- Home
- A-Z Publications
- Annual Review of Public Health
- Previous Issues
- Volume 36, 2015
Annual Review of Public Health - Volume 36, 2015
Volume 36, 2015
- Preface
-
-
-
Commentary: Evidence to Guide Gun Violence Prevention in America
Vol. 36 (2015), pp. 1–4More LessGun violence is a major threat to the public's health and safety in the United States. The articles in this volume's symposium on gun violence reveal the scope of the problem and new trends in mortality rates from gunfire. Leading scholars synthesize research evidence that demonstrates the ability of numerous policies and programs—each consistent with lessons learned from successful efforts to combat public health problems—to prevent gun violence. Each approach presents challenges to successful implementation. Future research should inform efforts to assess which approaches are most effective and how to implement evidence-based interventions most effectively.
-
-
-
The Epidemiology of Firearm Violence in the Twenty-First Century United States
Vol. 36 (2015), pp. 5–19More LessThis brief review summarizes the basic epidemiology of firearm violence, a large and costly public health problem in the United States for which the mortality rate has remained unchanged for more than a decade. It presents findings for the present in light of recent trends. Risk for firearm violence varies substantially across demographic subsets of the population and between states in patterns that are quite different for suicide and homicide. Suicide is far more common than homicide and its rate is increasing; the homicide rate is decreasing. As with other important health problems, most cases of fatal firearm violence arise from large but low-risk subsets of the population; risk and burden of illness are not distributed symmetrically. Compared with other industrialized nations, the United States has uniquely high mortality rates from firearm violence.
-
-
-
Effects of Policies Designed to Keep Firearms from High-Risk Individuals
Vol. 36 (2015), pp. 21–37More LessThis article summarizes and critiques available evidence from studies published between 1999 and August 2014 on the effects of policies designed to keep firearms from high-risk individuals in the United States. Some prohibitions for high-risk individuals (e.g., those under domestic violence restraining orders, violent misdemeanants) and procedures for checking for more types of prohibiting conditions are associated with lower rates of violence. Certain laws intended to prevent prohibited persons from accessing firearms—rigorous permit-to-purchase, comprehensive background checks, strong regulation and oversight of gun dealers, and requiring gun owners to promptly report lost or stolen firearms—are negatively associated with the diversion of guns to criminals. Future research is needed to examine whether these laws curtail nonlethal gun violence and whether the effects of expanding prohibiting conditions for firearm possession are modified by the presence of policies to prevent diversion.
-
-
-
Cure Violence: A Public Health Model to Reduce Gun Violence
Vol. 36 (2015), pp. 39–53More LessScholars and practitioners alike in recent years have suggested that real and lasting progress in the fight against gun violence requires changing the social norms and attitudes that perpetuate violence and the use of guns. The Cure Violence model is a public health approach to gun violence reduction that seeks to change individual and community attitudes and norms about gun violence. It considers gun violence to be analogous to a communicable disease that passes from person to person when left untreated. Cure Violence operates independently of, while hopefully not undermining, law enforcement. In this article, we describe the theoretical basis for the program, review existing program evaluations, identify several challenges facing evaluators, and offer directions for future research.
-
-
-
Focused Deterrence and the Prevention of Violent Gun Injuries: Practice, Theoretical Principles, and Scientific Evidence
Vol. 36 (2015), pp. 55–68More LessFocused deterrence strategies are a relatively new addition to a growing portfolio of evidence-based violent gun injury prevention practices available to policy makers and practitioners. These strategies seek to change offender behavior by understanding the underlying violence-producing dynamics and conditions that sustain recurring violent gun injury problems and by implementing a blended strategy of law enforcement, community mobilization, and social service actions. Consistent with documented public health practice, the focused deterrence approach identifies underlying risk factors and causes of recurring violent gun injury problems, develops tailored responses to these underlying conditions, and measures the impact of implemented interventions. This article reviews the practice, theoretical principles, and evaluation evidence on focused deterrence strategies. Although more rigorous randomized studies are needed, the available empirical evidence suggests that these strategies generate noteworthy gun violence reduction impacts and should be part of a broader portfolio of violence prevention strategies available to policy makers and practitioners.
