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1.
DANIEL M. WALKER VALERIE A. YEAGER JOHN LAWRENCE ANN SCHECK MCALEARNEY 《The Milbank quarterly》2021,99(2):393
Policy Points
- Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges.
- Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues.
- Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies.
2.
Policy Points
- Millions of life‐sustaining implantable devices collect and relay massive amounts of digital health data, increasingly by using user‐downloaded smartphone applications to facilitate data relay to clinicians via manufacturer servers.
- Our analysis of health privacy laws indicates that most US patients may have little access to their own digital health data in the United States under the Health Insurance Portability and Accountability Act Privacy Rule, whereas the EU General Data Protection Regulation and the California Consumer Privacy Act grant greater access to device‐collected data.
- Our normative analysis argues for consistently granting patients access to the raw data collected by their implantable devices.
3.
ERIC S. KIM SCOTT W. DELANEY LOUIS TAY YING CHEN ED DIENER TYLER J. VANDERWEELE 《The Milbank quarterly》2021,99(1):209-239
Policy Points
- Several intergovernmental organizations (Organisation for Economic Co‐operation and Development, World Health Organization, United Nations) are urging countries to use well‐being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions.
- As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well‐being outcomes we might observe from policies aimed at improving life satisfaction.
- The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well‐being, health behaviors, and physical health outcomes.
4.
Despite recent declines, racial segregation remains a detriment to minority neighborhoods. However, existing research is inconclusive as to the effects racial segregation has on health. Some argue that racial segregation is related to poor health outcomes, whereas others suspect that racial segregation may actually lead to improved health for some minority communities. Even less is known about whether minority access to white neighborhoods improves health. We address these gaps with individual data from the 2010 Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey and census tract data from the 2010 Decennial Census and the 2006–2010 American Community Survey. We implement logistic multilevel models to determine whether and how a resident’s self-rated health is affected by the racial/ethnic segregation of their neighborhoods. Our key finding suggests that the effects of segregation on self-rated health depend on an individual’s race/ethnicity, with blacks and Latino residents most likely to experience adverse effects. Particularly, minorities living in predominantly white communities have a significantly higher likelihood to report poor/fair health than they would in segregated minority neighborhoods. These findings make clear that access to white neighborhoods is not sufficient to improve minority health; fuller neighborhood integration is necessary to ensure all have health equity. 相似文献
5.
WALTER D. DAWSON NATHAN A. BOUCHER ROBYN STONE COURTNEY H. VAN HOUTVEN 《The Milbank quarterly》2021,99(2):565
Policy Points
- To address systemic problems amplified by COVID‐19, we need to restructure US long‐term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near‐term and long‐term policy solutions.
- Seven near‐term policy recommendations include requiring the uniform public reporting of COVID‐19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations.
- Long‐term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age‐friendly public health system.
6.
JONATHAN PURTLE RENNIE JOSHI FLICE LÊSCHERBAN ROSIE MAE HENSON ANA V. DIEZ ROUX 《The Milbank quarterly》2021,99(3):794
Policy Points
- Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income‐based life expectancy disparity in their city.
- Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents.
- Highly visible and publicized information about mortality disparities, such as that related to COVID‐19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.
7.
JI E. CHANG ALDEN YUANHONG LAI AVNI GUPTA ANN M. NGUYEN CAROLYN A. BERRY DONNA R. SHELLEY 《The Milbank quarterly》2021,99(2):340
Policy Points
- Telehealth has many potential advantages during an infectious disease outbreak such as the COVID‐19 pandemic, and the COVID‐19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode.
- Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID‐19 pandemic.
- Without proactive efforts to address both patient‐ and provider‐related digital barriers associated with socioeconomic status, the wide‐scale implementation of telehealth amid COVID‐19 may reinforce disparities in health access in already marginalized and underserved communities.
- To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
8.
Policy Points
- Upstream factors—social structures/systems, cultural factors, and public policy—are primary forces that drive downstream patterns and inequities in health that are observed across race and locations.
- A public policy agenda that aims to address inequities related to the well-being of children, creation and perpetuation of residential segregation, and racial segregation can address upstream factors.
- Past successes and failures provide a blueprint for addressing upstream health issues and inhibit health equity.
9.
