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August 25, 2010

Comparative Effectiveness—of What?Evaluating Strategies to Improve Population Health

Author Affiliations

Author Affiliations: School of Medicine and Public Health, University of Wisconsin–Madison, Madison (Drs Kindig and Mullahy); and National Bureau of Economic Research, Cambridge, Massachusetts (Dr Mullahy).

JAMA. 2010;304(8):901-902. doi:10.1001/jama.2010.1215

How much, then, should go for medical care and how much for other programs affecting health, such as pollution control, fluoridation of water, accident prevention and the like?There is no simple answer, partly because the question has rarely been explicitly asked.—Victor Fuchs1

Significant comparative effectiveness research (CER) efforts should be dedicated to understanding the effectiveness of investments across broad determinants of health instead of focusing primarily within the health care domain alone. For instance, the obesity epidemic poses a threat to health outcomes, and costs related to obesity unquestionably arise from a combination of determinants, including medical care; health behaviors; social, economic, and cultural factors; characteristics of the physical and built environment; and genetics. However, limited evidence exists to guide public and private policy makers regarding investments across these determinants. Can CER be used to address such important questions?

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