Milbank Quarterly最新文献

Policy Points Firearm injury is a leading cause of death in the United States, with fatality rates increasing 34.9% over the past decade (2010-2020). Firearm injury is preventable through multifaceted evidence-based approaches. Reviewing past challenges and successes in the field of firearm injury prevention can highlight the future directions needed in the field. Adequate funding, rigorous and comprehensive data availability and access, larger pools of diverse and scientifically trained researchers and practitioners, robust evidence-based programming and policy implementation, and a reduction in stigma, polarization, and politicization of the science are all needed to move the field forward.

Policy Points Although a single definition of the population health workforce does not yet exist, this workforce needs to have the skills and competencies to address the social determinants of health, to understand intersectionality, and to coordinate and work in concert with an array of skilled providers in social and health care to address multiple health drivers. On-the-job training programs and employer support are needed for the current health workforce to gain skills and competencies to address population health. Funding and leadership combined are critical for developing the population health workforce with the goal of supporting a broad set of workers beyond health and social care to include, for example, those in urban planning, law enforcement, or transportation professions to address population health.

Policy Points The commercial determinants of health (CDH) framework can inform public health policy, practice, and research in ways that contribute to overcoming the world's most serious public health challenges. By documenting the pathways by which commercial actors shape health, the CDH framework can provide a unifying focus for collective action to prevent and ameliorate global health crises. To realize these opportunities, CDH proponents need to find synergies in the multiple emerging streams of research, practice, and advocacy and create a body of scientific evidence, methodologies, and ideas that can inform a public health practice for the 21st century.

Policy Points In America, wages appear to be growing relative to purchasing power over time. However, while the ability to purchase consumer goods has indeed improved, the cost of basic survival needs such as health care and education has increased faster than wages have grown. America's weakening social policy landscape has led to a massive socioeconomic rupture in which the middle class is disappearing, such that most Americans now cannot afford basic survival needs, such as education and health insurance. Social policies strive to rebalance societal resources from socioeconomically advantaged groups to those in need. Education and health insurance benefits have been experimentally proven to also improve health and longevity. The biological pathways through which they work are also understood.

Policy Points To meaningfully impact population health and health equity, health care organizations must take a multipronged approach that ranges from education to advocacy, recognizing that more impactful efforts are often more complex or resource intensive. Given that population health is advanced in communities and not doctors' offices, health care organizations must use their advocacy voices in service of population health policy, not just health care policy. Foundational to all population health and health equity efforts are authentic community partnerships and a commitment to demonstrating health care organizations are worthy of their communities' trust.

Policy Points Cities, which are where the majority of the world's population lives today, directly and indirectly shape human health and well-being. Urban health research, policy, and practice are increasingly using a systems science approach to address the upstream and downstream drivers of health in cities, which include social and environmental factors, features of the built environment, conditions of living, and health care resources. To guide future scholarship and policy, we propose an urban health agenda for 2050 focused on revitalizing the sanitation movement, integrating data, scaling best practices, adopting the Health in All Policies approach, and addressing intraurban health inequities.

Policy Points After decades of scientific progress and growth in academic literature, there is a recognition that climate change poses a substantial threat to the health and well-being of individuals and communities both in the United States and globally. Solutions to mitigate and adapt to climate change can have important health cobenefits. A vital component of these policy solutions is that they must also take into consideration historic issues of environmental justice and racism, and implementation of these policies must have a strong equity lens.

Policy Points Accurate and reliable data systems are critical for delivering the essential services and foundational capabilities of public health for a 21^st -century public health infrastructure. Chronic underfunding, workforce shortages, and operational silos limit the effectiveness of America's public health data systems, with the country's anemic response to COVID-19 highlighting the results of long-standing infrastructure gaps. As the public health sector begins an unprecedented data modernization effort, scholars and policymakers should ensure ongoing reforms are aligned with the five components of an ideal public health data system: outcomes and equity oriented, actionable, interoperable, collaborative, and grounded in a robust public health system.

Policy Points The predominantly fee-for-service reimbursement architecture of the US health care system contributes to waste and excess spending. While the past decade of payment reforms has galvanized the adoption of alternative payment models and generated moderate savings, uptake of truly population-based payment systems continues to lag, and interventions to date have had limited impact on care quality, outcomes, and health equity. To realize the promise of payment reforms as instruments for delivery system transformation, future policies for health care financing must focus on accelerating the diffusion of value-based payment, leveraging payments to redress inequities, and incentivizing partnerships with cross-sector entities to invest in the upstream drivers of health.