Author: The National Academies Press

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For thousands of years, the underground has provided humans refuge, useful resources, physical support for surface structures, and a place for spiritual or artistic expression. More recently, many urban services have been placed underground. Over this time, humans have rarely considered how underground space can contribute to or be engineered to maximize its contribution to the sustainability of society. As human activities begin to change the planet and population struggle to maintain satisfactory standards of living, placing new infrastructure and related facilities underground may be the most successful way to encourage or support the redirection of urban development into sustainable patterns. Well maintained, resilient, and adequately performing underground infrastructure, therefore, becomes an essential part of sustainability, but much remains to be learned about improving the sustainability of underground infrastructure itself.

At the request of the National Science Foundation (NSF), the National Research Council (NRC) conducted a study to consider sustainable underground development in the urban environment, to identify research needed to maximize opportunities for using underground space, and to enhance understanding among the public and technical communities of the role of underground engineering in urban sustainability.

Underground Engineering for Sustainable Urban Development explains the findings of researchers and practitioners with expertise in geotechnical engineering, underground design and construction, trenchless technologies, risk assessment, visualization techniques for geotechnical applications, sustainable infrastructure development, life cycle assessment, infrastructure policy and planning, and fire prevention, safety and ventilation in the underground. This report is intended to inform a future research track and will be of interest to a broad audience including those in the private and public sectors engaged in urban and facility planning and design, underground construction, and safety and security.

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Topics: Engineering and Technology

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A surprising degree of uncertainty surrounds one seemingly simple point of fact about the U.S. Census Bureau’s American Community Survey (ACS): When did the ACS begin? Some statements cast the ACS as a very new survey— largely through comparison with the 2010 decennial census, in which the ACS replaced the “long-form” questionnaire administered in previous decades to a sample of respondents. Others claim a longer lifetime for the concepts and questions of the ACS, alternately describing the ACS as dating back to the first decennial census in 1790, which started the precedent of asking for more detail than a simple headcount; to 1940 and the first major use of statistical sampling for some content in a decennial census; or to 1960, the first census in which a full-fledged long-form questionnaire was administered.

As the 2000 census approached, a notion originally advanced in the early 1940s as a possible replacement for the census began to gain traction, albeit as a replacement for the long-form sample rather than the entire census.To secure approval for the full-scale ACS, the ACS was made an integral part of plans for the 2010 decennial census—the basic bargain being that shifting the historical long-form content to the ACS would free the main 2010 census to be conducted as a “short-form only” count. In this spirit, the content and questions of the ACS were closely patterned after the long-form sample questionnaire used in the 2000 census. As years have passed, new questions have gradually been added to the survey.The charge of the workshop
emphasizes the benefits of the ACS and its title retained the wording used at the
project’s inception—literally expressing “burdens” as a parenthetical.

The workshop itself was held on the afternoon of June 14 and the full day of June 15, 2012, at the National Academies’ Keck Center in Washington, DC. The workshop drew roughly 80 attendees across both days, with the first afternoon’s proceedings drawing a particularly strong crowd. Benefits, Burdens, and Prospects of the American Community Survey: Summary of a Workshop explains the happenings of the workshop.

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Topics: Behavioral and Social Sciences

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Across the United States, thousands of hazardous waste sites are contaminated with chemicals that prevent the underlying groundwater from meeting drinking water standards. These include Superfund sites and other facilities that handle and dispose of hazardous waste, active and inactive dry cleaners, and leaking underground storage tanks; many are at federal facilities such as military installations. While many sites have been closed over the past 30 years through cleanup programs run by the U.S. Department of Defense, the U.S. EPA, and other state and federal agencies, the remaining caseload is much more difficult to address because the nature of the contamination and subsurface conditions make it difficult to achieve drinking water standards in the affected groundwater.

Alternatives for Managing the Nation’s Complex Contaminated Groundwater Sites estimates that at least 126,000 sites across the U.S. still have contaminated groundwater, and their closure is expected to cost at least $110 billion to $127 billion. About 10 percent of these sites are considered “complex,” meaning restoration is unlikely to be achieved in the next 50 to 100 years due to technological limitations. At sites where contaminant concentrations have plateaued at levels above cleanup goals despite active efforts, the report recommends evaluating whether the sites should transition to long-term management, where risks would be monitored and harmful exposures prevented, but at reduced costs.

