix A: References Appendix B: Statement of Task and Workshop Agenda Appendix C: Speaker Biographical Sketches Appendix D: Registered Attendees

Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Research and Development of Medical Products are summarized in this report. Table of Contents Front Matter 1 Introduction 2 Models and Incentives for Engagement 3 Discovery Research 4 Development 5 Convergence of Regulatory Expectations, Review, and Approval 6 Manufacturing, Stockpiling, and Distribution 7 Critical Considerations for Facilitating Medical Product Research and Development 8 Crosscutting Themes and Closing Remarks Appendix A: References Appendix B: Workshop Statement of Task Appendix C: Workshop Agenda Appendix D: Workshop Speaker Biographies

Business Engagement in Building Healthy Communities is the summary of a workshop convened by the Institute of Medicine's Roundtable on Population Health Improvement in July 2014 to consider the role of business in improving population health beyond the usual worksite wellness and health promotion activities. The workshop followed previous roundtable discussions on the importance of applying a health lens to decision making in non-health sectors and the need for cross-sector collaborations to advance population health. Invited speakers included representatives from several businesses that have taken action to improve the health of their communities and representatives of business coalitions on health. The workshop was designed to discuss why engaging in population health improvement is good for business; explore how businesses can be effective key leaders in improving the health of communities; and discuss ways in which businesses can engage in population health improvement. This report is a record of the presentations and discussion of the event Table of Contents Front Matter 1 Introduction 2 Lessons from the Blue Zones 3 Why Should Businesses Engage in Population Health Improvement? 4 The Impact of Business on Population Health 5 Community/Population Health as an Intentional Business Strategy 6 Stimulating and Supporting Business Engagement in Health Improvement 7 Reflections on the Day Appendix A: References Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers

The Role and Potential of Communities in Population Health Improvement is the summary of a workshop held by the Institute of Medicine Roundtable on Population Health Improvement in April 2014 that featured invited speakers from community groups that have taken steps to improve the health of their communities. Speakers from communities across the United States discussed the potential roles of communities for improving population health. The workshop focused on youth organizing, community organizing or other types of community participation, and partnerships between community and institutional actors. This report explores the roles and potential of the community as leaders, partners, and facilitators in transforming the social and environmental conditions that shape health and well-being at the local level.

Despite advances in the delivery of high-quality cancer care and improvements in patient outcomes in recent years, disparities in cancer incidence, care, and patient outcomes persist. To examine opportunities to improve health equity across the cancer care continuum, the National Cancer Policy Forum and the Roundtable on the Promotion of Health Equity hosted a public workshop, Promoting Health Equity in Cancer Care, on October 25 and October 26, 2021. This virtual workshop featured presentations and panel discussions on topics that included: opportunities to improve equitable access to affordable, high-quality cancer care; strategies to identify and address the intersectionality of structural racism and implicit bias in cancer care delivery; the potential for quality measurement and payment mechanisms to incentivize health equity in cancer care delivery; and clinical practice data collection efforts to better assess and care for people living with and beyond cancer. This publication summarizes the presentation and discussion of the workshop. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Statement of Task Appendix B: Workshop Agenda

The evolution of health care is expanding the possibilities for integration of clinical research into the continuum of clinical care; new approaches are enabling the collection of data in real-world settings; and new modalities, such as digital health technologies and artificial intelligence applications, are being leveraged to overcome challenges and advance clinical research. At the same time, the clinical research enterprise is strained by rising costs, varying global regulatory and economic landscapes, increasing complexity of clinical trials, barriers to recruitment and retention of research participants, and a clinical research workforce that is under tremendous demands. Looking ahead to 2030, the Forum on Drug Discovery, Development, and Translation of the National Academies of Sciences, Engineering, and Medicine convened a public workshop for stakeholders from across the drug research and development life cycle to reflect on the lessons learned over the past 10 years and consider opportunities for the future. The workshop was designed to consider goals and priority action items that could advance the vision of a 2030 clinical trials enterprise that is more efficient, effective, person-centered, inclusive, and integrated into the health care delivery system so that outcomes and experiences for all stakeholders are improved. This Proceedings of a Workshop summarizes the presentations and discussions that took place during the four-part virtual public workshop held on January 26, February 9, March 24, and May 11, 2021. Table of Contents Front Matter 1 Introduction 2 Defining the Vision 3 Enhancing Outcomes in a More Person-Centered and Inclusive Clinical Trials Enterprise 4 Practical Applications for Technology to Enhance the Clinical Trials Enterprise 5 Building a More Resilient, Sustainable, and Transparent Clinical Trials Enterprise 6 Opportunities for Transformation References Appendix A: Health Affairs Blog Posts Appendix B: Speaker and Moderator Biographies Appendix C: Workshop Agendas

