Dispensing of Oral Antiviral Drugs for Treatment of COVID-19 by Zip Code-Level Social Vulnerability - United States, December 23, 2021-May 21, 2022.

The COVID-19 pandemic has highlighted and exacerbated long-standing inequities in the social determinants of health (1-3). Ensuring equitable access to effective COVID-19 therapies is essential to reducing health disparities. Molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid) are oral antiviral agents effective at preventing hospitalization and death in patients with mild to moderate COVID-19 who are at high risk* for progression to severe COVID-19 when initiated within 5 days of symptom onset. These medications received Emergency Use Authorization from the Food and Drug Administration (FDA) in December 2021† and were made available at no cost to recipients through the U.S. Department of Health and Human Services (HHS) on December 23, 2021. Beginning March 7, 2022, a series of strategies was implemented to expand COVID-19 oral antiviral access, including the launch of the Test to Treat initiative.§ Data from December 23, 2021-May 21, 2022, were analyzed to describe oral antiviral prescription dispensing overall and by week, stratified by zip code social vulnerability. Zip codes represented areas classified as low, medium, or high social vulnerability; approximately 20% of U.S. residents live in low-, 31% in medium-, and 49% in high-social vulnerability zip codes.¶ During December 23, 2021-May 21, 2022, a total of 1,076,762 oral antiviral prescriptions were dispensed (Lagevrio = 248,838; Paxlovid = 827,924). Most (70.3%) oral antivirals were dispensed during March 7-May 21, 2022. During March 6, 2022-May 21, 2022, the number of oral antivirals dispensed per 100,000 population increased from 3.3 to 77.4 in low-, from 4.5 to 70.0 in medium-, and from 7.8 to 35.7 in high-vulnerability zip codes. The number of oral antivirals dispensed rose substantially during the overall study period, coincident with the onset of initiatives to increase access. However, by the end of the study period, dispensing rates in high-vulnerability zip codes were approximately one half the rates in medium- and low-vulnerability zip codes. Additional public health, regulatory, and policy efforts might help decrease barriers to oral antiviral access, particularly in communities with high social vulnerability.

Expanding Public Health Practice to Address Older Adult Health and Well-being.

CONTEXT: The older adult population in the United States is experiencing unprecedented growth and is accompanied by a parallel increase in the health challenges of these individuals. Public health has, historically, not played a large role in older adult health, but given its contributions to longevity, it makes sense for public health to now prioritize the health of this population. PROGRAM: With the goal of public health prioritization of healthy aging, Trust for America's Health, with support from The John A. Hartford Foundation, launched an initiative to demonstrate the crucial roles public health departments can play to improve the health of older adults. IMPLEMENTATION: An Age-Friendly Public Health Systems (AFPHS) Learning and Action Network was created to provide local health departments in Florida with training and technical assistance through in-person and virtual activities, as well as access to events, opportunities, and resources to increase expertise and capacity to address healthy aging. AFPHS Network participants attended monthly learning activities to enhance their capacity around data analysis, health equity, partnerships and collaboration, social determinants of health, and other age-friendly initiatives. EVALUATION: Network participants are being tracked on 13 key indicators to improve the health and well-being of older adults, including data collection and dissemination; ensuring emergency preparedness plans target older adults; and targeting older adult health needs in community health assessments. DISCUSSION: Trust for America's Health's AFPHS initiative demonstrates that state and local public health departments have crucial roles to play to improve the health and well-being of older adults through data collection and analysis, collaboration with aging sector stakeholders, and adapting policies and programs to become age-friendly.

Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan.

Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan's rapid implementation of disease prevention measures helped detect and isolate the country's first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan's government during the first 50 days of the COVID-19 outbreak.

COVID-19 Exposes the Cracks in Our Already Fragile Mental Health System.

