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March 10, 2004

The Immediate vs the Important

Author Affiliations

Author Affiliations: The Robert Wood Johnson Foundation, Princeton, NJ (Dr McGinnis) and the Bill and Melinda Gates Foundation, Seattle, Wash (Dr Foege).

JAMA. 2004;291(10):1263-1264. doi:10.1001/jama.291.10.1263

When Hippocrates observed that "protecting and developing health must rank even above that of restoring it when it is impaired,"1 he set a standard that is difficult to meet. One of the most difficult challenges is to ensure that the urgent does not crowd out the important. In health, this challenge is especially difficult because urgent matters can be so riveting. At the personal level, the presence of illness or injury often overpowers all other concerns, and the search for effective treatment often dominates all other pursuits. At the policy level, with 15% of the US gross domestic product devoted to health care,2 medical care expenditures often drive decisions in which cost cutting is aimed first at discretionary investments, such as those in prevention and public health that offer the greatest prospects for overall health improvement. Hence, tools are needed to facilitate the gathering, analyzing, and reporting of data in a fashion that enables taking action not merely on the urgent but on issues most important to the health of a population.

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