On February 26, 2020, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 1-day public workshop in Washington, DC, to examine current and emerging bioethical issues that might arise in the context of biomedical research and to consider research topics in bioethics that could benefit from further attention. The scope of bioethical issues in research is broad, but this workshop focused on issues related to the development and use of digital technologies, artificial intelligence, and machine learning in research and clinical practice; issues emerging as nontraditional approaches to health research become more widespread; the role of bioethics in addressing racial and structural inequalities in health; and enhancing the capacity and diversity of the bioethics workforce. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Ethically Leveraging Digital Technology for Health 3 Ethical Questions Concerning Nontraditional Approaches for Data Collection and Use 4 Understanding the Impact of Inequality on Health, Disease, and Who Participates in Research 5 Bioethics Research Workforce 6 Reflecting on the Workshop and Looking to the Future References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task Appendix D: Registered Attendees

To explore the role of the National Institutes of Health (NIH) in innovative drug development and its impact on patient access, the Board on Health Care Services and the Board on Health Sciences Policy of the National Academies jointly hosted a public workshop on July 24?25, 2019, in Washington, DC. Workshop speakers and participants discussed the ways in which federal investments in biomedical research are translated into innovative therapies and considered approaches to ensure that the public has affordable access to the resulting new drugs. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Statement of Task Appendix B: Workshop Agenda

Evidence from the public health sector demonstrates that health care is only one of the determinants of health, which also include genes, behavior, social factors, and the built environment. These contextual elements are key to understanding why health care organizations are motivated to focus beyond their walls and to consider and respond in unprecedented ways to the social needs of patients, including transportation needs. In June 2016 the National Academies of Sciences, Engineering, and Medicine held a joint workshop to explore partnerships, data, and measurement at the intersection of the health care and transportation sectors. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Transportation to Health-Related Destinations 3 Cross-Sector Collaboration to Provide Transportation Services in Urban Settings 4 Cross-Sector Collaboration to Provide Transportation Services in Rural/Small Urban/Suburban Settings 5 Report Back from Breakout Groups 6 Data Sources and Tools for Understanding and Addressing Health-Related Transportation Needs 7 Connecting Patients to Transportation: Incentives and Return on Investment 8 Reflections on the Workshop Appendix A: References Appendix B: Workshop Agenda Appendix C: Environmental Scan Appendix D: Biosketches of Speakers and Discussants Appendix E: Structured Annotated Bibliography

In 2013 the Institute of Medicine (IOM) Roundtable on Population Health Improvement organized a workshop to discuss opportunities to foster a health in all policies approach in non-health sectors such as housing, transportation, defense, education, and others. Much of the discussion focused on public-sector organizations, and roundtable members saw the need for further discussion of the role of the private sector, both as stakeholder and partner. On June 4, 2015, the roundtable convened a follow-up workshop focused on applying a health lens to the role and potential of businesses in improving economic well-being and community health outcomes. Participants explored what businesses can offer the movement to improve population health and areas of potential, as well as models for how businesses can impact the determinants of health, and developed a platform for discussing how to promote and support health in all business practices, policies, and investments. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Increasing Private-Sector Investment in the Nonmedical Determinants of Health 3 Business Practices to Produce Health 4 Developing Human Capital in Communities 5 Revitalizing Communities 6 Investing in People and Partnerships to Create Healthy Communities 7 Reflections on the Day Appendix A: References Appendix B: Workshop Agenda Appendix C: Statement of Task Appendix D: Speaker and Moderator Biographical Sketches

Emerging infectious disease threats that may not have available treatments or vaccines can directly affect the security of the world's health since these diseases also know no boundaries and will easily cross borders. Sustaining public and private investment in the development of medical countermeasures (MCMs) before an emerging infectious disease becomes a public health emergency in the United States has been extremely challenging. Interest and momentum peak during a crisis and wane between events, and there is little interest in disease threats outside the United States until they impact people stateside. On March 26 and 27, 2015, the Institute of Medicine convened a workshop in Washington, DC to discuss how to achieve rapid and nimble MCM capability for new and emerging threats. Public- and private-sector stakeholders examined recent efforts to prepare for and respond to outbreaks of Ebola Virus Disease, pandemic influenza, and coronaviruses from policy, budget, and operational standpoints. Participants discussed the need for rapid access to MCM to ensure national security and considered strategies and business models that could enhance stakeholder interest and investment in sustainable response capabilities. This report summarizes the presentations and discussions from this workshop. Table of Contents Front Matter 1 Introduction 2 A Wake-Up Call: The 2014 Ebola Outbreak Response 3 Preparedness as an Issue of National Security 4 Rapid Development of Ebola Vaccines 5 Influenza Risk Assessment and Pandemic Preparedness 6 Developing MCMs for Coronaviruses 7 Sustainable Business Models to Ensure Rapid and Nimble Responses 8 Supporting MCM Development Across Threats and Funding Cycles A References B Acronyms and Abbreviations C Statement of Task D Agenda E Biosketches of Invited Speakers and Facilitators

