month, MATCH Project staff review a wide variety of academic journals to identify recent
articles having particular relevance to population health policy,
research, and practice. These are listed below, in alphabetical order by first author.
Bambra C. (2010). Yesterday once more? Unemployment and health in the 21st century. Journal of Epidemiology and Community Health. 64, 213-215.
The relationship between economic recession, higher unemployment and poorer health is well established in the medical and social science research literature. Much of this research resulted from the last major economic recessions of the early 1980s and 1990s. Many parallels are being made between then and now. Therefore, this paper revisits this literature to ascertain what the unemployment consequences of the economic recession may mean for public health and health services. However, this research agenda paper also outlines key differences between then and now focusing on the structure of the welfare system and the organization and experience of work. Therefore, it is not simply a case of ‘yesterday once more’ and public health research, policy and practice needs to be sensitive and responsive to these changes.
Barr CD, Dominici F. (2009). Mitigation emissions: Public health benefits from air pollution cap and trade legislation for greenhouse gas. JAMA, 303(1), 69-70.
Legislation to cap and trade greenhouse gas emissions was approved by a 219-212 vote of the US House of Representatives on June 26, 20091 (counterpart legislation passed through the Environment and Public Works Committee in the Senate on November 5, 2009). Cap and trade policy articulated in the American Clean Energy and Security (ACES) Act of 20091 regulates greenhouse gases, including carbon dioxide, methane, nitrous oxide, sulfur hexafluoride, hydrofluorocarbons, perfluorocarbons, and nitrogen trifluoride. Debate over the ACES Act focused heavily on economic issues contrasted against concerns about climate change.2 However, discussion largely ignored the potential for cap and trade legislation to contribute to reductions in levels of other harmful air pollutants, such as sulfur dioxide, particulate matter, and ozone precursors, which share emission sources with greenhouse gases.
Bayer R, Kelly M. (2010). Tobacco control and free speech—An American dilemma. The New England Journal of Medicine, 362(4), 281-283.
On June 22, 2009, President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This landmark legislation, which passed the House by a vote of 307 to 97 and the Senate 79 to 17, grants the Food and Drug Administration (FDA) extensive authority to regulate tobacco products. In signing the law, Obama underscored the importance of radically limiting the tobacco industry’s capacity to market its products to young people. “The kids today don’t just start smoking for no reason,” he said. “They’re aggressively targeted as customers by the tobacco industry. They’re exposed to a constant and insidious barrage of advertising where they live, where they learn, and where they play.”
Brownell KD, Kersh R, Ludwig D, Post RC, Puhl RM, Schwartz MB, Willett WC. (2010). Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs, 29(3), 379-387.
The concept of personal responsibility has been central to social, legal, and political approaches to obesity. It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. These environmental conditions can override individual physical and psychological regulatory systems that might otherwise stand in the way of weight gain and obesity, hence undermining personal responsibility, narrowing choices, and eroding personal freedoms. Personal responsibility can be embraced as a value by placing priority on legislative and regulatory actions such as improving school nutrition, menu labeling, altering industry marketing practices, and even such controversial measures as the use of food taxes that create healthier defaults, thus supporting responsible behavior and bridging the divide between views based on individualistic versus collective responsibility.
Carter R, Moodie M, Markwick A, Magnus A, Vos T, Swinburn B, Haby M. (2009). Assessing cost-effectiveness in obesity (ACE-Obesity): an overview f the ACE approach, economic methods and cost results. BMC Public Health, 9, 419.
The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modeled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study.
Cherukupalli R. (2010). A behavioral economics perspective on tobacco taxation. American Journal of Public Health, 100(4), 609-615.
Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco’s hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country’s circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.
Elder RW, Lawrence B, Ferguson A, Naimi TS, Brewer RD, Chattopadhyay SJ, Toomey TL, Fielding JE. (2010). The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. American Journal of Preventive Medicine, 38(2), 217-229.
A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups.
Gollust SE, Lantz PM, Ubel PA. (2009). The polarizing effect of news media messages about the social determinants of health. American Journal of Public Health, 99(12), 2160-2167.
