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A recent National Academies report recommended that health systems invest in new infrastructure to integrate social and medical care. Although many health systems routinely screen patients for social concerns, few health systems achieve the recommended model of integration. In this critical case study in an urban safety net health system, we describe the human capital, operational redesign, and financial investment needed to implement the National Academy recommendations. Using data from this case study, we estimate that other health systems seeking to build and maintain this infrastructure would need to invest $1 million to $3 million per year. While health systems with robust existing resources may be able to bootstrap short-term funding to initiate this work, we conclude that long-term investments by insurers and other payers will be necessary for most health systems to achieve the recommended integration of medical and social care. Researchers seeking to test whether integrating social and medical care leads to better patient and population outcomes require access to health systems and communities who have already invested in this model infrastructure. (Am J Public Health. 2024;114(6):619–625. https://doi.org/10.2105/AJPH.2024.307602) [ABSTRACT FROM AUTHOR]

The author addresses the question of whether the field of public health should use public health monitoring instead of public health surveillance or even public health data. She discusses the argument by W. J. Kassler and C. L. Bowman on the need of the field of public health to drop the phrase surveillance, her three lines of argument to support her claim that public health monitoring fits the bill, and reasons for the name change offered by G. L. Stuart and S. E. Ramsey.

The article revisits the landmark 1988 report, "The Future of Public Health (FOPH)" from the Institute of Medicine (IOM) which highlighted the fragmented and non-interconnected public health system, along with public complacency. Cited are the current state of U.S. public health in light of the 1988 report, and an assessment of where there is significant progress, where progress is lagging, and where there are strong warning signs and harms.

The article proposes that cultural safety frameworks and tools for transformation toward true equity should not seek to create only awareness of or perceptions of being competent with the cultural norms and practices of marginalized communities. Topics include notable health inequities experienced by indigenous peoples in the U.S., key concepts of cultural safety, and comparison of key concepts between cultural safety and cultural competency.

CRISPR (clustered regularly interspaced short palindromic repeats) is a Nobel Prize–winning technology that holds significant promise for revolutionizing the prevention and treatment of human disease through gene editing. However, CRISPR's public health implications remain relatively uncertain and underdiscussed because (1) targeting genetic factors alone will have limited influence on population health, and (2) minority populations (racial/ethnic, sexual and gender)—who bear the nation's greatest health burdens—historically suffer unequal benefits from emerging health care innovations and tools. This article introduces CRISPR and its potential public health benefits (e.g., improving virus surveillance, curing genetic diseases that pose public health problems such as sickle cell anemia) while outlining several major ethical and practical threats to health equity. This includes minorities' grave underrepresentation in genomics research, which may lead to less effective and accepted CRISPR tools and therapies for these groups, and their anticipated unequal access to these tools and therapies in health care. Informed by the principles of fairness, justice, and equitable access, ensuring gene editing promotes rather than diminishes health equity will require the meaningful centering and engagement of minority patients and populations in gene-editing research using community-based participatory research approaches. (Am J Public Health. 2023;113(8):874–882. https://doi.org/10.2105/AJPH.2023.307315) [ABSTRACT FROM AUTHOR]

Objectives. To examine whether, and if so how, US national and state survey response rates changed after the onset of the COVID-19 pandemic. Methods. We compared the change in response rates between 2020 and 2019 of 6 (3 social and economic, 3 health focused) major US national surveys (2 with state response rates). Results. All the ongoing surveys except 1 reported relative decreases (∼29%) in response rates. For example, the household response rate to the US Census American Community Survey decreased from 86.0% in 2019 to 71.2% in 2020, and the response rate of the US National Health Interview Survey decreased from 60.0% to 42.7% from the first to the second quarter of 2020. For all surveys, the greatest decreases in response rates occurred among persons with lower income and lower education. Conclusions. Socially patterned decreases in response rates pose serious challenges and must be addressed explicitly in all studies relying on data obtained since the onset of the pandemic. Public Health Implications. Artifactual reduction of estimates of the magnitude of health inequities attributable to differential response rates could adversely affect efforts to reduce these inequities. (Am J Public Health. 2023;113(6):667–670. https://doi.org/10.2105/AJPH.2023.307267) [ABSTRACT FROM AUTHOR]

An introduction to articles in the issue is presented on topics including contemporary trends in the quantity and quality of available information and on the distortion of public confidence in information created by spin and social media, principles that may be helpful in fostering agreements about public health issues, and the Crosscurrents Dialogue Model.

