Annual Review of Public Health - Volume 46, 2025

Vaccines are lifesaving interventions that reduce the morbidity and mortality of disease. Fortunately, serious adverse events with vaccination are uncommon, but they must promptly be recognized and evaluated to assess and clarify the safety of future administration, a process that the public must understand in order to feel safe in receiving vaccines. In this article, we provide a review of vaccine development, discuss the process by which safety is ensured, and describe key adverse events associated with their administration. We review in detail existing mechanisms for reporting these events and assessing them following recovery, as well as communication related to vaccine safety. We also describe barriers to vaccination, such as nocebo effects and antivaccination groups, and use lessons learned from the successful development of COVID-19 vaccines during the recent pandemic to define future opportunities and directions for vaccine safety.

Achieving health equity necessitates high-quality data to address disparities that have remained stagnant or even worsened over time despite public health interventions. Data disaggregation, the breakdown of data into detailed subcategories, is crucial in health equity research. It reveals and contextualizes hidden trends and patterns about marginalized populations and guides resource allocation and program development for specific needs in these populations. Data disaggregation underpins data equity, which uses community engagement to democratize data and develop better solutions for communities. Years of research on disaggregation show that researchers must collaborate closely with communities for adequate representation. However, despite generally positive support for this approach in health disparities research, data disaggregation faces methodological and political challenges. This review offers a framework for understanding data disaggregation in the context of data equity and highlights critical aspects of implementation, including challenges, opportunities, and recent policy and community-based efforts to address hurdles.

This review explores the transformative potential of just-in-time adaptive interventions (JITAIs) as a scalable solution for addressing health disparities in underserved populations. JITAIs, delivered via mobile health technologies, could provide personalized, context-aware interventions based on real-time data to address public health challenges such as addiction treatment, chronic disease management, and mental health support. JITAIs can dynamically adjust intervention strategies, enhancing accessibility and engagement for marginalized communities. We highlight the utility of JITAIs in reducing opportunity costs associated with traditional in-person health interventions. Examples from various health domains demonstrate the adaptability of JITAIs in tailoring interventions to meet diverse needs. The review also emphasizes the need for community involvement, robust evaluation frameworks, and ethical considerations in implementing JITAIs, particularly in low- and middle-income countries. Sustainable funding models and technological innovations are necessary to ensure equitable access and effectively scale these interventions. By bridging the gap between research and practice, JITAIs could improve health outcomes and reduce disparities in vulnerable populations.

This article provides a guide for rigorous, theory-driven measurement approaches, proposing best practices for the scientific study of systemic racism in health research. We argue that the analytical crux of measuring systemic racism—a complex, interconnected, and dynamic system—lies in operationalizing the collective logics, properties, and mechanisms that undergird racial inequities. Misalignment between measurement tools and these fundamental features undermines research validity, as incongruent measures distort findings and obscure systemic racism's true impacts. To address this, we draw on interdisciplinary theories and evidence to dissect key features of systemic racism, emphasizing their implications for measurement. We further recommend incorporating temporal processes in health research by leveraging core principles of the life course perspective, which elucidate the intricate interplay of individual, historical, and societal trajectories. Our recommendations underscore the necessity of adopting robust, evidence-based methods to advance the understanding of how systemic racism operates and shapes public health.

Estimators of biological age hold promise for use in preventive medicine, for early detection of chronic conditions, and for monitoring the effectiveness of interventions aimed at improving population health. Among the promising biomarkers in this field are DNA methylation–based biomarkers, commonly referred to as epigenetic clocks. This review provides a survey of these clocks, with an emphasis on second-generation clocks that predict human morbidity and mortality. It explores the validity of epigenetic clocks when considering factors such as race, sex differences, lifestyle, and environmental influences. Furthermore, the review addresses the current challenges and limitations in this research area.

While public health practitioners and scholars have long theorized that structural forms of stigma shape the health of disadvantaged groups, they have frequently bemoaned the lack of research on this topic. A unique opportunity to address this lacuna occurred in the past two decades, with the advent of dramatic changes in laws, social attitudes, and other structural manifestations of stigma surrounding LGBTQ+ individuals. In a review of this literature, we conducted a meta-analysis of LGBTQ+ structural stigma and health, finding an effect size comparable to several other well-established macrolevel risk factors for poor health (e.g., income inequality, racial residential segregation, neighborhood socioeconomic status). In addition, we enumerated a range of established methodological strategies that studies have used to strengthen inferences; these strategies include documenting result specificity (i.e., structural stigma is unrelated to the health of cisgender heterosexuals), addressing alternative explanations (e.g., social selection), and triangulating evidence across multiple methods, measures, and health outcomes. We offer suggestions for future research to advance this rapidly expanding field, including identifying sources of unexplained heterogeneity in the structural stigma–health association. Finally, we discuss implications for other marginalized groups and for public health interventions and policies to reduce LGBTQ+ health disparities.

When complex public health and health services interventions are implemented in real-world settings, adaptations should be expected, embraced, and studied rather than suppressed and ignored. A substantial amount of recent research has been conducted on the assessment of some types of adaptations, and interest in guiding adaptations to both interventions and implementation strategies is growing. However, there is still a need to investigate the optimal ways to systematically and pragmatically document, analyze, and iteratively guide adaptations as well as to measure the impact of those adaptations on implementation and effectiveness outcomes. This article reviews key findings from the adaptations assessment literature, frameworks to guide classification of adaptations, and methodologies to study adaptations and their impact. We summarize research from diverse settings and populations from public health and health services research on the use of these methodologies and make recommendations for research and practice.

The prevalence and harms of societal weight stigma have increased attention to its presence in public health approaches and communication. Calls to action from scholars, advocates, and health professionals emphasize the need to address weight stigma as a social justice issue and eliminate harmful narratives that perpetuate weight bias and discrimination in public health messages, practices, and policies. However, debates surrounding issues of weight stigma in public health complicate, and at times impair, efforts to effectively address this problem. Different (and sometimes opposing) perspectives include views about the health risks versus stigma effects of high body weight, the use of body mass index (BMI) as a metric of health, weight-normative (i.e., weight-centric) versus weight-inclusive treatment approaches, stigmatizing language used to describe body weight, and potential challenges when framing obesity as a disease. This review summarizes the current evidence, debates, and best practices related to weight stigma in public health efforts.

Unmet social needs (e.g., housing instability, food insecurity, transportation barriers) impact a patient's ability to participate in health-seeking behaviors (e.g., physical activity, routine preventive care) and to achieve optimal health. A rapidly growing number of health care systems are incorporating social needs screening and assistance into clinical workflows, yet many implementation and sustainability challenges exist and require collaboration with social service organizations. This review highlights implementation approaches used within this rapidly changing US landscape and uses implementation science frameworks to systematically identify multilevel barriers to and facilitators of implementing and sustaining social needs care. Policies and economic investments are necessary as they determine critical barriers and facilitators within the clinical and social service contexts. Implementation may be further strengthened by cross-sector engagement, evidence-based implementation strategies, and capacity building within clinical and social service organizations. Successful, sustained implementation of social needs care may improve the quality of health care, population health, and health equity.

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

Life expectancy among American Indians and Alaska Natives (AI/ANs) has declined from 72 years in 2019 to 68 years in 2021. This current life expectancy for AI/ANs is equivalent to the overall life expectancy in the United States population in the 1940s. The significant and persistent nature of AI/AN health inequities, and the lack of clarity around what is driving them, requires urgent action. The purpose of this article is threefold. First, we provide a comprehensive conceptual framework of health that presents Indigenous perspectives of health and recognizes settler colonialism as a key structural determinant of the health of AI/ANs. Second, we underscore the importance of Tribal self-determination and sovereignty in public health research and practice and identify successful initiatives centering these efforts. Finally, we conclude with recommendations for future research, practice, and policy.

While public health practitioners and scholars have long theorized that structural forms of stigma shape the health of disadvantaged groups, they have frequently bemoaned the lack of research on this topic. A unique opportunity to address this lacuna occurred in the past two decades, with the advent of dramatic changes in laws, social attitudes, and other structural manifestations of stigma surrounding LGBTQ+ individuals. In a review of this literature, we conducted a meta-analysis of LGBTQ+ structural stigma and health, finding an effect size comparable to several other well-established macrolevel risk factors for poor health (e.g., income inequality, racial residential segregation, neighborhood socioeconomic status). In addition, we enumerated a range of established methodological strategies that studies have used to strengthen inferences; these strategies include documenting result specificity (i.e., structural stigma is unrelated to the health of cisgender heterosexuals), addressing alternative explanations (e.g., social selection), and triangulating evidence across multiple methods, measures, and health outcomes. We offer suggestions for future research to advance this rapidly expanding field, including identifying sources of unexplained heterogeneity in the structural stigma–health association. Finally, we discuss implications for other marginalized groups and for public health interventions and policies to reduce LGBTQ+ health disparities.

This review describes employees working in low-wage industries in the United States, their health risks, and their access to health promotion and other health-related resources through their employers. We use publicly available datasets to illustrate how low-wage jobs affect employees’ social determinants of health, health risk behaviors, and chronic conditions. We also discuss how the COVID-19 pandemic has shifted these employees’ and employers’ health-related priorities and work settings. We describe employees’ access to health supports through federal programs and their employers and the potential ways in which low-wage employers could support employee health and well-being. We close with a brief research and practice agenda to improve health equity for employees in low-wage industries. The goal of this review is to help practitioners and researchers in workplace health promotion, occupational health, and public health reach employees and employers in low-wage industries with interventions that address employees’ health risks and employees’ and employers’ health priorities.

Estimation of the disease burden attributable to environmental factors is a powerful tool for prioritizing environmental and pollution management and public health actions around the world. The World Health Organization (WHO) began estimating the environmental disease burden in 2000, which has formed the basis for the modern estimation approach conducted in the Global Burden of Disease, Injuries, and Risk Factor (GBD) study. In 2021, environmental and occupational risk factors in the GBD were responsible for 18.9% (12.8 million) of global deaths and 14.4% of all disability-adjusted life years (DALYs), led by ambient PM2.5 air pollution (4.2% DALYs, 4.7 million deaths) and household air pollution from the use of solid fuels for cooking (3.9% DALYs, 3.1 million deaths). Climate change exacerbates many environmental hazards, leading to increased disease burdens from heat, air pollution, vector-borne diseases, storms, and flooding. Other environmental risk factors not included in the GBD, such as poor indoor air quality, various chemical exposures, and environmental noise pollution, also significantly contribute to disease burden in many countries, though more efforts are needed to generate and integrate data resources for inclusion in global estimations.

Health authorities have promoted community water fluoridation (CWF) to prevent dental caries for more than 75 years. However, growing evidence has raised questions about the safety of this public health intervention, particularly for young children who are at risk of excess fluoride intake. Divergent opinions about the risk–benefit ratio of CWF have ignited a global debate. The efficacy of topical fluoride in preventing dental caries is strong, whereas contemporary evidence for systemic administration of fluoride is weaker. Inequalities in access to dental care and topical fluorides introduce an additional layer of complexity. This review discusses evidence showing that fluoride ingestion is not essential for caries prevention, offers little benefit to the fetus and young infant, and can cause dental fluorosis and cognitive deficits. In an environment where fluoride is available from multiple sources, community-based administration of systemic fluoride may pose an unfavorable risk–benefit ratio for pregnant women and young children.

Health is at the forefront of clean air and climate action. However, most existing studies of health impacts were based on additive single-exposure effects, which often oversimplify the relationships between atmospheric components and health outcomes. This review examines various atmospheric components’ common sources and differential health effects, including greenhouse gases and major air pollutants such as fine particulate matter (PM2.5). It emphasizes the need for a comparative assessment of health impacts across various atmospheric components. We further highlight black carbon as an illustrative example, given its higher toxicity compared with other major PM2.5 components. By integrating the best available findings on the differential effects of particulate matter components with multiple gridded estimates of air pollution concentrations and population data, we conducted a risk assessment to quantify the health benefits of particulate matter reductions associated with China's clean air actions (2013–2020) and future climate mitigation scenarios (2020–2060). Our assessments indicate that, in regions or during periods where black carbon accounts for a higher proportion of exposure reduction relative to other PM2.5 components, reducing per-unit concentrations of PM2.5 can prevent more premature deaths. We propose a conceptual framework for a health-oriented strategy to enhance the effectiveness of clean air and climate initiatives.

This review describes employees working in low-wage industries in the United States, their health risks, and their access to health promotion and other health-related resources through their employers. We use publicly available datasets to illustrate how low-wage jobs affect employees’ social determinants of health, health risk behaviors, and chronic conditions. We also discuss how the COVID-19 pandemic has shifted these employees’ and employers’ health-related priorities and work settings. We describe employees’ access to health supports through federal programs and their employers and the potential ways in which low-wage employers could support employee health and well-being. We close with a brief research and practice agenda to improve health equity for employees in low-wage industries. The goal of this review is to help practitioners and researchers in workplace health promotion, occupational health, and public health reach employees and employers in low-wage industries with interventions that address employees’ health risks and employees’ and employers’ health priorities.

While energy transitions have always taken place, shifts have historically been primarily from one type of fossil fuel to another (e.g., from coal to oil). Yet today we are experiencing transitions away from fossil fuel toward cleaner and sustainable energy sources. These transitions include shifts to renewable energy, electric vehicles, pedestrian pathways and more walkable cities, energy efficiency measures in the built environment, and increased public transportation. This restructuring of our energy system will bring impacts on public health (e.g., improved air quality from lower use of traditional gasoline-powered vehicles). Furthermore, the transition can lower emissions of greenhouse gases (GHGs), thereby helping slow climate change and minimize its anticipated impacts on public health. While more work is needed to understand the full implications of these energy transitions, including the implications for environmental justice in terms of who will share in the health benefits and potential detriments such as increased emissions from brake wear for electric vehicles, the existing literature indicates substantial benefits to public health. Moving away from fossil fuel may offer a rare win-win strategy for a healthier society with a cleaner environment and lower GHGs.

The prevalence and harms of societal weight stigma have increased attention to its presence in public health approaches and communication. Calls to action from scholars, advocates, and health professionals emphasize the need to address weight stigma as a social justice issue and eliminate harmful narratives that perpetuate weight bias and discrimination in public health messages, practices, and policies. However, debates surrounding issues of weight stigma in public health complicate, and at times impair, efforts to effectively address this problem. Different (and sometimes opposing) perspectives include views about the health risks versus stigma effects of high body weight, the use of body mass index (BMI) as a metric of health, weight-normative (i.e., weight-centric) versus weight-inclusive treatment approaches, stigmatizing language used to describe body weight, and potential challenges when framing obesity as a disease. This review summarizes the current evidence, debates, and best practices related to weight stigma in public health efforts.

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.

Life expectancy among American Indians and Alaska Natives (AI/ANs) has declined from 72 years in 2019 to 68 years in 2021. This current life expectancy for AI/ANs is equivalent to the overall life expectancy in the United States population in the 1940s. The significant and persistent nature of AI/AN health inequities, and the lack of clarity around what is driving them, requires urgent action. The purpose of this article is threefold. First, we provide a comprehensive conceptual framework of health that presents Indigenous perspectives of health and recognizes settler colonialism as a key structural determinant of the health of AI/ANs. Second, we underscore the importance of Tribal self-determination and sovereignty in public health research and practice and identify successful initiatives centering these efforts. Finally, we conclude with recommendations for future research, practice, and policy.

This review describes employees working in low-wage industries in the United States, their health risks, and their access to health promotion and other health-related resources through their employers. We use publicly available datasets to illustrate how low-wage jobs affect employees’ social determinants of health, health risk behaviors, and chronic conditions. We also discuss how the COVID-19 pandemic has shifted these employees’ and employers’ health-related priorities and work settings. We describe employees’ access to health supports through federal programs and their employers and the potential ways in which low-wage employers could support employee health and well-being. We close with a brief research and practice agenda to improve health equity for employees in low-wage industries. The goal of this review is to help practitioners and researchers in workplace health promotion, occupational health, and public health reach employees and employers in low-wage industries with interventions that address employees’ health risks and employees’ and employers’ health priorities.

Public policies have been instrumental in influencing population health, and the desire to study their impact led to the development of the fields of policy surveillance and legal epidemiology. The standardized practice of creating policy measurement systems allows researchers to track and evaluate policy impacts across jurisdictions and over time. Policy measures may take many forms, including dichotomous measures, ordinal ratings, composite measures, or scale measures. The policy measures are determined largely based on the research question but should also consider factors impacting policy implementation and equity. Many sources of evidence, including expert input, national standards, scientific evidence, and existing policies, can be used in the development of policy measurement and rating systems. Any system must be tested, reliable, and clearly documented to create a robust and rigorous dataset. This article reviews key considerations for the development of policy measurement and rating systems for use in public health research.

Suicide rates have increased in the United States in recent years. Public policies have great potential to prevent suicide death, and well-designed quasi-experimental studies have identified policies that are effective at reducing suicide rates; however, evidence about these policies has not been synthesized. This review summarizes evidence across three domains of public policies: (a) policies that affect structural determinants of suicide risk (e.g., policies that improve economic security), (b) policies that promote access to clinical services (e.g., Medicaid expansion), and (c) policies that limit access to lethal means for completing suicide (e.g., policies that restrict access to firearms). The historical context of suicide prevention in US public policy is provided, considerations for successful suicide prevention policy implementation are discussed—such as policy awareness among key groups, enforcement, and sufficient funding—and priority areas for future research are enumerated.

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies. These programs exist on a limited scale and often face restrictions on their funding and scope of operations. While research demonstrates the effectiveness of existing programs in preventing infectious disease transmission and fatal overdose, there is less evidence about conditions that support the effective expansion and sustainment of existing models. Other harm reduction interventions such as overdose prevention centers and safer supply programs have promising international evidence but are prohibited or severely restricted under US law. In this review, we summarize the evidence for harm reduction interventions, describe the policy environment in which they exist, and provide recommendations to better align drug policy with existing and emerging evidence in the US context.

Immunization has saved an estimated 154 million lives over the past 50 years since the launch of the Essential (formerly Expanded) Program on Immunization in 1974, representing 6 lives saved every minute, every year, for 50 years. But achieving and maintaining high immunization coverage have required sustained political and public commitment, financial resources, strong partnerships, research and innovation, and communication and advocacy. New and evolving challenges to maintaining high immunization coverage have emerged alongside long-standing stubborn obstacles. We review some of these key challenges to immunization in this dynamic, changing world and summarize some promising solutions. Success in some regions of the world in eliminating polio, measles, and rubella, and reducing morbidity and mortality from other vaccine-preventable diseases, should provide hope that progress can be made in achieving and maintaining high immunization coverage. We cannot afford to do otherwise.

Development and amplification of effective, culturally resonant, trustworthy, and evidence-based public health communication are urgently needed. Research evidence, theory, and practical experience from within and beyond the interdisciplinary field of health communication are well-positioned to help public health authorities, researchers, and advocates navigate the complex societal challenges that influence health and well-being in global contexts. This review offers a broad overview of the field, considers what constitutes “effectiveness” versus “effects” in public health communication, and describes core concepts of public health communication as a process rather than a product. We review domains and dominant foci of public health communication research, articulate challenges for health communication to advance health and social equity and address mis-/disinformation, and offer practical guidance on message development, audience segmentation, multilevel intervention, and evaluation of communication programs. We conclude by identifying important questions for future public health communication research, interventions, and funding.

The Roe era was hardly a monolith. For more than 50 years—beginning with abortion reforms in the 1960s and continuing through the Dobbs decision in 2022—state regulations of abortion were neither uniform nor consistent. States reformed and repealed abortion bans leading up to the Roe decision in 1973. Following Roe, they enacted both demand-side regulations of people seeking abortions and supply-side regulations of people providing abortions. The resulting laboratory of state policies affords natural experiments that have yielded evidence on the effects of abortion regulations on demographic, health, economic, and other social outcomes. I present a brief history of state policy variation from 1967 through 2016 and review the empirical scholarship studying its effects. This literature demonstrates that the liberalization of abortion access in the 1960s and 1970s allowed women greater control over their fertility, resulting in increased educational attainment and earnings. Subsequent state restrictions in the 1980s through 2010s had the opposite effect, particularly when they increased the financial and logistical costs of obtaining an abortion. I conclude with a discussion of implications for the post-Dobbs era, considering to what extent evidence from the past foretells the future.

The health care safety net provides essential clinical care and social services for low-income, uninsured, and underinsured populations in the United States. Despite these important functions, the health care safety net has experienced recurrent financial instability, growing market pressures, and workforce strain. Payment reform has also introduced unique challenges for safety net providers related to measuring and reaching quality benchmarks. A common theme among these challenges is that many of them result from applying standard health policy approaches to the safety net instead of using safety net–specific approaches. This review describes progress toward strengthening the safety net, key challenges, and opportunities moving forward.

Unmet social needs (e.g., housing instability, food insecurity, transportation barriers) impact a patient's ability to participate in health-seeking behaviors (e.g., physical activity, routine preventive care) and to achieve optimal health. A rapidly growing number of health care systems are incorporating social needs screening and assistance into clinical workflows, yet many implementation and sustainability challenges exist and require collaboration with social service organizations. This review highlights implementation approaches used within this rapidly changing US landscape and uses implementation science frameworks to systematically identify multilevel barriers to and facilitators of implementing and sustaining social needs care. Policies and economic investments are necessary as they determine critical barriers and facilitators within the clinical and social service contexts. Implementation may be further strengthened by cross-sector engagement, evidence-based implementation strategies, and capacity building within clinical and social service organizations. Successful, sustained implementation of social needs care may improve the quality of health care, population health, and health equity.

The Roe era was hardly a monolith. For more than 50 years—beginning with abortion reforms in the 1960s and continuing through the Dobbs decision in 2022—state regulations of abortion were neither uniform nor consistent. States reformed and repealed abortion bans leading up to the Roe decision in 1973. Following Roe, they enacted both demand-side regulations of people seeking abortions and supply-side regulations of people providing abortions. The resulting laboratory of state policies affords natural experiments that have yielded evidence on the effects of abortion regulations on demographic, health, economic, and other social outcomes. I present a brief history of state policy variation from 1967 through 2016 and review the empirical scholarship studying its effects. This literature demonstrates that the liberalization of abortion access in the 1960s and 1970s allowed women greater control over their fertility, resulting in increased educational attainment and earnings. Subsequent state restrictions in the 1980s through 2010s had the opposite effect, particularly when they increased the financial and logistical costs of obtaining an abortion. I conclude with a discussion of implications for the post-Dobbs era, considering to what extent evidence from the past foretells the future.

The prevalence of burnout among health workers is alarmingly high and worsening. Many factors across the domains of culture of wellness, efficiency of practice and work demands, and personal resilience place workers at risk for burnout. Intervention research has disproportionately studied individually focused interventions to strengthen personal resilience, demonstrating small benefit from such interventions. While coping strategies may have value, we stress the need to focus interventions on mitigating work conditions that breed burnout, such as inadequate levels of staffing, and to rigorously evaluate such interventions. A conceptual framework on burnout must include critical theory interrogating the broader economic, political, and structural forces shaping health care and the relative power of workers. The concept of moral injury may be more apt than burnout for describing the effects on workers’ well-being of accelerating health care consolidation by investor-owned organizations, government austerity policies, and the disempowered position of labor.

Human-centered design (HCD) is an approach that aligns innovation development with the needs of the people and the settings where those innovations will be used. HCD is increasingly being applied across a variety of health domains, most often with the goals of translating research into real-world settings and expanding innovation adoption. This review introduces key HCD concepts, reviews the growth of HCD in public health and its alignment with the complementary field of implementation science, and details four prominent proximal outcomes of design processes: (a) usability, (b) user burden, (c) contextual appropriateness, and (d) engagement. For each outcome, we provide a definition and background, measurement options, and critiques and future directions. We conclude with a series of opportunities and challenges, including an inclusive big tent spanning different design traditions, pathways for enhancing HCD's scientific legitimacy, and explicit promotion of equitable design processes to improve individual, community, and population health.

We summarize the state of the evidence on the long-term services and supports infrastructure to support aging-in-place. We find an extensive literature describing the importance of affordable medical and social services delivered in the home, support for family caregivers, and the role of technology for improving communication among patients, caregivers, and health care teams to support aging-in-place. We identify gaps in access to affordable services and an inadequate workforce prepared to support aging-in-place, raising concerns about meeting the future needs of our aging population. Interventions have been directed primarily at the individual level rather than at the system or policy level. Those systems-level interventions that do exist have been primarily within the health care sector: Little attention has been directed at developing holistic interventions that address multiple sectors, which reflects the lack of a cohesive public health delivery system for long-term services and supports nationally. Our findings collectively highlight the multifaceted nature of supports to enable aging-in-place and the necessity for future research to focus on drawing connections across domains of health services infrastructure.

Among health care researchers, there is increasing debate over how best to assess and ensure the fairness of algorithms used for clinical decision support and population health, particularly concerning potential racial bias. Here we first distill concerns over the fairness of health care algorithms into four broad categories: (a) the explicit inclusion (or, conversely, the exclusion) of race and ethnicity in algorithms, (b) unequal algorithm decision rates across groups, (c) unequal error rates across groups, and (d) potential bias in the target variable used in prediction. With this taxonomy, we critically examine seven prominent and controversial health care algorithms. We show that popular approaches that aim to improve the fairness of health care algorithms can in fact worsen outcomes for individuals across all racial and ethnic groups. We conclude by offering an alternative, consequentialist framework for algorithm design that mitigates these harms by instead foregrounding outcomes and clarifying trade-offs in the pursuit of equitable decision-making.

The health care safety net provides essential clinical care and social services for low-income, uninsured, and underinsured populations in the United States. Despite these important functions, the health care safety net has experienced recurrent financial instability, growing market pressures, and workforce strain. Payment reform has also introduced unique challenges for safety net providers related to measuring and reaching quality benchmarks. A common theme among these challenges is that many of them result from applying standard health policy approaches to the safety net instead of using safety net–specific approaches. This review describes progress toward strengthening the safety net, key challenges, and opportunities moving forward.

A 2008 review in the Annual Review of Public Health considered the question of whether health insurance improves health. The answer was a cautious yes because few studies provided convincing causal evidence. We revisit this question by focusing on a single outcome: mortality. Because of multiple high-quality studies published since 2008, which exploit new sources of quasi-experimental variation as well as new empirical approaches to evaluating older data, our answer is more definitive. Studies using different data sources and research designs provide credible evidence that health insurance coverage reduces mortality. The effects, which tend to be strongest for adults in middle age or older and for children, are generally evident shortly after coverage gains and grow over time. The evidence now unequivocally supports the conclusion that health insurance improves health.

Achieving health equity necessitates high-quality data to address disparities that have remained stagnant or even worsened over time despite public health interventions. Data disaggregation, the breakdown of data into detailed subcategories, is crucial in health equity research. It reveals and contextualizes hidden trends and patterns about marginalized populations and guides resource allocation and program development for specific needs in these populations. Data disaggregation underpins data equity, which uses community engagement to democratize data and develop better solutions for communities. Years of research on disaggregation show that researchers must collaborate closely with communities for adequate representation. However, despite generally positive support for this approach in health disparities research, data disaggregation faces methodological and political challenges. This review offers a framework for understanding data disaggregation in the context of data equity and highlights critical aspects of implementation, including challenges, opportunities, and recent policy and community-based efforts to address hurdles.

Estimation of the disease burden attributable to environmental factors is a powerful tool for prioritizing environmental and pollution management and public health actions around the world. The World Health Organization (WHO) began estimating the environmental disease burden in 2000, which has formed the basis for the modern estimation approach conducted in the Global Burden of Disease, Injuries, and Risk Factor (GBD) study. In 2021, environmental and occupational risk factors in the GBD were responsible for 18.9% (12.8 million) of global deaths and 14.4% of all disability-adjusted life years (DALYs), led by ambient PM2.5 air pollution (4.2% DALYs, 4.7 million deaths) and household air pollution from the use of solid fuels for cooking (3.9% DALYs, 3.1 million deaths). Climate change exacerbates many environmental hazards, leading to increased disease burdens from heat, air pollution, vector-borne diseases, storms, and flooding. Other environmental risk factors not included in the GBD, such as poor indoor air quality, various chemical exposures, and environmental noise pollution, also significantly contribute to disease burden in many countries, though more efforts are needed to generate and integrate data resources for inclusion in global estimations.

Health is at the forefront of clean air and climate action. However, most existing studies of health impacts were based on additive single-exposure effects, which often oversimplify the relationships between atmospheric components and health outcomes. This review examines various atmospheric components’ common sources and differential health effects, including greenhouse gases and major air pollutants such as fine particulate matter (PM2.5). It emphasizes the need for a comparative assessment of health impacts across various atmospheric components. We further highlight black carbon as an illustrative example, given its higher toxicity compared with other major PM2.5 components. By integrating the best available findings on the differential effects of particulate matter components with multiple gridded estimates of air pollution concentrations and population data, we conducted a risk assessment to quantify the health benefits of particulate matter reductions associated with China's clean air actions (2013–2020) and future climate mitigation scenarios (2020–2060). Our assessments indicate that, in regions or during periods where black carbon accounts for a higher proportion of exposure reduction relative to other PM2.5 components, reducing per-unit concentrations of PM2.5 can prevent more premature deaths. We propose a conceptual framework for a health-oriented strategy to enhance the effectiveness of clean air and climate initiatives.

While energy transitions have always taken place, shifts have historically been primarily from one type of fossil fuel to another (e.g., from coal to oil). Yet today we are experiencing transitions away from fossil fuel toward cleaner and sustainable energy sources. These transitions include shifts to renewable energy, electric vehicles, pedestrian pathways and more walkable cities, energy efficiency measures in the built environment, and increased public transportation. This restructuring of our energy system will bring impacts on public health (e.g., improved air quality from lower use of traditional gasoline-powered vehicles). Furthermore, the transition can lower emissions of greenhouse gases (GHGs), thereby helping slow climate change and minimize its anticipated impacts on public health. While more work is needed to understand the full implications of these energy transitions, including the implications for environmental justice in terms of who will share in the health benefits and potential detriments such as increased emissions from brake wear for electric vehicles, the existing literature indicates substantial benefits to public health. Moving away from fossil fuel may offer a rare win-win strategy for a healthier society with a cleaner environment and lower GHGs.

Human-centered design (HCD) is an approach that aligns innovation development with the needs of the people and the settings where those innovations will be used. HCD is increasingly being applied across a variety of health domains, most often with the goals of translating research into real-world settings and expanding innovation adoption. This review introduces key HCD concepts, reviews the growth of HCD in public health and its alignment with the complementary field of implementation science, and details four prominent proximal outcomes of design processes: (a) usability, (b) user burden, (c) contextual appropriateness, and (d) engagement. For each outcome, we provide a definition and background, measurement options, and critiques and future directions. We conclude with a series of opportunities and challenges, including an inclusive big tent spanning different design traditions, pathways for enhancing HCD's scientific legitimacy, and explicit promotion of equitable design processes to improve individual, community, and population health.