Framing health problems in terms of the social determinants of health aims to shift policy attention to nonmedical strategies to improve population health, yet little is known about how the public responds to these messages. We conducted an experiment to test the effect of a news article describing the social determinants of type 2 diabetes on the public’s support for diabetes prevention strategies. We found that exposure to the social determinants message led to a divergence between Republicans’ and Democrats’ opinions, relative to their opinions after viewing an article with no message about the causes of diabetes. These results signify that increasing public awareness of the social determinants of health may not uniformly increase public support for policy action.
Hartman M, Martin A, Nuccio O, Catlin A, National Health Expenditure Accounts Team. (2010). Health spending growth at a historic low in 2008. Health Affairs, 29(1), 147-155.
In 2008, U.S. health care spending growth slowed to 4.4 percent—the slowest rate of growth over the past forty-eight years. The deceleration was broadly based for nearly all payers and health care goods and services, as growth in both price and nonprice factors slowed amid the recession. Despite the slowdown, national health spending reached $2.3 trillion, or $7,681 per person, and the health care portion of gross domestic product (GDP) grew from 15.9 percent in 2007 to 16.2 percent in 2008. These developments reflect the general pattern that larger increases in the health spending share of GDP generally occur during or just after periods of economic recession. Despite the overall slowdown in national health spending growth, increases in this spending continue to outpace growth in the resources available to pay for it.
Homer J, Milstein B, Wile K, Trogdon J, Huang P, Labarthe D, Orenstein D. (2010). Simulating and evaluating local interventions to improve cardiovascular health. Preventing Chronic Disease, 7(1).
Numerous local interventions for cardiovascular disease are available, but resources to deliver them are limited. Identifying the most effective interventions is challenging because cardiovascular risks develop through causal pathways and gradual accumulations that defy simple calculation. We created a simulation model for evaluating multiple approaches to preventing and managing cardiovascular risks. The model incorporates data from many sources to represent all US adults who have never had a cardiovascular event. It simulates trajectories for the leading direct and indirect risk factors from 1990 to 2040 and evaluates 19 interventions. The main outcomes are first-time cardiovascular events and consequent deaths, as well as total consequence costs, which combine medical expenditures and productivity costs associated with cardiovascular events and risk factors. We used sensitivity analyses to examine the significance of uncertain parameters. A base case scenario shows that population turnover and aging strongly influence the future trajectories of several risk factors. At least 15 of 19 interventions are potentially cost saving and could reduce deaths from first cardiovascular events by approximately 20% and total consequence costs by 26%. Some interventions act quickly to reduce deaths, while others more gradually reduce costs related to risk factors. Although the model is still evolving, the simulated experiments reported here can inform policy and spending decisions.
Lindtrom M. (2009. Marital status, social capital, material conditions and self-rated health: A population-based study. Health Policy, 93, 172-179.
Associations between marital status and self-rated health were investigated, adjusting for material conditions and trust (social capital). The 2004 public-health survey in Skane is a cross-sectional study. A total of 27,757 persons aged 18–80 years answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate associations between marital status and self-rated health, adjusting for economic problems and trust. Results suggest that the never married and the divorced have significantly higher age-adjusted odds ratios of poor self-rated health than the married/cohabitating group. Economic problems but not trust seem to affect the association between marital status and poor self-rated health.
Lomas J, Brown Adalsteinn. (2009). Research and advice-giving: A functional view of evidence-informed policy advice in a Canadian Ministry of Health. The Milbank Quarterly, 87(4), 903-926.
As evidence-based medicine grows in influence and scope, its applicability to health policy prompts two questions: Can the principles and, more specifically, the tools used to bring research into the clinical world apply to civil servants offering advice to politicians? If not, what approach should the evidence-oriented health policy organization take to improve the use of research? This article reviews evidence-based medicine and models of research use in policy. Then it reports the results of interviews with civil servants in the Ontario Ministry of Health, which recently adopted a stewardship rather than an operational role, incorporating many evidence-oriented strategies. The interviews focused on functional roles for research-based evidence in policy advice. Findings suggest that the clinical context and tools for evidence-based medicine can rarely be generalized to policy. Most current models of research use offer lessons to researchers wishing to apply their work to policy but little help for civil servants wishing to become more evidence oriented. The interviews revealed functional roles for research in setting agendas (noting upcoming issues and screening interest groups’ claims), developing new policies (reducing uncertainty, helping speak truth to power, and preventing repetition and duplication), and monitoring or modifying existing policies (continuously improving programs and creating a culture of inquiry). Each area requires different tools to help filter the push of evidence from researchers and set agendas, to facilitate the urgent pull on relevant research by civil servants developing new policy, and to support ongoing linkage and exchange between civil servants and researchers for monitoring and modifying existing policy.