Philip M. Massey Brent A. Langellier Tetine Sentell Jennifer Manganello 《Ethnicity & health》2017,22(6):596-609
Objective: To examine differences in health information seeking between U.S.-born and foreign-born populations in the U.S.Design: Data from 2008 to 2014 from the Health Information National Trends Survey were used in this study (n?=?15,249). Bivariate analyses, logistic regression, and predicted probabilities were used to examine health information seeking and sources of health information.Results: Findings demonstrate that 59.3% of the Hispanic foreign-born population reported looking for health information, fewer than other racial/ethnic groups in the sample. Compared with non-Hispanic White, non-Hispanic Black (OR?=?0.62) and Hispanic foreign-born individuals (OR?=?0.31) were the least likely to use the internet as a first source for health information. Adjustment for language preference explains much of the disparity in health information seeking between the Hispanic foreign-born population and Whites; controlling for nativity, respondents who prefer Spanish have 0.25 the odds of using the internet as a first source of health information compared to those who prefer English.Conclusion: Foreign-born nativity and language preference are significant determinants of health information seeking. Further research is needed to better understand how information seeking patterns can influence health care use, and ultimately health outcomes. To best serve diverse racial and ethnic minority populations, health care systems, health care providers, and public health professionals must provide culturally competent health information resources to strengthen access and use by vulnerable populations, and to ensure that all populations are able to benefit from evolving health information sources in the digital age. 相似文献
10.
ObjectiveTo examine the changes in health insurance coverage, access to care, and health services utilization among nonelderly sexual minority and heterosexual adults between pooled years 2013‐2014 and 2017‐2018.Data SourcesData on 3223 sexual minorities (lesbians, gay men, bisexual individuals, and other nonheterosexual populations) and 86 181 heterosexuals aged 18‐64 years were obtained from the 2013, 2014, 2017, and 2018 National Health Interview Surveys.Study DesignUnadjusted and regression‐adjusted estimates compared changes in health insurance status, access to care, and health services utilization for nonelderly adults by sexual minority status. Regression‐adjusted changes were obtained from logistic regression models controlling for demographic and socioeconomic characteristics.Principal FindingsUninsurance declined for both sexual minority adults (5 percentage points, P < .05) and heterosexual adults (2.5 percentage points, P < .001) between 2013‐2014 and 2017‐2018. Reductions in uninsurance for sexual minority and heterosexual adults were associated with increases in Medicaid coverage. Sexual minority and heterosexual adults were also less likely to report unmet medical care in 2017‐2018 compared with 2013‐2014. Low‐income adults (regardless of sexual minority status) experienced relatively large increases in Medicaid coverage and substantial improvements in access to care over the study period. The gains in coverage and access to care across the study period were generally similar for heterosexual and sexual minority adults.ConclusionsSexual minority and heterosexual adults have experienced improvements in health insurance coverage and access to care in recent years. Ongoing health equity research and public health initiatives should continue to monitor health care access and the potential benefits of recent health insurance expansions by sexual orientation and sexual minority status when possible. 相似文献
11.
ROBERT HANDFIELD DANIEL JOSEPH FINKENSTADT EUGENE S. SCHNELLER A. BLANTON GODFREY PETER GUINTO 《The Milbank quarterly》2020,98(4):1058-1090
Policy Points
- Reflecting on current response deficiencies, we offer a model for a national contingency supply chain cell (NCSCC) construct to manage the medical materials supply chain in support of emergencies, such as COVID‐19. We develop the following:
- a framework for governance and response to enable a globally independent supply chain;
- a flexible structure to accommodate the requirements of state and county health systems for receiving and distributing materials; and
- a national material “control tower” to improve transparency and real‐time access to material status and location.
12.
GEORGE STOYE BEN ZARANKO MARTIN SHIPLEY MARTIN MCKEE ERIC J. BRUNNER 《The Milbank quarterly》2020,98(4):1134-1170
Policy Points
- US policymakers considering proposals to expand public health care (such as “Medicare for all”) as a means of reducing inequalities in health care access and use could learn from the experiences of nations where well‐funded universal health care systems are already in place.
- In England, which has a publicly funded universal health care system, the use of core inpatient services by adults 65 years and older is equal across groups defined by education level, after controlling for health status. However, variation among these groups in the use of outpatient and emergency department care developed between 2010 and 2015, a period of relative financial austerity.
- Based on England''s experience, introducing universal health care in the United States seems likely to reduce, but not entirely eliminate, inequalities in health care use across different population groups.
13.
Policy Points
- We compared the structure of health care systems and the financial effects of the COVID‐19 pandemic on health care providers in the United States, England, Germany, and Israel: systems incorporating both public and private insurers and providers.
- The negative financial effects on health care providers have been more severe in the United States than elsewhere, owing to the prevalence of activity‐based payment systems, limited direct governmental control over available provider capacity, and the structure of governmental financial relief.
- In a pandemic, activity‐based payment reverses the conventional financial positions of payers and providers and may prevent providers from prioritizing public health because of the desire to avoid revenue loss caused by declines in patient visits.
14.
FREDERICK J. ZIMMERMAN 《The Milbank quarterly》2021,99(1):9-23
Policy Points
- The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized‐control trials, a lack of formal theoretical models, and a fear of politics.