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Topics: Environment and Environmental Studies | Earth Sciences

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The charge of the Army Research Laboratory Technical Assessment Board (ARLTAB) is to provide biennial assessments of the scientific and technical quality of the research, development, and analysis programs at the Army Research Laboratory (ARL). The ARLTAB is assisted by six panels, each of which focuses on the portion of the ARL program conducted by one of ARL’s six directorates1. When requested to do so by ARL, the ARLTAB also examines work that cuts across the directorates. For example, during 2011-2012, ARL requested that the ARLTAB examine crosscutting work in the areas of autonomous systems and network science.

The overall quality of ARL’s technical staff and their work continues to be impressive. Staff continue to demonstrate clear, passionate mindfulness of the importance of transitioning technology to support immediate and longer-term Army needs. Their involvement with the wider scientific and engineering community continues to expand. Such continued involvement and collaboration are fundamentally important for ARL’s scientific and technical activities and need to include the essential elements of peer review and interaction through publications and travel to attend professional meetings, including international professional meetings. In general, ARL is working very well within an appropriate research and development niche and has been demonstrating significant accomplishments, as exemplified in the following discussion, which also addresses opportunities and challenges.

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Topics: Conflict and Security Issues | Engineering and Technology

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In 2012, the Defense Intelligence Agency (DIA) approached the National Research Council’s TIGER standing committee and asked it to develop a list of workshop topics to explore the impact of emerging science and technology. One topic that came out of that list was adaptive structural materials. This workshop was held on July 11-12, 2012.

The objectives for the workshop were to explore the potential use of adaptive structural materials science and technology for military application. Understanding the current research in this area, and the potential opportunities to use this research by U.S. adversaries, allows the Defense Warning Office to advise U.S. policy makers in an appropriate and timely manner to take action on those areas deemed a national security risk. The workshop featured invited presentations and discussions that aimed to:
1. Review the latest advances and applications both nationally and internationally related to adaptive structural materials scientific research and technology development.
2. Review adaptive materials related to shape memory, magnetostrictive materials, magnetic shape memory alloys, phase change materials, and other metal and non-metallic materials research that may be uncovered during the course of workshop preparation and execution, to include all soft or nanoscale materials such as those used in human bone or tissue.
3. Review modeling, processing and fabrication related to defining designs or design requirements for future military or dual-use air, space, land, sea or human systems.
4. Review dual-use applications of commercial adaptive structural materials research and development, and the potential impacts on U.S. national security interests.
5. The workshop then focused on the application of adaptive structural materials technology and the national security implications for the United States, discussing U.S. and foreign researchers’ current research, why the state or non-state actor application of a technology is important in the context of technological and military capabilities, and what critical breakthroughs are needed to advance the field.

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Topics: Conflict and Security Issues

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The principal goals of the study were to articulate the scientific rationale and objectives of the field and then to take a long-term strategic view of U.S. nuclear science in the global context for setting future directions for the field. Nuclear Physics: Exploring the Heart of Matter provides a long-term assessment of an outlook for nuclear physics.

The first phase of the report articulates the scientific rationale and objectives of the field, while the second phase provides a global context for the field and its long-term priorities and proposes a framework for progress through 2020 and beyond. In the second phase of the study, also developing a framework for progress through 2020 and beyond, the committee carefully considered the balance between universities and government facilities in terms of research and workforce development and the role of international collaborations in leveraging future investments.

Nuclear physics today is a diverse field, encompassing research that spans dimensions from a tiny fraction of the volume of the individual particles (neutrons and protons) in the atomic nucleus to the enormous scales of astrophysical objects in the cosmos. Nuclear Physics: Exploring the Heart of Matter explains the research objectives, which include the desire not only to better understand the nature of matter interacting at the nuclear level, but also to describe the state of the universe that existed at the big bang. This report explains how the universe can now be studied in the most advanced colliding-beam accelerators, where strong forces are the dominant interactions, as well as the nature of neutrinos.