Maty S, James S, Kaplan G. (2010). Life-course socioeconomic position and incidence of diabetes mellitus among blacks and whites: The Alameda County Study, 1965-1999. American Journal of Public Health, 100(1), 137-145.
We examined associations between several life-course socioeconomic position (SEP) measures (childhood SEP, education, income, occupation) and diabetes incidence from 1965 to 1999 in a sample of 5422 diabetes-free Black and White participants in the Alameda County Study. Results revealed that diabetes incidence was twice as high for Blacks as for Whites. Diabetes risk factors independently increased risk, but effect sizes were greater among Whites. Low childhood SEP elevated risk for both racial groups. Protective effects were suggested for low education and blue-collar occupation among Blacks, but these factors increased risk for Whites. Income was protective for Whites but not Blacks. Covariate adjustment had negligible effects on associations between each SEP measure and diabetes incidence for both racial groups. These findings suggest an important role for life-course SEP measures in determining risk of diabetes, regardless of race and after adjustment for factors that may confound or mediate these associations.
Mechanic D. (2010). Replicating high-quality medical care organizations. JAMA, 303(6), 555-556.
Most agree on the need for restructuring the US health care delivery system and increasing the capacity to provide coordinated care across the illness continuum in a patient centered fashion. There is strong interest in developing accountable care organizations that have the capacities to (1) monitor meaningfully patient needs and outcomes, (2) use performance indicators for assessment of physicians and other professionals, and (3) implement new forms of reimbursement that result in improved quality while constraining increases in cost. A range of exemplary models are commonly used as examples including the Mayo Clinic, the Cleveland Clinic, Kaiser-Permanente, and Geisinger Health System but these examples are poorly matched to the existing distribution of medical practices and their small sizes.
Mohai P, Lantz PM, Morenoff J, House JS, Mero RP. (2009). Racial and socioeconomic disparities in residential proximity to polluting industrial facilities: Evidence from the Americans’ Changing Lives Study. American Journal of Public Health, 99(S3), S649-S656.
We sought to demonstrate the advantages of using individual level survey data in quantitative environmental justice analyses and to provide new evidence regarding racial and socioeconomic disparities in the distribution of polluting industrial facilities. The study involved geocoding addresses of respondents in the baseline sample of the Americans’ Changing Lives Study and polluting industrial facilities in the Environmental Protection Agency’s Toxic Release Inventory to allow assessments of distances between respondents’ homes and polluting facilities. The associations between race and other sociodemographic characteristics and living within 1 mile (1.6 km) of a polluting facility were estimated via logistic regression. Findings reveal that Blacks and respondents at lower educational levels and, to a lesser degree, lower income levels were significantly more likely to live within a mile of a polluting facility. Racial disparities were especially pronounced in metropolitan areas of the Midwest and West and in suburban areas of the South. These results add to the historical record demonstrating significant disparities in exposures to environmental hazards in the US population and provide a paradigm for studying changes over time in links to health.
Nanney MS, Nelson T, Wall M, Kubik M, Laska MN, Story M. (2010). State school nutrition and physical activity policy environments and youth obesity. American Journal of Preventive Medicine, 38(1), 9-16.
With the epidemic of childhood obesity, there is national interest in state-level school policies related to nutrition and physical activity, policies adopted by states, and relationships to youth obesity. This study develops a comprehensive state-level approach to characterize the overall obesity prevention policy environment for schools and links the policy environments to youth obesity for each state. Using 2006 School Health Policies and Programs Study (SHPPS) state data, qualitative and quantitative methods were used (2008 –2009) to construct domains of state-level school obesity prevention policies and practices, establish the validity and reliability of the domain scales, and examine their associations with state-level obesity prevalence among youth aged 10–17 years from the 2003 National Survey of Children’s Health. More than 250 state-level obesity prevention–policy questions were identified from the SHPPS. Three broad policy topic areas containing 100 food service and nutrition (FSN) questionnaire items; 146 physical activity and education (PAE) items; and two weight assessment (WA) items were selected. Principal components analysis and content validity assessment were used to further categorize the items into six FSN, ten PAE, and one WA domain. Using a proportional scaled score to summarize the number of policies adopted by states, it was found that on average states adopted about half of the FSN (49%), 38% of the PAE, and 17% of the WA policies examined. After adjusting for state-level measures of ethnicity and income, the average proportion of FSN policies adopted by states was correlated with the prevalence of youth obesity at r _0.35 (p_0.01). However, no correlation was found between either PAE or WA policies and youth obesity (PAE policies at r_0.02 [p_0.53] and WA policies at r _0.16 [p_0.40]). Results suggest that states appear to be doing a better job adopting FSN policies than PA or WA policies, and adoption of policies is correlated with youth obesity. Continued monitoring of these policies seems to be warranted.