-
-
-
Has Epidemiology Become Infatuated With Methods? A Historical Perspective on the Place of Methods During the Classical (1945–1965) Phase of Epidemiology
Vol. 36 (2015), pp. 69–88More LessBefore World War II, epidemiology was a small discipline, practiced by a handful of people working mostly in the United Kingdom and in the United States. Today it is practiced by tens of thousands of people on all continents. Between 1945 and 1965, during what is known as its “classical” phase, epidemiology became recognized as a major academic discipline in medicine and public health. On the basis of a review of the historical evidence, this article examines to which extent classical epidemiology has been a golden age of an action-driven, problem-solving science, in which epidemiologists were less concerned with the sophistication of their methods than with the societal consequences of their work. It also discusses whether the paucity of methods stymied or boosted classical epidemiology's ability to convince political and financial agencies about the need to intervene in order to improve the health of the people.
-
-
-
Statistical Foundations for Model-Based Adjustments
Vol. 36 (2015), pp. 89–108More LessMost epidemiology textbooks that discuss models are vague on details of model selection. This lack of detail may be understandable since selection should be strongly influenced by features of the particular study, including contextual (prior) information about covariates that may confound, modify, or mediate the effect under study. It is thus important that authors document their modeling goals and strategies and understand the contextual interpretation of model parameters and model selection criteria. To illustrate this point, we review several established strategies for selecting model covariates, describe their shortcomings, and point to refinements, assuming that the main goal is to derive the most accurate effect estimates obtainable from the data and available resources. This goal shifts the focus to prediction of exposure or potential outcomes (or both) to adjust for confounding; it thus differs from the goal of ordinary statistical modeling, which is to passively predict outcomes. Nonetheless, methods and software for passive prediction can be used for causal inference as well, provided that the target parameters are shifted appropriately.
-
-
-
The Elusiveness of Population-Wide High Blood Pressure Control
Vol. 36 (2015), pp. 109–130More LessHigh blood pressure (hypertension) is a leading risk factor for cardiovascular disease. It is highly prevalent in the US general population, especially in those who are old, African American, or socially disadvantaged. Prevalence is also high and increasing worldwide. Awareness, treatment, and control of hypertension have improved over time, but there is still considerable room for improvement. The optimal solution to this health challenge varies by country. Several nonpharmacologic and pharmacologic interventions are well proven as effective means to prevent hypertension and improve control rates in those with established hypertension. Better prevention and control of hypertension will yield substantial general population health benefits and remain high priorities in public health.
-
-
-
Fitness of the US Workforce
Vol. 36 (2015), pp. 131–149More LessFitness matters for the prevention of premature death, chronic diseases, productivity loss, excess medical care costs, loss of income or family earnings, and other social and economic concerns. The workforce may be viewed as a corporate strategic asset, yet its fitness level appears to be relatively low and declining. Over the past half-century, obesity rates have doubled, physical activity levels are below par, and cardiorespiratory fitness often does not meet minimum acceptable job standards. During this time, daily occupational energy expenditure has decreased by more than 100 calories. Employers should consider best practices and design workplace wellness programs accordingly. Particular attention should be paid to human-centered cultures. Research should address ongoing surveillance needs regarding fitness of the US workforce and close gaps in the evidence base for fitness and business-relevant outcomes. Policy priorities should consider the impact of both state and federal regulations, adherence to current regulations that protect and promote worker health, and the introduction of incentives that allow employers to optimize the fitness of their workforce through supportive legislation and organizational policies.
-
-
-
Food System Policy, Public Health, and Human Rights in the United States
Vol. 36 (2015), pp. 151–173More LessThe US food system functions within a complex nexus of social, political, economic, cultural, and ecological factors. Among them are many dynamic pressures such as population growth, urbanization, socioeconomic inequities, climate disruption, and the increasing demand for resource-intensive foods that place immense strains on public health and the environment. This review focuses on the role that policy plays in defining the food system, particularly with regard to agriculture. It further examines the challenges of making the food supply safe, nutritious, and sustainable, while respecting the rights of all people to have access to adequate food and to attain the highest standard of health. We conclude that the present US food system is largely unhealthy, inequitable, environmentally damaging, and insufficiently resilient to endure the impacts of climate change, resource depletion, and population increases, and is therefore unsustainable. Thus, it is imperative that the US embraces policy reforms to transform the food system into one that supports public health and reflects the principles of human rights and agroecology for the benefit of current and future generations.