The coronavirus pandemic has caused enormous concern among many people. Every morning, we are met with an increasing deluge of dire news about the most recent number of people to contract COVID-19 and to die from it, decreases in the stock market, and countries implementing broad travel restrictions and stay-at-home orders.1,2 The current state of affairs is having a negative effect on the mental well-being of our country's residents. It also highlights the policy gaps in our current system that inhibit the vital conditions for well-being and resiliency.3 Although the primary focus has rightfully been on stopping the spread of COVID-19, we should also quickly prepare to address the mental toll the pandemic is taking on individuals and communities across the country. (Am J Public Health. Published online ahead of print May 21, 2020: e1-e2. doi:10.2105/AJPH.2020.305699).

Improving Hypertension Control Population-wide in Minnesota.

CONTEXT: Hypertension is a common and costly risk factor for cardiovascular disease, but just over half of all adults with hypertension have their blood pressure controlled nationally. In Minneapolis-St Paul, Minnesota, the rate of hypertension control is approximately 70% despite a rate of hypertension control similar to the national average as recently as the first half of the 1990s. OBJECTIVE: The purposes of this study were to identify factors in Minneapolis-St Paul and state-level policies and programs in Minnesota that may have contributed to the more rapid increase in blood pressure control there than that in the rest of the nation and to identify factors that can potentially be replicated in other jurisdictions. DESIGN, SETTING, PARTICIPANTS: The study included analysis of trends in hypertension control since 1980 based on the Minnesota Heart Survey and the National Health and Nutrition Examination Survey, as well as interviews with health care and public health leaders in Minnesota. MAIN OUTCOME MEASURE: Prevalence of hypertension control. RESULTS: Probable contributing factors identified include a focus on collaborative and continuous quality improvement; a forum for setting statewide clinical guidelines and measures; the willing participation from the largest health systems, purchasers, and nonprofit health plans; and the use of widely accepted mechanisms for providing feedback to clinicians and reporting performance. The relatively high rate of insurance coverage and socioeconomic status may have contributed but do not fully explain the difference in hypertension control as compared with the rest of the United States. CONCLUSIONS: The experience in Minnesota demonstrates that it is possible to dramatically increase hypertension control at the population level, across health systems, and health plans in a relatively short period of time. Lessons learned may be helpful to informing local, state, and national efforts to improve hypertension control.

Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21st Century.

Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.

Declines in Opioid Prescribing After a Private Insurer Policy Change - Massachusetts, 2011-2015.

Overdose deaths involving opioid pain medications are epidemic in the United States, in part because of high opioid prescribing rates and associated abuse of these drugs (1). In 2014, nearly 2 million U.S. residents either abused or were dependent on prescription opioids (2). In Massachusetts, unintentional opioid-related overdose deaths, including deaths involving heroin, increased 45% from 2012 to 2013.* In 2014, the rate of these deaths reached 20.0 per 100,000, nearly 2.5 times higher than the U.S. rate overall (3,4). On July 1, 2012, Blue Cross Blue Shield of Massachusetts (BCBSMA), the largest insurer in the state with approximately 2.8 million members,† implemented a comprehensive opioid utilization program after learning that many of its members were receiving new prescriptions with a >30-day supply of opioids. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommends avoiding opioids as a first-line therapy for chronic pain and limiting quantities when initiating opioids for acute pain (5). CDC analyzed BCBSMA prescription claims data for the period 2011-2015 to assess the effect of the new utilization program on opioid prescribing rates. During the first 3 years after policy implementation, the average monthly prescribing rate for opioids decreased almost 15%, from 34 per 1,000 members to 29. The percentage of BCBSMA members per month with current opioid prescriptions also declined. The temporal association between implementation of the program and statistically significant declines in both prescribing rates and proportion of members using opioids suggests that the BCBSMA initiative played a role in reducing the use of prescription opioids among its members. Public and private insurers in the United States could benefit from developing their own best practices for prescription opioid utilization that ensure accessible pain care, while reducing the risk for dependence and abuse associated with these drugs.

Sidney Blatt's Contributions to Personality Assessment.

