Annual Review of Public Health最新文献

Several groups in the United States, including communities of color and low-income communities, are frequently disproportionately exposed to ambient (i.e., outdoor) air pollution, reflecting unjust placement of emission sources, systemic bias, and historic race-based land use planning. Eliminating these inequities is critical for advancing environmental justice. This review synthesizes methodological innovations for characterizing and mitigating ambient air pollution inequities, focusing on the past 10 years, mostly in the United States. Advances in exposure assessment (e.g., empirical models, satellite remote sensing, mobile monitoring, sensor networks) provide new tools for characterizing disparities. Advances in techniques for attributing pollution to specific sources (e.g., reduced-complexity models) reveal how emission-reduction approaches may or may not eliminate disparities. Spatially targeted emission reductions are critical for eliminating relative disparities; conventional approaches (e.g., sectoral emission reductions, national concentration standards) are unlikely to eliminate those disparities. This article provides insights for effective interventions to promote equity in ambient air pollution exposure.

Medicare spending growth has slowed markedly over the last 20 years, defying projections despite a growing beneficiary population and expansion of the costlier Medicare Advantage program. Demographic, policy, and economic factors contributed to the spending growth slowdown. Key drivers include low payment rate increases-particularly following passage of the Affordable Care Act and sequestration policies-modest demographic shifts, and the evolving role of financial incentives and medical technology. The orientation toward value-based care played a role, though precise impacts of broad policies are difficult to quantify. While spending moderation is viewed as a success, it may mask trade-offs in access, quality, and service adequacy, especially for vulnerable populations facing unmet needs. We explore future spending projections and highlight the importance of balancing cost control with improving Medicare's capacity to serve high-need beneficiaries. Research insights are critical for shaping Medicare policy that is financially sustainable and responsive to beneficiaries' evolving needs.

Historically rooted in US Black feminist activism, intersectionality emerged as an analytical lens through which to enhance knowledge about how multiple and interlocking systems of oppression (e.g., racism, sexism, and class exploitation) shape the lives of US Black women and other historically marginalized populations, and as a tool for critical praxis, not empirical research. Intersectionality has numerous benefits for the field of public health. Accordingly, interest in intersectionality and intersectionality research has flourished within US and global public health. This review highlights some of the theoretical and methodological articles and systematic and scoping reviews focused on intersectionality in the field. It also addresses several of the conceptual and methodological complexities and challenges of qualitative and quantitative intersectionality research with the introduction of a Framework for Applied Intersectionality Research (FAIR). FAIR aims to reframe intersectionality as a critical transformative tool to advance health equity and social justice action, not just empirical research.

Poverty is a fundamental driver of health, influencing access to resources and contributing to chronic stress and poor health. There has been substantial recent growth in the literature on the impacts of economic policies as upstream interventions to address poverty and reduce health inequities. This review synthesizes evidence on US income support policies with varying design features and populations served, e.g., tax policies, minimum wage, and guaranteed income programs. Drawing on robust quasi-experimental and experimental studies, findings suggest that policies increasing income, particularly the Earned Income Tax Credit, can meaningfully improve maternal, infant, and mental health and alleviate food insecurity. For many policies, however, there is insufficient research; for some, such as the minimum wage, evidence is mixed. Methodological challenges include data limitations, exposure misclassification, and policy co-occurrence. Future research should leverage longitudinal approaches, examine policy interactions, address equity of impact, and strengthen partnerships with policymakers to inform effective, equitable poverty alleviation strategies to improve health.

Global progress toward universal health coverage (UHC) has varied widely across low- and middle-income countries (LMICs) in recent years. To better understand these differences, we used an analytical framework to compare individual health system components, or substructures, across selected LMICs, identifying institutional and policy mechanisms that shape UHC performance. Our case study comparison includes 12 countries spanning high and low UHC performance, as indicated by World Bank and World Health Organization (WHO) indicators for service coverage and financial risk protection as well as considerations of equity concerns not captured by these metrics. We highlight that stronger performance is associated with unified risk pooling, strategic purchasing, robust primary care-based integrated delivery, a systemic approach toward public/private service delivery, strategic investments in health infrastructure and workforce, and accountable governance. Future analyses and reviews using this comparative case study method with a structured analytical framework would be helpful in further advancing our understanding of the drivers of UHC progress and guiding policy reform.

