Consensus
The Roundtable on Environmental Health Sciences, Research, and Medicine wanted to address the link between environmental factors and the development of cancer in light of recent advances in genomics. They asked what research tools are needed, how new scientific information can be applied in a timely manner to reduce the burden of cancer, and how this can be flexible enough to treat the individual.
160 pages
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ISBN Paperback: 0-309-08475-X
ISBN Ebook: 0-309-50506-2
DOI:
https://doi.org/10.17226/10464
Institute of Medicine. 2002. Cancer and the Environment: Gene-Environment Interaction. Washington, DC: The National Academies Press.
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A decade ago, two National Academies reports — U.S. Health in International Perspective: Shorter Lives, Poorer Health and For the Public's Health: Investing in a Healthier Future — made important recommendations regarding the nation's health and the policies and investments that shape it. They also aimed to raise alarm about the public's lack of awareness that the nation's unrivaled spending on health care is not matched by health outcomes and appears to be worsening.
Although experts know what factors support longer and healthier lives and close health gaps along lines of race and ethnicity, the nation falls short in implementing policies around those factors or investing in needed system changes and interventions to address them (e.g., equitable education, poverty reduction). The National Academies' Roundtable on Population Health Improvement hosted a March 2023 symposium to explore innovative policies addressing poverty and other socio-economic factors and next steps toward more balanced spending on health.
This proceedings document summarizes symposium discussions.
12 pages
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ISBN Ebook: 0-309-70246-1
DOI:
https://doi.org/10.17226/27010
National Academies of Sciences, Engineering, and Medicine. 2023. Exploring Policies, Investments, and Case-Making for Longer, Healthier Lives for All: Proceedings of a Symposium—in Brief. Washington, DC: The National Academies Press.
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Consensus
The COVID-19 pandemic spurred a rapid expansion of wastewater-based infectious disease surveillance systems to monitor and anticipate disease trends in communities.The Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System in September 2020 to help coordinate and build upon those efforts. Produced at the request of CDC, this report reviews the usefulness of community-level wastewater surveillance during the pandemic and assesses its potential value for control and prevention of infectious diseases beyond COVID-19.
Wastewater-based Disease Surveillance for Public Health Action concludes that wastewater surveillance is and will continue to be a valuable component of infectious disease management. This report presents a vision for a national wastewater surveillance system that would track multiple pathogens simultaneously and pivot quickly to detect emerging pathogens, and it offers recommendations to ensure that the system is flexible, equitable, and economically sustainable for informing public health actions. The report also recommends approaches to address ethical and privacy concerns and develop a more representative wastewater surveillance system. Predictable and sustained federal funding as well as ongoing coordination and collaboration among many partners will be critical to the effectiveness of efforts moving forward.
168 pages
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ISBN Paperback: 0-309-69551-1
ISBN Ebook: 0-309-69552-X
DOI:
https://doi.org/10.17226/26767
National Academies of Sciences, Engineering, and Medicine. 2023. Wastewater-based Disease Surveillance for Public Health Action. Washington, DC: The National Academies Press.
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Workshop
The Roundtable on Population Health Improvement, a convening activity of the National Academies of Sciences, Engineering, and Medicine, held a workshop on March 15-16, 2021, to explore issues related to increasing health care spending in the United States. The workshop, U.S. Health Care Expenditures: Costs, Lessons, and Opportunities, was organized to highlight the persisting challenge of health care expenditures that are not commensurate with the health outcomes they produce. This publication summarizes the presentation and discussion of the workshop.
114 pages
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ISBN Paperback: 0-309-27515-6
ISBN Ebook: 0-309-27517-2
DOI:
https://doi.org/10.17226/26425
National Academies of Sciences, Engineering, and Medicine. 2023. U.S. Health Care Expenditures: Costs, Lessons, and Opportunities: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Workshop_in_brief
The National Academies Roundtable on Health Literacy convened the first of three workshops to explore the positive impacts on health equity improved literacy practices in clinical settings can have. To relate and inspire confidence, physicians must communicate plainly and at the literacy level of the patient and recognize the knowledge the patient brings. Equality and equity are not the same, and treating every patient, their conditions, history, and identity, identically can interfere with trust. Diversifying the work force can facilitate better clinical practices that honor all patients. This Proceedings document summarizes workshop discussions.