The article discusses a study by Peitzmeier et al on the prevalence and correlates of intimate partner violence (IPV) against transgender people. Topics include why transgender people only increasingly the focus of politicians' campaigns, parents' self-Help Facebook groups, pop culture's commentary, gun-toting extremists' protests, and legislator's public agendas; the book "Transsexual Empire: The Making of the She-Male" by Janice Raymond; and key lesson from the study.

The article presents a study which provided reliable estimates of prevalence by key demographics, including information at the province level. Topics discussed include the Seroepidemiological Survey of SARS-CoV2 Virus Infection in Spain, studies initiated in the United Kingdom to measure the prevalence of virus and of antibodies in random samples of the population, and lessons from the studies that may be used for monitoring future outbreaks of severe respiratory infections.

Public Health 3.0 calls for the inclusion of new partners and novel data to bring systemic change to the US public health landscape. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has illuminated significant data gaps influenced by ongoing colonial legacies of racism and erasure. American Indian and Alaska Native (AI/AN) populations and communities have been disproportionately affected by incomplete public health data and by the COVID-19 pandemic itself. Our findings indicate that only 26 US states were able to calculate COVID-19‒related death rates for AI/AN populations. Given that 37 states have Indian Health Service locations, we argue that public health researchers and practitioners should have a far larger data set of aggregated public health information on AI/AN populations. Despite enormous obstacles, local Tribal facilities have created effective community responses to COVID-19 testing, tracking, and vaccine administration. Their knowledge can lead the way to a healthier nation. Federal and state governments and health agencies must learn to responsibly support Tribal efforts, collect data from AI/AN persons in partnership with Indian Health Service and Tribal governments, and communicate effectively with Tribal authorities to ensure Indigenous data sovereignty. (Am J Public Health. 2021;111(S3): S208–S214. https://doi.org/10.2105/AJPH.2021.306415) [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the public health impact of the COVID-19 virus on sexual and gender minorities such as LGBTQ+ individuals and intersex people in the U.S., and it mentions the collection of sexual orientation and gender identity (SOGI) data in places such as Pennsylvania and Rhode Island. Population health and the need for federal government leadership are assessed.

The article discusses systematic reviews in medical research and the authors argue that such reviews should incorporate the risks of adverse health effects broadly and narrowly due to the wide variety of individual diet and environmental factors. The article also presents an example of accounting the prevention of cardiovascular diseases.

The article discusses a study published in the issue which showed that declines in U.S. health are not limited to social and political changes that started in the 1970s but rather originate in the preceding decades. Topics include challenges in the comparisons of life expectancy between the U.S. and other countries, factor attributed to the worsening of U.S. population health, and the uniqueness of the U.S. political and social context.

The "political economy of health" is concerned with how political and economic domains interact and shape individual and population health outcomes. However, the term is variously defined in the public health, medical, and social science literatures. This could result in confusion about the term and its associated tradition, thereby constituting a barrier to its application in public health research and practice. To address these issues, I survey the political economy of health tradition, clarify its specifically Marxian theoretical legacy, and discuss its relevance to understanding and addressing public health issues. I conclude by discussing the benefits of employing critical theories of race and racism with Marxian political economy to better understand the roles of class exploitation and racial oppression in epidemiological patterning. [ABSTRACT FROM AUTHOR]

The unique health and aging challenges of rural populations often go unnoticed. In fact, the rural United States is home to disproportionate shares of older and sicker people, there are large and growing rural–urban and within-rural mortality disparities, many rural communities are in population decline, and rural racial/ethnic diversity is increasing. Yet rural communities are not monolithic, and although some rural places are characterized by declining health, others have seen large improvements in population health. We draw on these realities to call for new research in five areas. First, research is needed to better describe health disparities between rural and urban areas and, because rural places are not monolithic, across rural America. Second, research is needed on how trends in rural population health and aging are affecting rural communities. Third, research is needed on the ways in which economic well-being and livelihood strategies interact with rural health and aging. Fourth, we need to better understand the health implications of the physical and social isolation characterizing many rural communities. Finally, we argue for new research on the implications of local natural environments and climate change for rural population health and aging. [ABSTRACT FROM AUTHOR]

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals. Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations. Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population. Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location. Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups. Main Results: We identified 85 articles from 74 unique data sets (ntotal = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations. Authors' Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed. Public Health Implications : Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population. [ABSTRACT FROM AUTHOR]

Objectives. To assess health system transformation and alignment in the Better Health Together (BHT) accountable community of health (ACH) region of Eastern Washington. Methods. This trend study leveraged cross-sectional data collected in 2017 and 2019 in Eastern Washington. A total of 165 responses from individuals representing 112 organizations were collected in 2017, and 211 responses from individuals representing 92 organizations were collected in 2019. More than one third (38%; n = 35 organizations) of cases overlapped between the 2 samples. Implementation of the ACH model is the exposure. Outcomes of interest included indicators of system transformation and alignment. Results. Organizations throughout BHT's region became more engaged, less siloed, and better connected from 2017 to 2019. At least some of the increased connectivity observed was directly attributable to the role BHT played in facilitating the creation or maintenance of interorganizational relationships across Eastern Washington. Conclusions. The ACH model is a promising approach to aligning health and social service systems for population health improvement. Evidence shows that ACH organizations can serve as trusted conveners able to facilitate interorganizational relationships across sectors. [ABSTRACT FROM AUTHOR]

Objectives. To describe partnerships between US local health departments (LHDs) and community organizations and assess the relationship between the types of activities performed in these partnerships and LHD engagement in population-based activities to prevent mental health conditions. Methods. Data were derived from 457 LHDs that responded to module 1 of the 2016 Profile Study conducted by the National Association of County and City Health Officials. These data were used to assess the presence of partnerships with community organizations and examine associations between the types of activities performed in such partnerships and LHDs' participation in population-based activities to prevent mental health conditions. Results. LHDs had higher odds of participating in population-based activities to prevent mental health conditions if they shared personnel or resources or had written agreements with mental health or substance use disorder providers, held regularly scheduled meetings with hospitals, or shared personnel or resources with community health centers. Odds were reduced if they exchanged information with community health centers or shared personnel or resources with faith-based organizations. Conclusions. This study offers an improved understanding of how the types of activities performed in cross-sector partnerships affect LHDs' participation in population-based activities to prevent mental health conditions, which is important as public policies, programs, and funding initiatives continue to encourage cross-sector partnership building. [ABSTRACT FROM AUTHOR]

Objectives. To examine spending and resource allocation decision-making to address health and social service integration challenges within and between governments. Methods. We performed a mixed methods case study to examine the integration of health and social services in a large US metropolitan area, including a city and a county government. Analyses incorporated annual budget data from the city and the county from 2009 to 2018 and semistructured interviews with 41 key leaders, including directors, deputies, or finance officers from all health care–, health-, or social service–oriented city and county agencies; lead budget and finance managers; and city and county executive offices. Results. Participants viewed public health and social services as qualitatively important, although together these constituted only $157 or $1250 total per capita spending in 2018, and per capita public health spending has declined since 2009. Funding streams can be siloed and budget approaches can facilitate or impede service integration. Conclusions. Health and social services should be integrated through greater attention to the budgetary, jurisdictional, and programmatic realities of health and social service agencies and to the budget models used for driving the systems-level pursuit of population health. [ABSTRACT FROM AUTHOR]

The article discusses the challenges faced by rural public health workers during the COVID-19 pandemic. Topics include ways public health professionals responded to COVID-19 with limited resources, comparison of the rural and urban public health workforces, and suggested strategies to strengthen rural public health.

An editorial on the health in all policies approach to population health is presented. The authors discuss the relationship between health and a variety of government policies, not just medical policy, how the social determinants of health are affected by various policies, and how health promotion and accessibility to health health services can be improved.

An editorial is presented in which the authors discuss access to abortion, legislation and potential U.S. Supreme Court hearings concerning abortion in U.S. states, and public and population health.

Increasing in frequency and impact in the United States and worldwide, disasters can lead to serious mental health consequences. Although US census data are essential for disaster preparedness and the identification of community-level risk factors for adverse postdisaster mental health outcomes, the US Census Bureau faces many challenges as we approach 2020 Decennial Census data collection. Despite the utility of the information provided by the Census and American Community Survey (ACS), the 2020 US Census and subsequent ACS data face threats to validity. As a result, public health funding could be misallocated, and disaster preparedness and response efforts misinformed; this can also contribute to the worsening of mental health inequities, particularly in the context of disaster. Undercutting the Census and the ACS, rich data sources that allow representation of all people in the United States, is a step backward in our effort to mitigate the population mental health consequences of disasters. [ABSTRACT FROM AUTHOR]

