In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Education and health care significantly influence well-being and health outcomes, especially throughout adolescence. In fact, doctors note that performance in school is highly reflective of a child's current and future health. Despite knowledge of this connection, pediatricians are rarely aware of their patients' school performance and have a limited understanding of the education system. Fostering collaboration and aligning efforts within the health and education sectors is a critical step towards building stronger and healthier communities. On June 14, 2018, the National Academies convened a workshop to discuss how efforts within the health sector can support children's education from pre-kindergarten through 12th grade and to explore the barriers between these sectors. The committee also examined case examples of health-education collaboration and opportunities in policy. This publication summarizes the presentations and discussions from the workshop.

In response to a request from the US Department of Agriculture, the Health and Medicine Division (HMD) of the National Academies established the Standing Committee to Review the Dietary Reference Intake (DRI) Framework. The committee was asked to respond to DRI-related questions to inform the Federal DRI working group about the conduct of new DRI reviews and DRI-related issues more broadly, including their application. This second letter report advises the Federal DRI Working Group on three questions: 1) Are de novo systematic reviews are needed in future DRI reviews or can qualified systematic reviews be used? 2) If qualified systematic reviews can be used, what are the appropriate inclusion and exclusion criteria? 3) Can previously published systematic review be updated? In response, the standing committee developed a report that includes a decision tree that addresses the need for systematic reviews to support the DRI process.

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.

Although the general public in the United States assumes children to be generally healthy and thriving, a substantial and growing number of children have at least one chronic health condition. Many of these conditions are associated with disabilities and interfere regularly with children's usual activities, such as play or leisure activities, attending school, and engaging in family or community activities. In their most severe forms, such disorders are serious lifelong threats to children's social, emotional well-being and quality of life, and anticipated adult outcomes such as for employment or independent living. However, pinpointing the prevalence of disability among children in the U.S. is difficult, as conceptual frameworks and definitions of disability vary among federal programs that provide services to this population and national surveys, the two primary sources for prevalence data. Opportunities for Improving Programs and Services for Children with Disabilities provides a comprehensive analysis of health outcomes for school-aged children with disabilities. This report reviews and assesses programs, services, and supports available to these children and their families. It also describes overarching program, service, and treatment goals; examines outreach efforts and utilization rates; identifies what outcomes are measured and how they are reported; and describes what is known about the effectiveness of these programs and services.

In September 2015, the National Academies of Sciences, Engineering, and Medicine hosted a workshop to explore the basic and translational research needs for population health science, and to discuss specific research priorities and actions to foster population health improvement. The workshop was designed to provide frameworks for understanding population health research and its role in shaping and having an effect on population health, identify individual and institutional facilitators and challenges regarding the production, communication, and use of research for population health improvement, and identify key areas for future research critical to the advancement of population health improvement. This publication summarizes the presentations and discussions from the workshop.

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

Building on previous National Academies of Sciences, Engineering, and Medicine workshops that explored how safe and healthy communities are a necessary component of health equity and efforts to improve population health, the Roundtable on Population Health Improvement wanted to explore how a variety of community-based organizations came together to achieve population health. To do so, the roundtable hosted a workshop in Oakland, California, on December 8, 2016, to explore multisector health partnerships that engage residents, reduce health disparities, and improve health and well-being. This publication summarizes the presentations and discussions from the workshop.

Black men are increasingly underrepresented in medical schools and in the medical profession. A diverse workforce is a key attribute of quality healthcare and research suggests that a diverse workforce may help to advance cultural competency and increase access to high-quality health care, especially for underserved populations. Conversely, lack of diversity in the health workforce threatens health care quality and access and contributes to health disparities. In this way, the growing absence of Black men in medicine is especially troubling, because their absence in medicine may have adverse consequences for health care access, quality, and outcomes among Black Americans and Americans overall. To better understand the factors that contribute to the low participation of Black men in the medical profession, facilitate discussion of current strategies used to increase their participation in medical education, and explore new strategies along the educational and professional pipeline that may have potential to increase participation in medicine, the National Academies of Sciences, Engineering, and Medicine and the Cobb Institute jointly convened a 2-day workshop in November 2017, in Washington, DC. This publication summarizes the presentations and discussions from the workshop.

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.