- The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.
15.
Keith Elder Keon Gilbert Louise Meret Hanke Caress Dean Shahida Rice Marquisha Johns Crystal Piper Jacqueline Wiltshire Tondra Moore Jing Wang 《AIMS Public Health》2014,1(3):123-136
BackgroundChronic diseases are highly prevalent among men in the United States and chronic disease management is problematic for men, particularly for racial and ethnic minority men.ObjectivesThis study examined the association between health information seeking and confidence to manage chronic diseases among men.MethodsStudy data were drawn from the 2007 Health Tracking Household Survey and analyzed using multiple binary logistic regressions. The analytical sample included 2,653 men, 18 years and older with a chronic illness. Results: Health information seeking was not associated with confidence to manage chronic illnesses. African-American men had lower odds than White men to agree to take actions to prevent symptoms with their health. Hispanic men had lower odds than White men to agree to tell a doctor concerns they have, even when not asked.ConclusionsRacial and ethnic minority men with a chronic condition appear to be less confident to manage their health compared to white men. Chronic disease management needs greater exploration to understand the best ways to help racial and ethnic minority men successfully manage their chronic condition. 相似文献
16.
PAULA M. LANTZ KATHERINE MICHELMORE MICHELLE H. MONIZ OKEOMA MMEJE WILLIAM G. AXINN KAYTE SPECTOR-BAGDADY 《The Milbank quarterly》2023,101(Z1):283-301
Policy Points
- The historic 2022 Supreme Court Dobbs v Jackson Women's Health Organization decision has created a new public policy landscape in the United States that will restrict access to legal and safe abortion for a significant proportion of the population.
- Policies restricting access to abortion bring with them significant threats and harms to health by delaying or denying essential evidence-based medical care and increasing the risks for adverse maternal and infant outcomes, including death.
- Restrictive abortion policies will increase the number of children born into and living in poverty, increase the number of families experiencing serious financial instability and hardship, increase racial inequities in socioeconomic security, and put significant additional pressure on under-resourced social welfare systems.
17.
ARLINE T. GERONIMUS JAY A. PEARSON ERIN LINNENBRINGER ALEXA K. EISENBERG CARMEN STOKES LANDON D. HUGHES AMY J. SCHULZ 《The Milbank quarterly》2020,98(4):1171
Policy Points
- Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches.
- Targeted universalism, wellness‐based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions.
- State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan.
18.
《Disability and health journal》2022,15(3):101316
BackgroundLittle is known about the factors that contribute to racial/ethnic disparities among children with special health care needs (CSHCN).ObjectiveTo quantify the contributions of determinants of racial/ethnic disparities in health and health care among CSHCN in Boston, Massachusetts.MethodsA sample of 326 Black, Latino, and white CSHCN was drawn from the Boston Survey of Children's Health, a city-wide representative sample of children. The study implemented Oaxaca–Blinder-style decomposition techniques to examine the relative contributions of health resources and child-, family-, and neighborhood-level factors to disparities in four outcomes: health status, barriers to medical care, oral health status, and utilization of preventive dental care.ResultsWhite CSHCN had a greater likelihood of having very good/excellent health and oral health and were less likely to experience barriers to care than Black CSHCN. Compositional differences on predictors explained 63%, 98%, and 80% of these gradients, respectively. Group variation in household income, family structure, neighborhood support, and exposure to adverse childhood experiences accounted for significant portions of the Black–white gaps in health and access. White CSHCN were also more likely to have very good/excellent health and oral health compared to Latino CSHCN. Differences on predictors accounted for about 86% and 80% of these gaps, respectively. Household income, adverse childhood experiences, and household language emerged as significant determinants of Latino–white disparities.ConclusionsRacial/ethnic health disparities among CSHCN are explained by relatively few determinants. Several of the contributing factors that emerged from the analysis and could be targeted by public health and policy interventions. 相似文献
19.
Donna Shelley Stefanie Russell Nina S. Parikh Marianne Fahs 《Journal of urban health》2011,88(4):651-662
There is a growing burden of oral disease among older adults that is most significantly borne by minorities, the poor, and
immigrants. Yet, national attention to oral heath disparities has focused almost exclusively on children, resulting in large
gaps in our knowledge about the oral health risks of older adults and their access to care. The projected growth of the minority
and immigrant elderly population as a proportion of older adults heightens the urgency of exploring and addressing factors
associated with oral health-related disparities. In 2008, the New York City Health Indicators Project (HIP) conducted a survey
of a representative sample of 1,870 adults over the age of 60 who attended a random selection of 56 senior centers in New
York City. The survey included questions related to oral health status. This study used the HIP database to examine differences
in self-reported dental status, dental care utilization, and dental insurance, by race/ethnicity, among community-dwelling
older adults. Non-Hispanic White respondents reported better dental health, higher dental care utilization, and higher satisfaction
with dental care compared to all other racial/ethnic groups. Among minority older adults, Chinese immigrants were more likely
to report poor dental health, were less likely to report dental care utilization and dental insurance, and were less satisfied
with their dental care compared to all other racial/ethnic groups. Language fluency was significantly related to access to
dental care among Chinese immigrants. Among a diverse community-dwelling population of older adults in New York City, we found
significant differences by race/ethnicity in factors related to oral health. Greater attention is needed in enhancing the
cultural competency of providers, addressing gaps in oral health literacy, and reducing language barriers that impede access
to care. 相似文献
20.