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Topics: Math, Chemistry and Physics

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Overall Air Force weapon system sustainment (WSS) costs are growing at more than 4 percent per year, while budgets have remained essentially flat. The cost growth is due partly to aging of the aircraft fleet, and partly to the cost of supporting higher performance aircraft and new capabilities provided by more complex and sophisticated systems, such as the latest intelligence, surveillance, and reconnaissance (ISR) platforms. Furthermore, the expectation for the foreseeable future is that sustainment budgets are likely to decrease, so that the gap between budgets and sustainment needs will likely continue to grow wider. Most observers accept that the Air Force will have to adopt new approaches to WSS if it is going to address this problem and remain capable of carrying out its missions.

In this context, the original intent of this 3 day workshop was to focus on ways that science and technology (S&T) could help the Air Force reduce sustainment costs. However, as the workshop evolved, the discussions focused more and more on Air Force leadership, management authority, and culture as the more critical factors that need to change in order to solve sustainment problems. Many participants felt that while S&T investments could certainly help—particularly if applied in the early stages (“to the left”) of the product life cycle—adopting a transformational management approach that defines the user driven goals of the enterprise, empowers people to achieve them, and holds them accountable, down to the shop level. Several workshop participants urged Air Force leaders to start the process now, even though it will take years to percolate down through the entire organization. These sustainment concerns are not new and have been studied extensively, including recent reports from the National Research Council’s Air Force Studies Board and the Air Force Scientific Advisory Board.

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Topics: Conflict and Security Issues | Engineering and Technology

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Astronomy occupies a special place in the research portfolio of this country. Understanding the cosmos is one of the oldest intellectual goals of humanity, and the discoveries of astronomers clearly excite the imagination of the public at large. From primary schools to universities, from planetaria to features in the media, astronomy offers numerous opportunities to improve the scientific literacy of this nation, and astronomers are increasingly engaged in these educational activities. Although for many people astronomy is a clear example of one of the noblest of basic research activities, it is often less recognized that it can and does contribute to other national goals. In particular, its research activities depend on and contribute to the applied development of sophisticated sensors, an essential enabling technology for many scientific fields and for the defense, medical, and commercial sectors, modern astronomical facilities, and their sophisticated instrumentation, utilizing state-of- the-art detectors, computing resources, and optical design, are expensive.

Astronomers are fortunate that the Congress has authorized the construction of numerous major national facilities. National ground-based astronomical facilities are supported primarily by the National Science Foundation (NSF), both in the construction and operations phases. Still, roughly half of U.S. astronomers must rely entirely on the National Optical Astronomy Observatories (NOAO) for access to telescopes, and nearly all rely on NOAO facilities for some aspects of their work. In this eventuality, the panel recommends that the proper instrumentation and operation of the Gemini telescopes should have first priority. The panel also affirms the high priority for the ATI program, which was recommended by the Astronomy and Astrophysics Survey Committee (AASC) report.

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Topics: Space and Aeronautics

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The Institute of Medicine (IOM) Roundtable on Health Literacy focuses on bringing together leaders from the federal government, foundations, health plans, associations, and private companies to address challenges facing health literacy practice and research and to identify approaches to promote health literacy in both the public and private sectors. The roundtable serves to educate the public, press, and policy makers regarding the issues of health literacy, sponsoring workshops to discuss approaches to resolve health literacy challenges. It also builds partnerships to move the field of health literacy forward by translating research findings into practical strategies for implementation. The Roundtable held a workshop March 29, 2012, to explore the field of oral health literacy.

The workshop was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning group was composed of Sharon Barrett, Benard P. Dreyer, Alice M. Horowitz, Clarence Pearson, and Rima Rudd. The role of the workshop planning committee was limited to planning the workshop. Unlike a consensus committee report, a workshop summary may not contain conclusions and recommendations, except as expressed by and attributed to individual presenters and participants. Therefore, the summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop.

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Topics: Health and Medicine

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Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade–in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD).

To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM’s task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.