8 pages
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ISBN Ebook: 0-309-70034-5
DOI:
https://doi.org/10.17226/26888
National Academies of Sciences, Engineering, and Medicine. 2023. The Roles of Trust and Health Literacy in Achieving Health Equity: Clinical Settings: Proceedings of a Workshop-in Brief. Washington, DC: The National Academies Press.
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Workshop_in_brief
The National Academies Roundtable on Health Literacy convened the third of three workshops to address the themes of trust and positive health equity outcomes that arise from strategic community-based organization practices. Given the historical and current reasons individuals and communities with marginalized identities have to mistrust public health communications and institutions, health literacy is essential. To bolster mutual trust, hospitals, payers, providers, and public health professionals should have the cultural competence and humility to match the health literacy needed from their patients.This Proceedings document summarizes workshop discussions.
10 pages
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ISBN Ebook: 0-309-70035-3
DOI:
https://doi.org/10.17226/26889
National Academies of Sciences, Engineering, and Medicine. 2023. The Roles of Trust and Health Literacy in Achieving Health Equity: Community Settings: Proceedings of a Workshop-in Brief. Washington, DC: The National Academies Press.
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Workshop_in_brief
The National Academies Roundtable on Health Literacy convened the second of three workshops, this one focusing on how health literacy best practices might affect trust in public health institutions at the state, local, tribal, and federal levels. The different contexts of trust include self-trust, trust within interpersonal relationships, trust within an organization, trust outside of an organization, and trust on a societal level, and public health institutions are reliant on trust on all of these levels to operate. This Proceedings document summarizes workshop discussions.
8 pages
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ISBN Ebook: 0-309-70036-1
DOI:
https://doi.org/10.17226/26890
National Academies of Sciences, Engineering, and Medicine. 2023. The Roles of Trust and Health Literacy in Achieving Health Equity: Public Health Institutions: Proceedings of a Workshop-in Brief. Washington, DC: The National Academies Press.
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Workshop
There is increasing evidence that civic participation - from voting to volunteering - is a social driver of health. The National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement convened a workshop to explore the links between civics and health; between measures of civic engagement and quantitative and qualitative measures of health equity; and the roles that civic infrastructure, narrative, and media play in shaping civic engagement. Presenters discussed voting along with other important dimensions of civic engagement; others include the ability to set agendas, shape how policies are implemented, communicate information, model civic behavior, and support the involvement and inclusion of other individuals and groups.
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ISBN Paperback: 0-309-68930-9
ISBN Ebook: 0-309-68931-7
DOI:
https://doi.org/10.17226/26590
National Academies of Sciences, Engineering, and Medicine. 2023. Civic Engagement and Civic Infrastructure to Advance Health Equity: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Consensus
Beginning with the 1990–1991 Gulf War, more than 3.7 million U.S. service members have been deployed to Southwest Asia, where they have been exposed to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand, diesel exhaust, and poor-quality ambient air. Many service members, particularly those who served in Iraq and Afghanistan, have reported health problems they attribute to their exposure to emissions from open-air burn pits on military installations.
In 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to "ascertain and monitor" the health effects of such exposures. This report serves as a follow-up to an initial assessment of the AH&OBP Registry completed by an independent committee of the National Academies in 2017. This reassessment does not include any strength-of-the-evidence assessments of potential relationships between exposures to burn pits or airborne hazards and health effects. Rather, this report assesses the ability of the registry to fulfill the intended purposes that Congress and VA have specified for it.
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ISBN Paperback: 0-309-69423-X
ISBN Ebook: 0-309-69424-8
DOI:
https://doi.org/10.17226/26729
National Academies of Sciences, Engineering, and Medicine. 2022. Reassessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry. Washington, DC: The National Academies Press.
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The staggering number of deaths and emergency department visits caused by firearm injuries has only grown with time. Costs associated with firearm related injuries amount to over a billion dollars annually in the United States alone, not including physician charges and postdischarge costs.
To address this epidemic, in April of 2022, the National Academies of Sciences, Engineering, and Medicine's Board on Population Health and Public Health Practice, in collaboration with Northwell Heath and the PEACE Initiative, brought together firearm injury prevention thought leaders to explore how health systems can integrate interventions for firearm injury prevention into routine care for the purpose of improving the health of patients and communities. The workshop speakers discussed strategies for firearm injury and mortality prevention and its integration into routine care. Speakers also explored facilitators and barriers to implementation strategies, and how health systems might work to overcome those barriers.
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ISBN Paperback: 0-309-69349-7
ISBN Ebook: 0-309-69350-0
DOI:
https://doi.org/10.17226/26707
National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press.