Objectives. To identify disparities in several types of insured health care costs in the Netherlands across neighborhoods with different socioeconomic statuses and to assess the room for improvement. Methods. We used 2015 Dutch whole-population registry data to estimate the age- and gender-specific cost structure by neighborhood for total, specialist, pharmaceutical, and mental health care. Classifying neighborhoods by the quintile of their neighborhood socioeconomic status (NSES), we determined differences in observed and expected health care costs for several scenarios of NSES improvement. Results. From low to high NSES, we found a clear downward gradient in health care costs. Total health care costs would drop by 7.3% if each neighborhood's cost structure was equal to that of the most affluent neighborhoods. The potential for cost reduction appeared highest for females, for age groups between 40 and 60 years, and for pharmaceutical care. Conclusions. Low NSES is associated with relatively high health care costs, and represents considerable potential for cost savings in health care. Public Health Implications. Our research suggests that policies aimed at improving the socioeconomic determinants of health locally may be pivotal in containing health care costs. [ABSTRACT FROM AUTHOR]

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure. [ABSTRACT FROM AUTHOR]

Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair—before, during, and after the Great Recession—offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data. [ABSTRACT FROM AUTHOR]

Objectives. To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. Methods. A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record–generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. Results. At 3 months, there was no difference between groups in mental (–1.03; 95% confidence interval [CI] = −3.02, 0.96) or physical HRQOL (0.59; 95% CI = −0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. Conclusions. CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. Trial Registration. ClinicalTrials.gov Identifier: NCT02435511. [ABSTRACT FROM AUTHOR]

The author reflects on application of novel and powerful state-of-the-art methodological approaches to advance population health. Topics discussed include two pioneers in the development and application of group or cluster randomized trials, and study on links to R code and methods for sample size calculations for sequential multiple assignment randomized trials (SMARTs) as well as for the statistical analysis of such trials.

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health. [ABSTRACT FROM AUTHOR]

Although community capacity has been prominent in the public health literature for nearly 20 years, the field has only operationalized a few dimensions. An intriguing dimension of capacity is a community's ability to critically reflect. On the basis of previous research as well as theoretical and practical insights from management and organizational learning literature, we offer a process framework for critical reflexivity practice in community. The framework draws on ideas regarding cognition and agency, praxis, as well as the transformative learning model to conceptualize how reflexivity happens as an emergent community process. The implication is that reflexivity is a community-level process of making meaning of experiences that drive a common narrative. Inclusivity and establishing consensus are paramount, and can be difficult in light of power dynamics and consideration of dissenting voices and different experiences; enlightened self-interest and creating conducive spaces for dialogue are key in this process. Strengthening communities' ability to gain and employ collective wisdom from their experience will also build their overall capacity for population health improvement. [ABSTRACT FROM AUTHOR]

Anthropogenic activity will bring immediate changes and disruptions to the global climate with accompanying health implications. Although policymakers and public health advocates are beginning to acknowledge the health implications of climate change, current policy approaches are lagging behind. We proposed that 4 key policy principles are critical to successful policymaking in this arena: mainstreaming, linking mitigation and adaptation policy, applying population perspectives, and coordination. We explored California's progress in addressing the public health challenges of climate change in the San Joaquin Valley as an example. We discussed issues of mental health and climate change, and used the San Joaquin Valley of California as an example to explore policy approaches to health issues and climate change. The California experience is instructive for other jurisdictions. [ABSTRACT FROM AUTHOR]

We define measures of effect used in public health evaluations, which include the risk difference and the risk ratio, the population-attributable risk, years of life lost or gained, disability-adjusted life years, quality-adjusted life years, and the incremental costeffectiveness ratio. Except for the risk ratio, all of these are absolute effect measures. For constructing externally generalizable absolute measures of effect when there is superior fit of the multiplicative model, we suggest using the multiplicative model to estimate relative risks, which will often be obtained in simple linear formwith no interactions, and then converting these to the desired absolute measure. The externally generalizable absolute measure of effect can be obtained by suitably standardizing to the risk factor distribution of the population to which the results are to be generalized. External generalizability will often be compromised when absolutemeasures are computed from study populations with risk factor distributions different from those of the population to whom the results are to be generalized, even when these risk factors are not confounders of the intervention effect. [ABSTRACT FROM AUTHOR]

Social work is a core health profession with origins deeply connected to the development of contemporary public health in the United States. Today, many of the nation’s 600 000 social workers practice broadly in public health and in other health settings, drawing on a century of experience in combining clinical, intermediate, and population approaches for greater health impact. Yet, the historic significance of this long-standing interdisciplinary collaboration—and its current implications— remains underexplored in the present era. This article builds on primary and contemporary sources to trace the historic arc of social work in public health, providing examples of successful collaborations. The scope and practices of public health social work practice are explored, and we articulate a rationale for an expanded place for social work in the public health enterprise. [ABSTRACT FROM AUTHOR]