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Topics: Health and Medicine | Conflict and Security Issues

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The potential for using fusion energy to produce commercial electric power was first explored in the 1950s. Harnessing fusion energy offers the prospect of a nearly carbon-free energy source with a virtually unlimited supply of fuel. Unlike nuclear fission plants, appropriately designed fusion power plants would not produce the large amounts of high-level nuclear waste that requires long-term disposal. Due to these prospects, many nations have initiated research and development (R&D) programs aimed at developing fusion as an energy source. Two R&D approaches are being explored: magnetic fusion energy (MFE) and inertial fusion energy (IFE).

An Assessment of the Prospects for Inertial Fusion Energy describes and assesses the current status of IFE research in the United States; compares the various technical approaches to IFE; and identifies the scientific and engineering challenges associated with developing inertial confinement fusion (ICF) in particular as an energy source. It also provides guidance on an R&D roadmap at the conceptual level for a national program focusing on the design and construction of an inertial fusion energy demonstration plant.

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Topics: Energy and Energy Conservation | Engineering and Technology | Math, Chemistry and Physics

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In the fall of 2010, the Office of the U.S. Department of Energy’s (DOE’s) Secretary for Science asked for a National Research Council (NRC) committee to investigate the prospects for generating power using inertial confinement fusion (ICF) concepts, acknowledging that a key test of viability for this concept—ignition —could be demonstrated at the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL) in the relatively near term. The committee was asked to provide an unclassified report. However, DOE indicated that to fully assess this topic, the committee’s deliberations would have to be informed by the results of some classified experiments and information, particularly in the area of ICF targets and nonproliferation. Thus, the Panel on the Assessment of Inertial Confinement Fusion Targets (“the panel”) was assembled, composed of experts able to access the needed information. The panel was charged with advising the Committee on the Prospects for Inertial Confinement Fusion Energy Systems on these issues, both by internal discussion and by this unclassified report.

A Panel on Fusion Target Physics (“the panel”) will serve as a technical resource to the Committee on Inertial Confinement Energy Systems (“the Committee”) and will prepare a report that describes the R&D challenges to providing suitable targets, on the basis of parameters established and provided to the Panel by the Committee. The Panel on Fusion Target Physics will prepare a report that will assess the current performance of fusion targets associated with various ICF concepts in order to understand:
1. The spectrum output; 2. The illumination geometry; 3. The high-gain geometry; and 4. The robustness of the target design. The panel addressed the potential impacts of the use and development of current concepts for Inertial Fusion Energy on the proliferation of nuclear weapons information and technology, as appropriate. The Panel examined technology options, but does not provide recommendations specific to any currently operating or proposed ICF facility.

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Topics: Energy and Energy Conservation | Engineering and Technology | Math, Chemistry and Physics

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The U.S. government supports programs to combat global HIV/AIDS through an initiative that is known as the President’s Emergency Plan for AIDS Relief (PEPFAR). This initiative was originally authorized in the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 and focused on an emergency response to the HIV/AIDS pandemic to deliver lifesaving care and treatment in low- and middle-income countries (LMICs) with the highest burdens of disease. It was subsequently reauthorized in the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (the Lantos-Hyde Act).

Evaluation of PEPFAR makes recommendations for improving the U.S. government’s bilateral programs as part of the U.S. response to global HIV/AIDS. The overall aim of this evaluation is a forward-looking approach to track and anticipate the evolution of the U.S. response to global HIV to be positioned to inform the ability of the U.S. government to address key issues under consideration at the time of the report release.

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Topics: Health and Medicine

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Optics and photonics technologies are ubiquitous: they are responsible for the displays on smart phones and computing devices, optical fiber that carries the information in the internet, advanced precision manufacturing, enhanced defense capabilities, and a plethora of medical diagnostics tools. The opportunities arising from optics and photonics offer the potential for even greater societal impact in the next few decades, including solar power generation and new efficient lighting that could transform the nation’s energy landscape and new optical capabilities that will be essential to support the continued exponential growth of the Internet.

As described in the National Research Council report Optics and Photonics: Essential Technologies for our Nation, it is critical for the United States to take advantage of these emerging optical technologies for creating new industries and generating job growth. The report assesses the current state of optical science and engineering in the United States and abroad–including market trends, workforce needs, and the impact of photonics on the national economy. It identifies the technological opportunities that have arisen from recent advances in, and applications of, optical science and engineering. The report also calls for improved management of U.S. public and private research and development resources, emphasizing the need for public policy that encourages adoption of a portfolio approach to investing in the wide and diverse opportunities now available within photonics.

Optics and Photonics: Essential Technologies for our Nation is a useful overview not only for policymakers, such as decision-makers at relevant Federal agencies on the current state of optics and photonics research and applications but also for individuals seeking a broad understanding of the fields of optics and photonics in many arenas.

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Topics: Engineering and Technology | Math, Chemistry and Physics

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For many household surveys in the United States, responses rates have been steadily declining for at least the past two decades. A similar decline in survey response can be observed in all wealthy countries. Efforts to raise response rates have used such strategies as monetary incentives or repeated attempts to contact sample members and obtain completed interviews, but these strategies increase the costs of surveys. This review addresses the core issues regarding survey nonresponse. It considers why response rates are declining and what that means for the accuracy of survey results. These trends are of particular concern for the social science community, which is heavily invested in obtaining information from household surveys. The evidence to date makes it apparent that current trends in nonresponse, if not arrested, threaten to undermine the potential of household surveys to elicit information that assists in understanding social and economic issues. The trends also threaten to weaken the validity of inferences drawn from estimates based on those surveys. High nonresponse rates create the potential or risk for bias in estimates and affect survey design, data collection, estimation, and analysis.

The survey community is painfully aware of these trends and has responded aggressively to these threats. The interview modes employed by surveys in the public and private sectors have proliferated as new technologies and methods have emerged and matured. To the traditional trio of mail, telephone, and face-to-face surveys have been added interactive voice response (IVR), audio computer-assisted self-interviewing (ACASI), web surveys, and a number of hybrid methods. Similarly, a growing research agenda has emerged in the past decade or so focused on seeking solutions to various aspects of the problem of survey nonresponse; the potential solutions that have been considered range from better training and deployment of interviewers to more use of incentives, better use of the information collected in the data collection, and increased use of auxiliary information from other sources in survey design and data collection. Nonresponse in Social Science Surveys: A Research Agenda also documents the increased use of information collected in the survey process in nonresponse adjustment.

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Topics: Behavioral and Social Sciences

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Congress has an ongoing interest in ensuring that the 500,000 buildings and other structures owned and operated by the Department of Defense (DOD) are operated effectively in terms of cost and resource use. Section 2830 of the National Defense Authorization Act for fiscal year requires the Secretary of Defense to submit a report to the congressional defense committees on the energy-efficiency and sustainability standards used by DOD for military construction and major renovations of buildings.

DOD’s report must include a cost-benefit analysis, return on investment, and long-term payback for the building standards and green building certification systems, including:
(A) American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 189.1-2011 for the Design of High-Performance, Green Buildings Except Low-Rise Residential.
(B) ASHRAE Energy Standard 90.1-2010 for Buildings Except Low-Rise Residential.
(C) Leadership in Energy and Environmental Design (LEED) Silver, Gold, and Platinum certification for green buildings, as well as the LEED Volume certification.
(D) Other American National Standards Institute (ANSI) accredited standards.

DOD’s report to the congressional defense committees must also include a copy of DOD policy prescribing a comprehensive strategy for the pursuit of design and building standards across the department that include specific energy-efficiency standards and sustainable design attributes for military construction based on the cost-benefit analysis, return on investment, and demonstrated payback required for the aforementioned building standards and green building certification systems. Energy-Efficiency Standards and Green Building Certification Systems Used by the Department of Defense for Military Construction and Major Renovations summarizes the recommendations for energy efficiency.

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Topics: Energy and Energy Conservation | Conflict and Security Issues | Engineering and Technology

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The Consumer Expenditure (CE) surveys are the only source of information on the complete range of consumers’ expenditures and incomes in the United States, as well as the characteristics of those consumers. The CE consists of two separate surveys: (1) a national sample of households interviewed five times at three-month intervals; and (2) a separate national sample of households that complete two consecutive one-week expenditure diaries. For more than 40 years, these surveys, the responsibility of the Bureau of Labor Statistics (BLS), have been the principal source of knowledge about changing patterns of consumer spending in the U.S. population.

In February 2009, BLS initiated the Gemini Project, the aim of which is to redesign the CE surveys to improve data quality through a verifiable reduction in measurement error with a particular focus on underreporting. The Gemini Project initiated a series of information-gathering meetings, conference sessions, forums, and workshops to identify appropriate strategies for improving CE data quality. As part of this effort, BLS requested the National Research Council’s Committee on National Statistics (CNSTAT) to convene an expert panel to build on the Gemini Project by conducting further investigations and proposing redesign options for the CE surveys.

The charge to the Panel on Redesigning the BLS Consumer Expenditure Surveys includes reviewing the output of a Gemini-convened data user needs forum and methods workshop and convening its own household survey producers workshop to obtain further input. In addition, the panel was tasked to commission options from contractors for consideration in recommending possible redesigns. The panel was further asked by BLS to create potential redesigns that would put a greater emphasis on proactive data collection to improve the measurement of consumer expenditures. Measuring What We Spend summarizes the deliberations and activities of the panel, discusses the conclusions about the uses of the CE surveys and why a redesign is needed, as well as recommendations for the future.

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Topics: Industry and Labor | Behavioral and Social Sciences

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The adulteration and fraudulent manufacture of medicines is an old problem, vastly aggravated by modern manufacturing and trade. In the last decade, impotent antimicrobial drugs have compromised the treatment of many deadly diseases in poor countries. More recently, negligent production at a Massachusetts compounding pharmacy sickened hundreds of Americans. While the national drugs regulatory authority (hereafter, the regulatory authority) is responsible for the safety of a country’s drug supply, no single country can entirely guarantee this today.

The once common use of the term counterfeit to describe any drug that is not what it claims to be is at the heart of the argument. In a narrow, legal sense a counterfeit drug is one that infringes on a registered trademark. The lay meaning is much broader, including any drug made with intentional deceit. Some generic drug companies and civil society groups object to calling bad medicines counterfeit, seeing it as the deliberate conflation of public health and intellectual property concerns. Countering the Problem of Falsified and Substandard Drugs accepts the narrow meaning of counterfeit, and, because the nuances of trademark infringement must be dealt with by courts, case by case, the report does not discuss the problem of counterfeit medicines.

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Topics: Health and Medicine

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The Food Forum convened a public workshop on February 22-23, 2012, to explore current and emerging knowledge of the human microbiome, its role in human health, its interaction with the diet, and the translation of new research findings into tools and products that improve the nutritional quality of the food supply. The Human Microbiome, Diet, and Health: Workshop Summary summarizes the presentations and discussions that took place during the workshop. Over the two day workshop, several themes covered included:

1. The microbiome is integral to human physiology, health, and disease.
2. The microbiome is arguably the most intimate connection that humans have with their external environment, mostly through diet.
3. Given the emerging nature of research on the microbiome, some important methodology issues might still have to be resolved with respect to undersampling and a lack of causal and mechanistic studies.
4. Dietary interventions intended to have an impact on host biology via their impact on the microbiome are being developed, and the market for these products is seeing tremendous success. However, the current regulatory framework poses challenges to industry interest and investment.

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Topics: Food and Nutrition

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Rising health care costs are a central fiscal challenge confronting the United States. National spending on health care currently accounts for 18 percent of gross domestic product (GDP), but is anticipated to increase to 25 percent of GDP by 2037. The Bipartisan Policy Center argues that “this rapid growth in health expenditures creates an unsustainable burden on America’s economy, with far-reaching consequences”. These consequences include crowding out many national priorities, including investments in education, infrastructure, and research; stagnation of employee wages; and decreased international competitiveness.In spite of health care costs that far exceed those of other countries, health outcomes in the United States are not considerably better.

With the goal of ensuring that patients have access to high-quality, affordable cancer care, the Institute of Medicine’s (IOM’s) National Cancer Policy Forum convened a public workshop, Delivering Affordable Cancer Care in the 21st Century, October 8-9, 2012, in Washington, DC. Delivering Affordable Cancer Care in the 21st Century summarizes the workshop.

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Topics: Health and Medicine