Over a long, distinguished career, Sidney Blatt contributed to theory and research in personality development, personality assessment, and psychotherapy. Best known for his 2-configurations model of personality and author or co-author of more than 250 articles and 18 books and monographs, Blatt was also a master clinician, a psychoanalyst who was awarded the 1989 Bruno J. Klopfer Award by the Society for Personality Assessment (SPA) for his contributions to both self-report and performance-based assessment. He was also the president of SPA from 1984 to 1986. This special series contains papers by writers who participated in all aspects of Blatt's contributions to personality assessment, both self-report and performance-based. Topics covered include Blatt's 2-configurations model of personality, development, and psychopathology; boundary disturbance and psychosis in performance-based assessment; the interaction of gender and personality on narrative assessments; and the Object Relations Inventory and differentiation relatedness, especially as these relate to therapeutic outcome.

Sidney Blatt's Object Relations Inventory: Contributions and Future Directions.

In this article, we provide a historical overview of the Object Relations Inventory (ORI) and related methods for the assessment of object relations constructed by Sidney Blatt and colleagues (e.g., Blatt, Bers, & Schaffer, 1992 ; Blatt, Wein, Chevron, & Quinlan, 1979 ; Diamond, Kaslow, Coonerty, & Blatt, 1990 ). We clarify terminology that has been used inconsistently in the literature, especially by way of differentiating the methods used to collect descriptions of significant figures, such as the ORI and its predecessor, the Parental Description (PD) task, and the rating scales that Blatt and colleagues constructed to rate those descriptions. We provide a tabular summary of empirical studies of the measure and offer a critical review of those aspects of the instrument that require further empirical investigation and methodological rigor.

Creating incentives to move upstream: developing a diversified portfolio of population health measures within payment and health care reform.

I examined the feasibility of developing a balanced portfolio of population health measures that would be useful within the current deliberations about health care and payment reform. My commentary acknowledges that an obstacle to the selection of population health metrics is the differing definitions of population health. Rather than choosing between these definitions, I identified five categories of indicators, ranging from traditional clinical care prevention interventions to those that measure investment in community-level nonclinical services, that in various combinations might yield the most promising results. I offer concrete examples of markers in each of the categories and show that there is a growing number of individuals eager to receive concrete recommendations and implement population health pilot programs.

Transforming Public Health Practice With Generative Artificial Intelligence.

Public health practice appears poised to undergo a transformative shift as a result of the latest advancements in artificial intelligence (AI). These changes will usher in a new era of public health, charged with responding to deficiencies identified during the COVID-19 pandemic and managing investments required to meet the health needs of the twenty-first century. In this Commentary, we explore how AI is being used in public health, and we describe the advanced capabilities of generative AI models capable of producing synthetic content such as images, videos, audio, text, and other digital content. Viewing the use of AI from the perspective of health departments in the United States, we examine how this new technology can support core public health functions with a focus on near-term opportunities to improve communication, optimize organizational performance, and generate novel insights to drive decision making. Finally, we review the challenges and risks associated with these technologies, offering suggestions for health officials to harness the new tools to accomplish public health goals.

The Community As A Full Partner: A New Model For Public Health.

The COVID-19 pandemic demonstrated a need to strengthen the US public health system by shifting toward much greater community engagement and leadership. In November and December 2023, we conducted separate online surveys of community-based organizations and large metropolitan health departments to identify barriers and opportunities for building a public health system with strong community partnerships. Identified barriers included mistrust, siloed health departments with structural challenges in funding community-based organizations, and insufficient shared decision making. The surveys helped inform our six policy recommendations: establish state and local community councils to formalize the roles of community-based organizations in public health decision making; dedicate funding to these organizations; offer funding that is not limited to a specific disease or condition; simplify procurement and reporting processes directed to community-based organizations; create a training and technical assistance program for these organizations; and increase public health worker diversity, including sustainable funding for community health workers.