Annual Review of Public Health最新文献

Federally Qualified Health Centers (FQHCs) were founded to improve access to primary health care for medically underserved areas and populations. Since their inception in the 1960s, FQHCs have grown to provide comprehensive primary care services to more than 31 million patients in 2023. In this review, we provide an overview of the role and growth of the FQHC program, summarize the existing evidence on its association with key outcomes, and discuss opportunities and challenges for the FQHC model. Evidence finds that FQHCs have played a crucial role in expanding access to primary care for low-income populations and that quality of care delivered in FQHCs often compares similarly or favorably to that of other settings. The ability to sustain and expand FQHCs' role is contingent, however, on stabilizing revenue streams and financing, developing comprehensive models of safety-net health care that include linkages with specialists, and implementing policies to support workforce recruitment and retention.

Compound climate events involve the intersection of individual climate events that are linked through space, time, or both. Anthropogenic climate change will likely increase the burden of these compound events, which often have synergistic health effects, meaning that the combined effect exceeds the sum of their individual parts. These include multivariate (co-occurring) events such as extreme heat and wildfires as well as temporally compounding (sequential) events such as debris flows after wildfire events. Existing epidemiological evidence has mostly identified synergistic health effects, primarily associated with multivariate compound climate exposures at short timescales. The research, however, is often limited by a lack of information on explicit exposure pathways that link changes in climate to health outcomes and inequalities. We discuss opportunities for public health interventions and methodological considerations for future studies in a compound climate and health framework.

Direct-to-consumer (DTC) advertisements for prescription drugs are an enduring feature of the US media landscape. These ads are costly (>$8 billion expended by drug manufacturers in 2023), legally protected, and tightly regulated in theory but less so in practice. DTC ads are well-established in magazines and television, with recent encroachment into social media and telehealth. Many ads rely on emotional appeals and captivating visuals, while few ads provide quantitative information on drug benefits and harms. Research shows that DTC advertising increases consumer awareness, drives prescription requests by patients, promotes prescribing by clinicians, and increases pharmaceutical expenditures. Based on limited data, effects on prescribing quality are mixed. Legal constraints notwithstanding, a case for more energetic regulation of DTC advertising can be made on normative, empirical, and logical grounds. Three broad strategies are recommended: (a) increased scrutiny, achieved by better funding of the US Food and Drug Administration and creative deployment of new technologies, including artificial intelligence; (b) moratoria on advertising for new, incompletely tested, or particularly hazardous drugs; and (c) selective prohibition of ads for specialty drugs that are almost universally prescribed by bona fide experts.

Unmet social needs (e.g., housing instability, food insecurity, transportation barriers) impact a patient's ability to participate in health-seeking behaviors (e.g., physical activity, routine preventive care) and to achieve optimal health. A rapidly growing number of health care systems are incorporating social needs screening and assistance into clinical workflows, yet many implementation and sustainability challenges exist and require collaboration with social service organizations. This review highlights implementation approaches used within this rapidly changing US landscape and uses implementation science frameworks to systematically identify multilevel barriers to and facilitators of implementing and sustaining social needs care. Policies and economic investments are necessary as they determine critical barriers and facilitators within the clinical and social service contexts. Implementation may be further strengthened by cross-sector engagement, evidence-based implementation strategies, and capacity building within clinical and social service organizations. Successful, sustained implementation of social needs care may improve the quality of health care, population health, and health equity.

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies. These programs exist on a limited scale and often face restrictions on their funding and scope of operations. While research demonstrates the effectiveness of existing programs in preventing infectious disease transmission and fatal overdose, there is less evidence about conditions that support the effective expansion and sustainment of existing models. Other harm reduction interventions such as overdose prevention centers and safer supply programs have promising international evidence but are prohibited or severely restricted under US law. In this review, we summarize the evidence for harm reduction interventions, describe the policy environment in which they exist, and provide recommendations to better align drug policy with existing and emerging evidence in the US context.

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

While public health practitioners and scholars have long theorized that structural forms of stigma shape the health of disadvantaged groups, they have frequently bemoaned the lack of research on this topic. A unique opportunity to address this lacuna occurred in the past two decades, with the advent of dramatic changes in laws, social attitudes, and other structural manifestations of stigma surrounding LGBTQ+ individuals. In a review of this literature, we conducted a meta-analysis of LGBTQ+ structural stigma and health, finding an effect size comparable to several other well-established macrolevel risk factors for poor health (e.g., income inequality, racial residential segregation, neighborhood socioeconomic status). In addition, we enumerated a range of established methodological strategies that studies have used to strengthen inferences; these strategies include documenting result specificity (i.e., structural stigma is unrelated to the health of cisgender heterosexuals), addressing alternative explanations (e.g., social selection), and triangulating evidence across multiple methods, measures, and health outcomes. We offer suggestions for future research to advance this rapidly expanding field, including identifying sources of unexplained heterogeneity in the structural stigma-health association. Finally, we discuss implications for other marginalized groups and for public health interventions and policies to reduce LGBTQ+ health disparities.

Immunization has saved an estimated 154 million lives over the past 50 years since the launch of the Essential (formerly Expanded) Program on Immunization in 1974, representing 6 lives saved every minute, every year, for 50 years. But achieving and maintaining high immunization coverage have required sustained political and public commitment, financial resources, strong partnerships, research and innovation, and communication and advocacy. New and evolving challenges to maintaining high immunization coverage have emerged alongside long-standing stubborn obstacles. We review some of these key challenges to immunization in this dynamic, changing world and summarize some promising solutions. Success in some regions of the world in eliminating polio, measles, and rubella, and reducing morbidity and mortality from other vaccine-preventable diseases, should provide hope that progress can be made in achieving and maintaining high immunization coverage. We cannot afford to do otherwise.

Public policies have been instrumental in influencing population health, and the desire to study their impact led to the development of the fields of policy surveillance and legal epidemiology. The standardized practice of creating policy measurement systems allows researchers to track and evaluate policy impacts across jurisdictions and over time. Policy measures may take many forms, including dichotomous measures, ordinal ratings, composite measures, or scale measures. The policy measures are determined largely based on the research question but should also consider factors impacting policy implementation and equity. Many sources of evidence, including expert input, national standards, scientific evidence, and existing policies, can be used in the development of policy measurement and rating systems. Any system must be tested, reliable, and clearly documented to create a robust and rigorous dataset. This article reviews key considerations for the development of policy measurement and rating systems for use in public health research.

A 2008 review in the Annual Review of Public Health considered the question of whether health insurance improves health. The answer was a cautious yes because few studies provided convincing causal evidence. We revisit this question by focusing on a single outcome: mortality. Because of multiple high-quality studies published since 2008, which exploit new sources of quasi-experimental variation as well as new empirical approaches to evaluating older data, our answer is more definitive. Studies using different data sources and research designs provide credible evidence that health insurance coverage reduces mortality. The effects, which tend to be strongest for adults in middle age or older and for children, are generally evident shortly after coverage gains and grow over time. The evidence now unequivocally supports the conclusion that health insurance improves health.