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Workshop
The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop at Hunter College in New York City, New York on February 6, 2020, to explore the value of co-creating and keeping inclusive healthy spaces. The workshop was designed to understand and highlight the economics of inclusive placemaking and to explore its value in improving health, equity, and well-being. Placemaking (the work of creating livable, vibrant, or quality places, especially public places) draws on various traditions of community development, arts and culture, regional planning, and civic engagement, combining different disciplinary perspectives into a creative way of shaping public spaces, land use, commerce, transportation, housing, and social fabric.
The workshop (1) examined the economics of this work, (2) described how inclusive placemakers gather resources to do their work, and (3) explored the social and economic value they are able to generate when places are designed with health, equity, and well-being in mind. This publication is a summary of the presentations and discussions that occurred during the workshop.
80 pages
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ISBN Paperback: 0-309-68313-0
ISBN Ebook: 0-309-68316-5
DOI:
https://doi.org/10.17226/26212
National Academies of Sciences, Engineering, and Medicine. 2022. Harnessing the Value of Co-Creating and Stewarding Places for Health, Equity, and Well-Being: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Workshop
Involvement with the juvenile justice system can impact young people's physical and mental health and well-being throughout their lives, as well as the health and well-being of their families and communities. Youth of color are more likely to become involved with the juvenile justice system, and suffer worse outcomes in sentencing, during incarceration, and after release. The National Academies of Sciences, Engineering, and Medicine's Roundtable on the Promotion of Health Equity convened a workshop to discuss the impact that juvenile justice system involvement has on the health and well-being of adolescents, families, and communities of color; examine policies that are successful in improving outcomes; and explore what needs to be done to improve all aspects of encounters with the juvenile justice system.
The workshop suggested pursuing alternatives to traditional juvenile justice systems that would allow adolescents to stay in their communities rather than in detention, responding to behavioral problems in youth with interventions that promote health and positive development rather than punishment, and tailoring interventions and programming to participants' cultural background and gender identity. This report summarizes the proceedings of the workshop.
96 pages
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ISBN Paperback: 0-309-69053-6
ISBN Ebook: 0-309-69054-4
DOI:
https://doi.org/10.17226/26623
National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of Juvenile Justice System Involvement on the Health and Well-Being of Youth, Families, and Communities of Color: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Approximately 7.4 million people in the United States live with an intellectual or developmental disability (IDD), defined by the Centers for Disease Control and Prevention as "a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person's lifetime." Individuals with IDD and their caretakers face exceptional barriers to staying healthy and accessing appropriate health services. Among these barriers are difficulty finding care providers that are adequately trained in meeting their specialized needs, unwieldy payment structures, and a lack of coordination between the various systems of care with which patients with IDD may interact (e.g., education, social work, various segments of the health care system).
The National Academies of Sciences, Engineering, and Medicine hosted a workshop to discuss promising innovations in (1) workforce development, (2) financing and payment, and (3) care coordination; and to share visions for improved systems of care. Participants noted that while many existing approaches could serve as models for improving care, large changes will need to be made in these 3 facets of the care system in order to make them accessible to all IDD patients. This publication summarizes the presentations and discussions of the workshop.
132 pages
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ISBN Paperback: 0-309-69060-9
ISBN Ebook: 0-309-69061-7
DOI:
https://doi.org/10.17226/26624
National Academies of Sciences, Engineering, and Medicine. 2022. Optimizing Care Systems for People with Intellectual and Developmental Disabilities: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Workshop
The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on September 19, 2019 titled Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream. The term upstream refers to the higher levels of action to improve health. Medical services act downstream (i.e., at the patient level) in improving population health, while such activities as screening and referring to social and human services (e.g., for housing, food assistance) are situated midstream, and the work of changing laws, policies, and regulations (e.g., toward affordable housing, expanding healthy food access) to improve the community conditions for health represents upstream action.
The workshop explored the growing attention on population health, from health care delivery and health insurance organizations to the social determinants of health and their individual-level manifestation as health-related social needs, such as patients' needs. The workshop showcased collaborative population health improvement efforts, each of which included one or more health systems. This publication summarizes the presentations and discussions from the workshop.