Norheim OF, Asada Y. (2009). The ideal of equal health revisited: definitions and measures of inequity in health should be better integrated with theories of distributive justice. International Journal for Equity in Health, 8(40).
The past decade witnessed great progress in research on health inequities. The most widely cited definition of health inequity is, arguably, the one proposed by Whitehead and Dahlgren: "Health inequalities that are avoidable, unnecessary, and unfair are unjust." We argue that this definition is useful but in need of further clarification because it is not linked to broader theories of justice. We propose an alternative, pluralist notion of fair distribution of health that is compatible with several theories of distributive justice. Our proposed view consists of the weak principle of health equality and the principle of fair trade-offs. The weak principle of health equality offers an alternative definition of health equity to those proposed in the past. It maintains the all-encompassing nature of the popular Whitehead/Dahlgren definition of health equity, and at the same time offers a richer philosophical foundation. This principle states that every person or group should have equal health except when: (a) health equality is only possible by making someone less healthy, or (b) there are technological limitations on further health improvement. In short, health inequalities that are amenable to positive human intervention are unfair. The principle of fair trade-offs states that weak equality of health is morally objectionable if and only if: (c) further reduction of weak inequality leads to unacceptable sacrifices of average or overall health of the population, or (d) further reduction in weak health inequality would result in unacceptable sacrifices of other important goods, such as education, employment, and social security.
Roberto CA, Schartz MB, Brownell KD. (2009). Rationale and Evidence for Menu-Labeling Legislation. American Journal of Preventive Medicine, 37(6), 546-551.
Menu-labeling legislation is a proposed public health intervention for poor diet and obesity that requires chain restaurants to provide nutrition information on menus and menu boards. The restaurant industry has strongly opposed menu-labeling legislation. Using scientific evidence, this paper counters industry arguments against menu labeling by demonstrating that consumers want chain restaurant nutrition information to be disclosed; the current methods of providing nutrition information are inadequate; the expense of providing nutrition information is minimal; the government has the legal right to mandate disclosure of information; consumers have the right to know nutrition information; a lack of information reduces the efficiency of a market economy; and menu labeling has the potential to make a positive public health impact.
Rummery K. (2009). Healthy partnerships, healthy citizens? An international review of partnerships in health and social care and patient/user outcomes. Social Science and Medicine, 69, 1797-1804.
As a result of changes in the governance of health and social care organizations across developed welfare states they are under increasing pressure to work in partnership with each other (at an organizational and inter-professional level) and with the private and voluntary sector. Drawing on a comparative literature review of the theoretical and empirical evidence from health and social care partnerships across developed welfare states, this paper aims to examine the policy drivers behind such changes and the effects the changes have had on the governance of health and social care, the results for service Commissioners and practitioners, and particularly the results for patients and service users. It examines some of the evidence that suggests that patient/user involvement and outcomes may at best be unaffected, and at worst be negatively compromised by shifts towards increasing partnership working in health and social care. It will conclude by discussing what lessons can be drawn about service reorganization and user involvement in welfare organizations generally, and how best to protect the interests of vulnerable and disenfranchised groups of service users.
Sheffer MA, Redmond LA, Kobinski KH, Keller PA, McAfee T, Fiore MC. (2000). Creating a perfect storm to increase consumer demand for Wisconsin’s tobacco quitline. American Journal of Preventive Medicine, 38(3S)S343-S346.