Background. Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. Objectives. To systematically review international studies of the effect of social work–involved health services on health and economic outcomes. Search Methods. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017. Selection Criteria. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Data Collection and Analysis. Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Main Results. Average study quality was fair. Studies of 7 social work– led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Conclusions. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team-based care. Public Health Implications. The economic and health benefits reported in these studies suggest that the broad health perspective taken by the social work profession for patient, personal, and environmental needs may be particularly valuable for achieving goals of cost containment, prevention, and population health. Novel approaches that move beyond cost savings to articulate the specific value-added of social work are much needed. As health service delivery focuses increasingly on interprofessional training, practice, and integrated care, more research testing the impact of social work prevention and intervention efforts on the health and well-being of vulnerable populations while also measuring societal costs and benefits is essential. [ABSTRACT FROM AUTHOR]

Accountable care organizations agree to be accountable for the cost and outcomes of an attributed population. However, in many, no provisions have been made to account for oral health. There are several social, medical, and financial implications for health care provider and payer systems and health careoutcomeswhenoral health is not accounted for in patient management. How can an organization strive to improve population health without including the oral health system? Total systemic health for a population must include oral health. Accountable care organizations are positioned to change the course of oral health in the United States and close the disparities that exist among vulnerable populations, including seniors. Such efforts will reduce health care costs. Opportunities abound to expand points of entry into the health care system via dental or medical care. Closing the great divide between 2 historically isolated professions will position the United States to make gains in true population health. I provide evidence of the need to mandate access to oral health care services for all Americans--specifically adults, because legislation currently exists for pediatric dental coverage. [ABSTRACT FROM AUTHOR]

Objectives. To describe the health status of the transgender population in the United States. Methods. We used 2014 Behavioral Risk Factor Surveillance System data that comprised a probability sample from 19 US states and Guam (n = 151 456). Results. Bivariate analyses showed that, in comparison with cisgender individuals, transgender individuals had a higher prevalence of poor general health (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.2, 2.4), more days per month of poor physical (b = 2.43; 95% CI = 0.61, 4.24; P < .01) and mental (b = 1.74; 95% CI = 0.28, 3.19; P = .02) health, and a higher prevalence of myocardial infarction (OR = 1.7; 95% CI = 1.1, 2.5). In addition, more transgender than cisgender people lacked health care coverage (OR = 1.8; 95% CI = 1.2, 2.7) and a health care provider (OR = 1.5; 95% CI = 1.0, 2.1), and they were less likely to have visited a dentist in the preceding year (OR = 0.7; 95% CI = 0.5, 1.0). However, transgender individuals did not differ from cisgender individuals with respect to prevalence of chronic diseases, cancers, or depressive disorders or in terms of health behaviors such as smoking, binge drinking, and always wearing a seatbelt. Conclusions. Our findings highlight areas of unmet needs in the transgender population. [ABSTRACT FROM AUTHOR]

Numerous examples exist in population health of work that erroneously forces the causes of health to sumto 100%.This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several highprofile examples, including Doll and Peto's 1981 opus on the causes of cancer and its current interpretations; a 2015 highpublicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site "County Health Rankings & Roadmaps: Building a Culture of Health, County by County," whosemodel sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeplyflawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity. [ABSTRACT FROM AUTHOR]

Counterfactual frameworks and statistical methods for supporting causal inference are powerful tools to clarify scientific questions and guide analyses in public health research. Counterfactual accounts of causation contrast what would happen to a population’s health under alternative exposure scenarios. A long-standing debate in counterfactual theory relates to whether sex, race, and biological characteristics, including obesity, should be evaluated as causes, given that these variables do not directly correspond to clearly defined interventions. We argue that sex, race, and biological characteristics are important health determinants. Quantifying the overall health effects of these variables is often a natural starting point for disparities research. Subsequent assessments of biological or social pathways mediating those effects can facilitate the development of interventions designed to reduce disparities. [ABSTRACT FROM AUTHOR]

Enhancing effective preventive interventions to address contemporary public health problems requires improved capacity for applied public health research. A particular need has been recognized for capacity development in population health intervention research to address the complex multidisciplinary challenges of developing, implementing, and evaluating public health practices, intervention programs, and policies. Research training programs need to adapt to these new realities. We have presented an example of a 2003 to 2015 training program in transdisciplinary research on public health interventions that embedded doctoral and postdoctoral trainees in public health organizations in Quebec, Canada. This university–public health partnership for research training is an example of how to link science and practice to meet emerging needs in public health. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the authors' views about the relationship between public health and politics, and it mentions the science of population health and another article in the same issue of the journal which deals with U.S. health aid investments. Public health education and practices are examined, along with political action. The concept of a public health of consequence is assessed.