-
-
-
Regulating Chemicals: Law, Science, and the Unbearable Burdens of Regulation
Vol. 36 (2015), pp. 175–191More LessThe challenges of regulating industrial chemicals remain unresolved in the United States. The Toxic Substances Control Act (TSCA) of 1976 was the first legislation to extend coverage to the regulation of industrial chemicals, both existing and newly registered. However, decisions related to both law and science that were made in passing this law inevitably rendered it ineffectual. Attempts to fix these shortcomings have not been successful. In light of the European Union's passage of innovative principles and requirements for chemical regulation, it is no longer possible to deny the opportunity and need for reform in US law and practice.
-
-
-
The Haves, the Have-Nots, and the Health of Everyone: The Relationship Between Social Inequality and Environmental Quality
Vol. 36 (2015), pp. 193–209More LessA growing body of literature suggests that more unequal societies have more polluted and degraded environments, perhaps helping explain why more unequal societies are often less healthy. We summarize the mechanisms by which inequality can lead to environmental degradation and their relevance for public health. We review the evidence of a relationship between environmental quality and social inequality along the axes of income, wealth, political power, and race and ethnicity. Our review suggests that the evidence is strongest for air- and water-quality measures that have more immediate health implications; evidence is less strong for more dispersed pollutants that have longer-term health impacts. More attention should be paid in research and in practice to links among inequality, the environment, and health, including more within-country studies that may elucidate causal pathways and points of intervention. We synthesize common metrics of inequality and methodological considerations in an effort to bring cohesion to such efforts.
-
-
-
The Impact of Toxins on the Developing Brain
Vol. 36 (2015), pp. 211–230More LessThe impact of toxins on the developing brain is usually subtle for an individual child, but the damage can be substantial at the population level. Numerous challenges must be addressed to definitively test the impact of toxins on brain development in children: We must quantify exposure using a biologic marker or pollutant; account for an ever-expanding set of potential confounders; identify critical windows of vulnerability; and repeatedly examine the association of biologic markers of toxins with intellectual abilities, behaviors, and brain function in distinct cohorts. Despite these challenges, numerous toxins have been implicated in the development of intellectual deficits and mental disorders in children. Yet, too little has been done to protect children from these ubiquitous but insidious toxins. The objective of this review is to provide an overview on the population impact of toxins on the developing brain and describe implications for public health.
-
-
-
Unintentional Home Injuries Across the Life Span: Problems and Solutions
Vol. 36 (2015), pp. 231–253More LessHome injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors.
The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals—such as architects, home builders, home visitors, and fire and emergency medical services providers—who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.
-
-
-
Cross-Sector Partnerships and Public Health: Challenges and Opportunities for Addressing Obesity and Noncommunicable Diseases Through Engagement with the Private Sector
Vol. 36 (2015), pp. 255–271More LessOver the past few decades, cross-sector partnerships with the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious diseases in low- and middle-income countries. Now these partnerships are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of noncommunicable diseases. Partnering with businesses presents a means to acquire resources, as well as opportunities to influence the private sector toward more healthful practices. Yet even though collaboration is a core principle of public health practice, public–private or nonprofit–private partnerships present risks and challenges that warrant specific consideration. In this article, we review the role of public health partnerships with the private sector, with a focus on efforts to address obesity and noncommunicable diseases in high-income settings. We identify key challenges—including goal alignment and conflict of interest—and consider how changes to partnership practice might address these.