Telephone quitlines are a clinically proven and cost-effective population-wide tobacco dependence treatment, and this option is now available in all 50 states. Yet, only 1% of the smoking population accesses these services annually. This report describes a series of policy, programmatic, and communication initiatives recently implemented in Wisconsin that resulted in a dramatic increase in consumer demand for the Wisconsin Tobacco Quitline (WTQL). In 2007, the Wisconsin legislature voted to increase the state cigarette excise tax rate by $1.00, from $0.77/pack to $1.77/pack effective January 1, 2008. In preparation for the tax increase, the Wisconsin Tobacco Prevention and Control Program, the University of Wisconsin Center for Tobacco Research and Intervention, which manages the WTQL, and the state’s quitline service provider, Free & Clear, Inc., collaborated to enhance quitline knowledge, availability, and services with the goal of increasing consumer demand for services. The enhancements included for the first time, a free 2-week supply of over-the-counter nicotine replacement medication for tobacco users who agreed to receive multi-session quitline counseling. A successful statewide earned media campaign intensif?ed the impact of these activities, which were timed to coincide with temporal smoking-cessation behavioral patterns (i.e., New Year’s resolutions). As a result, the WTQL fielded a record 27,000 calls during the first 3 months of 2008, reaching nearly 3% of adult Wisconsin smokers. This experience demonstrates that consumer demand for quitline services can be markedly enhanced through policy and communication initiatives to increase the population reach of this evidence-based treatment.
Silveira MJ, Kim SY, Langa KM. (2000). Advance directives and outcomes of surrogate decision making before death. The New England Journal of Medicine, 362, 1211-1218.
Recent discussions about health care reform have raised questions regarding the value of advance directives. We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. Findings suggest that patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.
Stiefel MC, Perla RJ, Zell B. (2010). A healthy bottom line: Healthy life expectancy as an outcome measure for health improvement efforts. The Milbank Quarterly, 88(1), 30-53.
Good health is the most important outcome of health care, and healthy life expectancy (HLE), an intuitive and meaningful summary measure combining the length and quality of life, has become a standard in the world for measuring population health. This article critically reviews the literature and practices around the world for measuring and improving HLE and synthesizes that information as a basis for recommendations for the adoption and adaptation of HLE as an outcome measure in the United States. This article makes the case for adoption of HLE as an outcome measure at the national, state, community, and health care system levels in the United States to compare the effectiveness of alternative practices, evaluate disparities, and guide resource allocation.
This article concludes that HLE is a clear, consistent, and important population health outcome measure that can enable informed judgments about value for investments
in health care.
Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, Singh-Manoux A. (2010). Association of socioeconomic position with health behaviors and mortality. JAMA, 303(12), 1159-1166.
Previous studies may have underestimated the contribution of health behaviors to social inequalities in mortality because health behaviors were assessed only at the baseline of the study. The objective of this study was to examine the role of health behaviors in the association between socioeconomic position and mortality and compare whether their contribution differs when assessed at only 1 point in time with that assessed longitudinally through the follow-up period. Established in 1985, the British Whitehall II longitudinal cohort study includes 10,308 civil servants, aged 35 to 55 years, living in London, England. Analyses are based on 9590 men and women followed up for mortality until April 30, 2009. Socioeconomic position was derived from civil service employment grade (high, intermediate, and low) at baseline. Smoking, alcohol consumption, diet, and physical activity were assessed 4 times during the follow-up period. A total of 654 participants died during the follow-up period. In the analyses adjusted for sex and year of birth, those with the lowest socioeconomic position had 1.60 times higher risk of death from all causes than those with the highest socioeconomic position (a rate difference of 1.94/1000 person-years). This association was attenuated by 42% (95% confidence interval [CI], 21%-94%) when health behaviors assessed at baseline were entered into the model and by 72% (95% CI, 42%-154%) when they were entered as time-dependent covariates. The corresponding attenuations were 29% (95% CI, 11%-54%) and 45% (95% CI, 24%-79%) for cardiovascular mortality and 61% (95% CI, 16%-425%) and 94% (95% CI, 35%-595%) for noncancer and noncardiovascular mortality. The difference between the baseline only and repeated assessments of health behaviors was mostly due to an increased explanatory power of diet (from 7% to 17% for all-cause mortality, respectively), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality). The role of smoking, the strongest mediator in these analyses, did not change when using baseline or repeat assessments (from 32% to 35% for all-cause mortality). Results indicate that in a civil service population in London, England, there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly.