Aligning U.S. Spending Priorities Using the Health Impact Pyramid Lens

This article examines the need to integrate and align public health, social services, and medical care in the United States through the lens of Thomas Frieden’s “health impact pyramid.”

The “health impact pyramid” presents a hierarchy in which the wide base of the pyramid of socioeconomic factors at a population level has more impact on the health of the public than do individually focused interventions at the pyramid’s top. From this pyramid perspective, the United States’ spending priorities are misaligned, as expenses targeted at public health and socioeconomic factors are far outstripped by spending on individual health care services at the top of the pyramid.

These findings are part of a collection of 15 new studies released on July 14, 2020 in a special issue of the American Journal of Public Health, all focused on the topic of aligning health and social systems to improve population health.