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Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population Milbank Q. (IF 6.6) Pub Date : 2024-03-01 TRACY LAM‐HINE, SARAH FORTHAL, CANDICE Y. JOHNSON, HELEN B. CHIN
Policy Points Health equity work primarily centers monoracial populations; however, the rapid growth of the Multiracial population and increasingly clear health disparities affecting the people in that population complicate our understanding of racial health equity. Limited resources exist for health researchers and professionals grappling with this complexity, likely contributing to the relative dearth
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Overcoming Common Anxieties in Knowledge Translation: Advice for Scholarly Issue Advocates Milbank Q. (IF 6.6) Pub Date : 2024-02-16 PAUL KERSHAW, VERENA ROSSA-ROCCOR
Policy Points Faced with urgent threats to human health and well-being such as climate change, calls among the academic community are getting louder to contribute more effectively to the implementation of the evidence generated by our research into public policy. As interest in knowledge translation (KT) surges, so have a number of anxieties about the field's shortcomings. Our paper is motivated by
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Keeping It Political and Powerful: Defining the Structural Determinants of Health Milbank Q. (IF 6.6) Pub Date : 2024-02-16 JONATHAN C. HELLER, MARJORY L. GIVENS, SHERI P. JOHNSON, DAVID A. KINDIG
Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work—implicitly and explicitly—to
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Policy Interventions to Enhance Medical Care for People With Obesity in the United States—Challenges, Opportunities, and Future Directions Milbank Q. (IF 6.6) Pub Date : 2024-02-08 JAMES RENÉ JOLIN, MINSOO KWON, ELIZABETH BROCK, JONATHAN CHEN, AISHA KOKAN, RYAN MURDOCK, FATIMA CODY STANFORD
Policy Points Health policymakers have insufficiently addressed care for people with obesity (body mass index ≥ 30 kg/m2) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. We argue for a novel policy framework to increase access to effective obesity therapeutics and care, recognizing that, though prevention is critical, the epidemic proportions
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Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature Milbank Q. (IF 6.6) Pub Date : 2024-01-28 TIMOTHY W. LEVENGOOD, RENA M. CONTI, SEAN CAHILL, MEGAN B. COLE
Policy Points The 340B Drug Pricing Program accounts for roughly 1 out of every 100 dollars spent in the $4.3 trillion US health care industry. Decisions affecting the program will have wide-ranging consequences throughout the US safety net. Our scoping review provides a roadmap of the questions being asked about the 340B program and an initial synthesis of the answers. The highest-quality evidence
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Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis Milbank Q. (IF 6.6) Pub Date : 2024-01-31 MICHAL SHIMONOVICH, MHAIRI CAMPBELL, RACHEL M. THOMSON, PHILIP BROADBENT, VALERIE WELLS, DANIEL KOPASKER, GERRY McCARTNEY, HILARY THOMSON, ANNA PEARCE, S. VITTAL KATIKIREDDI
Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects
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Revising the Logic Model Behind Health Care's Social Care Investments Milbank Q. (IF 6.6) Pub Date : 2024-01-25 LAURA M. GOTTLIEB, DANIELLE HESSLER, HOLLY WING, ALEJANDRA GONZALEZ-ROCHA, YURI CARTIER, CAROLINE FICHTENBERG
Policy Points This article summarizes recent evidence on how increased awareness of patients’ social conditions in the health care sector may influence health and health care utilization outcomes. Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.
