In 2021, U.S. Navy personnel accidentally caused two releases of kerosene-based aviation fuel (jet propellant 5, or JP-5) from the Red Hill Bulk Fuel Storage Facility on O'ahu, Hawai'i, contaminating the drinking water supply for Joint Base Pearl Harbor-Hickam and the Aliamanu Military Reservation. This exposure impacted up to 93,000 individuals, disrupting their lives and, for many, resulting in acute and ongoing health concerns.
The Department of Veterans Affairs and the Defense Health Agency tasked the National Academies with convening an expert committee to make recommendations for monitoring the health of community members exposed. The resulting report was informed by exposed community members. It reviews and determines the strength of scientific evidence; reviews available exposure assessments and models: provides recommendations on clinical surveillance, testing, and care: and identifies research needs.
Topics: Environment and Environmental Studies » Pollutants and Toxics | Environment and Environmental Studies » Environmental Health and Safety
Sickle cell disease (SCD), a group of inherited blood disorders affecting approximately 100,000 people in the U.S., is a life-long condition that impacts every organ system in the body. Symptoms and complications vary from mild to severe and can include acute and chronic pain, acute chest syndrome, stroke, and organ damage. The cumulative burden of SCD-related health effects can affect an individual's quality of life as well as their ability to participate in school and work. These factors impact how the Social Security Administration (SSA) determines whether applicants with SCD qualify for benefits.
The SSA tasked the National Academies with convening an expert committee to review the latest published scientific research and address best practices and patient experiences in the management and treatment of SCD. The resulting report, Sickle Cell Disease in Social Security Disability Evaluations, presents the committee's findings and conclusions including the importance of coordinated care and support for patients navigating the transition from pediatric to adult health care.
Topics: Health and Medicine » Other Diseases | Health and Medicine » Healthcare and Quality
Recent advances in pediatric health, such as declines in child mortality, would never have happened without significant and consistent federal investment - supported by Congress and led by the National Institutes of Health (NIH). Despite these advances, there is broad consensus among experts that child health is in crisis as children in the United States are experiencing rising rates of chronic diseases and poor mental, emotional, and behavioral health.
NIH tasked the National Academies with convening a committee to examine NIH's pediatric research portfolio and structure and to provide recommendations focused on improving NIH's overall support of pediatric health research. The resulting report provides evidence and eight recommendations to guide NIH's integration of a pediatric and life-course focus throughout its research and funding priorities.
Topics: Health and Medicine » Children's Health | Health and Medicine » Health Sciences | Policy for Science and Technology » Research and Data
Early relationships are foundational for lifelong health, learning, and well-being. Mutual, meaningful, and affirming moments of connection in the youngest relationships support brain development, resilience, and social-emotional growth. These experiences, known as early relational health (ERH), can also buffer the impacts of adversity and help create pathways toward thriving children, families, and communities.
Early Relational Health: Building Foundations for Child, Family, and Community Well-Being provides evidence-based opportunities for advancing ERH. Developed by a committee of experts, this report highlights opportunities for practice, policy, and research to strengthen supportive relationships. It emphasizes asset-based approaches, family and community leadership, workforce supports, and cross-sector collaboration to promote ERH across health care, education, and social systems.
Topics: Behavioral and Social Sciences » Children, Youth and Families | Behavioral and Social Sciences » Population Studies | Health and Medicine » Children's Health
The scientific community has been studying the question of how human-caused emissions of greenhouse gases are affecting the climate for well over a century. Much is known today, drawing on decades of direct observations of the Earth system and detailed research. This report summarizes the latest evidence on whether greenhouse gas emissions threaten public health and welfare in the United States.
The impetus for this report was a notice of proposed rulemaking issued in August 2025 by the U.S. Environmental Protection Agency (EPA) indicating its intention to rescind the 2009 Finding of Endangerment and Cause or Contribute Findings for Greenhouse Gases Under Section 202(a) of the Clean Air Act. Recognizing that significantly more evidence is available today, the National Academies of Sciences, Engineering, and Medicine launched this study to review newly available scientific evidence on the topics included in a Technical Support Document that EPA prepared to inform its decision-making on the finding.
The report’s authoring committee found that EPA’s 2009 finding that human-caused emissions of greenhouse gases adversely affect human health and welfare was accurate, has stood the test of time, and is now reinforced by even stronger evidence. Today, many of EPA’s conclusions are further supported by longer observational records and multiple new lines of evidence. Moreover, research has uncovered additional risks that were not apparent in 2009.
Topics: Environment and Environmental Studies » Climate Change | Environment and Environmental Studies » Environmental Health and Safety | Health and Medicine » Environmental Health
Individuals and families across the United States face growing challenges in accessing timely, high-quality primary care, which is essential to overall health and well-being. The delivery of such care is becoming more complex, placing undue strain on primary care clinicians and exacerbating existing workforce shortages.
A National Academies committee recently examined the inputs and functions needed for interprofessional teams to successfully and sustainably deliver high-quality primary care. The committee concluded the nation must support the primary care workforce through appropriate and supportive payment; hold payers, states, and health systems accountable in ensuring that such payment reaches primary care practices; and sufficiently train an interprofessional workforce. This report offers nine specific recommendations for how federal agencies and other key players can better support the provision of high-quality, interprofessional, team-based primary care.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Education and Training | Education » Medical Training and Workforce
Military families raising children with autism often face unique challenges in accessing consistent, high-quality care across frequent moves and deployments. Applied behavior analysis, or ABA, is widely recognized as an effective intervention for many autistic individuals, yet military families report barriers that delay or restrict their access to these services.
The report The Comprehensive Autism Care Demonstration: Solutions for Military Families examines how the Department of Defense's autism care demonstration program is serving families and whether ABA should be covered as a TRICARE Basic benefit. Drawing on a careful review of the scientific literature, the report finds that ABA meets the Department's own standards for reliable medical evidence and should be formally authorized as a TRICARE Basic benefit.
The report identifies key areas where current demonstration policies differ from clinical standards. These include restrictive rules around assessments, limited flexibility in treatment goals and settings, and administrative requirements that impose unnecessary burdens on both families and ABA providers.
Topics: Behavioral and Social Sciences » Children, Youth and Families | Health and Medicine » Children's Health | Health and Medicine » Healthcare and Quality
Every community across the United States faces impacts on their health and well-being from a wide range of sources including pollution of air, water, and soil and extreme events such as wildfires and other natural or human-caused disasters. Impacts may be heightened by factors such as unaffordable housing, limited or no access to healthcare, poverty, and unemployment. Cumulative impact assessment (CIA) is a tool to help environmental and other relevant decision-makers consider multiple factors in evaluating priorities and potential changes in policies or regulations, with a focus on improving health and well-being.
In response to a request from the U.S. Environmental Protection Agency (EPA), this report provides recommendations on the state of the science of CIA and on fostering its application at the community, state, regional, tribal, and national levels. On the basis of input gathered in a number of public meetings, the report recommends EPA expand its CIA framework in important conceptual ways, including to encompass multiple dimensions of health and well-being. Further, the factors that undermine health and well-being (stressors) should be distinguished from those that promote health and well-being (resources).
State of the Science and the Future of Cumulative Impact Assessment lays out an expanded, five-step process for cumulative impact assessment that is driven by ongoing meaningful engagement and includes a final step of monitoring and evaluation of decisions implemented. This report's authoring committee applied its recommended five-step process to eight case studies across different contexts and scales - including the region in Louisiana known as "cancer alley"; a tribal population in Colorado; the train derailment and chemical fire in East Palestine, Ohio; the Los Angeles, California wildfires; and the replacement of lead service lines across the nation - concluding that the recommendations can increase the effectiveness of actions to improve health and well-being.
Topics: Environment and Environmental Studies » Environmental Health and Safety | Environment and Environmental Studies » Policy, Reviews and Evaluations | Health and Medicine » Environmental Health
The Centers for Disease Control and Prevention's (CDC) Immunization Safety Office (ISO) is responsible for studying vaccine risks once vaccines are administered to the public. During the COVID-19 pandemic, ISO played a central role in vaccine safety evaluation.
At the request of the CDC, the National Academies convened an expert committee to assess the ISO's statistical and epidemiological methods in vaccine risk monitoring and evaluation, including processes designed to detect, evaluate, and report potential problems associated with COVID vaccines. The committee also evaluated CDC's external communication strategies and provided recommendations to sustain and enhance ISO's vaccine risk monitoring and communication systems. The resulting report presents the committee's conclusions and recommendations.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Policy, Reviews and Evaluations
Military personnel, who are often exposed to a variety of hazards while deployed, have expressed concerns that mental, behavioral, and neurologic health issues may arise from these exposures. The U.S. Department of Veterans Affairs, in accordance with Section 507 of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), requested that the National Academies convene a committee of experts to assess possible relationships between exposures experienced during military service and mental, behavioral, and neurologic health conditions and chronic multisymptom illness. Consistent with the PACT Act, the committee focused on veterans deployed to the Southwest Asia Theater of Operations or Afghanistan after September 11, 2001. The resulting report offers conclusions regarding possible risk-conferring relationships between nine categories of exposures and health outcomes including depression, anxiety, and dementia.
Topics: Health and Medicine » Military and Veterans | Health and Medicine » Mental Health and Behavior | Health and Medicine » Environmental Health
This is the first of two reports requested by the Social Security Administration (SSA) to address best practices and community experiences in the management and treatment of sickle cell disease (SCD). SCD, a group of inherited blood disorders affecting approximately 100,000 people in the United States, is a chronic, life-long condition that affects every organ system in the body. The life of an individual with SCD is often complicated by frequent bouts of extreme pain and hospitalizations, fatigue, organ damage, and mental health conditions. The cumulative burden of SCD-related health effects can significantly affect quality of life, including the ability to regularly attend and participate fully in school and work.
In response to SSA's request, the National Academies of Sciences, Engineering, and Medicine convened an expert, ad hoc committee to review the latest published scientific research and generate findings and conclusions on a variety of topics related to SCD. This report is the first report in a two-report series, and presents the committee's findings and conclusions pertaining to SCD pain crises, pain management, and treatment settings relevant to SSA disability determinations.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
The United States is a global leader in biomedical research, generating therapeutic breakthroughs that advance the health of the nation and the world. The public and private sectors contribute to this advancement by funding biomedical research and development. The current level of investment in pharmaceutical development in the United States, while substantial, does not always yield desired health outcomes or meet the needs of patients. Public and private funders face a myriad of challenges that affect their funding decisions and hinder the ability of the drug development system to prioritize disease burden and unmet need - often leaving critical gaps in available treatment options.
To better understand these gaps, Gates Ventures and the Peterson Center on Healthcare asked the National Academies to examine current challenges and offer strategies and recommendations for improvement. The resulting report emphasizes that current research prioritization does not systematically account for disease burden and unmet needs, and describes how a robust, timely, accessible data system is needed. It also explores the ways in which implementing recommended policy changes could deliver better health outcomes.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Medical Technologies and Treatments | Health and Medicine » Policy, Reviews and Evaluations
Emerging Cognitive Neuroscience and Related Technologies, from the National Research Council, identifies and explores several specific research areas that have implications for U.S. national security, and should therefore be monitored consistently by the intelligence community. These areas include:
As these fields continue to grow, it will be imperative that the intelligence community be able to identify scientific advances relevant to national security when they occur. To do so will require adequate funding, intelligence analysts with advanced training in science and technology, and increased collaboration with the scientific community, particularly academia.
A key tool for the intelligence community, this book will also be a useful resource for the health industry, the military, and others with a vested interest in technologies such as brain imaging and cognitive or physical enhancers.
Topics: Health and Medicine » Military and Veterans | Behavioral and Social Sciences » Aging
For over 60 years, public health newborn screening programs have served families in the United States by identifying babies at risk of serious but treatable conditions and connecting them to clinical care. Today, more than 98% of infants receive dried blood spot screening, which entails collecting a few drops of blood during the first days of life, applying them to a paper card, and sending the card to a lab to be tested for markers of specific health conditions like congenital hypothyroidism, cystic fibrosis, and sickle cell disease. The public health impacts of newborn screening are vast, with over 7,000 infants identified annually for timely interventions. Despite these achievements, challenges in implementing newborn screening programs persist.
In response to a congressional request, the Office on Women's Health of the U.S. Department of Health and Human Services asked the National Academies to convene an ad hoc committee of subject matter experts to examine the current landscape of newborn screening in the United States, recommend options to strengthen this public health service, and establish a vision for the future. Supplementary funding was provided by the Chan Zuckerberg Initiative to enable additional public engagement. The resulting report provides actionable recommendations for navigating the path ahead while preserving and enhancing what is already considered a valuable and effective public health achievement.
Topics: Health and Medicine » Children's Health | Health and Medicine » Policy, Reviews and Evaluations | Behavioral and Social Sciences » Children, Youth and Families
Visual field is the total area of space a person can see when the eyes are focused on a central point. Impairment of the visual field can have significant negative effects on well-being. Individuals with moderate to severe visual field loss may have difficulty performing routine tasks, such as reading, driving, and navigating environments, as well as engaging in social activities. More profound loss leads to greater disability and poorer quality of life. Nearly 8 million people in the U.S. indicate they have blindness or difficulty seeing even while wearing corrective lenses, and the prevalence of visual impairment among U.S. preschool-aged children may be as high as five percent.
Testing for visual field impairment involves a combination of hardware, stimuli, testing patterns, and algorithms. The Social Security Administration (SSA) uses the results of such testing to determine whether applicants for disability based on visual field loss qualify for benefits. In response to a request from SSA, the National Academies convened a committee of experts to review the research and science on methods for testing visual field impairment. The resulting report reviews current and emerging practices and known limitations in visual field testing and offers conclusions to inform disability evaluations.
Topics: Health and Medicine » Medical Technologies and Treatments | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
As people get older, they become more likely to have hearing difficulties in certain situations; for example, having conversations in public settings where there is naturally more noise. This can sometimes lead to isolation, depression, or even fatigue from the effort needed to communicate with others. Clinicians and researchers often do not use standardized outcome measures for hearing interventions that reflect patients' perceptions of real-life improvements.
The National Academies of Sciences, Engineering, and Medicine convened a committee of experts to identify a core set of outcomes and corresponding measures that researchers and clinicians should use each time they assess the effectiveness of hearing aids and other treatments in addressing hearing difficulties. The resulting report, Measuring Meaningful Outcomes for Adult Hearing Health Interventions, presents those outcomes and measures, as well as recommendations for promoting their use within the hearing health community.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Public Health and Prevention
Over the last decade, advances in artificial intelligence (AI) technologies have created transformational opportunities for health, health care, and biomedical science. While new tools are available to improve effectiveness and efficiency in myriad applications in health and health care, challenges persist, including those related to increasing costs of care, staff burnout and shortages, and the growing disease burden of an aging population. The need for new approaches to address these long-standing challenges is evident and AI offers both new hope and new concerns.
An Artificial Intelligence Code of Conduct for Health and Medicine: Essential Guidance for Aligned Action presents a unifying AI Code of Conduct (AICC) framework developed to align the field around responsible development and application of AI and to catalyze collective action to ensure that the transformative potential of AI in health and medicine is realized. Designed to be applied at every level of decision making—from boardroom to bedside and from innovation labs to reimbursement policies—the publication serves as a blueprint for building trust, protecting patients, and ensuring that innovation benefits people.
Topics: Computers and Information Technology » Information Technology | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Around 10-20% of people who contract Lyme disease, the most common tickborne disease in the U.S., develop persistent, often debilitating symptoms such as chronic pain, fatigue, and cognitive dysfunction. Lyme infection-associated chronic illnesses (IACI) share symptoms common to other IACI such as Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome. Despite the chronic impact on the quality of life for many people, there are currently no validated interventions to treat Lyme IACI.
In response to this unmet need, the Steven & Alexandra Cohen Foundation asked the National Academies to convene a committee of experts to assess the evidence for disease mechanisms, diagnoses, and treatments of Lyme IACI and illuminate a pathway for the development of new treatments. The resulting report, Charting a Path Toward New Treatments for Lyme Infection-Associated Chronic Illnesses, makes recommendations around developing treatments that improve function and quality of life based on currently available evidence, while continuing research to identify root causes and mechanisms of the disease.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
Mental, emotional, and behavioral (MEB) disorders, including mental illness and substance use disorders, affect every U.S. population group, community, and neighborhood. Existing infrastructure focuses more on responding to MEB crises, through treatment and recovery, rather than preventing them through evidence-based policy approaches and programs. Prevention services that do exist are insufficiently funded and fragmented.
Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders focuses on building and sustaining a comprehensive prevention infrastructure for MEB disorders as a whole. Conclusions and recommendations of this report focus on closing research gaps, supporting an MEB disorder prevention workforce, ensuring adequate data to support prevention and reporting, establishing clear governance, securing sustainable funding, and enacting evidence-based policies.
Topics: Health and Medicine » Mental Health and Behavior | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
When someone experiences the loss of a limb or severe facial disfigurement, one of their options may be vascularized composite allotransplantation (VCA), which transfers a graft containing multiple tissues transferred as a functional unit. Using VCA to restore the functionality and aesthetics of a lost upper limb or disfigured face is a profound and life-altering gift; however, the process and the decision to accept (or donate) a VCA graft is complex and deeply emotional. In addition to psychosocial considerations, a VCA recipient must commit to undergoing years of rigorous rehabilitation, have a robust support system in place, and accept and understand the risks of being on immunosuppressive drugs for the rest of their life. Despite VCA advances over the last 25 years, challenges remain, and the small number of recipients of face or hand transplants makes it difficult to generalize outcomes.
To address these challenges, the Department of Defense Reconstructive Transplant Research Program tasked a committee of the National Academies with developing principles and a framework for the standardization, assessment, and validation of protocols and standard operating procedures for face and hand transplantation. The resulting report offers guidance for the newly established Clinical Organization Network for Standardization of Reconstructive Transplantation (CONSORT), but it also includes specific recommendations to enable the larger VCA community to mature, advance, and thrive into the future.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Healthcare and Quality | Health and Medicine » Medical Technologies and Treatments
Formula is often the sole source of nutrition for many infants, making its safety and quality particularly critical. While most food laws and regulations apply to infant formulas, they are also subject to additional requirements and manufacturer regulations for certain quality factors. These include an assessment of protein quality and demonstration that the formula supports normal infant physical growth.
Per the Food and Drug Omnibus Reform Act of 2022, the U.S. Food and Drug Administration asked the National Academies to examine and report on the state of the science regarding methodologies for assessing the biological quality of protein in infant formula and the ability of infant formula to support normal physical growth. The committee's statement of task noted that its analysis should include the examination of current study designs and methods that could demonstrate quality factors have been met. The resulting report presents conclusions, recommendations, and areas of future research to improve standardized procedures for assessing protein quality in infant formula.
Topics: Health and Medicine » Health Sciences | Food and Nutrition » Diet and Health | Food and Nutrition » Policy, Reviews and Evaluations
The integration of large language models (LLMs) and generative artificial intelligence (AI) in health care holds the potential to transform the practice of medicine, the work and experiences of health care providers, and the health and well-being of patients. Generative AI can support clinical decision making and streamline workflows, promote patients and their support networks' engagement in care processes, and support clinical research.
However, successful and ethical implementation of generative AI requires careful consideration of the associated risks, particularly those concerning data privacy, bias, transparency, and infrastructure limitations.
Generative Artificial Intelligence in Health and Medicine: Opportunities and Responsibilities for Transformative Innovation explores the transformative potential of generative AI in health care, with a focus on its applications in clinical decision making, administrative efficiency, and patient engagement.
Topics: Health and Medicine » Health Sciences | Computers and Information Technology » Computers
Since its founding, the Center for Medicare & Medicaid Innovation (CMMI) has tested more than 50 alternative payment models reaching more than 28 million patients across 528,000 health care providers and plans, yielding invaluable insights on the implementation of models to achieve better care, better health, and lower costs. On the other hand, many basic lessons learned are lessons unapplied. U.S. population health outcomes lag behind its highly economically developed peers and our health system is still firmly entrenched in the fee-for-service payment system that rewards service volume.
This Special Publication suggests six key priority actions for CMMI centered on signaling, mapping, measuring, modeling, partnering, and demonstrating. These priority actions, coupled with implementation considerations that focus on meaningful and continuous engagement, intersectionality and diversity, and expanding CMMI activities and impact, are intended to assist in aligning, supporting, and informing the implementation of CMMI’s Strategic Refresh.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Climate change is a defining health challenge of the 21st century. Its impacts, from heat-related illness and extreme weather to food insecurity and mental health distress, are already affecting populations across the United States and globally. However, gaps in research, data, infrastructure, and public engagement hinder the nation's ability to respond effectively and equitably.
A Research Agenda to Protect Human Health and Build Resilience in the Face of a Changing Climate outlines a bold vision to advance climate-health research. This agenda identifies key research domains including health impacts, adaptation and mitigation strategies, infrastructure and capacity building, and policy and public engagement. The publication provides actionable guidance to accelerate transdisciplinary science, inform evidence-based policy, and support community resilience, especially for those most vulnerable to climate threats.
Topics: Health and Medicine » Environmental Health | Environment and Environmental Studies » Environmental Health and Safety
Veterans are more likely than non-veterans to experience pain, trauma, and mental health challenges due to training and combat-related service. Treatment often results in the prescription of opioid and benzodiazepine medications.
In 2024, the National Academies were tasked with convening a committee of experts to evaluate the effects of these medications on all-cause mortality of veterans, including suicide, regardless of whether information relating to such deaths was reported to the U.S. Centers for Disease Control and Prevention.
The resulting report examines newly dispensed opioid pharmacotherapy in veterans without and with current benzodiazepine pharmacotherapy; varying levels of the initial baseline dosage and dosage escalation of dispensed opioid pharmacotherapy; and newly dispensed benzodiazepine compared to alternative non-benzodiazepine pharmacotherapy in veterans with consistent opioid pharmacotherapy.
Topics: Health and Medicine » Military and Veterans | Health and Medicine » Medical Technologies and Treatments | Health and Medicine » Health Sciences
Alzheimer's disease and related dementias (AD/ADRD), a collection of neurodegenerative conditions, take a heavy physical, emotional, and financial toll on individuals, families, and communities. Developing effective strategies for preventing and treating these conditions, which impact millions of people in the United States, is one of the most pressing needs in biomedical research today. The National Institutes of Health has invested billions of dollars in this research, which has led to numerous scientific advances over the last decade. However, the pace of progress has not kept up with the growing needs of people living with AD/ADRD and those at risk.
Consequently, the National Institute on Aging and the National Institute of Neurological Disorders and Stroke asked the National Academies to convene an expert committee to examine and assess the current state of biomedical research and recommend research priorities to advance the prevention and treatment of AD/ADRD. Preventing and Treating Dementia outlines these research priorities and recommends strategies to overcome barriers to progress.
Topics: Behavioral and Social Sciences » Aging | Health and Medicine » Aging | Behavioral and Social Sciences » Policy, Reviews and Evaluations
Women make up over half of the U.S. population, yet research on women's health conditions, including those that are female specific such as fibroids, more common among women such as anxiety, or affect women differently such as cardiovascular disease, is severely lacking. Medical advances for women have lagged, in part due to a lack of understanding of basic sex-based differences in physiology. To address this, the National Institutes of Health's (NIH) Office of Research in Women's Health tasked the National Academies with convening a committee of experts to assess the state of women's health research at NIH, identify critical knowledge gaps, assess the level of funding for women's health research, and more.
The resulting report outlines specific recommendations for NIH women's health research priorities; training and education efforts to build, support, and maintain a robust women's health research workforce; improving internal structures, systems and processes; soliciting, reviewing, and supporting women's health research; and ensuring appropriate levels of funding.
Topics: Health and Medicine » Women's Health | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
In 2023, the National Academies convened an expert committee to assess the current use of racial and ethnic categories in biomedical research, review existing guidance for researchers, and provide new guidance for future use. The resulting 2025 report, Rethinking Race and Ethnicity in Biomedical Research, outlines nine actionable recommendations and associated resources for advancing the responsible use of race and ethnicity.
The recommendations of Rethinking Race and Ethnicity in Biomedical Research address how to: decide whether to use race and ethnicity in different research contexts; characterize and disclose limitations of datasets that include racial and ethnic information; identify factors to investigate instead of or alongside race and ethnicity; include overlooked populations in analysis; and support sustained community engagement.
Topics: Health and Medicine » Health Equity | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
Ensuring every child is on an optimal trajectory to a healthy and productive adulthood is imperative for the nation's future. Investments in children and families improves child health, but also health equity, education outcomes, workforce productivity, and cost-effectiveness in public spending. Despite advances in health care, children, especially those from historically marginalized groups, face rising rates of chronic diseases, obesity, and mental health challenges.
Launching Lifelong Health by Improving Health Care for Children, Youth, And Families presents a vision for transforming the child and adolescent health care system. This report also examines how the health care system can be better positioned to equitably address the needs of all children and families and leverage community supports. This requires transforming key components, such as health care financing, public health investment, community partnerships, and accountability strategies, to encourage team-based care delivery models and attention to and health promotion, prevention, and root causes of health disparities.
Topics: Behavioral and Social Sciences » Children, Youth and Families | Health and Medicine » Healthcare and Quality | Health and Medicine » Children's Health
The COVID-19 pandemic sparked widespread implementation of wastewater surveillance in communities across the United States to help track the spread of the disease. In contrast to clinical laboratory testing that tracks individual cases of infection, wastewater surveillance provides a way to measure the amount of DNA from pathogens coming from homes, businesses, and other institutions that share a sewer system. To help coordinate and centralize early efforts, the U.S. Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS) in September 2020, with pilot sites in eight states. As of April 2024, the NWSS is receiving data from more than 1,300 active sampling sites, covering a population of 130 million individuals.
A Phase 1 report released in early 2023 examined the usefulness of the NWSS during the COVID-19 pandemic, described the potential value of a robust national wastewater surveillance system beyond COVID-19, and provided recommendations to increase the public health impact of such a system. This Phase 2 report details the technical constraints and opportunities to improve wastewater surveillance for the prevention and control of infectious diseases in the U.S. It recommends improvements in the consistency and quality of national wastewater sampling, testing, and data analysis, and identifies research and technology development needs for a national wastewater surveillance system that can serve ongoing and changing public health needs in the United States.
Topics: Health and Medicine » Public Health and Prevention | Environment and Environmental Studies » Policy, Reviews and Evaluations
The U.S. biomedical research enterprise has played a vital role in advancing science, human health, and the economy. It has contributed significantly to fields such as agriculture, environmental remediation, job creation, and technological innovation. Over the past 80 years, landmark achievements include reducing cancer mortality, developing HIV/AIDS treatments, sequencing the human genome, and creating vaccines that mitigated the impact of the COVID-19 pandemic. The enterprise has grown remarkably in less than a century and holds even greater potential for future success. However, its progress is hindered by a lack of high-level national coordination, a fragmented funding system, and a declining workforce.
The State of the U.S. Biomedical and Health Research Enterprise: Strategies for Achieving a Healthier America addresses these challenges in five key areas—strategic vision, funding, health equity, coordination and convergence science, and workforce development—offering a roadmap that could be used to sustain U.S. leadership in global health.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
Transgender and gender diverse (TGD) people and people with variations in sex traits (VSTs) can experience serious health challenges and often have a greater burden of disability or greater morbidity from chronic disease compared with the general population.
"Transgender and gender diverse" refers to people whose gender identity differs from what is typically associated with their sex recorded at birth. "Variations in sex traits" refers to genetic, anatomical, and hormonal variations that affect the genitourinary tract and reproduction systems; individuals with VSTs may have a sex and/or gender identity that differs from their sex recorded at birth.
The U.S. Social Security Administration (SSA) asked the National Academies to convene a committee of experts to evaluate how contemporary conceptions of sex and gender in medicine and current clinical guidelines impact disability determinations. The resulting report offers conclusions in key areas including (1) the collection of data on sex and gender identity, (2) disability considerations for SSA' Listings of Impairments (medical criteria that apply to the evaluation of disability) with sex-specific diagnostic criteria, (3) inclusive language in disability Listings of Impairments, and (4) guidance for adjudicators on assessing disability for TGD applicants and applicants with VSTs.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Health Equity
Over the past several decades, more than half of all U.S. states have legalized cannabis for adult and/or medical use, but it remains illegal at the federal level. The public health consequences of cannabis policy changes have not been comprehensively evaluated.
Therefore, the Centers for Disease Control and Prevention and the National Institutes of Health tasked the National Academies with reviewing cannabis and cannabinoid availability in the U.S., assessing regulatory frameworks for the industry with an emphasis on equity, and describing strengths and weaknesses of surveillance systems for cannabis.
The resulting report finds that there has been limited federal guidance to states regarding protecting public health, which has led to inconsistent protection across the states. The report recommends a strategy to minimize public health harms through stronger federal leadership, a robust research agenda, and more.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Health Equity | Health and Medicine » Policy, Reviews and Evaluations
Rare diseases, such as sickle cell disease and thalassemia, affect up to 30 million people in the United States and at least 300 million across the globe. Congress called on the U.S. Food and Drug Administration (FDA) to sponsor a National Academies study on processes for evaluating the safety and efficacy of drugs for rare diseases or conditions in the United States and the European Union. The resulting report provides recommendations for enhancing and promoting rare disease drug development by improving engagement with people affected by a rare disease, advancing regulatory science, and fostering collaboration between FDA and the European Medicines Agency.
Topics: Health and Medicine » Medical Technologies and Treatments | Health and Medicine » Policy, Reviews and Evaluations
About 20 percent of all Americans live with a behavioral health condition, but only half of this population receives treatment - with direct consequences that include poor physical health outcomes, increased health care costs, and reduced quality of life and life span.
Barriers to obtaining behavioral health treatment are most evident in populations receiving Medicare, Medicaid, and Marketplace plans. Behavioral health care providers serving individuals enrolled in these plans are more likely to experience challenges around reimbursement and training, which disincentivizes participation.
The Centers for Medicare & Medicaid Services and the Substance Abuse and Mental Health Services Administration asked the National Academies to convene an expert committee to examine current challenges in ensuring broad access to evidence-based behavioral health care services through Medicare, Medicaid, and Marketplace programs and propose strategies to address those challenges.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Women in the United States experience a higher prevalence of many chronic conditions, including Alzheimer's disease, depression, and osteoporosis, than men; they also experience female-specific conditions, such as endometriosis and pelvic floor disorders. A lack of research into both the biological and social factors that influence these conditions greatly hinders diagnosis, treatment, and prevention efforts, thus contributing to poorer health outcomes for women and substantial costs to individuals and for society.
The National Institutes of Health's Office of Research on Women's Health asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee to identify gaps in the science on chronic conditions that are specific to or predominantly impact women, or affect women differently, and propose a research agenda. The committee's report presents their conclusions and recommendations.
Topics: Health and Medicine » Women's Health
The United States is an important food producer globally, in part because of its abundance of agriculturally productive soils. However, management practices that maximize yields have caused losses in soil organic matter, poor soil structure and water-holding capacity, and increased salinity on millions of acres of land - and have adversely affected the microbial communities that are the drivers of many soil processes. At the same time, recent scientific advances have spurred interest in how microbial communities can support soil health, food quality, and human health.
It is in this context that the U.S. Department of Agriculture National Institute of Food and Agriculture asked the National Academies to explore the linkages between soil health and human health. The report finds that to improve soil health, federal agencies need to promote the importance of soil health, support translational research, and develop a coordinated national approach to monitor soil health over time and space. Given the potential that microbiomes have in modulating soil, plant, and human health, there is also a pressing need to determine which microbial features, if any, contribute to quantifying or fortifying health in both human and soil systems and to understand the direct and indirect roles of soil, alongside other environmental factors, in influencing human microbial colonization and subsequent health outcomes. Such investigation involves delving into the relatively sparse or disconnected research regarding the microbiome continuum that links soil and human systems.
Topics: Earth Sciences » Soil Science | Food and Nutrition » Production and Safety | Agriculture » Policy, Reviews and Evaluations | Health and Medicine » Environmental Health
Myopia, commonly called nearsightedness, has been increasing globally. If current trends continue, there will be 5 billion near-sighted individuals globally by 2050. The understanding of myopia has been enhanced by advances in genetics, investigations employing animal models, understanding of physiology, ocular imaging, epidemiology, environmental research, and clinical trials of interventional strategies. To further develop the knowledge base related to myopia and to reduce the incidence and negative consequences of the disease, eye care professionals, federal agencies, and funding agencies need to make improvements to standardize care, increase funding to study treatments, encourage outdoor time, and overall facilitate the standardization of assessments and diagnostics. Progress in these areas is imperative to address the current increase in myopia across the country.
Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease identifies and assesses the current mechanistic understanding of myopia pathogenesis and the causes of its increased prevalence. This report also examines knowledge gaps and barriers to progress and develops a research agenda aimed at better understanding the biological and environmental factors that could explain the increasing incidence of myopia.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Medical Technologies and Treatments
At any one time, at least 30,000 people in the U.S. are living with amyotrophic lateral sclerosis (ALS), a rapidly progressive, fatal neurological disease affecting individuals, caregivers, at-risk genetic carriers, and others. In 2022, Congress directed the National Institutes of Health to commission a National Academies committee of experts to recommend key actions public, private, and nonprofit sectors should take to make ALS a livable disease within the next 10 years. The resulting report, Living with ALS, focuses on an integrated ALS multidisciplinary care and research system to help facilitate earlier diagnosis and connections to specialty care.
Topics: Health and Medicine » Medical Technologies and Treatments | Health and Medicine » Healthcare and Quality | Health and Medicine » Health Sciences
Racial and ethnic inequities in health and health care impact individual well-being, contribute to millions of premature deaths, and cost the United States hundreds of billions of dollars annually. Addressing these inequities is vital to improving the health of the nation's most disadvantaged communities—and will also help to achieve optimal health for all. In 2003, the Institute of Medicine examined these inequities in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
Because disparities persist, the National Academies convened an expert committee with support from the Agency for Healthcare Research and Quality and the National Institutes of Health. The committee's report reviews the major drivers of health care disparities, provides insight into successful and unsuccessful interventions, identifies gaps in the evidence base, and makes recommendations to advance health equity.
Topics: Health and Medicine » Health Equity | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, many individuals infected with the virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have continued to experience lingering symptoms for months or even years following infection. Some symptoms can affect a person's ability to work or attend school for an extended period of time. Consequently, in 2022, the Social Security Administration requested that the National Academies convene a committee of relevant experts to investigate and provide an overview of the current status of diagnosis, treatment, and prognosis of long-term health effects related to Long COVID. This report presents the committee conclusions.
Topics: Health and Medicine » Infectious Disease
Vaccines are a public health success story, as they have prevented or lessened the effects of many infectious diseases. To address concerns around potential vaccine injuries, the Health Resources and Services Administration (HRSA) administers the Vaccine Injury Compensation Program (VICP) and the Countermeasures Injury Compensation Program (CICP), which provide compensation to those who assert that they were injured by routine vaccines or medical countermeasures, respectively. The National Academies of Sciences, Engineering, and Medicine have contributed to the scientific basis for VICP compensation decisions for decades.
HRSA asked the National Academies to convene an expert committee to review the epidemiological, clinical, and biological evidence about the relationship between COVID-19 vaccines and specific adverse events, as well as intramuscular administration of vaccines and shoulder injuries. This report outlines the committee findings and conclusions.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
Concerted efforts to deepen understanding of RNA modifications and their role in living systems hold the potential to advance human health, improve crop yields, and address other pressing societal challenges. RNA, which carries the information encoded by DNA to the places where it is needed, is amazingly diverse and dynamic. RNA is processed and modified through natural biological pathways, giving rise to hundreds, in some cases thousands, of distinct RNA molecules for each gene, thereby diversifying genetic information. RNA modifications are known to be pivotal players in nearly all biological processes, and their dysregulation has been implicated in a wide range of human diseases and disorders. Yet, our knowledge of RNA modifications remains incomplete, hindered by current technological limitations. Existing methods cannot discover all RNA modifications, let alone comprehensively sequence them on every RNA molecule. Nonetheless, what is known about RNA modifications has already been leveraged in the development of vaccines that helped saved millions of lives worldwide during the COVID-19 pandemic. RNA modifications also have applications beyond health, for example, enhancing agricultural productivity.
Charting a Future for Sequencing RNA and Its Modifications: A New Era for Biology and Medicine calls for a focused, large-scale effort to accelerate technological innovation to harness the full potential of RNA modifications to address pressing societal challenges in health, agriculture, and beyond. This report assesses the scientific and technological breakthroughs, workforce, and infrastructure needs to sequence RNA and its modifications, and ultimately understand the roles RNA modifications play in biological processes and disease. It proposes a roadmap of innovation that will make it possible for any RNA from any biological system to be sequenced end-to-end with all of its modifications - a capability that could lead to more personalized and targeted treatments and instigate transformative changes across various sectors beyond health and medicine.
Topics: Biology and Life Sciences » Genetics | Health and Medicine » Genetics | Health and Medicine » Health Sciences
The lack of a clear and consistent definition for Long COVID presents challenges for policymakers, researchers, public health professionals, clinicians, support services, and patients. As such, the Administration for Strategic Preparedness and Response and the Office of the Assistant Secretary for Health asked the National Academies to assemble a committee of experts to produce a consensus definition for Long COVID. The resulting report, A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences, presents the 2024 NASEM Long COVID Definition, developed based on findings reported in existing literature, as well as stakeholder and patient input.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Global Health | Health and Medicine » Policy, Reviews and Evaluations
Seafood--including marine and freshwater fish, mollusks, and crustaceans--is a healthy food choice, but it can also contain contaminants. It is currently unclear how much seafood children or pregnant and lactating women are consuming, and what impact seafood consumption is having on children's growth and development.
The U.S. Department of Health and Human Services, the U.S. Department of Agriculture, the U.S. Environmental Protection Agency, and the National Oceanic and Atmospheric Administration tasked the National Academies of Sciences, Engineering, and Medicine with convening an expert committee to examine associations between seafood intake for children, adolescents, and pregnant and lactating women and child growth and development. The committee also evaluated when to conduct risk-benefit analyses (RBAs), while considering contextual factors such as equity, diversity, inclusion, and access to health care, and explored how these factors might impact RBAs.
Topics: Health and Medicine » Children's Health | Food and Nutrition » Diet and Health | Health and Medicine » Policy, Reviews and Evaluations
Congress called on the National Academies to convene a committee to examine the real and perceived risks of liability arising from research conducted with pregnant and lactating women. The resulting report, Clinical Research with Pregnant and Lactating Populations: Overcoming Real and Perceived Liability Risks, explores and finds limited evidence of legal liability for inclusion of pregnant and lactating women in clinical research, contradicting perceptions of heightened liability. The committee also makes recommendations that could lead to a more robust evidence base about the safety and efficacy of medications for pregnant and lactating women that would facilitate more informed decision making regarding care while mitigating liability.
Topics: Health and Medicine » Women's Health | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
Climate change is increasing the frequency and severity of floods, posing serious threats to lives, livelihoods, and the future of affected communities. To explore opportunities to prevent and mitigate inequitable health impacts from flooding, the National Academies Environmental Health Matters Initiative (EHMI) organized a workshop on March 13 and 18, 2024, titled Communities, Climate Change, and Health Equity: Exploring Flood Adaptation Strategies to Support Health Equity. The workshop was the fourth in a series of EHMI events exploring the state of knowledge on climate-related health disparities. Through presentations, shared stories, and interactive discussions, participants explored health risks posed by flooding events, effective adaptation strategies for community resilience and climate adaptation, and ways to foster partnerships among government, academia, and the private sector to implement these strategies both locally and regionally.
Topics: Health and Medicine » Environmental Health | Health and Medicine » Public Health and Prevention | Health and Medicine » Emergency Medicine
At the request of the Administration for Strategic Preparedness and Response, the National Academies convened a committee to examine lessons learned from the COVID-19 pandemic and mpox multi-country outbreak to inform an evaluation of the state of smallpox research, development, and stockpiling of medical countermeasures (MCM). In the resulting report, the committee presents findings and conclusions that may inform U.S. Government investment decisions in smallpox MCM readiness, as well as the official U.S. position on the disposition of live viral collections at future World Health Assembly meetings.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Global Health
A National Academies committee was tasked with identifying essential health care services for women related to intimate partner violence (IPV) during steady state conditions, determining whether the essential health care services related to IPV differ during public health emergencies (PHEs), and identifying strategies to sustain access to those essential health care services during PHEs. This report, Essential Health Care Services Addressing Intimate Partner Violence, presents findings from research and deliberations and lays out recommendations for leaders of health care systems, federal agencies, health care providers, emergency planners, and those involved in IPV research.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
As the United States devotes extensive resources to health care, evaluating how successfully the U.S. system delivers high-quality, high-value care in an equitable manner is essential. At the request of Congress, the Agency for Healthcare Research and Quality (AHRQ) annually produces the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The reports have revealed areas in which health care performance has improved over time, but they also have identified major shortcomings. After five years of producing the NHQR and NHDR, AHRQ asked the IOM for guidance on how to improve the next generation of reports.
The IOM concludes that the NHQR and NHDR can be improved in ways that would make them more influential in promoting change in the health care system. In addition to being sources of data on past trends, the national healthcare reports can provide more detailed insights into current performance, establish the value of closing gaps in quality and equity, and project the time required to bridge those gaps at the current pace of improvement.
Topics: Health and Medicine » Health Equity | Health and Medicine » Healthcare and Quality | Health and Medicine » Public Health and Prevention
Social media has been fully integrated into the lives of most adolescents in the U.S., raising concerns among parents, physicians, public health officials, and others about its effect on mental and physical health. Over the past year, an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine examined the research and produced this detailed report exploring that effect and laying out recommendations for policymakers, regulators, industry, and others in an effort to maximize the good and minimize the bad. Focus areas include platform design, transparency and accountability, digital media literacy among young people and adults, online harassment, and supporting researchers.
Topics: Health and Medicine » Children's Health | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.
The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan's vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the "quintuple aim."
Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.
Topics: Health and Medicine » Policy, Reviews and Evaluations
Approximately 3.6 million live births occur every year in the United States. Between 8 and 9 percent of infants are born with low birth weight (LBW), defined by the medical community as less than 2,500 grams or 5.5 pounds at birth. While most infants born with LBW are not impacted by severe developmental disabilities or major or multiple health conditions, research indicates that these infants often do experience elevated rates of mild to moderate chronic health conditions that have meaningful functional impacts throughout an individuals life course.
The Social Security Administration (SSA) asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee to provide an overview of the current status of the identification, treatment, and prognosis of LBW babies, including trends in survivability, in the U.S. population under age 1 year. SSA also asked the committee to provide information on the short- and long-term functional outcomes associated with and the most common conditions related to LBW, available treatments and services, and other considerations. The resulting report, Low Birth Weight Babies and Disability, presents the committees conclusions.
Topics: Health and Medicine » Children's Health | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
The United States is experiencing a decline in life expectancy despite high health care spending due to a multitude of factors, including the COVID-19 pandemic, opioid epidemic, high burden of chronic disease, and systemic and structural inequities.
A response proportional to this crisis is required. Valuing America's Health: Aligning Financing to Reward Better Health and Well-Being explores opportunities to transform the current health and health care system to one that promotes whole person and whole population health. The publication emphasizes the need for a bold vision and sustainable financing strategies to prioritize health and well-being for all. Authors of the publication highlight the importance of building a movement to prioritize health, repairing systemic failures, holding stakeholders accountable, controlling health care costs, incentivizing health promotion, adopting collaborative financing and policy-making approaches, and empowering individuals and communities in health decision-making.
The way is clear; what is needed now is the will to move forward. Learn more about how to ensure our nation's health and health care system can support optimal health for all.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Advances in biomedical science, data science, engineering, and technology are leading to high-pace innovation with potential to transform health and medicine. These innovations simultaneously raise important ethical and social issues, including how to fairly distribute their benefits and risks. The National Academies of Sciences, Engineering, and Medicine, in collaboration with the National Academy of Medicine, established the Committee on Creating a Framework for Emerging Science, Technology, and Innovation in Health and Medicine to provide leadership and engage broad communities in developing a framework for aligning the development and use of transformative technologies with ethical and equitable principles. The committees resulting report describes a governance framework for decisions throughout the innovation life cycle to advance equitable innovation and support an ecosystem that is more responsive to the needs of a broader range of individuals and is better able to recognize and address inequities as they arise.
Topics: Health and Medicine » Health Equity | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
Pediatric subspecialists are critical to ensuring quality care and pursuing research to improve prevention, diagnosis, and treatment for children. However, there are substantial disincentives to pursuing a career as a pediatric subspecialist, which are often heightened for individuals from groups underrepresented in medicine, and more effective collaboration with primary care clinicians is needed. Changing health care needs, increasing care complexity, and access barriers to pediatric subspecialty care have raised concerns about the current and future availability of pediatric subspecialty care and research.
In response, the National Academies, with support from a coalition of sponsors, formed the Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being to recommend strategies and actions to ensure an adequate pediatric subspecialty physician workforce to support broad access to high quality subspecialty care and a robust research portfolio to advance the health and health care of infants, children, and adolescents. This report outlines recommendations that, if fully implemented, can improve the quality of pediatric medical subspecialty care through a well-supported, superbly trained, and appropriately used primary care, subspecialty, and physician-scientist workforce.
Topics: Behavioral and Social Sciences » Children, Youth and Families | Health and Medicine » Children's Health | Health and Medicine » Policy, Reviews and Evaluations
While there is a limited data on safety-sensitive professionals, substance use disorders potentially affect pilots and flight attendants at the same rate as the general population - around 15 percent - but due to the high-risk nature of their jobs, aircraft operators are held to a higher standard for substance misuse on the job.
To protect the safety of the public and the aviation workforce, the Human Intervention Motivation Study (HIMS) and the Flight Attendant Drug and Alcohol Program (FADAP) were launched to help treat critical aviation workers - pilots and flight attendants, respectively - who misuse substances. In response to a congressional mandate, this new report reviews available evidence on the effectiveness of HIMS and FADAP and offers recommendations for improving these programs.
Topics: Health and Medicine » Mental Health and Behavior | Transportation and Infrastructure » Aviation
Complementary feeding refers to the introduction of foods other than human milk or formula to an infants diet. In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children. The interventions studied took place in the U.S. and other high-income country health care systems; early care and education settings; university cooperative extension programs; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); home visiting programs; and other settings. This consensus study report summarizes evidence and provides information on interventions that could be scaled up or implemented at a community or state level.
Topics: Food and Nutrition » Policy, Reviews and Evaluations | Health and Medicine » Children's Health
Racially and ethnically minoritized populations and tribal communities often face preventable inequities in health outcomes due to structural disadvantages and diminished opportunities around health care, employment, education, and more. Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity analyzes how past and current federal policies may create, maintain, and/or amplify racial, ethnic, and tribal health inequities. This report identifies key features of policies that have served to reduce inequities and makes recommendations to help achieve racial, ethnic, and tribal health equity.
Topics: Health and Medicine » Health Equity | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United States is currently devoting 18% of its Gross Domestic Product to delivering medical care—more than $3 trillion annually and nearly double the expenditure of other advanced industrialized countries—the U.S. health system ranked only 37 in performance in a World Health Organization assessment of member nations. In Vital Directions for Health & Health Care: An Initiative of the National Academy of Medicine, the National Academy of Medicine (NAM), which has long stood as the nation's most trusted independent source of guidance in health, health care, and biomedical science, has marshaled the wisdom of more than 150 of the nation's best researchers and health policy experts to assess opportunities for substantially improving the health and well-being of Americans, the quality of care delivered, and the contributions of science and technology. This publication identifies practical and affordable steps that can and must be taken across eight action and infrastructure priorities, ranging from paying for value and connecting care, to measuring what matters most and accelerating the capture of real-world evidence. Without obscuring the difficulty of the changes needed, in Vital Directions, the NAM offers an important blueprint and resource for health, policy, and leaders at all levels to achieve much better health outcomes at much lower cost.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
In 2016, the National Academy of Medicine (NAM) hosted a series of meetings, which was sponsored by the Patient-Centered Outcomes Research Institute, with support from NAM's Executive Leadership Network. The series underscored the importance of partnerships between researchers and health system leadership and considered opportunities to build institutional capacity, cross-institutional synergy, and system-wide learning. During these meetings, health system executives, researchers, and others discussed building infrastructure that simultaneously facilitates care delivery, care improvement and evidence development. The vision is a digital system-wide progress toward continuous and seamless learning and improvement throughout health and health care. This publication aims to answer the following questions:
Topics: Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health equity for all. Organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of ways in which health disparities manifest in communities of color, this Special Publication provides a stark look at how health and well-being are nurtured, protected, and preserved where people live, learn, work, and play. All of our nation's institutions have important roles to play even if they do not think of their purpose as fundamentally linked to health and well-being. The rich discussions found throughout Perspectives on Health Equity and Social Determinants of Health make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved by health care alone. They cannot be solved by public health alone. Collective action is needed, and it is needed now.
Topics: Health and Medicine » Health Equity | Health and Medicine » Policy, Reviews and Evaluations
There is no question that opioid use disorder has become the fastest growing, serious, and far-reaching public health crisis facing our nation today. The growing and unprecedented opioid epidemic is a critical issue for public health and medical care throughout the country. Provisional estimates suggest that nearly 65,000 Americans died from a drug overdose in 2016, a 21% increase from the previous year and at a level higher than occurred during the peak years for deaths from HIV infection and automobile fatalities.
Nearly half of opioid overdose deaths are related to medications obtained legally by prescription, sparking deep concern among leaders in the health care sector. The need is clear for clinicians, as the "gatekeepers" of opioid prescriptions, and as the front line in facilitating access to treatment for addiction, to work together with state and community leaders to reduce the impact of opioid misuse on American communities.
At the request of the National Governors Association, the National Academy of Medicine convened a group of experts and field leaders to explore clinicians' roles in addressing opioid misuse and addiction. The resulting Special Publication is informed by, and builds on, initiatives and guidelines that have been stewarded by various stakeholder organizations providing leadership in addressing these issues. In the midst of evolving understanding of and experience in pain management and substance abuse, the authors offer to clinicians a set of axioms applicable both to responsible, appropriate opioid prescribing practices, and to recognition and treatment of substance use disorder. Also underscored are actions that clinicians can take to improve their skills and effectiveness in the face of the growing need, including leadership engagement to ensure that communities have the resources and tools that clinicians require to fulfill their responsibilities.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016. The resulting special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, summarizes the presentations, discussions, and relevant literature.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Health services research is "the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care and the quality and cost of health care." Since the 1960s, health services research has provided the foundation for progress, effectiveness, and value in health care. Ironically, at a time in which appreciation has never been higher for both the need and potential from health services research, the political and financial support for sustenance and growth appear to be weakening.
With funding support from AcademyHealth, the American Association of Colleges of Nursing, the American Board of Family Medicine, the American Society of Anesthesiologists, the Association of American Medical Colleges, the Federation of American Hospitals, and the Robert Wood Johnson Foundation, this National Academy of Medicine Special Publication identifies the range of issues that health services research must consider, address, and potentially overcome to transform the field to meet the needs of a 21st-century health care system. These issues are broad, multidisciplinary, and will require a coordinated effort to address—as well as dedicated and sustainable funding. Federal support for health services research has never been more critical. Now is a critical time for the field to articulate its priorities, demonstrate its utility, and transform to meet the needs of a 21st-century health care system. The physical and financial health of the nation is at stake.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Realizing the promise of digital technology will depend on the ability to share information across time and space from multiple devices, sources, systems, and organizations. The major barrier to progress is not technical; rather, it is in the failure of organizational demand and purchasing requirements. In contrast to many other industries, the purchasers of health care technologies have not marshaled their purchasing power to drive interoperability as a key requirement. Better procurement practices, supported by compatible interoperability platforms and architecture, will allow for better, safer patient care; reduced administrative workload for clinicians; protection from cybersecurity attacks; and significant financial savings across multiple markets.
With funding support from the Gordon and Betty Moore Foundation, this National Academy of Medicine Special Publication represents a multi-stakeholder exploration of the path toward achieving large-scale interoperability through strategic acquisition of health information technology solutions and devices. In this publication, data exchanges over three environments are identified as critical to achieving interoperability: facility-to-facility (macro-tier); intra-facility (meso-tier); and at point-of-care (micro-tier). The publication further identifies the key characteristics of information exchange involved in health and health care, the nature of the requirements for functional interoperability in care processes, the mapping of those requirements into prevailing contracting practices, the specification of the steps necessary to achieve system-wide interoperability, and the proposal of a roadmap for using procurement specifications to engage those steps. The publication concludes with a series of checklists to be used by health care organizations and other stakeholders to accelerate progress in achieving system-wide interoperability.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Evidence-based medicine arose from a clear need and represents a major advance in the science of clinical decision making. Despite broad acceptance of evidence-based medicine, however, a fundamental issue remains unresolved: evidence is derived from groups of people, yet medical decisions are made by and for individuals. Despite persistent assertions from clinicians that determining the best therapy for each patient is a more complicated endeavor than just picking the best treatment on average, traditional approaches have been overly reliant on the average effects estimated from the outcomes of clinical trials.
This Special Publication is based on a workshop, held by the National Academy of Medicine, that considered patient and stakeholder perspectives on the importance of understanding heterogeneous treatment effects (HTE) and best practices for implementing clinical programs that take HTE into account. For evidence to be more applicable to individual patients, we need to combine methods for strong causal inference (first and foremost, randomization) with methods for prediction that permit inferences about which particular patients are likely to benefit and which are not. Better population-based outcomes will only be realized when we understand more completely how to treat patients as the unique individuals they are.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
The emergence of artificial intelligence (AI) in health care offers unprecedented opportunities to improve patient and clinical team outcomes, reduce costs, and impact population health. While there have been a number of promising examples of AI applications in health care, it is imperative to proceed with caution or risk the potential of user disillusionment, another AI winter, or further exacerbation of existing health- and technology-driven disparities.
This Special Publication synthesizes current knowledge to offer a reference document for relevant health care stakeholders. It outlines the current and near-term AI solutions; highlights the challenges, limitations, and best practices for AI development, adoption, and maintenance; offers an overview of the legal and regulatory landscape for AI tools designed for health care application; prioritizes the need for equity, inclusion, and a human rights lens for this work; and outlines key considerations for moving forward.
AI is poised to make transformative and disruptive advances in health care, but it is prudent to balance the need for thoughtful, inclusive health care AI that plans for and actively manages and reduces potential unintended consequences, while not yielding to marketing hype and profit motives.
Topics: Health and Medicine » Medical Technologies and Treatments | Computers and Information Technology » Information Technology
The effective use of data is foundational to the concept of a learning health system—one that leverages and shares data to learn from every patient experience, and feeds the results back to clinicians, patients and families, and health care executives to transform health, health care, and health equity. More than ever, the American health care system is in a position to harness new technologies and new data sources to improve individual and population health.
Learning health systems are driven by multiple stakeholders—patients, clinicians and clinical teams, health care organizations, academic institutions, government, industry, and payers. Each stakeholder group has its own sources of data, its own priorities, and its own goals and needs with respect to sharing that data. However, in America's current health system, these stakeholders operate in silos without a clear understanding of the motivations and priorities of other groups. The three stakeholder working groups that served as the authors of this Special Publication identified many cultural, ethical, regulatory, and financial barriers to greater data sharing, linkage, and use. What emerged was the foundational role of trust in achieving the full vision of a learning health system.
This Special Publication outlines a number of potentially valuable policy changes and actions that will help drive toward effective, efficient, and ethical data sharing, including more compelling and widespread communication efforts to improve awareness, understanding, and participation in data sharing. Achieving the vision of a learning health system will require eliminating the artificial boundaries that exist today among patient care, health system improvement, and research. Breaking down these barriers will require an unrelenting commitment across multiple stakeholders toward a shared goal of better, more equitable health.
We can improve together by sharing and using data in ways that produce trust and respect. Patients and families deserve nothing less.
Topics: Health and Medicine » Policy, Reviews and Evaluations | Computers and Information Technology » Information Security and Privacy
In response to a growing national awareness that the development and use of new diagnostic, therapeutic, and preventive interventions had been occurring at a quickening pace—one far outstripping the evidence necessary to make informed decisions about their comparative advantage—the Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 as part of the Affordable Care Act legislation. PCORI is guided by the imperative to help patients, families, clinicians, and other health care stakeholders make better informed health care decisions and improve care and outcomes. To inform the next steps in its organizational strategy, PCORI enlisted the National Academy of Medicine (NAM) to leverage its deep experience in convening experts on matters of significant national importance, including its long-standing thought leadership role in the realization of a learning health system. The NAM formed a multi-stakeholder workgroup and held two virtual convenings with the objective of engaging with patients, clinicians, health system leaders, researchers, and other stakeholders from the broader health community to identify and discuss high-priority emerging issues in health, health care, and biomedical science and technology. The key messages from these meetings are outlined in the Special Publication Priorities on the Health Horizon: Informing PCORI's Strategic Plan.
Given the breadth of the domains considered in the Priorities on the Health Horizon meetings—emerging technologies, social and environmental factors, optimizing value, and infrastructure—a formidable set of pressing health and health care research needs were reviewed and discussed. In addition, certain fundamental strategic priorities emerged as basic and critical to progress in the field: (1) the need to reorient research perspectives and activities to patient and family priorities and values, and in particular, those conditions that drive inequities; (2) the need to foster strategic learning partnerships across groups, organizations, and sectors; and (3) the need to build the continuous learning infrastructure to produce new insights at the pace and scale necessary for health and health care improvement.
Moving forward, building the capacity to continuously improve learning and sharing throughout the system will entail stakeholders working together as seamlessly as possible. The NAM and PCORI worked together to facilitate an expansive dialogue with key stakeholders and engender trust through a focus on shared commitments to progress on improving health for all Americans in the decade ahead.
Topics: Health and Medicine » Policy, Reviews and Evaluations
The United States is in the midst of an urgent and complex opioid crisis. To address how education and training can more effectively respond to this crisis, we must have a better understanding of problems in practice—or professional practice gaps—for health professionals and teams in practice. A coordinated response requires identifying and addressing professional practice gaps (PPGs) related to pain management, opioid use disorder, and other substance use disorder (SUD) care, as well as integrating evidence-based best practices into health professional education and training curricula across the continuum from undergraduate training into post-graduate continuing education This Special Publication presents two information-gathering efforts to assess persisting PPGs pertaining to pain management and SUD care and to better understand the current health professional education environment: the first is a comprehensive literature review, and the second is a survey of the regulatory landscape.
The results underscore the need to collaboratively develop a harmonized interprofessional, person- and family-centered approach for the continuum of health professions education to more effectively address the opioid crisis.
In this Special Publication, the Health Professional Education and Training Workgroup of the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic identified five action-oriented priorities to support this goal:
With due effort and support, these approaches will amplify effective practices while harmonizing and improving the environment for health care professionals to best serve the needs of their patients and communities.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
Sharing health data and information across stakeholder groups is the bedrock of a learning health system. As data and information are increasingly combined across various sources, their generative value to transform health, health care, and health equity increases significantly. Health data have proven their centrality in guiding action to change the course of individual and population health, if properly stewarded and used.
In the context of the COVID-19 pandemic, both data and a lack of data illuminated profound shortcomings that affected health care and health equity. Yet, a silver lining of the pandemic was a surge in collaboration among data holders in public health, health care, and technology firms, suggesting that an evolution in health data sharing is visible and tangible.
This Special Publication features some of these novel data-sharing collaborations, and has been developed to provide practical context and implementation guidance that is critical to advancing the lessons learned identified in its parent NAM Special Publication, Health Data Sharing: Building a Foundation of Stakeholder Trust. The focus of this publication is to identify and describe exemplar groups to dispel the myth that sharing health data more broadly is impossible and illuminate the innovative approaches that are being taken to make progress in the current environment. It also serves as a resource for those waiting in the wings, showing how barriers were addressed and harvesting lessons and insights from those on the front lines.
In the meantime, knowledge is already available to foster better health care and health outcomes. The examples described in this volume suggest how intentional attention to health data sharing can enable unparalleled advances, securing a healthier and more equitable future for all.
Topics: Health and Medicine » Healthcare and Quality | Computers and Information Technology » Information Security and Privacy | Health and Medicine » Policy, Reviews and Evaluations
Genetic and genomic information has become far more accessible, and research using human genetic data has grown exponentially over the past decade. Genetics and genomics research is now being conducted by a wide range of investigators across disciplines, who often use population descriptors inconsistently and/or inappropriately to capture the complex patterns of continuous human genetic variation.
In response to a request from the National Institutes of Health, the National Academies assembled an interdisciplinary committee of expert volunteers to conduct a study to review and assess existing methodologies, benefits, and challenges in using race, ethnicity, ancestry, and other population descriptors in genomics research. The resulting report focuses on understanding the current use of population descriptors in genomics research, examining best practices for researchers, and identifying processes for adopting best practices within the biomedical and scientific communities.
Topics: Health and Medicine » Genetics | Health and Medicine » Health Sciences | Behavioral and Social Sciences » Population Studies
Nonhuman primates represent a small fraction of animals used in biomedical research, but they remain important research models due to their similarities to humans with respect to genetic makeup, anatomy, physiology, and behavior. Limitations in the availability of nonhuman primates have been exacerbated by the COVID-19 pandemic and recent restrictions on their exportation and transportation, impacting National Institutes of Health (NIH)-funded research necessary for both public health and national security. Additionally, there is continued interest in understanding whether and how nonanimal models can be used to answer scientific questions for which nonhuman primates are currently used.
At the direction of the U.S. Congress, NIH asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee to conduct a landscape analysis of current and future use of nonhuman primates in NIH-supported biomedical research, as well as opportunities for new approach methodologies to complement or reduce reliance on nonhuman primate models. This report provides the committee findings and conclusions.
Topics: Biology and Life Sciences » Laboratory Animal Research | Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
The Comprehensive Addiction and Recovery Act (CARA; P.L. 114-198) was signed into law in 2016 to help address the challenges of overdose deaths and opioid use disorder, and to expand access to evidence-based treatment. Among these efforts was the authorization of four grant programs to be overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA).
In 2018, SAMHSA requested that the National Academies establish a committee to conduct a review of the four programs, which focus primarily on opioids, but occasionally include treatment and recovery services for co-occurring substance use disorders. The review resulted in three consensus study reports over five years. This third and final report aims to (1) understand the processes of the four grant programs; actions taken by grantees and their partners; impacts to clients, patients, the community, and public; and structural or environmental changes that might have resulted from grant funding, and (2) analyze how future congressionally mandated evaluations can be structured and carried out to better support policy makers.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
Whole health is physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities. Whole health care is an interprofessional, team-based approach anchored in trusted relationships to promote well-being, prevent disease, and restore health. It aligns with a person's life mission, aspiration, and purpose. It shifts the focus from a reactive disease-oriented medical care system to one that prioritizes disease prevention, health, and well-being. It changes the health care conversation from "What's wrong with you?" to "What matters to you?"
The Department of Veterans Affairs (VA), the Samueli Foundation, and the Whole Health Institute commissioned the National Academies of Sciences, Engineering, and Medicine to establish a committee to provide guidance on how to fill gaps and create processes to accelerate the transformation to whole health care for veterans, both inside and outside the VA system, and the rest of the U.S. population. The resulting report presents findings and recommendations that provide a roadmap for improving health and well-being for veterans and the nation.
Topics: Health and Medicine » Military and Veterans | Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
The COVID-19 pandemic spurred a rapid expansion of wastewater-based infectious disease surveillance systems to monitor and anticipate disease trends in communities.The Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System in September 2020 to help coordinate and build upon those efforts. Produced at the request of CDC, this report reviews the usefulness of community-level wastewater surveillance during the pandemic and assesses its potential value for control and prevention of infectious diseases beyond COVID-19.
Wastewater-based Disease Surveillance for Public Health Action concludes that wastewater surveillance is and will continue to be a valuable component of infectious disease management. This report presents a vision for a national wastewater surveillance system that would track multiple pathogens simultaneously and pivot quickly to detect emerging pathogens, and it offers recommendations to ensure that the system is flexible, equitable, and economically sustainable for informing public health actions. The report also recommends approaches to address ethical and privacy concerns and develop a more representative wastewater surveillance system. Predictable and sustained federal funding as well as ongoing coordination and collaboration among many partners will be critical to the effectiveness of efforts moving forward.
Topics: Environment and Environmental Studies » Water Quality | Health and Medicine » Environmental Health | Health and Medicine » Public Health and Prevention
The Dietary Reference Intakes (DRIs) are a set of reference values that encompass a safe range of intake and provide recommended nutrient intakes for the United States and Canada. The DRIs for energy are used widely to provide guidance for maintaining energy balance on both an individual and group level.
U.S. and Canadian governments asked the National Academies to convene an expert committee to examine available evidence and provide updated Estimated Energy Requirements (EERs) for their populations. The resulting report presents EER equations that provide a baseline for dietary planners and assessors who are estimating energy needs and monitoring energy balance to enhance the general health of individuals and populations.
Topics: Food and Nutrition » Nutrition - Dietary Reference Intakes | » Health and Medicine
In mid-2022, the United States has lost more than 1 million people to the COVID-19 pandemic. We have been real-time witnesses to scores of heroic responses to the disease, death, inequity, and economic strife unleashed by the virus, but have also experienced the consequences of poor pandemic preparedness and long-standing structural failures in our health system.
For decades, the U.S. health system has fallen far short of its potential to support and improve individual and population health. The COVID-19 pandemic has presented death and devastation—but also an unprecedented opportunity to truly transform U.S. health, health care, and health delivery.
To capitalize on this opportunity, the National Academy of Medicine gathered field leaders from across all of the major health system sectors to assess how each sector has responded to the pandemic and the opportunities that exist for health system transformation. The opportunity is now to capitalize on the hard-won lessons of COVID-19 and build a health care system that centers patients, families, and communities; cares for clinicians; supports care systems, public health, and biomedical research to perform at the best of their abilities; applies innovations from digital health and quality, safety, and standards organizations; and encourages health care payers and health product manufacturers and innovators to produce products that benefit all.
Topics: Health and Medicine » Public Health and Prevention
Regular use of sunscreens has been shown to reduce the risk of sunburn and skin cancer, and slow photoaging of skin. Sunscreens can rinse off into water where people are swimming or wading, and can also enter bodies of water through wastewater such as from bathing or showering. As a result, the ultraviolet (UV) filters - the active ingredients in sunscreens that reduce the amount of UV radiation on skin - have been detected in the water, sediment, and animal tissues in aquatic environments. Because the impact of these filters on aquatic ecosystems is not fully understood, assessment is needed to better understand their environmental impacts.
This report calls on the U.S. Environmental Protection Agency to conduct an ecological risk assessment of UV filters to characterize the possible risks to aquatic ecosystems and the species that live in them. EPA should focus on environments more likely to be exposed such as those with heavy recreational use, or where wastewater and urban runoff enter the water. The risk assessment should cover a broad range of species and biological effects and could consider potential interacting effects among UV filters and with other environmental stresses such as climate change. In addition, the report describes the role of sunscreens in preventing skin cancer and what is known about how human health could be affected by potential changes in usage. While the need for a risk assessment is urgent, research is needed to advance understanding of both risks to the environment from UV filters and impacts to human health from changing sunscreen availability and usage.
Topics: Environment and Environmental Studies » Environmental Health and Safety | Health and Medicine » Public Health and Prevention
With unprecedented global aging, societies must undertake all-of-society efforts to maximize the benefits and minimize the burdens of aging populations. The Global Roadmap for Healthy Longevity (Global Roadmap) describes a realistic vision of healthy longevity that could be achieved by 2050. The vision includes full inclusion of people of all ages, regardless of health or functional status, in all aspects of society and societies characterized by social cohesion and equity.
To achieve the vision, Global Roadmap recommends changes that need to be made to health systems, social infrastructure, physical environments, education, work, and retirement. In some cases, the recommended changes benefit older people most directly, but when older people thrive, people of all ages benefit. If taken up, the recommendations of this report can support individuals of all ages in all corners of the globe to live long, meaningful, and purpose-driven lives by 2050.
Topics: Health and Medicine » Global Health | Health and Medicine » Policy, Reviews and Evaluations
Heritable disorders of connective tissue (HDCTs) are a diverse group of inherited genetic disorders and subtypes. Because connective tissue is found throughout the body, the impairments associated with HDCTs manifest in multiple body systems and may change or vary in severity throughout an affected individual's lifetime. In some cases, these impairments may be severe enough to qualify an eligible child or adult for monetary benefits through the U.S. Social Security Administration's (SSA's) Social Security Disability Insurance or Supplemental Security Income program. SSA asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee that would provide current information regarding the diagnosis, treatment, and prognosis of selected HDCTs, including Marfan syndrome and the Ehlers-Danlos syndromes, and the effect of the disorders and their treatment on functioning. The resulting report, Selected Heritable Disorders of Connective Tissue and Disability, presents the committee's findings and conclusions.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Policy, Reviews and Evaluations
The U.S. Social Security Administration (SSA) administers the Social Security Disability Insurance program and the Supplemental Security Income program. As part of their process, immune system disorders are evaluated under Listing of Impairments 14.00 for adults and 114.00 for children. At the request of the SSA, the National Academies of Sciences, Engineering, and Medicine assembled a committee to review selected conditions related to the immune system. In particular, the SSA was interested in the current status of the diagnosis, treatment, and prognosis of immune system disorders including systemic lupus erythematosus (SLE), scleroderma, polymyositis, Sjögren's syndrome/disease, and inflammatory arthritis.
This report provides an overview of the current status of the diagnosis, treatment, and prognosis of these immune system disorders in the U.S. population and the relative levels of functional limitation typically associated with them, common treatments, and other considerations.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Other Diseases | Health and Medicine » Policy, Reviews and Evaluations
In thousands of communities across the United States, drinking water is contaminated with chemicals known as perfluoroalkyl and polyfluoroalkyl substances (PFAS). PFAS are used in a wide range of products, such as non-stick cookware, water and stain repellent fabrics, and fire-fighting foam, because they have properties that repel oil and water, reduce friction, and resist temperature changes. PFAS can leak into the environment where they are made, used, disposed of, or spilled. PFAS exposure has been linked to a number of adverse health effects including certain cancers, thyroid dysfunction, changes in cholesterol, and small reductions in birth weight.
This report recommends that the Centers for Disease Control and Prevention (CDC) update its clinical guidance to advise clinicians to offer PFAS blood testing to patients who are likely to have a history of elevated exposure, such as those with occupational exposures or those who live in areas known to be contaminated. If testing reveals PFAS levels associated with an increased risk of adverse effects, patients should receive regular screenings and monitoring for these and other health impacts. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up recommends that the CDC, Agency for Toxic Substances and Disease Registry (ATSDR), and public health departments support clinicians by creating educational materials on PFAS exposure, potential health effects, the limitations of testing, and the benefits and harms of testing.
Topics: Environment and Environmental Studies » Environmental Health and Safety | Health and Medicine » Environmental Health
The U.S. Centers for Disease Control and Prevention (CDC) is responsible for preventing the introduction, transmission, and spread of communicable diseases into the United States. It does this primarily through the Division of Global Migration and Quarantine (DGMQ), which oversees the federal quarantine station network. Over the past two decades, the frequency and volume of microbial threats worldwide have continued to intensify. The COVID-19 pandemic, in particular, has prompted a reevaluation of many of our current disease control mechanisms, including the use and role of quarantine as a public health tool.
The emergence of COVID-19 prompted CDC to request that the National Academies of Sciences, Engineering, and Medicine convene a committee to assess the role of DGMQ and the federal quarantine station network in mitigating the risk of onward communicable disease transmission in light of changes in the global environment, including large increases in international travel, threats posed by emerging infections, and the movement of animals and cargo. The committee was also tasked with identifying how lessons learned during COVID-19 and other public health emergencies can be leveraged to strengthen pandemic response. The report's findings and recommendations span five domains: organizational capacity, disease control and response efforts, new technologies and data systems, coordination and collaboration, and legal and regulatory authority.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Policy, Reviews and Evaluations
The Office of the Assistant Secretary for Planning and Evaluation (ASPE), in partnership with other agencies and divisions of the United States Department of Health and Human Services, coordinates a portfolio of projects that build data capacity for conducting patient-centered outcomes research (PCOR). PCOR focuses on producing scientific evidence on the effectiveness of prevention and treatment options to inform the health care decisions of patients, families, and health care providers, taking into consideration the preferences, values, and questions patients face when making health care choices.
ASPE asked the National Academies to appoint a consensus study committee to identify issues critical to the continued development of the data infrastructure for PCOR. Building Data Capacity for Patient-Centered Outcomes Research contains findings and conclusions in the areas that could benefit from being prioritized as part of ASPE's work, and offers input on strengthening the overall framework for building the data infrastructure over the coming years. The committee authoring this report also issued three interim reports, which summarized discussions from three workshops, and are included as appendices in the final report.
Topics: Health and Medicine » Healthcare and Quality | Computers and Information Technology » Information Technology
Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of nursing home care have resulted in a system that often fails to ensure the well-being and safety of nursing home residents. The devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.
With support from a coalition of sponsors, the National Academies of Sciences, Engineering, and Medicine formed the Committee on the Quality of Care in Nursing Homes to examine how the United States delivers, finances, regulates, and measures the quality of nursing home care. The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff identifies seven broad goals and supporting recommendations which provide the overarching framework for a comprehensive approach to improving the quality of care in nursing homes.
Topics: Health and Medicine » Healthcare and Quality | Health and Medicine » Policy, Reviews and Evaluations
Over the past several decades, supply chain disruptions have repeatedly plagued the U.S. health care system, costing health care systems millions of dollars per year, threatening the clinical research enterprise, and most importantly, imperiling the health and lives of patients. The Committee on Security of America's Medical Supply Chain, convened by the National Academies of Sciences, Engineering, and Medicine, was charged with addressing this important issue by examining the root causes of medical product shortages and identifying ways to enhance their resilience - both in so-called normal times and during public health emergencies.
Building Resilience into the Nation's Medical Product Supply Chains outlines the committee's seven recommendations and presents a framework of protection comprising awareness, mitigation, preparedness, and response measures.
Topics: Health and Medicine » Policy, Reviews and Evaluations
The early to mid-1990s saw a large surge in U.S. cigar consumption, including premium cigars. Based on recent import data, premium cigar use may be increasing, though they currently make up a small percent of the total U.S. cigar market. Premium cigars have also been the subject of legal and regulatory efforts for the past decade. In 1998, the National Cancer Institute undertook a comprehensive review of available knowledge about cigars - the only one to date. The resulting research recommendations have largely not been addressed, and many of the identified information gaps persist. Furthermore, there is no single, consistent definition of premium cigars, making research challenging.
In response, the Food and Drug Administration (FDA) and the National Institutes of Health commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee of experts to address this issue. The resulting report, Premium Cigars: Patterns of Use, Marketing, and Health Effects, includes 13 findings, 24 conclusions, and nine priority research recommendations and assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of the product, and short- long-term health effects.
Topics: Health and Medicine » Policy, Reviews and Evaluations
Autoimmune diseases occur when the body's immune system malfunctions and mistakenly attacks healthy cells, tissues, and organs. Strong data on the incidence and prevalence of autoimmune diseases are limited, but a 2009 study estimated the prevalence of autoimmune diseases in the U.S. to be 7.6 to 9.4 percent, or 25 to 31 million people today. This estimate, however, includes only 29 autoimmune diseases, and it does not account for increases in prevalence in the last decade. By some counts, there are around 150 autoimmune diseases, which are lifelong chronic illnesses with no known cures. The National Academies of Sciences, Engineering, and Medicine was asked to assess the autoimmune disease research portfolio of the National Institutes of Health (NIH).
Enhancing NIH Research on Autoimmune Disease finds that while NIH has made impressive contributions to research on autoimmune diseases, there is an absence of a strategic NIH-wide autoimmune disease research plan and a need for greater coordination across the institutes and centers to optimize opportunities for collaboration. To meet these challenges, this report calls for the creation of an Office of Autoimmune Disease/Autoimmunity Research in the Office of the Director of NIH. The Office could facilitate NIH-wide collaboration, and engage in prioritizing, budgeting, and evaluating research. Enhancing NIH Research on Autoimmune Disease also calls for the establishment of long term systems to collect epidemiologic and surveillance data and long term studies (20+ years) to study disease across the life course. Finally, the report provides an agenda that highlights research needs that crosscut many autoimmune diseases, such as understanding the effect of environmental factors in initiating disease.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Other Diseases | Health and Medicine » Policy, Reviews and Evaluations
Each year, the individuals and organizations in the U.S. organ donation, procurement, allocation, and distribution system work together to provide transplants to many thousands of people, but thousands more die before getting a transplant due to the ongoing shortage of deceased donor organs and inequitable access to transplant waiting lists.
Realizing the Promise of Equity in the Organ Transplantation System, a new consensus study report from the National Academies of Sciences, Engineering, and Medicine's Committee on A Fairer and More Equitable, Cost-Effective, and Transparent System of Donor Organ Procurement, Allocation, and Distribution, provides expert recommendations to improve fairness, equity, transparency, and cost-effectiveness in the donor organ system.
Topics: Health and Medicine » Medical Technologies and Treatments
Every community is affected by traumatic brain injury (TBI). Causes as diverse as falls, sports injuries, vehicle collisions, domestic violence, and military incidents can result in injuries across a spectrum of severity and age groups. Just as the many causes of TBI and the people who experience it are diverse, so too are the physiological, cognitive, and behavioral changes that can occur following injury. The overall TBI ecosystem is not limited to healthcare and research, but includes the related systems that administer and finance healthcare, accredit care facilities, and provide regulatory approval and oversight of products and therapies. TBI also intersects with the wide range of community organizations and institutions in which people return to learning, work, and play, including the education system, work environments, professional and amateur sports associations, the criminal justice system, and others.
Traumatic Brain Injury: A Roadmap for Accelerating Progress examines the current landscape of basic, translational, and clinical TBI research and identifies gaps and opportunities to accelerate research progress and improve care with a focus on the biological, psychological, sociological, and ecological impacts. This report calls not merely for improvement, but for a transformation of attitudes, understanding, investments, and care systems for TBI.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Healthcare and Quality | Health and Medicine » Medical Technologies and Treatments
Individuals in the United States and Americans abroad are exposed to inhalation hazards from a variety of sources, and these hazards can have both short- and long-term adverse effects on health. For example, exposure to wildfire smoke, which contains particulate matter and toxic chemicals, can lead to respiratory problems, increased risk for heart attacks, and other adverse health outcomes. Individuals also may be exposed to airborne infectious agents through aerosol or droplet transmission, and as demonstrated by the COVID-19 pandemic, the individual and public health consequences of these exposures can be severe. Storms, floods, and hurricanes can increase exposure to moisture-driven hazards, such as mold, and to accidental releases from production facilities or transport vehicles that may result in chemical exposures.
The current regulatory system is focused primarily on ensuring access to respiratory protection in occupational settings characterized by well-defined hazards and employer-employee relationships. With this narrow regulatory focus, the respiratory protection needs of the public and many workers are not being met. As climate change increases the incidence and severity of wildfires, hurricanes, floods, infectious disease outbreaks, and other phenomena that impact air quality and human health, it is imperative that the United States ensure that the respiratory protection needs of the public and all workers are met. Recognizing the urgent need to address the gaps in the nation's ability to meet the respiratory protection needs of the public and workers without workplace respiratory protection programs, this report makes recommendations for a framework of responsibilities and authorities that would provide a unified and authoritative source of information and effective oversight for the development, approval, and use of respiratory protection.
Topics: Health and Medicine » Occupational and Workplace Health | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
Closing Evidence Gaps in Clinical Prevention, a new consensus study report from the National Academies of Sciences, Engineering, and Medicine's Board on Population Health and Public Health Practice, evaluates evidence gaps in clinical prevention recommendations described by the United States Preventive Services Task Force and other clinical practice guideline developers and presents a taxonomy of these evidence gaps for future use. This report aims to improve the coordination of efforts to describe and communicate priority evidence gaps among funders and researchers. It also proposes new opportunities for collaboration among researchers, funders, and guideline developers to accelerate research that could close evidence gaps.
The authoring committee has also developed an interactive graphic that can be used as a workflow diagram for implementing the taxonomy. This workflow walks users through reviewing evidence, characterizing evidence gaps using relevant taxonomies, and developing a research agenda. Click here to view and engage with the interactive graphic.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
Service dogs have been promoted as a potential intervention for veterans with posttraumatic stress disorder (PTSD); however, research supporting their effectiveness is limited. At the request of the U.S. Department of Veterans Affairs (VA), the National Academies provided iterative reviews of a VA monograph that assesses the economic impact and cost effectiveness of programs involving trained service dogs or emotional support dogs and veterans with PTSD. The reviews evaluated the draft monograph with regard to consistency and the use of accepted scientific principles. Working from this input, the VA finalized and released the monograph, The Economic Impact and Cost Effectiveness of Service Dogs for Veterans with Post Traumatic Stress Disorder, in January 2022.
Topics: Health and Medicine » Military and Veterans | Health and Medicine » Mental Health and Behavior | Health and Medicine » Policy, Reviews and Evaluations
Antimicrobial resistance is a health problem that threatens to undermine almost a century of medical progress. Moreover, it is a global problem that requires action both in the United States and internationally.
Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine discusses ways to improve detection of resistant infections in the United States and abroad, including monitoring environmental reservoirs of resistance. This report sets out a strategy for improving stewardship and preventing infections in humans and animals. The report also discusses the strength of the pipeline for new antimicrobial medicines and steps that could be taken to bring a range of preventive and therapeutic products for humans and animals to the market.
Topics: Health and Medicine » Health Sciences | Health and Medicine » Public Health and Prevention | Health and Medicine » Policy, Reviews and Evaluations
The global response to COVID-19 has demonstrated the importance of vigilance and preparedness for infectious diseases, particularly influenza. There is a need for more effective influenza vaccines and modern manufacturing technologies that are adaptable and scalable to meet demand during a pandemic. The rapid development of COVID-19 vaccines has demonstrated what is possible with extensive data sharing, researchers who have the necessary resources and novel technologies to conduct and apply their research, rolling review by regulators, and public-private partnerships. As demonstrated throughout the response to COVID-19, the process of research and development of novel vaccines can be significantly optimized when stakeholders are provided with the resources and technologies needed to support their response.
Vaccine Research and Development to Advance Pandemic and Seasonal Influenza Preparedness and Response focuses on how to leverage the knowledge gained from the COVID-19 pandemic to optimize vaccine research and development (R&D) to support the prevention and control of seasonal and pandemic influenza. The committee's findings address four dimensions of vaccine R&D: (1) basic and translational science, (2) clinical science, (3) manufacturing science, and (4) regulatory science.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Policy, Reviews and Evaluations
The COVID-19 pandemic has challenged the world's preparedness for a respiratory virus event. While the world has been combating COVID-19, seasonal and pandemic influenza remain imminent global health threats. Non-vaccine public health control measures can combat emerging and ongoing influenza outbreaks by mitigating viral spread.
Public Health Lessons for Non-Vaccine Influenza Interventions examines provides conclusions and recommendations from an expert committee on how to leverage the knowledge gained from the COVID-19 pandemic to optimize the use of public health interventions other than vaccines to decrease the toll of future seasonal and potentially pandemic influenza. It considers the effectiveness of public health efforts such as use of masks and indoor spacing, use of treatments such as monoclonal antibodies, and public health communication campaigns.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Policy, Reviews and Evaluations
The COVID-19 pandemic has laid bare the fragility of the global system of preparedness and response to pandemics and the fragmentation of our research and development ecosystem. The pandemic has provided a disruptive moment to advance new norms and frameworks for influenza. It also has demonstrated how innovative global public-private partnerships and coordination mechanisms can lead to rapid successes in viral vaccine research, manufacturing, and risk pooling.
Countering the Pandemic Threat Through Global Coordination on Vaccines identifies ways to strengthen pandemic and seasonal influenza global coordination, partnerships, and financing. This report presents seven overarching recommendations for how the urgent influenza threat should be conceptualized and prioritized within the global pandemic preparedness and response agenda in the future.
Topics: Health and Medicine » Public Health and Prevention | Health and Medicine » Infectious Disease | Health and Medicine » Policy, Reviews and Evaluations