Spread, Scale, and Sustainability in Population Health is the summary of a workshop convened by the Institute of Medicine's Roundtable on Population Health Improvement in December 2014 to discuss the spread, scale, and sustainability of practices, models, and interventions for improving health in a variety of inter-organizational and geographical contexts. This report explores how users measure whether their strategies of spread and scale have been effective and discusses how to increase the focus on spread and scale in population health. Table of Contents Front Matter 1 Introduction 2 Spread and Scale 3 Approaches to Spread, Scale, and Evaluation of Impact 4 Learning About Spread and Scale from Other Sectors 5 Learning from the Spread and Scale of Tobacco Control: From Concept to Movement 6 Accelerating Spread and Scale in Population Health 7 Reflections on the Day Appendix A: References Appendix B: Workshop Agenda Appendix C: Background Questions and Panelist Responses Appendix D: Speaker and Moderator Biographies

Over the past decade, preparedness and response capacities of government agencies, hospitals and clinics, public health agencies, and academic researchers in the United States and abroad have been challenged by a succession of public health emergencies, ranging from radiological threats to pandemics to earthquakes. Through After Action Reports, each of these emergencies has yielded important information and lessons learned that can inform future disaster response and recovery efforts. However, important information that needs to be collected during and immediately following these emergencies is often missed because of barriers and obstacles to gathering such data, such as varying institutional review board restrictions in different states, no sustainable funding network for this type of work, uncertainty on who should be involved in research response, and a lack of knowledge around how best to integrate research into response and recovery frameworks. Taking action to enable medical and public health research during disasters was the focus of a workshop held on June 12 and 13, 2014, coordinated and supported jointly by the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events, National Institute of Environmental Health Sciences, the National Library of Medicine, the U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response, and the Centers for Disease Control and Prevention. Invited speakers and participants from federal, state, and local government, academia, and community and worker organizations came together to discuss how to integrate research into existing response structures; identify critical research needs and priorities; identify obstacles and barriers to research; discuss structures and strategies needed for deployment of a research study; share ideas, innovations, and technologies to support research; and explore data collection tools and data-sharing mechanisms for both rapid and longitudinal research. Enabling Rapid and Sustainable Public Health Research During Disasters summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Science Preparedness: Conducting Research During Public Health Emergencies 3 Health Research Needs and Actions: Lessons from Recent Disasters 4 Addressing Institutional Review Board Barriers to Health Research Implementation 5 Partnering with the Community to Enable Research 6 Improving Data Collection Capabilities and Information Resources 7 Considerations for Rapid and Sustained Funding Mechanisms for Research in Disasters 8 Improving the Role of Extramural Research Networks 9 Coordinating Logistics to Execute Rapid Research in Disaster Response 10 Actions to Build the Future of Disaster Research Appendix A: References Appendix B: Acronyms Appendix C: Agenda Appendix D: Biographical Sketches of Invited Speakers and Panelists Appendix E: Speakers and Registered Attendees Appendix F: Statement of Task

Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system. The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities. Table of Contents Front Matter 1 Introduction 2 How the ACA Will Change the Health Care Delivery System 3 Preparedness Impacts of the Changes to Health Care System Financing and Delivery Infrastructure 4 The Evolving Health Workforce 5 Needs and Logistics of Data Sharing and Health Information Technology 6 Potential Opportunities to Enhance Preparedness Through Health Information Exchanges and Predictive Analytics 7 Leveraging the Affordable Care Act and Information Technology to Innovate 8 The Continuing Role for Public Health Preparedness and Response Appendix A: References Appendix B: Acronyms Appendix C: Statement of Task Appendix D: Agenda Appendix E: Biographical Sketches of Invited Speakers and Panelists Appendix F: Key Features of the Affordable Care Act by Year