-
-
-
Deciphering the Imperative: Translating Public Health Quality Improvement into Organizational Performance Management Gains
Vol. 36 (2015), pp. 273–287More LessWith the launching of the national public health accreditation program under the auspices of the Public Health Accreditation Board (PHAB), health department momentum around quality improvement adoption has accelerated. Domain 9 of the PHAB standards (one of 12 domains) focuses on evaluation and improvement of performance and is acting as a strong driver for quality improvement and performance management implementation within health departments. Widespread adoption of quality improvement activities in public health trails that in other US sectors. Several performance management models have received broad acceptance, including models among government and nonprofits. A model specifically for public health has been developed and is presented herein. All models in current use reinforce customer focus; streamlined, value-added processes; and strategic alignment. All are structured to steer quality improvement efforts toward organizational priorities, ensuring that quality improvement complements performance management. High-performing health departments harness the synergy of quality improvement and performance management, providing powerful tools to achieve public health strategic imperatives.
-
-
-
Identifying the Effects of Environmental and Policy Change Interventions on Healthy Eating
Vol. 36 (2015), pp. 289–306More LessObesity has been characterized as a disease. Strategies to change the incidence and prevalence of this disease include a focus on changing physical and social environments, over and above individual-level strategies, using a multilevel or systems approach. We focus our attention on evidence published between 2008 and 2013 on the effectiveness of interventions in nutrition environments, i.e., environmental interventions designed to influence the intake of healthful foods and amount of energy consumed. An overarching socioecological framework that has guided much of this research was used to characterize different types of environmental strategies. Intervention examples in each area of the framework are provided with a discussion of key findings and related conceptual and methodological issues. The emphasis in this review is on adults, but clearly this literature is only one part of the picture. Much research has been focused on child-specific interventions, including environmental interventions. Some evidence suggests effectiveness of policy-based or other types of interventions that aim to regulate or restructure environments to promote healthy dietary choices, and these strategies would apply to both children and adults. Opportunities to evaluate these policy changes in adults' social and physical environments are rare. Much of the existing research has been with children. As conceptual and methodological issues continue to be identified and resolved, we hope that future research in this domain will identify environmental strategies that can be included in intervention toolboxes to build healthy nutrition environments for both adults and children.
-
-
-
Lessons from Complex Interventions to Improve Health
Vol. 36 (2015), pp. 307–323More LessComplexity—resulting from interactions among many component parts—is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health.
-
-
-
Trade Policy and Public Health
Vol. 36 (2015), pp. 325–344More LessTwenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policy influences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standard of health. In this article, we provide an overview of the modern global trade environment, illustrate the pathways between trade and health, and explore the emerging twenty-first-century trade policy landscape and its implications for health and health equity. We conclude with a call for more interdisciplinary research that embraces complexity theory and systems science as well as the political economy of health and that includes monitoring and evaluation of the impact of trade agreements on health.
-
-
-
Uses of Electronic Health Records for Public Health Surveillance to Advance Public Health
Vol. 36 (2015), pp. 345–359More LessPublic health surveillance conducted by health departments in the United States has improved in completeness and timeliness owing to electronic laboratory reporting. However, the collection of detailed clinical information about reported cases, which is necessary to confirm the diagnosis, to understand transmission, or to determine disease-related risk factors, is still heavily dependent on manual processes. The increasing prevalence and functionality of electronic health record (EHR) systems in the United States present important opportunities to advance public health surveillance. EHR data have the potential to further increase the breadth, detail, timeliness, and completeness of public health surveillance and thereby provide better data to guide public health interventions. EHRs also provide a unique opportunity to expand the role and vision of current surveillance efforts and to help bridge the gap between public health practice and clinical medicine.
-
-
-
What Is Health Resilience and How Can We Build It?*
Vol. 36 (2015), pp. 361–374More LessWhether a community is in the path of a natural disaster, the target of an act of terror, or simply striving to meet the demands of increasingly dense urban populations, a community resilience paradigm can help communities and individuals not just to mitigate damage and heal, but to thrive. This article discusses experiences from recent, large-scale disasters to explore how community resilience might serve as a sustainable paradigm for organizing public health and medical preparedness, response, and recovery. By strengthening health systems, meeting the needs of vulnerable populations, and promoting organizational competence, social connectedness, and psychological health, community resilience encourages actions that build preparedness, promote strong day-to-day systems, and address the underlying social determinants of health. Thus, community resilience resonates with a wide array of stakeholders, particularly those whose work routinely addresses health, wellness, or societal well-being.