ZACKARY BERGER VIVIAN ALTIERY DE JESUS SABRINA A. ASSOUMOU TRISHA GREENHALGH 《The Milbank quarterly》2021,99(2):519
Policy Points
Open in a separate windowThe natural history of long COVID appears to be gradual improvement over time in most cases, though recovery is typically measured in months. 6 , 8 Some patients require comprehensive assessment to exclude serious complications that might underlie their symptoms (notably, thrombo‐embolic disease of the lungs, heart, and brain), along with holistic clinical intervention and follow‐up. Patients without concerning symptoms should be supported but spared overinvestigation and overmedicalization. 6 , 16 , 17 Those who have survived admission to an intensive care unit and those with preexisting respiratory, cardiovascular, or cerebrovascular disease are likely to require more specialized and prolonged rehabilitation. 16 , 18 , 19 Given the paucity of evidence, it is currently unclear which of these issues related to long COVID are directly related to or caused by the disease itself and which are unrelated but may be made more difficult to treat owing to COVID‐19 and its after‐effects.Acute COVID‐19 is associated with significant racial disparities. 20 , 21 , 22 , 23 Black, Latinx, American Indian, Alaska Native, Asian, Native Hawaiian and Pacific Islander, and other non‐white racial groups in the United States are less likely to have access to testing; 24 , 25 more likely to be infected; 25 , 26 , 27 , 28 more likely to be hospitalized overall, 29 though less likely to be hospitalized for any given level of severity, 21 and more likely to have an adverse clinical outcome (including death). 21 , 27 , 30 , 31 In addition, these racial groups are overrepresented in high‐risk occupations, including those with a higher risk of mortality from COVID‐19 (e.g., health and care workers, hospital porters and cleaners, bus drivers, transport workers), 32 are less likely to have adequate health insurance, 33 and are less likely to receive compassionate end‐of‐life care. 34 They are also more likely to be severely affected economically with job losses or lack of access to welfare. 35 , 36 While they are also more likely to have comorbidities and poor prognostic features (e.g., obesity), 4 , 37 controlling for such factors reduces the differences in COVID‐19 mortality among ethnic groups and, in some cases, eradicates them altogether, 20 , 38 prompting calls to go beyond “biological” explanations. 3 , 39 Later we discuss structural explanations for racial disparities in the onset and outcome of acute COVID‐19, summarized schematically in Figure 1. 2 , 3 , 4 , 20 , 40 , 41 , 42 Open in a separate windowFigure 1Relationship Between Structural Inequalities and COVID‐19, Which Explains the “Confounders” in the High Mortality Rates for Some Ethnic GroupsAdapted from an original diagram by Bentley 2 under Creative Commons License.Whereas the association between race/ethnicity and health inequity in acute COVID‐19 is now well established, the association of inequities with long COVID is relatively unexplored. 4 , 22 , 43 To improve the care of vulnerable populations with long COVID, we need to (1) understand, acknowledge, and engage with the densely woven patterns of disadvantage that encumber those with postacute and chronic illness; 44 (2) strengthen existing services, especially in ambulatory primary care; (3) optimize data quality and use those data strategically for planning and monitoring; and (4) provide access to resources in acknowledgement of the multiple nested domains of inequity operating at global, national, community, and individual scales. We will consider these approaches in turn. 相似文献
- An estimated 700,000 people in the United States have “long COVID,” that is, symptoms of COVID‐19 persisting beyond three weeks.
- COVID‐19 and its long‐term sequelae are strongly influenced by social determinants such as poverty and by structural inequalities such as racism and discrimination.
- Primary care providers are in a unique position to provide and coordinate care for vulnerable patients with long COVID.
- Policy measures should include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity.
The Lived Experience Symptoms may be continuous or fluctuating
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Clinical Examination and Tests May identify signs of past infection, active inflammatory disease or systemic complications, including
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Comorbidities and Other Relevant Concerns Note: not all new symptoms in a patient after COVID‐19 are due to long COVID
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