Rapid decarbonization and climate adaptation are urgent to avoid the worst impacts of climate change, but past efforts at large-scale societal change and infrastructure investments have often exacerbated racialized and socioeconomic inequalities and further entrenched the structural drivers and root causes of climate change. We review dimensions of climate justice in the literature and define just climate solutions as those that (a) address root causes and dismantle structural drivers of social inequality and injustice; (b) are community centered and ground-truthed; (c) are reparative and maximally beneficial for historically marginalized populations; and (d) disrupt existing power relations to transform who controls framing, design, implementation, and accountability. We offer a set of guiding questions to help researchers, practitioners, community advocates, and policymakers operationalize this definition to evaluate climate actions in the context of mitigation, adaptation, and disaster response and recovery efforts.

Racism is an underlying cause of health inequities and is entrenched in health systems, disproportionately affecting marginalized groups. Advancing health equity requires reimagining health systems to uproot racism from health-related policymaking. Racism, in its systemic, cultural, and interpersonal forms, remains a significant threat to health equity, a barrier to reform, and a public health crisis. This review draws lessons from US social movements-including tobacco control, sexual and gender minority rights, criminal justice reform, civil rights, and reproductive justice-to identify effective strategies for change. Drawing on key theories, typologies, and insights from the literature, we examine how organizing, messaging, and mobilization have shaped narratives, have fostered public will, and have driven policy reform. Prior movements can serve as a guide for the development and implementation of a social change movement aimed at addressing racism in public health.

Scientists are facing increasing challenges concerned with improving the health of the public. Declining trust in expertise, new diseases, widening disparities in access to care, and environmental changes all challenge population health science to lean into work that can help move societies closer to solutions. To do this work effectively, we need to nudge population health science toward research that engages with consequential health challenges, which will require a reprioritization of how we generate, measure, and articulate health impact. In this review, we provide a history of evaluating impact, along with a comprehensive framework for conceptualizing future public health research impacts. In addition, we review evaluation models and highlight best practices for measuring impact. We introduce a new framework that builds on realist evaluation principles for assessing the impact of public health research and addresses the need to communicate these impacts to diverse audiences. To achieve this reprioritization, we recognize the need for organizational and systemic changes that can incentivize, prioritize, and reward impact-driven engagement.

Policing in the United States functions as a structural determinant of health, with direct and collateral impacts that extend well beyond maintaining order and public safety. This review synthesizes recent evidence (from 2015 to 2025) on the relationship between policing and health. Using a rapid evidence assessment, we examine peer-reviewed and gray literature to capture physical, mental, and community-level outcomes, as well as pathways and mechanisms that link policing to health. Findings indicate that police use of force results in significant injury and deaths annually, disproportionately affecting communities of color. Beyond direct effects, policing contributes to chronic stress, trauma, and economic strain across community and occupational ecosystems. These collateral impacts compound existing structural inequities. Despite promising alternatives to police responses, evidence gaps and reliance on cross-sectional studies limit causal inference. Future research should strengthen data systems, focus on causal research, and integrate public health priorities into public safety strategies.

Early-onset cancers (EOCs), typically defined as cancers diagnosed before age 50, are rising across multiple organ sites and populations globally. EOCs often exhibit more aggressive biology than later-onset cancers and contribute disproportionately to premature mortality and morbidity. A large sex disparity exists, with two-thirds of EOCs diagnosed in women. While EOC incidence is increasing broadly, patterns vary by geography, income, and race/ethnicity, offering clues about the role of health behaviors, environmental exposures, preventive care, and broader social and economic contexts. Gaps remain in our etiologic understanding of EOCs, including the contribution of modifiable environmental factors. Addressing this burden will require coordinated research using novel epidemiologic, intervention, and implementation science approaches, alongside policy action. We provide an overview of EOC trends, examine key methodological considerations, review established and suspected risk factors, and highlight opportunities to strengthen prevention and early detection, with a focus on US and relevant global considerations.