The burden of diabetes is rising rapidly, with the largest increases in low- and middle-income countries (LMICs). While most people with diabetes globally live in LMICs, high-quality data on diabetes prevalence, risk factors, complications, and mortality are scarce in these settings. Widespread challenges around health care financing, workforce capacity, and access to essential medicines and diagnostics compromise the reach and effectiveness of services for diabetes prevention and management in many countries. As a result, nearly half of people with diabetes remain undiagnosed, and a large share of those who are diagnosed do not achieve targets for glycemic control and prevention of complications. Targeted efforts are needed to close the research and implementation gaps between LMICs and high-income countries, with emphasis on improving disease surveillance, expanding access to essential medicines and diagnostics, and advancing implementation strategies to scale up and sustain evidence-based interventions.
Black-White health inequities, systemic and unjust differences in health, are well documented across a broad range of outcomes. Socioeconomic resources are often cited as a key determinant of racial health inequities in the United States. While accounting for socioeconomic status (SES) reduces racial health inequities, it does not eliminate them, as emerging evidence suggests that the process of mobility can also carry unique psychological and physiological burdens. This review describes why upwardly mobile Black Americans continue to have relatively worse health outcomes than White Americans despite higher SES attainment. We examine factors that contribute to the hidden health costs of upward social mobility for Black Americans, including exposure to persistent stressors such as financial precarity, the navigation of predominantly White spaces, and uplift strain, in addition to the use of high-effort coping strategies. The findings from this review are especially pertinent, considering the current sociopolitical climate of the United States.
Causal inference is a central endeavor in health disparities research. For decades, it has been used to both measure and explain disparity and discrimination and to evaluate the impact of interventions on disparity and discrimination. This article reviews the use of causal inference methods for each of these endeavors, highlighting critical challenges that emerging work attempts to overcome. A key feature of a newer proposal is to use a descriptive measure of disparity that builds in normative and ethical assumptions and then to perform causal inference on that measure of disparity when seeking to inform and evaluate interventions. In this way, the measure of disparity is applicable to real-world data; is consistent across measurement, intervention development, and evaluation efforts; and builds in normative and ethical assumptions that promote transparency, dialogue, debate, and reproducibility. The article also briefly highlights causal inference methods for transformative interventions.
In 1998, in the Annual Review of Public Health, we reviewed the development of community-based research, later titled community-based participatory research (CBPR). The field has grown since then in multiple ways, including the number of CBPR partnerships; the diversity of communities involved and issues addressed; credibility within communities and academia; the volume of publications and reports; the amount of evidence of effective interventions and policy change; increased capacity-building opportunities; increased funding opportunities; and the development of validated partnership evaluation tools. This review examines the evolution of CBPR in the United States since 1998, based on peer-reviewed literature. We examine five significant areas: evolution of CBPR principles; location of CBPR within a continuum of community involvement in research; conceptual models, research design, and evaluation; translation of research findings into policy; and structural change to promote health equity. We discuss lessons learned, impacts on the field, and recommendations, concluding with a discussion of future directions.
There is growing recognition that paternal involvement matters for child development and family well-being, even while we know comparatively little about how fatherhood affects men's own physical and mental health. This review brings together our current understanding of how becoming and being a father shapes men's health and the current efforts at improving the fatherhood experiences for men, thus indirectly influencing their children and families. We explore emerging work on father support systems, from mobile health interventions to successful community-based programs. The review also considers how policy—both historic and current—has shaped fathers’ health and their capacity to be involved parents. Our analysis reveals substantial gaps, particularly around understanding the nuances of paternal support. We conclude by identifying where research efforts should focus next and what practitioners and policymakers need to consider, as attention to the impact of fatherhood on men's health continues to grow.
A growing number of researchers use public health critical race praxis (PHCRP), an antiracism framework derived in part from critical race theory, to conceptualize racism as a public health problem and examine its contributions to health and health care inequities. Critical race scholars define racism as “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death,” as stated by Ruth Gilmore in her 2007 book Golden Gulag . Despite solid evidence for the prevalence and potential effects of racism, few studies provide data to guide the development, implementation, and evaluation of antiracism interventions in diverse settings (e.g., community, health care), activities that we refer to in this review as practice. A central focus of PHCRP is to guide evidence-based action to disrupt racism; therefore, the framework may be useful in guiding antiracism practice. However, evidence for its use for practice has not been established. To encourage the development, implementation, and evaluation of antiracism solutions, this review examines the evidence applying PHCRP to practice-focused research. The findings provide a baseline assessment to guide future evidence-based antiracism mitigation efforts. We offer recommendations to support future practice-focused work.
Maternal mortality in the United States is an urgent public health concern. Despite advances in medical technology and obstetric care, maternal mortality remains elevated in the United States, with disparate burden across racial and ethnic, socioeconomic, and geographic communities. The reasons for these disparities are myriad and include a confluence of structural and social determinants, variation in medical care access and quality, and individual risk factors. This review explores the evolving patterns of maternal mortality in the United States by examining contributing causes, demographic disparities, and systemic challenges, with an emphasis on the limitations of current US maternal mortality surveillance infrastructure. We highlight the urgent need for data-driven policy interventions, equitable health care reforms, and research innovation to enhance maternal health and eliminate disparities.
Climate change intensifies extreme weather events, and these events trigger cascading health impacts. Understanding the spatial variation of extreme weather events and their health impacts is critical for building tailored adaptation strategies. This review examines the trends in extreme weather events (including temperature extremes, floods, droughts, tropical cyclones, and wildfires), their linkages with climate change, the health impacts of these events, the global variations in the climate links and health impacts, and recommended adaptation policies. We found regional differences in observed trends and future projections in extreme weather events and discussed the associated uncertainty. Evidence on the global variations in health impacts is mixed and scarce, with differential hot spots identified by event type and by study. Adaptation policies should be designed and implemented in a holistic manner, including pre-event resilience building, during-event responses, and post-event recovery.
Environmental justice (EJ) research is an interdisciplinary field of study concerned with the unequal distribution of environmental burdens and benefits across different sociodemographic identities (e.g., race, class). While considerations of space and time with respect to environmental exposures and health outcomes have always been central to EJ, the state of the science on geospatial methods, measures, and technologies is rapidly advancing, as are their applications in research. We find that geospatial technologies have extended researchers’ abilities to more precisely link the spatial extents of environmental exposures to when and where people live, work, and play. Geospatial data are also useful in analyzing systemic oppression and structural racism as root causes of environmental injustice via metrics of segregation and redlining. This review provides an overview of how geospatial methods and technologies are being applied to EJ research for ( a ) population identification, ( b ) exposure assessment, ( c ) outcome ascertainment, and ( d ) research translation.
Financial incentives have been widely studied and implemented as instruments to encourage healthy behavior. This narrative expert review synthesizes evidence from 39 systematic, meta-analytic, narrative, and scoping reviews examining incentive-based interventions for four health behaviors: physical activity, smoking cessation, vaccination, and medication adherence. The reviewed studies encompass a wide range of populations and contexts, though the evidence is primarily in high-income settings, with less representation from low- and middle-income countries. Across domains, financial incentives tend to produce modest, often short-lived improvements; greater effectiveness is observed when incentives are substantial, promptly delivered, and contextually tailored and when behavioral outcomes are tracked using objective measures. Targeted incentives may reduce disparities in health behavior, though their ethical and social acceptability merit careful consideration. Gaps in the literature include short follow-up windows and limited cost-effectiveness data. Future research should probe long-term outcomes, explore heterogeneity of response to better understand mechanisms of sustained change, and study the effects of nonfinancial or social incentives.
Several groups in the United States, including communities of color and low-income communities, are frequently disproportionately exposed to ambient (i.e., outdoor) air pollution, reflecting unjust placement of emission sources, systemic bias, and historic race-based land use planning. Eliminating these inequities is critical for advancing environmental justice. This review synthesizes methodological innovations for characterizing and mitigating ambient air pollution inequities, focusing on the past 10 years, mostly in the United States. Advances in exposure assessment (e.g., empirical models, satellite remote sensing, mobile monitoring, sensor networks) provide new tools for characterizing disparities. Advances in techniques for attributing pollution to specific sources (e.g., reduced-complexity models) reveal how emission-reduction approaches may or may not eliminate disparities. Spatially targeted emission reductions are critical for eliminating relative disparities; conventional approaches (e.g., sectoral emission reductions, national concentration standards) are unlikely to eliminate those disparities. This article provides insights for effective interventions to promote equity in ambient air pollution exposure.
Medicare spending growth has slowed markedly over the last 20 years, defying projections despite a growing beneficiary population and expansion of the costlier Medicare Advantage program. Demographic, policy, and economic factors contributed to the spending growth slowdown. Key drivers include low payment rate increases—particularly following passage of the Affordable Care Act and sequestration policies—modest demographic shifts, and the evolving role of financial incentives and medical technology. The orientation toward value-based care played a role, though precise impacts of broad policies are difficult to quantify. While spending moderation is viewed as a success, it may mask trade-offs in access, quality, and service adequacy, especially for vulnerable populations facing unmet needs. We explore future spending projections and highlight the importance of balancing cost control with improving Medicare's capacity to serve high-need beneficiaries. Research insights are critical for shaping Medicare policy that is financially sustainable and responsive to beneficiaries’ evolving needs.
Historically rooted in US Black feminist activism, intersectionality emerged as an analytical lens through which to enhance knowledge about how multiple and interlocking systems of oppression (e.g., racism, sexism, and class exploitation) shape the lives of US Black women and other historically marginalized populations, and as a tool for critical praxis, not empirical research. Intersectionality has numerous benefits for the field of public health. Accordingly, interest in intersectionality and intersectionality research has flourished within US and global public health. This review highlights some of the theoretical and methodological articles and systematic and scoping reviews focused on intersectionality in the field. It also addresses several of the conceptual and methodological complexities and challenges of qualitative and quantitative intersectionality research with the introduction of a Framework for Applied Intersectionality Research (FAIR). FAIR aims to reframe intersectionality as a critical transformative tool to advance health equity and social justice action, not just empirical research.
Poverty is a fundamental driver of health, influencing access to resources and contributing to chronic stress and poor health. There has been substantial recent growth in the literature on the impacts of economic policies as upstream interventions to address poverty and reduce health inequities. This review synthesizes evidence on US income support policies with varying design features and populations served, e.g., tax policies, minimum wage, and guaranteed income programs. Drawing on robust quasi-experimental and experimental studies, findings suggest that policies increasing income, particularly the Earned Income Tax Credit, can meaningfully improve maternal, infant, and mental health and alleviate food insecurity. For many policies, however, there is insufficient research; for some, such as the minimum wage, evidence is mixed. Methodological challenges include data limitations, exposure misclassification, and policy co-occurrence. Future research should leverage longitudinal approaches, examine policy interactions, address equity of impact, and strengthen partnerships with policymakers to inform effective, equitable poverty alleviation strategies to improve health.
Global progress toward universal health coverage (UHC) has varied widely across low- and middle-income countries (LMICs) in recent years. To better understand these differences, we used an analytical framework to compare individual health system components, or substructures, across selected LMICs, identifying institutional and policy mechanisms that shape UHC performance. Our case study comparison includes 12 countries spanning high and low UHC performance, as indicated by World Bank and World Health Organization (WHO) indicators for service coverage and financial risk protection as well as considerations of equity concerns not captured by these metrics. We highlight that stronger performance is associated with unified risk pooling, strategic purchasing, robust primary care-based integrated delivery, a systemic approach toward public/private service delivery, strategic investments in health infrastructure and workforce, and accountable governance. Future analyses and reviews using this comparative case study method with a structured analytical framework would be helpful in further advancing our understanding of the drivers of UHC progress and guiding policy reform.
Rapid decarbonization and climate adaptation are urgent to avoid the worst impacts of climate change, but past efforts at large-scale societal change and infrastructure investments have often exacerbated racialized and socioeconomic inequalities and further entrenched the structural drivers and root causes of climate change. We review dimensions of climate justice in the literature and define just climate solutions as those that ( a ) address root causes and dismantle structural drivers of social inequality and injustice; ( b ) are community centered and ground-truthed; ( c ) are reparative and maximally beneficial for historically marginalized populations; and ( d ) disrupt existing power relations to transform who controls framing, design, implementation, and accountability. We offer a set of guiding questions to help researchers, practitioners, community advocates, and policymakers operationalize this definition to evaluate climate actions in the context of mitigation, adaptation, and disaster response and recovery efforts.
Racism is an underlying cause of health inequities and is entrenched in health systems, disproportionately affecting marginalized groups. Advancing health equity requires reimagining health systems to uproot racism from health-related policymaking. Racism, in its systemic, cultural, and interpersonal forms, remains a significant threat to health equity, a barrier to reform, and a public health crisis. This review draws lessons from US social movements—including tobacco control, sexual and gender minority rights, criminal justice reform, civil rights, and reproductive justice—to identify effective strategies for change. Drawing on key theories, typologies, and insights from the literature, we examine how organizing, messaging, and mobilization have shaped narratives, have fostered public will, and have driven policy reform. Prior movements can serve as a guide for the development and implementation of a social change movement aimed at addressing racism in public health.
Scientists are facing increasing challenges concerned with improving the health of the public. Declining trust in expertise, new diseases, widening disparities in access to care, and environmental changes all challenge population health science to lean into work that can help move societies closer to solutions. To do this work effectively, we need to nudge population health science toward research that engages with consequential health challenges, which will require a reprioritization of how we generate, measure, and articulate health impact. In this review, we provide a history of evaluating impact, along with a comprehensive framework for conceptualizing future public health research impacts. In addition, we review evaluation models and highlight best practices for measuring impact. We introduce a new framework that builds on realist evaluation principles for assessing the impact of public health research and addresses the need to communicate these impacts to diverse audiences. To achieve this reprioritization, we recognize the need for organizational and systemic changes that can incentivize, prioritize, and reward impact-driven engagement.
Policing in the United States functions as a structural determinant of health, with direct and collateral impacts that extend well beyond maintaining order and public safety. This review synthesizes recent evidence (from 2015 to 2025) on the relationship between policing and health. Using a rapid evidence assessment, we examine peer-reviewed and gray literature to capture physical, mental, and community-level outcomes, as well as pathways and mechanisms that link policing to health. Findings indicate that police use of force results in significant injury and deaths annually, disproportionately affecting communities of color. Beyond direct effects, policing contributes to chronic stress, trauma, and economic strain across community and occupational ecosystems. These collateral impacts compound existing structural inequities. Despite promising alternatives to police responses, evidence gaps and reliance on cross-sectional studies limit causal inference. Future research should strengthen data systems, focus on causal research, and integrate public health priorities into public safety strategies.