-
-
-
Immigration as a Social Determinant of Health
Vol. 36 (2015), pp. 375–392More LessAlthough immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena—social determinants of health and immigration—has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
-
-
-
Mobile Text Messaging for Health: A Systematic Review of Reviews
Vol. 36 (2015), pp. 393–415More LessThe aim of this systematic review of reviews is to identify mobile text-messaging interventions designed for health improvement and behavior change and to derive recommendations for practice. We have compiled and reviewed existing systematic research reviews and meta-analyses to organize and summarize the text-messaging intervention evidence base, identify best-practice recommendations based on findings from multiple reviews, and explore implications for future research. Our review found that the majority of published text-messaging interventions were effective when addressing diabetes self-management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy. However, we found limited evidence across the population of studies and reviews to inform recommended intervention characteristics. Although strong evidence supports the value of integrating text-messaging interventions into public health practice, additional research is needed to establish longer-term intervention effects, identify recommended intervention characteristics, and explore issues of cost-effectiveness.
-
-
-
Sleep as a Potential Fundamental Contributor to Disparities in Cardiovascular Health
Vol. 36 (2015), pp. 417–440More LessOptimal sleep is integral to health but is commonly not obtained. Despite its wide-ranging public health impact, sleep health is considered only rarely by policy makers, employers, schools, and others whose policies and structures can adversely affect sleep. An inadequate duration of sleep and poor-quality sleep are prevalent in minority and low-income populations, and may be fundamental to racial and socioeconomic status inequities that contribute to a range of health conditions, including cardiovascular disease (CVD). This review examines the relationship between sleep and disparities in CVD. We describe the public health importance of sleep and the role of sleep duration, as well as the two most common disorders (sleep apnea and insomnia) as risk factors for a number of chronic diseases. We use a multilevel model focused on population health and health disparities, which is based on the notion that individual behaviors, such as sleep, are influenced by complex and dynamic interrelations among individuals and their physical and social environments. We also describe modifiable factors that contribute to insufficient sleep and circadian misalignment, propose potential interventions in various sectors (e.g., neighborhoods, schools, workplaces) that can address social structures that contribute to disparities, and recommend areas for future research. Integrating sleep into public health research will identify novel approaches for closing gaps in health disparities.
-
-
-
Stress and Type 2 Diabetes: A Review of How Stress Contributes to the Development of Type 2 Diabetes
Vol. 36 (2015), pp. 441–462More LessCurrent policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.
-
-
-
Translating Evidence into Population Health Improvement: Strategies and Barriers
Vol. 36 (2015), pp. 463–482More LessAmong the challenges facing research translation—the effort to move evidence into policy and practice—is that key questions chosen by investigators and funders may not always align with the information priorities of decision makers, nor are the findings always presented in a form that is useful for or relevant to the decisions at hand. This disconnect is a problem particularly for population health, where the change agents who can make the biggest difference in improving health behaviors and social and environmental conditions are generally nonscientists outside of the health professions. To persuade an audience that does not read scientific journals, strong science may not be enough to elicit change. Achieving influence in population health often requires four ingredients for success: research that is responsive to user needs, an understanding of the decision-making environment, effective stakeholder engagement, and strategic communication. This article reviews the principles and provides examples from a national and local initiative.
-
-
-
Using New Technologies to Improve the Prevention and Management of Chronic Conditions in Populations
Vol. 36 (2015), pp. 483–505More LessLifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms—within the new communications landscape—to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field.
-
-
-
Assessing and Changing Organizational Social Contexts for Effective Mental Health Services
Vol. 36 (2015), pp. 507–523More LessCulture and climate are critical dimensions of a mental health service organization's social context that affect the quality and outcomes of the services it provides and the implementation of innovations such as evidence-based treatments (EBTs). We describe a measure of culture and climate labeled Organizational Social Context (OSC), which has been associated with innovation, service quality, and outcomes in national samples and randomized controlled trials (RCTs) of mental health and social service organizations. The article also describes an empirically supported organizational intervention model labeled Availability, Responsiveness, and Continuity (ARC), which has improved organizational social context, innovation, and effectiveness in five RCTs. Finally, the article outlines a research agenda for developing more efficient and scalable organizational strategies to improve mental health services by identifying the mechanisms that link organizational interventions and social context to individual-level service provider intentions and behaviors associated with innovation and effectiveness.