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Integrated Devices: A New Regulatory Pathway to Promote Revolutionary Innovation Milbank Q. (IF 6.6) Pub Date : 2024-01-22 TED CHO, VRUSHAB GOWDA, HENNING SCHULZRINNE, BRIAN J. MILLER
Policy Points Current medical device regulatory frameworks date back half a century and are ill suited for the next generation of medical devices that involve a significant software component. Existing Food and Drug Administration efforts are insufficient because of a lack of statutory authority, whereas international examples offer lessons for improving and harmonizing domestic medical device regulatory
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Is White Evangelical Antistructural Theology Related to Poor Health Outcomes? Milbank Q. (IF 6.6) Pub Date : 2024-01-19 DAVID A. KINDIG, YASMIN MOHD ARIFFIN, HANNAH OLSON-WILLIAMS
Policy Points White evangelical theology has an “antistructural” component. Counties with a high percentage of White evangelicals have higher mortality rates and more persons with fair/poor health. The potential influence of antistructural components in evangelical theology on decision making and resource allocation and, ultimately, the length and quality of life of community members presents a point
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Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement Milbank Q. (IF 6.6) Pub Date : 2024-01-16 CALEB DRESSER, ZACHARY JOHNS, AVERY PALARDY, SARAH McKINNON, SUELLEN BREAKEY, ANA M. VIAMONTE ROS, PATRICE K NICHOLAS
Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address
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Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities Milbank Q. (IF 6.6) Pub Date : 2024-01-14 KATIE HANNON MICHEL, MAYA HAZARIKA WATTS, JESSICA BRESLIN, ELIZABETH TOBIN-TYLER
Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords
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Mapping the Lobbying Footprint of Harmful Industries: 23 Years of Data From OpenSecrets Milbank Q. (IF 6.6) Pub Date : 2024-01-14 HOLLY CHUNG, KATHERINE CULLERTON, JENNIFER LACY-NICHOLS
Policy Points Our research reveals the similarities and differences among the lobbying activities of tobacco, alcohol, gambling, and ultraprocessed food industries, which are often a barrier to the implementation of public health policies. Over 23 years, we found that just six organizations dominated lobbying expenses in the tobacco and alcohol sectors, whereas the gambling sector outsourced most of
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Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health Milbank Q. (IF 6.6) Pub Date : 2023-12-29 SETH A. BERKOWITZ
Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic
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Four System Enablers of Large-System Transformation in Health Care: A Mixed Methods Realist Evaluation Milbank Q. (IF 6.6) Pub Date : 2023-12-25 EMILIE FRANCIS-AUTON, JANET C. LONG, MITCHELL SARKIES, NATALIE ROBERTS, JOHANNA WESTBROOK, JEAN-FREDERIC LEVESQUE, DIANE E. WATSON, REBECCA HARDWICK, PETER HIBBERT, CHIARA POMARE, JEFFREY BRAITHWAITE
Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the
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Leveraging Patients’ Creative Ideas for Innovation in Health Care Milbank Q. (IF 6.6) Pub Date : 2023-12-13 YUNA S. H. LEE, RACHEL GROB, INGRID NEMBHARD, DALE SHALLER, MARK SCHLESINGER
Policy Points Patients’ creative ideas may inform learning and innovation that improve patient-centered care. Routinely collected patient experience surveys provide an opportunity to invite patients to share their creative ideas for improvement. We develop and assess a methodological strategy that validates question wording designed to elicit creative ideas from patients. Health care organizations
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The Orphan Drug Act at 40: Legislative Triumph and the Challenges of Success Milbank Q. (IF 6.6) Pub Date : 2023-12-12 PETER SALTONSTALL, HEIDI ROSS, PAUL T. KIM
Policy Points The Orphan Drug Act (ODA) was the result of patient advocacy and by many measures has been strikingly successful. However, approximately 95% of the more than 7,000 known rare diseases still have no US Food and Drug Administration–approved treatment. The ODA's success led to sustained criticism of high drug prices, often for products that have orphan drug indications. Critics misconstrue
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Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings Milbank Q. (IF 6.6) Pub Date : 2023-11-22 MARGARET MCCONNELL, SUMIT AGARWAL, ERIKA HANSON, ERIN MCCRADY, MARGARET G. PARKER, KIRA BONA
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families
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Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings Milbank Q. (IF 6.6) Pub Date : 2023-11-22 MARGARET MCCONNELL, SUMIT AGARWAL, ERIKA HANSON, ERIN MCCRADY, MARGARET G. PARKER, KIRA BONA
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families
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The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health Milbank Q. (IF 6.6) Pub Date : 2023-10-25 EDUARDO J. GÓMEZ, NASON MAANI, SANDRO GALEA
Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.
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The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health Milbank Q. (IF 6.6) Pub Date : 2023-10-25 EDUARDO J. GÓMEZ, NASON MAANI, SANDRO GALEA
Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.
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Modeling State Firearm Law Adoption Using Temporal Network Models Milbank Q. (IF 6.6) Pub Date : 2023-10-11 DUNCAN A. CLARK, JAMES MACINKO, MAURIZIO PORFIRI
Policy Points Promoting healthy public policies is a national priority, but state policy adoption is driven by a complex set of internal and external factors. This study employs new social network methods to identify underlying connections among states and to predict the likelihood of new firearm-related policy adoption given changes to this interstate network. This approach could be used to assess
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Modeling State Firearm Law Adoption Using Temporal Network Models Milbank Q. (IF 6.6) Pub Date : 2023-10-11 DUNCAN A. CLARK, JAMES MACINKO, MAURIZIO PORFIRI
Policy Points Promoting healthy public policies is a national priority, but state policy adoption is driven by a complex set of internal and external factors. This study employs new social network methods to identify underlying connections among states and to predict the likelihood of new firearm-related policy adoption given changes to this interstate network. This approach could be used to assess
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Transportation Justice and Health Milbank Q. (IF 6.6) Pub Date : 2023-10-09 KELLIA J. HANSMANN, NA'AMAH RAZON
Policy Points The health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health. In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation
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Transportation Justice and Health Milbank Q. (IF 6.6) Pub Date : 2023-10-09 KELLIA J. HANSMANN, NA'AMAH RAZON
Policy Points The health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health. In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation
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The Effect of the Earned Income Tax Credit on Physical and Mental health—Results from the Atlanta Paycheck Plus Experiment Milbank Q. (IF 6.6) Pub Date : 2023-10-03 PETER MUENNIG, DANIEL W. BELSKY, DANIEL MALINSKY, KIEU-GIANG NGUYEN, ZOHN ROSEN, HEIDI ALLEN
Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health.
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The Effect of the Earned Income Tax Credit on Physical and Mental health—Results from the Atlanta Paycheck Plus Experiment Milbank Q. (IF 6.6) Pub Date : 2023-10-03 PETER MUENNIG, DANIEL W. BELSKY, DANIEL MALINSKY, KIEU-GIANG NGUYEN, ZOHN ROSEN, HEIDI ALLEN
Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health.
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Building High-Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?” Milbank Q. (IF 6.6) Pub Date : 2023-09-25 MONICA AGGARWAL, BRIAN HUTCHISON, REHAM ABDELHALIM, G. ROSS BAKER
Policy Points Considerable investments have been made to build high-performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high-performing
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Building High-Performing Primary Care Systems: After a Decade of Policy Change, Is Canada “Walking the Talk?” Milbank Q. (IF 6.6) Pub Date : 2023-09-25 MONICA AGGARWAL, BRIAN HUTCHISON, REHAM ABDELHALIM, G. ROSS BAKER
Policy Points Considerable investments have been made to build high-performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high-performing
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Association Between Partisan Affiliation of State Governments and State Mortality Rates Before and During the COVID-19 Pandemic Milbank Q. (IF 6.6) Pub Date : 2023-09-14 STEVEN H. WOOLF, ROY T. SABO, DEREK A. CHAPMAN, JONG HYUNG LEE
Policy Points The increasing political polarization of states reached new heights during the COVID-19 pandemic, when response plans differed sharply across party lines. This study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic—and in preceding years—but these associations often lost statistical
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Caught Between a Well-Intentioned State and a Hostile Federal System: Local Implementation of Inclusive Immigrant Policies Milbank Q. (IF 6.6) Pub Date : 2023-09-14 MARIA-ELENA DE TRINIDAD YOUNG, SHARON TAFOLLA, FABIOLA M. PEREZ-LUA
Policy Points Inclusive state immigrant policies that expand rights and resources for immigrants may improve population health, but little is known about their local-level implementation. Local actors that have anti-immigrant attitudes can hinder the implementation of state policies, whereas the persistent influence of anti-immigrant federal policies reinforces barriers to accessing health and other
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Caught Between a Well-Intentioned State and a Hostile Federal System: Local Implementation of Inclusive Immigrant Policies Milbank Q. (IF 6.6) Pub Date : 2023-09-14 MARIA-ELENA DE TRINIDAD YOUNG, SHARON TAFOLLA, FABIOLA M. PEREZ-LUA
Policy Points Inclusive state immigrant policies that expand rights and resources for immigrants may improve population health, but little is known about their local-level implementation. Local actors that have anti-immigrant attitudes can hinder the implementation of state policies, whereas the persistent influence of anti-immigrant federal policies reinforces barriers to accessing health and other
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Improving Food and Drug Administration–Centers for Medicare and Medicaid Services Coordination for Drugs Granted Accelerated Approval Milbank Q. (IF 6.6) Pub Date : 2023-08-29 PETER J. NEUMANN, ELLIOTT CRUMMER, JAMES D. CHAMBERS, SEAN R. TUNIS
Policy Points The increasing number of drugs granted accelerated approval by the Food and Drug Administration (FDA) has challenged the Medicare program, which often pays for expensive therapies despite substantial uncertainty about benefits and risks to Medicare beneficiaries. We recommend several administrative and legislative approaches for improving FDA–Centers for Medicare and Medicaid Services
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Improving Food and Drug Administration–Centers for Medicare and Medicaid Services Coordination for Drugs Granted Accelerated Approval Milbank Q. (IF 6.6) Pub Date : 2023-08-29 PETER J. NEUMANN, ELLIOTT CRUMMER, JAMES D. CHAMBERS, SEAN R. TUNIS
Policy Points The increasing number of drugs granted accelerated approval by the Food and Drug Administration (FDA) has challenged the Medicare program, which often pays for expensive therapies despite substantial uncertainty about benefits and risks to Medicare beneficiaries. We recommend several administrative and legislative approaches for improving FDA–Centers for Medicare and Medicaid Services
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Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020 Milbank Q. (IF 6.6) Pub Date : 2023-08-23 PEIYIN HUNG, MARION GRANGER, NANSI BOGHOSSIAN, JIANI YU, SAYWARD HARRISON, JIHONG LIU, BERRY A. CAMPBELL, BO CAI, CHEN LIANG, XIAOMING LI
Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable
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Dual Barriers: Examining Digital Access and Travel Burdens to Hospital Maternity Care Access in the United States, 2020 Milbank Q. (IF 6.6) Pub Date : 2023-08-23 PEIYIN HUNG, MARION GRANGER, NANSI BOGHOSSIAN, JIANI YU, SAYWARD HARRISON, JIHONG LIU, BERRY A. CAMPBELL, BO CAI, CHEN LIANG, XIAOMING LI
Policy Points The White House Blueprint for Addressing the Maternal Health Crisis report released in June 2022 highlighted the need to enhance equitable access to maternity care. Nationwide hospital maternity unit closures have worsened the maternal health crisis in underserved communities, leaving many birthing people with few options and with long travel times to reach essential care. Ensuring equitable
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Community Health Center Staff Perspectives on Financial Payments for Social Care Milbank Q. (IF 6.6) Pub Date : 2023-08-18 JUSTIN M. LOPEZ, HOLLY WING, SARA L. ACKERMAN, DANIELLE HESSLER, LAURA M. GOTTLIEB
Policy Points State and federal payers are actively considering strategies to increase the adoption of social risk screening and interventions in health care settings, including through the use of financial incentives. Activities related to social care in Oregon community health centers (CHCs) provided a unique opportunity to explore whether and how fee-for-service payments for social risk screening
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Community Health Center Staff Perspectives on Financial Payments for Social Care Milbank Q. (IF 6.6) Pub Date : 2023-08-18 JUSTIN M. LOPEZ, HOLLY WING, SARA L. ACKERMAN, DANIELLE HESSLER, LAURA M. GOTTLIEB
Policy Points State and federal payers are actively considering strategies to increase the adoption of social risk screening and interventions in health care settings, including through the use of financial incentives. Activities related to social care in Oregon community health centers (CHCs) provided a unique opportunity to explore whether and how fee-for-service payments for social risk screening
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Unrealized Cross-System Opportunities to Improve Employment and Employment-Related Services Among Autistic Individuals Milbank Q. (IF 6.6) Pub Date : 2023-08-01 ANNE M. ROUX, KAITLIN K. MILLER, SHA TAO, JESSICA E. RAST, JONAS VENTIMIGLIA, PAUL T. SHATTUCK, LINDSAY L. SHEA
Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States—just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports. Vocational Rehabilitation agencies appeared to be absorbing
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Unrealized Cross-System Opportunities to Improve Employment and Employment-Related Services Among Autistic Individuals Milbank Q. (IF 6.6) Pub Date : 2023-08-01 ANNE M. ROUX, KAITLIN K. MILLER, SHA TAO, JESSICA E. RAST, JONAS VENTIMIGLIA, PAUL T. SHATTUCK, LINDSAY L. SHEA
Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States—just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports. Vocational Rehabilitation agencies appeared to be absorbing
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The Role of Place in Person- and Family-Oriented Long-Term Services and Supports Milbank Q. (IF 6.6) Pub Date : 2023-07-28 CHANEE D. FABIUS, SAFIYYAH M. OKOYE, MINGCHE M. J. WU, ANDREW D. JOPSON, LINDA C. CHYR, JULIA G. BURGDORF, JEROMIE BALLREICH, DANNY SCERPELLA, JENNIFER L. WOLFF
Policy Points Little attention to date has been directed at examining how the long-term services and supports (LTSS) environmental context affects the health and well-being of older adults with disabilities. We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences. We find the LTSS environment is highly associated with person-reported
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The Role of Place in Person- and Family-Oriented Long-Term Services and Supports Milbank Q. (IF 6.6) Pub Date : 2023-07-28 CHANEE D. FABIUS, SAFIYYAH M. OKOYE, MINGCHE M. J. WU, ANDREW D. JOPSON, LINDA C. CHYR, JULIA G. BURGDORF, JEROMIE BALLREICH, DANNY SCERPELLA, JENNIFER L. WOLFF
Policy Points Little attention to date has been directed at examining how the long-term services and supports (LTSS) environmental context affects the health and well-being of older adults with disabilities. We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences. We find the LTSS environment is highly associated with person-reported
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Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children Milbank Q. (IF 6.6) Pub Date : 2023-07-26 KATELYN GIRTAIN, SURAL SHAH, ANA C. MONTERREY, J. RAUL GUTIERREZ, MARK KUCZEWSKI, JULIE M. LINTON
Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration
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Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children Milbank Q. (IF 6.6) Pub Date : 2023-07-26 KATELYN GIRTAIN, SURAL SHAH, ANA C. MONTERREY, J. RAUL GUTIERREZ, MARK KUCZEWSKI, JULIE M. LINTON
Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration
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The Water Surrounding the Iceberg: Cultural Racism and Health Inequities Milbank Q. (IF 6.6) Pub Date : 2023-07-12 ELI K. MICHAELS, TRACY LAM-HINE, THU T. NGUYEN, GILBERT C. GEE, AMANI M. ALLEN
Policy Points Cultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg,” whereas structural and institutional racism represent its base. This paper
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The Water Surrounding the Iceberg: Cultural Racism and Health Inequities Milbank Q. (IF 6.6) Pub Date : 2023-07-12 ELI K. MICHAELS, TRACY LAM-HINE, THU T. NGUYEN, GILBERT C. GEE, AMANI M. ALLEN
Policy Points Cultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg,” whereas structural and institutional racism represent its base. This paper
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Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms Milbank Q. (IF 6.6) Pub Date : 2023-06-28 STEPHEN MOLLDREM, ANTHONY K J SMITH, ALEXANDER McCLELLAND
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the “fourth pillar” of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory
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Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms Milbank Q. (IF 6.6) Pub Date : 2023-06-28 STEPHEN MOLLDREM, ANTHONY K J SMITH, ALEXANDER McCLELLAND
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the “fourth pillar” of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory
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The Role of Primary Care in Advancing Civic Engagement and Health Equity: A Conceptual Framework Milbank Q. (IF 6.6) Pub Date : 2023-06-22 DANIEL R. S. HABIB, LAUREN M. KLEIN, ELIANA M. PERRIN, ANDREW J. PERRIN, SARA B. JOHNSON
Policy Points Health and civic engagement are reciprocally and longitudinally linked: Poor health is associated with less civic engagement. Well-established social drivers of health and health inequality such as inadequate access to health care, poverty, racism, housing instability, and food insecurity are also drivers of lower civic engagement. A robust primary care system can play a key role in advancing
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The Role of Primary Care in Advancing Civic Engagement and Health Equity: A Conceptual Framework Milbank Q. (IF 6.6) Pub Date : 2023-06-22 DANIEL R. S. HABIB, LAUREN M. KLEIN, ELIANA M. PERRIN, ANDREW J. PERRIN, SARA B. JOHNSON
Policy Points Health and civic engagement are reciprocally and longitudinally linked: Poor health is associated with less civic engagement. Well-established social drivers of health and health inequality such as inadequate access to health care, poverty, racism, housing instability, and food insecurity are also drivers of lower civic engagement. A robust primary care system can play a key role in advancing
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The Profound Implications of the Meaning of Health for Health Care and Health Equity Milbank Q. (IF 6.6) Pub Date : 2023-06-21 KEVIN FISCELLA, RONALD M. EPSTEIN
Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies
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The Profound Implications of the Meaning of Health for Health Care and Health Equity Milbank Q. (IF 6.6) Pub Date : 2023-06-21 KEVIN FISCELLA, RONALD M. EPSTEIN
Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies
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Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study Milbank Q. (IF 6.6) Pub Date : 2023-05-26 MICHAEL S. SPARER, LAWRENCE D. BROWN
Policy Points The United States public health system relies on an inadequate and inefficient mix of federal, state, and local funding. Various state-based initiatives suggest that a promising path to bipartisan support for increased public health funding is to gain the support of local elected officials by providing state (and federal) funding directly to local health departments, albeit with performance
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Electoral Democracy and Working-Age Mortality Milbank Q. (IF 6.6) Pub Date : 2023-05-26 JENNIFER KARAS MONTEZ, KENT JASON CHENG, JACOB M. GRUMBACH
Policy Points The erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working-age mortality rates, which predate the COVID-19 pandemic. Eroding electoral democracy in a US state was associated with higher working-age mortality from homicide, suicide, and especially from drug poisoning and infectious disease. State and federal efforts to
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Politics and the Public Health Workforce: Lessons Suggested from a Five-State Study Milbank Q. (IF 6.6) Pub Date : 2023-05-26 MICHAEL S. SPARER, LAWRENCE D. BROWN
Policy Points The United States public health system relies on an inadequate and inefficient mix of federal, state, and local funding. Various state-based initiatives suggest that a promising path to bipartisan support for increased public health funding is to gain the support of local elected officials by providing state (and federal) funding directly to local health departments, albeit with performance
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Electoral Democracy and Working-Age Mortality Milbank Q. (IF 6.6) Pub Date : 2023-05-26 JENNIFER KARAS MONTEZ, KENT JASON CHENG, JACOB M. GRUMBACH
Policy Points The erosion of electoral democracy in the United States in recent decades may have contributed to the high and rising working-age mortality rates, which predate the COVID-19 pandemic. Eroding electoral democracy in a US state was associated with higher working-age mortality from homicide, suicide, and especially from drug poisoning and infectious disease. State and federal efforts to
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Toward a Values-Informed Approach to Complexity in Health Care: Hermeneutic Review Milbank Q. (IF 6.6) Pub Date : 2023-05-23 TRISHA GREENHALGH, EIVIND ENGEBRETSEN, ROLAND BAL, SOFIA KJELLSTRÖM
Policy Points The concept of value complexity (complexity arising from differences in people's worldviews, interests, and values, leading to mistrust, misunderstanding, and conflict among stakeholders) is introduced and explained. Relevant literature from multiple disciplines is reviewed. Key theoretical themes, including power, conflict, language and framing, meaning-making, and collective deliberation
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Toward a Values-Informed Approach to Complexity in Health Care: Hermeneutic Review Milbank Q. (IF 6.6) Pub Date : 2023-05-23 TRISHA GREENHALGH, EIVIND ENGEBRETSEN, ROLAND BAL, SOFIA KJELLSTRÖM
Policy Points The concept of value complexity (complexity arising from differences in people's worldviews, interests, and values, leading to mistrust, misunderstanding, and conflict among stakeholders) is introduced and explained. Relevant literature from multiple disciplines is reviewed. Key theoretical themes, including power, conflict, language and framing, meaning-making, and collective deliberation
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Structural Factors and Racial/Ethnic Inequities in Travel Times to Acute Care Hospitals in the Rural US South, 2007–2018 Milbank Q. (IF 6.6) Pub Date : 2023-05-15 ARRIANNA MARIE PLANEY, DONALD A. PLANEY, SANDY WONG, SARA L. MCLAFFERTY, MICHELLE J. KO
Policy Points Policymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures. Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities