Meeting the Institute of Medicine's 2030 US Life Expectancy Target

Regarding Investment in a Healthier Future: Impact of the 2012 Institute of Medicine Finance Report

CONTEXT

Governments at all levels work to ensure a healthy public, yet financing, organization, and delivery of public health services differ across the United States. A 2012 Institute of Medicine Finance report provided a series of recommendations to ensure a high-performing and adequately funded public health infrastructure.

OBJECTIVES

This review examines the influence of the Finance report's 10 recommendations on public health policy and practice.

DESIGN

This review utilized peer-reviewed and gray literature published since 2012.

ELIGIBILITY CRITERIA

Documents that address at least one of the Finance report's 10 recommendations and contain information on either official actions taken in response to the Finance report or evidence of the report's influence on the practice community.

RESULTS

Of 2394 unique documents found, a total of 56 documents met the eligibility criteria. Review of these 56 documents indicated that the most substantial activity related to the recommendations was focused on the "minimum package of public health services" concept and establishment of a uniform chart of accounts.

DISCUSSION

Progress has been mixed on the Finance report recommendations. Improved tracking and auditing of public health activity appears to be advancing, yet financial benchmarks remain unmet. Challenges remain in determining actual investment in public health and equitable resource allocation approaches. State and local health department use of cost estimation methodology and a uniform chart of accounts tool has contributed to an increase in understanding and improvement in public health spending.

CONCLUSIONS

The Finance report has served as a strong impetus for advocating for an increased investment in governmental public health. Efforts are bolstered by informed public health practitioners and stakeholders but often stymied by policy makers who must balance complex competing issues and priorities. Although many successes have occurred, further work is needed toward improving investment in the nation's public health.

Emerging political and demographic divides: State politics, welfare generosity, and adult mortality in U.S. states 1977-2017

Geographic disparities in adult mortality within the US have grown over the past several decades, but the reasons for these trends remain unclear. In this article, we examine trends in adult mortality (ages 55+) across US states from 1977 to 2017, paying close attention to the shifting geographic pattern of high- and low-mortality states. We find that states in the South tended to fall behind the rest of the country in the 1970s and 1980s, while states in the Great Plains and Mountain West tended to fall behind in the 1990s, 2000s, and 2010s. In contrast, states on the East and West Coasts have tended to see considerable improvement in mortality. We consider the role of state-level per-capita spending on public welfare programs in the mortality experience of states between 1977 and 2017. We use fixed effects models to show that greater state welfare generosity predicts greater yearly reductions in mortality. State shifts toward more generous welfare spending regimes may contribute to significant geographic divergences in adult mortality in the United States.

Reduction in US Health Care Spending Required to Meet the Institute of Medicine's 2030 Target

Objectives. To quantify changes in US health care spending required to reach parity with high-resource nations by 2030 or 2040 and identify historical precedents for these changes.Methods. We analyzed multiple sources of historical and projected spending from 1970 through 2040. Parity was defined as the Organisation for Economic Co-operation and Development (OECD) median or 90th percentile for per capita health care spending.Results. Sustained annual declines of 7.0% and 3.3% would be required to reach the median of other high-resource nations by 2030 and 2040, respectively (3.2% and 1.3% to reach the 90th percentile). Such declines do not have historical precedent among US states or OECD nations.Conclusions. Traditional approaches to reducing health care spending will not enable the United States to achieve parity with high-resource nations; strategies to eliminate waste and reduce the demand for health care are essential.Public Health Implications. Excess spending reduces the ability of the United States to meet critical public health needs and affects the country's economic competitiveness. Rising health care spending has been identified as a threat to the nation's health. Public health can add voices, leadership, and expertise for reversing this course.

Chewing ability and oral health-related quality of life in frail elders after new complete dentures insertion: A paired controlled clinical trial

AIMS

To compare the effect of new complete dentures (CDs) on self-perceived masticatory ability (MA) and oral health-related quality of life (OHRQoL) in frail and nonfrail elders.

METHODS AND RESULTS

Twenty completely edentulous elders were assigned to two groups: frail and nonfrail (n = 10/each). MA was evaluated using a visual analogue scale. OHRQoL was assessed with the Oral Health Impact Profile (OHIP-Edent). Variables were evaluated with volunteers wearing their old and unsatisfactory CDs. Then, a new set of CDs was manufactured and all outcomes were reassessed 2 months after the insertion. Data were analyzed by repeated measures' analyses of variance and Tukey tests. MA for lettuce and peanuts was improved (P < .05) for the frail group after new CD insertion. Psychological discomfort and handicap OHIP-Edent domain improved (P < .05) for both groups after prosthetic treatment. Before treatment, controls reported greater psychological discomfort than the frail group. Meanwhile, the handicap domain score of frail patients improved to a level similar to that of the nonfrail group after treatment. Regardless of frailty, elders showed better MA scores for most food types after treatment and decreased OHIP-Edent domain values.

CONCLUSION

Self-reported MA and OHRQoL of frail elderly people were greatly improved after new CD use.