94 pages
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ISBN Paperback: 0-309-26532-0
ISBN Ebook: 0-309-26545-2
DOI:
https://doi.org/10.17226/26059
National Academies of Sciences, Engineering, and Medicine. 2022. Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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Consensus
In thousands of communities across the United States, drinking water is contaminated with chemicals known as perfluoroalkyl and polyfluoroalkyl substances (PFAS). PFAS are used in a wide range of products, such as non-stick cookware, water and stain repellent fabrics, and fire-fighting foam, because they have properties that repel oil and water, reduce friction, and resist temperature changes. PFAS can leak into the environment where they are made, used, disposed of, or spilled. PFAS exposure has been linked to a number of adverse health effects including certain cancers, thyroid dysfunction, changes in cholesterol, and small reductions in birth weight.
This report recommends that the Centers for Disease Control and Prevention (CDC) update its clinical guidance to advise clinicians to offer PFAS blood testing to patients who are likely to have a history of elevated exposure, such as those with occupational exposures or those who live in areas known to be contaminated. If testing reveals PFAS levels associated with an increased risk of adverse effects, patients should receive regular screenings and monitoring for these and other health impacts. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up recommends that the CDC, Agency for Toxic Substances and Disease Registry (ATSDR), and public health departments support clinicians by creating educational materials on PFAS exposure, potential health effects, the limitations of testing, and the benefits and harms of testing.
300 pages
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ISBN Paperback: 0-309-48244-5
ISBN Ebook: 0-309-48245-3
DOI:
https://doi.org/10.17226/26156
National Academies of Sciences, Engineering, and Medicine. 2022. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. Washington, DC: The National Academies Press.
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The U.S. Centers for Disease Control and Prevention (CDC) is responsible for preventing the introduction, transmission, and spread of communicable diseases into the United States. It does this primarily through the Division of Global Migration and Quarantine (DGMQ), which oversees the federal quarantine station network. Over the past two decades, the frequency and volume of microbial threats worldwide have continued to intensify. The COVID-19 pandemic, in particular, has prompted a reevaluation of many of our current disease control mechanisms, including the use and role of quarantine as a public health tool.
The emergence of COVID-19 prompted CDC to request that the National Academies of Sciences, Engineering, and Medicine convene a committee to assess the role of DGMQ and the federal quarantine station network in mitigating the risk of onward communicable disease transmission in light of changes in the global environment, including large increases in international travel, threats posed by emerging infections, and the movement of animals and cargo. The committee was also tasked with identifying how lessons learned during COVID-19 and other public health emergencies can be leveraged to strengthen pandemic response. The report's findings and recommendations span five domains: organizational capacity, disease control and response efforts, new technologies and data systems, coordination and collaboration, and legal and regulatory authority.
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ISBN Paperback: 0-309-68969-4
ISBN Ebook: 0-309-68970-8
DOI:
https://doi.org/10.17226/26599
National Academies of Sciences, Engineering, and Medicine. 2022. Improving the CDC Quarantine Station Network's Response to Emerging Threats. Washington, DC: The National Academies Press.
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Workshop_in_brief
Communities of color experience significantly higher rates of COVID-19 infection compared to White Americans, but have gotten vaccinated at a slower pace. The National Academies of Sciences, Engineering, and Medicine's Roundtable on the Promotion of Health Equity hosted a public webinar to discuss lessons learned from the COVID-19 pandemic and previous vaccination efforts that could improve vaccination rates among communities of color. Five participants including Indigenous tribal authorities, state public health workers, labor advocates, and academics discussed the history of vaccination and disease control efforts for minority populations during and before the COVID-19 pandemic. This Proceedings of a Workshop-In Brief summarizes the content of the workshop discussions.
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ISBN Ebook: 0-309-69049-8
DOI:
https://doi.org/10.17226/26622
National Academies of Sciences, Engineering, and Medicine. 2022. COVID-19 Vaccines: Studying Historical Successes (and Failures) for Equity-Centered Approaches to Vaccinating Indigenous Communities, Undocumented Immigrants, and Communities of Color: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.
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Workshop
To explore issues related to community-driven power-building efforts to improve population health, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a virtual public workshop, "Community Power in Population Health Improvement", on January 28 and 29, 2021. Participants discussed the different components and dimensions of community-led action around different population health improvement topics such as education, transportation, environmental health, healthy eating, and active living, among others. This Proceedings of a Workshop summarizes the presentations and discussion of the workshop.
172 pages
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ISBN Paperback: 0-309-09349-X
ISBN Ebook: 0-309-09350-3
DOI:
https://doi.org/10.17226/26306
National Academies of Sciences, Engineering, and Medicine. 2022. Community Power in Population Health Improvement: Proceedings of a Workshop. Washington, DC: The National Academies Press.
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