Health is influenced by a wide range of factors, many of which fall outside of the health care delivery sector. These determinants of health include, for example, the characteristics of how people live, work, learn, and play. Decision and policy making in areas such as transportation, housing, and education at different levels of government, and in the private sector, can have far-reaching impacts on health. Throughout the United States there has been increasing dialogue on incorporating a health perspective into policies, programs, and projects outside the health field. Applying a Health Lens to Decision Making in Non-Health Sectors is the summary of a workshop convened in September 2013 by the Institute of Medicine Roundtable on Population Health Improvement to foster cross-sectoral dialogue and consider the opportunities for and barriers to improving the conditions for health in the course of achieving other societal objectives (e.g., economic development, efficient public transit). The roundtable engaged members, outside experts, and stakeholders on three core issues: supporting fruitful interaction between primary care and public health; strengthening governmental public health; and exploring community action in transforming the conditions that influence the public's health. This report is a discussion of health in all policies approaches to promote consideration for potential health effects in policy making in many relevant domains, such as education, transportation, and housing. Table of Contents Front Matter 1 Introduction 2 How Social Policies Shape Health 3 Highlights from the Work of Federal Agencies 4 Highlights from the Work of State and Local Governments 5 Working Across Sectors to Improve Health 6 Closing Remarks Appendix A: References Appendix B: Agenda Appendix C: Biosketches of Speakers and Planning Committee Members

Over the past several decades, new scientific tools and approaches for detecting microbial species have dramatically enhanced our appreciation of the diversity and abundance of the microbiota and its dynamic interactions with the environments within which these microorganisms reside. The first bacterial genome was sequenced in 1995 and took more than 13 months of work to complete. Today, a microorganism's entire genome can be sequenced in a few days. Much as our view of the cosmos was forever altered in the 17th century with the invention of the telescope, these genomic technologies, and the observations derived from them, have fundamentally transformed our appreciation of the microbial world around us. On June 12 and 13, 2012, the Institute of Medicine's (IOM's) Forum on Microbial Threats convened a public workshop in Washington, DC, to discuss the scientific tools and approaches being used for detecting and characterizing microbial species, and the roles of microbial genomics and metagenomics to better understand the culturable and unculturable microbial world around us. Through invited presentations and discussions, participants examined the use of microbial genomics to explore the diversity, evolution, and adaptation of microorganisms in a wide variety of environments; the molecular mechanisms of disease emergence and epidemiology; and the ways that genomic technologies are being applied to disease outbreak trace back and microbial surveillance. Points that were emphasized by many participants included the need to develop robust standardized sampling protocols, the importance of having the appropriate metadata, data analysis and data management challenges, and information sharing in real time. The Science and Applications of Microbial Genomics summarizes this workshop. Table of Contents Front Matter Workshop Overview Appendix A Appendix B--Agenda Appendix C--Acronyms Appendix D--Glossary Appendix E--Speaker Biographies

As information technology becomes an integral part of health care, it is important to collect and analyze data in a way that makes the information understandable and useful. Informatics tools-which help collect, organize, and analyze data-are essential to biomedical and health research and development. The field of cancer research is facing an overwhelming deluge of data, heightening the national urgency to find solutions to support and sustain the cancer informatics ecosystem. There is a particular need to integrate research and clinical data to facilitate personalized medicine approaches to cancer prevention and treatment-for example, tailoring treatment based on an individual patient's genetic makeup as well as that of the tumor-and to allow for more rapid learning from patient experiences. To further examine informatics needs and challenges for 21st century biomedical research, the IOM's National Cancer Policy Forum held a workshop February 27-28, 2012. The workshop was designed to raise awareness of the critical and urgent importance of the challenges, gaps and opportunities in informatics; to frame the issues surrounding the development of an integrated system of cancer informatics for acceleration of research; and to discuss solutions for transformation of the cancer informatics enterprise. Informatics Needs and Challenges in Cancer Research: Workshop Summary summarizes the workshop. Table of Contents Front Matter 1 Introduction 2 Overview of the Cancer Informatics Landscape 3 Informatics and Personalized Medicine 4 Informatics-Supported Cancer Research Endeavors 5 Potential Pathways and Models for Moving Forward 6 Proposal for a Coalition of All Stakeholders 7 Transforming Cancer Informatics: From Silos to Systems Acronyms Appendix A: Workshop Agenda Appendix B: Speaker, Moderator, and Panelist Biographies

Problems contacting emergency services and delayed assistance are not unusual when incidents occur in rural areas, and the consequences can be devastating, particularly with mass casualty incidents. The IOM's Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop to examine the current capabilities of emergency response systems and the future opportunities to improve mass casualty response in rural communities.

Biological differences between the sexes influence not only individual health but also public health, biomedical research, and health care. The Institute of Medicine held a workshop March 8-9, 2010, to discuss sex differences and their implications for translational neuroscience research, which bridges the gap between scientific discovery and application. Table of Contents Front Matter 1 Introduction 2 Studying Sex Differences in Health and Disease 3 Studying Sex Differences in Translational Research: Examples from Four Major Disease Areas 4 Reporting Sex Differences in Research Publications 5 Sex Differences in Drug Development: Policy and Practice 6 Needs, Opportunities, and Next Steps Appendix A: References Appendix B: Registered Attendees Appendix C: Workshop Agenda