-
-
-
Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act
Vol. 36 (2015), pp. 525–544More LessThe changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion; (c) demands on public and private systems of care; and (d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of nonphysician Latino health care workers.
-
-
-
Tax-Exempt Hospitals and Community Benefit: New Directions in Policy and Practice
Vol. 36 (2015), pp. 545–557More LessThe current community benefit standard for nonprofit hospital tax exemption has been the subject of mounting criticism. Many different constituencies have advanced the view that in its present form it fails to ensure that nonprofit hospitals provide adequate benefits to their communities in exchange for their tax exemption. In contrast, hospitals have often expressed the concern that the community benefit standard in its current form is vague and therefore difficult to comply with. Various suggestions have been made regarding how the existing community benefit standard could be improved or even replaced. In this article, we first discuss the historical and legal development of the community benefit standard. We then present the key controversies that have emerged in recent years and the policy responses attempted thus far. Finally, we evaluate possible future policy directions, which reform efforts could follow.
-
-
-
The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction
Vol. 36 (2015), pp. 559–574More LessPublic health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.
-
-
-
The Response of the US Centers for Disease Control and Prevention to the Obesity Epidemic
Vol. 36 (2015), pp. 575–596More LessThe recognition of the obesity epidemic as a national problem began in 1999 with the Centers for Disease Control and Prevention's (CDC's) publication of a series of annual state-based maps that demonstrated the rapid changes in the prevalence of obesity. Increasing rates of obesity had been noted in earlier CDC studies, but the maps provided evidence of a rapid, nationwide increase. The urgent need to respond to the epidemic led to the identification of state targets and the first generation of interventions for obesity prevention and control. The CDC's role was to provide setting- and intervention-specific guidance on implementing these strategies, and to assess changes in targeted policies and behaviors. The CDC's efforts were augmented by Congressional funding for community initiatives to improve nutrition and increase physical activity. Complementary investments by Kaiser Permanente, the Robert Wood Johnson Foundation, and the Institute of Medicine improved the evidence base and provided policy recommendations that reinforced the need for a multisectoral approach. Legislative, regulatory, and voluntary initiatives enacted by President Obama's administration translated many of the strategies into effective practice. Whether current efforts to address obesity can be sustained will depend on whether they can be translated into greater grass-roots engagement consistent with a social movement.
-
Previous Volumes
-
Volume 44 (2023)
-
Volume 43 (2022)
-
Volume 42 (2021)
-
Volume 41 (2020)
-
Volume 40 (2019)
-
Volume 39 (2018)
-
Volume 38 (2017)
-
Volume 37 (2016)
-
Volume 36 (2015)
-
Volume 35 (2014)
-
Volume 34 (2013)
-
Volume 33 (2012)
-
Volume 32 (2011)
-
Volume 31 (2010)
-
Volume 30 (2009)
-
Volume 29 (2008)
-
Volume 28 (2007)
-
Volume 27 (2006)
-
Volume 26 (2005)
-
Volume 25 (2004)
-
Volume 24 (2003)
-
Volume 23 (2002)
-
Volume 22 (2001)
-
Volume 21 (2000)
-
Volume 20 (1999)
-
Volume 19 (1998)
-
Volume 18 (1997)
-
Volume 17 (1996)
-
Volume 16 (1995)
-
Volume 15 (1994)
-
Volume 14 (1993)
-
Volume 13 (1992)
-
Volume 12 (1991)
-
Volume 11 (1990)
-
Volume 10 (1989)
-
Volume 9 (1988)
-
Volume 8 (1987)
-
Volume 7 (1986)
-
Volume 6 (1985)
-
Volume 5 (1984)
-
Volume 4 (1983)
-
Volume 3 (1982)
-
Volume 2 (1981)
-
Volume 1 (1980)
-
Volume 0 (1932)