Milbank Quarterly最新文献

{"title":"The Political Economy of Wellness: Commercial Determinants of a Burgeoning Industry.","authors":"Nancy Karreman, Marco Zenone, Nason Maani, Benjamin Hawkins","doi":"10.1111/1468-0009.70088","DOIUrl":"https://doi.org/10.1111/1468-0009.70088","url":null,"abstract":"<p><p>Policy Points Wellness has grown into a multi-trillion-dollar industry encompassing a multitude of products and practices that affect health and well-being. Applying a lens of commercial determinants of health to wellness is useful to examine its intersection with systems of capital production, corporate interests, and neoliberal norms of personal responsibility. The global digital revolution has fueled both the growth of the wellness industry and the spread of health misinformation, posing regulatory, social, and political challenges. As wellness movements gain prominence in American and global policymaking, attention to these intersections is crucial to understanding consequences for health policy.</p><p><strong>Context: </strong>The global wellness industry has multifaceted impacts on health and well-being, including through the sale and consumption of wellness products, the provision of health information to consumers, and the promotion of specific norms and values. Despite its growing prominence, the wellness industry and its impacts on health and policymaking remain understudied. This article examines how the wellness industry operates as a commercial, social, and political determinant of health.</p><p><strong>Methods: </strong>We draw on commercial determinants of health and corporate political activity frameworks to analyze the strategies, structures, and discourses of the wellness industry. We examine existing academic literature, regulatory documents, industry data, and media and policy sources to map the wellness industry's characteristics, regulatory environment, and political dimensions, including its role in shaping US public health policy through the Make America Healthy Again (MAHA) movement.</p><p><strong>Findings: </strong>The wellness industry deploys political strategies closely resembling those of other harmful commodities industries, including undermining scientists and policymakers, promoting personal empowerment, and lobbying against regulation. While wellness products and practices are often framed as responding to the erosion of institutional trust and health care systems' failure to address persistent health inequities, their promotion may deepen, rather than alleviate, these crises. The MAHA movement illustrates how wellness logics have become embedded in policymaking, platforming individualized wellness while falling short of addressing the systemic drivers of ill health and inequity.</p><p><strong>Conclusions: </strong>Applying a commercial determinants of health lens to wellness highlights the need for stronger regulatory oversight of health claims, demonetization of harmful online health misinformation, and structural investment in equitable health care systems. This is particularly urgent given the MAHA movement's alignment of wellness with populist politics. Further research is merited to systematically document wellness industry practices across diverse national contexts and investigate links between welln","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decommodifying and Humanizing Health Care: Revisiting Pellegrino's Ethical Imperative.","authors":"Kevin A Fiscella, Alejandro J Vera, Ashley M Jenkins","doi":"10.1111/1468-0009.70084","DOIUrl":"https://doi.org/10.1111/1468-0009.70084","url":null,"abstract":"<p><p>Policy Points A quarter of a century since bioethicist Edmund Pellegrino warned about the commodification of health and health care, the problem has significantly worsened. Commodification of health and health care objectifies and dehumanizes people and undermines core concepts of holistic person-centered health, much less core human rights, including fulfillment of human potential and comprehensive health care. Multilevel sustained strategies and multisector coalitions are required to decommodify and humanize health and health care based on mental models, national and state policies, practices, resource flow, power dynamics, and relationships and connections.</p><p><strong>Context: </strong>Edmund Pellegrino warned about the growing commodification of health and health care in the United States. After twenty-five years, it is worth revisiting Pellegrino's critique and examining this critique in the current era.</p><p><strong>Methods: </strong>We conducted a targeted review of the literature to revisit the state of commodification in health and health care as defined by Pellegrino, examined its relationship to dehumanization, and explored prospects for addressing commodification.</p><p><strong>Findings: </strong>The commodification of health and health care substantially worsened in the US, characterized by increased health care corporatization and consolidation, biomedical lobbying, and unaffordable costs. Commodification and dehumanization reinforce each other, undermining rights to health and health care, the provision of holistic person-centered health, and the fulfillment of human potential. Decommodifying and humanizing health and health care requires a paradigm shift towards whole-person definitions of health; the acknowledgement of human relationships as a foundation; the recognition of health as a social good; and the need for society and healthcare to partner to optimize health, including providing health care to all.</p><p><strong>Conclusions: </strong>This paradigm shift will require collective, cross-sectoral advocacy and mobilization not only by diverse health care professional organizations but also by organizations outside health care that are committed to improving health for all.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Recent Polarized Elections on Mental Health.","authors":"Michael E Shepherd, Bethany Albertson","doi":"10.1111/1468-0009.70086","DOIUrl":"https://doi.org/10.1111/1468-0009.70086","url":null,"abstract":"<p><p>Policy Points Researchers investigate how recent elections in the United States have influenced mental health, especially among political- and policy-based election losers. The previous two presidential elections worsened the self-reported mental health of Americans on average. Likely partisan election losers and those who had the most to lose in terms of health policy were even more likely to have their mental health affected by the results of elections. As American politics has become increasingly polarized and the perceived stakes of elections have loomed larger in recent years, elections have become a source of worsening mental health for Americans.</p><p><strong>Context: </strong>Politics is increasingly important to many Americans. Yet little is known about how the increasing centrality of politics affects Americans' mental health. This work aimed to evaluate how recent polarized elections have influenced Americans' mental health.</p><p><strong>Methods: </strong>To investigate this question, we compared online search interest in politically related mental health issues and self-reported mental health data. Analyses explored changes before and after election days in 2020 and 2024. The two outcome variables were aggregate Google search interest in politics-related mental health issues and individual responses to the following item from the Behavioral Risk Factor Surveillance System (BRFSS): ''Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? With BRFSS, we compared differential changes for likely Democrats and Republicans using multiple proxy measures and for those with health policy interest in the election.</p><p><strong>Findings: </strong>The 2020 and 2024 presidential elections substantially increased interest in politics-related mental health issues online. The 2020 election led to just under 0.2 additional days of poor mental health (P < .05), and the 2024 election led to just under 0.5 additional days of poorer mental health (P < .05). Likely losing partisans and those who stood to lose out from Trump's reelection in terms of health policy were found to drive most of this relationship, with just under 1 full additional day of poorer mental health for each group.</p><p><strong>Conclusions: </strong>The stakes of elections in this polarized era of American politics are worsening the mental health of Americans. Additional resources may be necessary to allow therapists and clinicians to navigate additional care-seeking surrounding and following elections.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Happens When Coverage is Cut? Looking Backward and Forward From the One Big Beautiful Bill.","authors":"Adam Gaffney, Danny McCormick, David Bor, David U Himmelstein, Steffie Woolhandler","doi":"10.1111/1468-0009.70082","DOIUrl":"https://doi.org/10.1111/1468-0009.70082","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points The One Big Beautiful Bill Act (OBBBA) may impose the largest coverage losses in US history, causing the number uninsured to rise by 55% in the coming decade. We examined four prior coverage contractions-Reagan-era Medicaid cuts, the 2005 TennCare disenrollment, 2019 Arkansas work requirements, and the Medicaid Unwinding-to shed light on the OBBBA's impacts. These suggest that most who lose Medicaid do not find alternative coverage, and that states are unlikely to compensate for federal cuts, findings that run counter to some assumptions adopted by the Congressional Budget Office in predicting the impacts of Medicaid cuts. Studies of coverage contractions complement data from coverage expansions in predicting worse health care access, household finances, and health for needy individuals due to the OBBBA. Studies also suggest that the magnitude of harms from contractions may exceed that suggested by expansions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;The so-called One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 will cut $1 trillion from federal health care programs over the coming decade and cause 10 million individuals to become uninsured according to the Congressional Budget Office. Most analyses of the bill's impacts have assumed they would be the inverse of those documented from previous coverage expansions. An examination of past coverage cuts might yield additional insights into the probable impacts of this legislation on the medical care and health of the needy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed studies of four prior large scale coverage contractions: Reagan-era Medicaid cuts, the 2005 Tenncare Disenrollment, the 2019 implementation of work requirements in Arkansas, and the postpandemic \"Unwinding\" of Medicaid.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The experience of these prior coverage contractions complements evidence from analyses of coverage expansions in predicting that widespread insurance loss will lead to a reduction in care utilization, an increase in household financial strain, and worsened physical and mental health for low-income individuals. These coverage contractions additionally suggest that most who lose Medicaid coverage will not find alternative coverage; that work requirements will impose burdensome administrative costs on states; that states are unlikely to offset reductions in federal Medicaid funding with internal funds; and that the second-order effects of coverage losses may, in some instances, be greater (in magnitude) than the benefits seen after coverage expansions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Cuts to federal health care programs will produce sharp contractions in public coverage that will worsen existing problems in US health care such as insurance churn, degrading care, and worsening health inequality. While states may take some steps to mitigate harmful impacts, better protection of the medically needy would require repeal of the legislation, while full pr","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Medicaid Estate Recovery with Homeownership, Home Equity, and Medicaid Enrollment.","authors":"Amanda Spishak-Thomas","doi":"10.1111/1468-0009.70087","DOIUrl":"https://doi.org/10.1111/1468-0009.70087","url":null,"abstract":"<p><p>Policy Points This study examines the association between the implementation of Medicaid estate recovery and homeownership, home equity, and Medicaid enrollment among low-income adults. Estate recovery is associated with a decrease in Medicaid enrollment among unmarried, low-income older adults and a decrease in home equity overall and among Black respondents, White respondents, and adults over 74 years of age. These findings suggest that low-income adults may behave as intended, avoiding Medicaid and extracting housing wealth to cover care costs; still, it is worth reconsidering a policy that recoups less than 1% of the Medicaid budget to the detriment of low-income families with few assets.</p><p><strong>Context: </strong>In response to the high cost of state-run Medicaid programs, the 1993 Medicaid estate recovery policy was established to enable states to recover assets from the estates of beneficiaries after death. Estate recovery may trigger behavioral responses from older adults who may no longer view real estate as an attractive asset, may borrow money from home equity to cover the cost of increasing care needs, or may avoid enrolling in Medicaid altogether.</p><p><strong>Methods: </strong>Using 1992-2008 data from the Health and Retirement Study, this study exploits the time variation in state adoption of estate recovery to determine the association of recovery policies with homeownership decisions, home equity, and Medicaid enrollment among low-income older adults using a difference-in-difference fixed-effects model.</p><p><strong>Findings: </strong>The implementation of estate recovery significantly decreased home equity in the overall sample and among Black and White subgroups as well as those over age 74 years. Additionally, estate recovery implementation was associated with a significant decrease in Medicaid enrollment among unmarried, low-income individuals aged 65 years and older. No significant association was found between homeownership and estate recovery overall or among subgroups.</p><p><strong>Conclusions: </strong>These findings suggest that those most at risk for Medicaid estate recovery, namely, low-income older adults, may behave exactly the way policymakers intended, avoiding enrollment in Medicaid and extracting housing wealth to cover the cost of their care. Still, it is worth reconsidering a policy that recoups less than 1% of the long-term services and supports budget from Medicaid estate recovery to the detriment of low-income families who already had few assets. These findings reflect the limited choices that older adults and their families have in making long-term care decisions, filling a gap in the extant literature, which has not adequately explored the impacts of estate recovery.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements.","authors":"Sage R Feltus, Christina M Andrews, Lauren Peterson, Colleen M Grogan, Amanda J Abraham, Olivia M Hinds, Maureen T Stewart","doi":"10.1111/1468-0009.70083","DOIUrl":"10.1111/1468-0009.70083","url":null,"abstract":"<p><p>Policy Points States contract with Medicaid managed care plans to administer benefits for roughly 70 million Medicaid enrollees, yet little is known about how plan benefit policies for substance use disorder (SUD) treatment medications align with state requirements. In this study, we found that among the population of 167 Medicaid managed care plans responsible for SUD pharmacy benefits in 2021, many did not align with state requirements to cover SUD treatment medications. Many plans imposed prior authorization requirements on these medications, even when prohibited from doing so. Alignment between state requirements and reported plan policies was less common among plans operating in Republican-leaning states.</p><p><strong>Context: </strong>Medicaid is the largest payer of substance use disorder (SUD) treatment in the United States. Managed care plays an important role, administering benefits for more than 80% of Medicaid enrollees. While state governments have enacted coverage requirements for SUD treatment medications that managed care plans must follow, the extent to which managed care coverage policies align with these rules remains largely unknown.</p><p><strong>Methods: </strong>We linked a national survey of state Medicaid officials regarding state requirements for SUD medication benefits in 2021 with data on SUD medication coverage and management from all 167 Medicaid managed care plans in 2021. We assessed the extent to which plans aligned with state requirements-overall, and by the dominant voter political lean in the state in which the plans were embedded.</p><p><strong>Findings: </strong>In 2021, the proportion of Medicaid managed care plans aligned with state coverage requirements for alcohol use disorder treatment medications was slightly higher than that for opioid use disorder treatment medications. Alignment for coverage was more common than alignment with prior authorization prohibitions. Democratic-leaning states were more likely to require coverage of alcohol and opioid use disorder medications, except in the case of methadone. In Republican-leaning states, most managed care plans did not align with requirements to cover disulfiram and acamprosate and 45.4% did not align with methadone coverage requirements. Plans in Republican-leaning states were less likely to align with prior authorization bans on every SUD treatment medication.</p><p><strong>Conclusions: </strong>Medicaid managed care plans located in Republican-leaning states were less likely to be subject to state requirements governing coverage and prior authorization of SUD treatment medications, with the exception of methadone, and were also less likely to align with requirements when imposed by states.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US State Policy Index for Population Health Analyses.","authors":"Jennifer Karas Montez, Iliya Gutin, Shannon M Monnat","doi":"10.1111/1468-0009.70085","DOIUrl":"https://doi.org/10.1111/1468-0009.70085","url":null,"abstract":"<p><p>Policy Points Changes in states' policy contexts since the 1980s may help explain why mortality rates among working-age adults have risen and become more unequal across geographic areas. Investigating this pressing issue requires a new, industry-standard measure of those contexts. During 1980-2023, higher scores on the State Policies and Politics Database (SPPD) State Policy Index (reflecting an adoption of policies that strengthen economic security, expand safety nets, and discourage risky behaviors) were strongly associated with lower working-age mortality rates. The SPPD State Policy Index is a valid, transparent, replicable, and easily updated measure that is useful for understanding how the general orientation of state policies predicts mortality.</p><p><strong>Context: </strong>Recent studies have linked the rising rates and growing disparities in working-age mortality partly to changes in US states' policy contexts since the 1980s. Yet, such studies largely rely on measures of states' policy contexts, or \"policy indices,\" that were created for other purposes, are not regularly updated, and use complex methods that can be difficult to interpret and replicate. Further elucidating the mortality trends and disparities would benefit from a policy index that is designed for population health analyses and a clearer understanding of the utility of such indices.</p><p><strong>Methods: </strong>Drawing on the World Health Organization's Social Determinants of Health Framework and existing studies of the impact of specific state policies, we identified 11 policies to be included in an annual index from 1980-2023. It ranges from 0 to 1 on a conservative-to-liberal continuum. We evaluated the index on multiple dimensions of validity.</p><p><strong>Findings: </strong>The index demonstrates strong validity. Exhibiting convergent validity, the index has a 0.89 correlation with two existing validated and widely used holistic policy indices created for other purposes using more than 135 state policies and two different modeling approaches. Exhibiting predictive validity, the index is strongly associated with all-cause and cause-specific working-age (ages 25-64) mortality rates. The strength of the associations is similar to those using the two existing indices but have standard errors of about one-third to one-half the size. The index is also associated with mortality at younger and older ages.</p><p><strong>Conclusions: </strong>The State Policies and Politics Database (SPPD) State Policy Index is valid for investigating the links between the general orientation of states' policies and mortality rates. It provides researchers with a straightforward, transparent, annual, and timely index. We discuss the reasons for using policy indices, particularly in an era of policy co-occurrence, and address two criticisms of indices.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended Pregnancy Medicaid During COVID-19 and Enrollment and Health Care Use in the Postpartum Year.","authors":"Erica L Eliason, Maria W Steenland, Rebecca A Gourevitch","doi":"10.1111/1468-0009.70079","DOIUrl":"10.1111/1468-0009.70079","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points The continuous coverage provision of the March 2020 Families First Coronavirus Response Act resulted in extended postpartum Medicaid for individuals with pregnancy Medicaid coverage, which increased postpartum Medicaid enrollment, improved continuity of coverage, and increased Medicaid-paid emergency department visits and mental and behavioral health diagnoses in the 3 to 12 months postpartum. These findings provide insight into the extent to which increased coverage translated into changes in postpartum Medicaid-paid care. Communication and outreach are likely needed to ensure that individuals are aware of and able to use their extended postpartum Medicaid coverage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Before the COVID-19 pandemic, persons with pregnancy Medicaid coverage were typically disenrolled after 60 days postpartum, at which point they could retain Medicaid only if they qualified through another eligibility category (most commonly as a parent). The March 2020 Families First Coronavirus Response Act (FFCRA) extended postpartum Medicaid coverage by requiring states to pause disenrollment in exchange for enhanced federal funding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study examined 2019-2022 Medicaid claims data from 15 states to determine the association between extended postpartum Medicaid coverage and Medicaid-paid care. We employed a continuous difference-in-difference design, leveraging variations in FFCRA-associated eligibility changes (state-level differences in pre-FFCRA pregnancy and parental Medicaid eligibility as a percentage of the federal poverty level [FPL]). The study population included individuals with a birth between January 2019 and December 2021 that was paid for by pregnancy Medicaid coverage. The study population was followed for 12 months after childbirth. Outcomes included Medicaid enrollment, continuity of coverage, outpatient and emergency department visits, and pregnancy-related and mental-health-related diagnoses. Care outcomes were measured from 3 to 12 months postpartum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;In adjusted models, we found that a 100 percentage-point FPL increase in postpartum Medicaid eligibility under the FFCRA was associated with 2.9 additional months of enrollment (95% CI: 0.9, 4.3), a 27.3 percentage-point increase in 12-month continuous Medicaid (95% CI: 2.3, 44.6), 107.2 more emergency department visits per 1,000 beneficiaries (95% CI: 18.7, 167.6), and a 3.2 percentage-point (95% CI: 1.7, 5.4) increase in services with mental and behavioral health diagnoses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Continuous Medicaid coverage during the FFCRA was associated with longer postpartum enrollment and increases in some health care utilization. However, no increases in Medicaid-paid outpatient care or care for pregnancy-related conditions were found, which may have been due to enrollees' limited awareness of their continued eligibility. Improved communication around extended postpartum Medic","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"US State Policy Contexts and Mental Health Among Working-Age Adults.","authors":"Iliya Gutin, Jennifer Karas Montez, Emily Wiemers, Shannon M Monnat, Douglas A Wolf","doi":"10.1111/1468-0009.70077","DOIUrl":"10.1111/1468-0009.70077","url":null,"abstract":"<p><p>Policy Points States' overarching policy contexts are a meaningful yet overlooked predictor of adults' mental health, with more conservative contexts associated with worse mental health outcomes over a 30-year period. Counterfactual analyses suggest that widespread policy shifts could meaningfully alter the national prevalence of mental distress, positioning state policy contexts as important yet underutilized levers for improving population mental health. These associations are strongest among adults without a college degree, underscoring that state policy contexts may exacerbate existing educational disparities in mental health.</p><p><strong>Context: </strong>Mental health among US working-age adults notably worsened during the COVID-19 pandemic, following a steady decades-long decline. The impact of states' COVID-19 policies on mental health has received much attention; however, less is known about the impact of a broader set of long-standing and overarching state policy contexts. This study examines how working-age adults' mental health was associated with states' policy contexts over 30 years. It also assesses whether the pandemic disrupted the association and whether the association is more pronounced among adults without a college degree.</p><p><strong>Methods: </strong>We use nationally representative data on adults ages 25-64 in the 1993-2022 waves of the Behavioral Risk Factor Surveillance System (N = 5,891,073), merged with measures of three state policy indices. The outcomes are self-rated poor mental health days in the last 30 days and extreme distress (poor mental health in all 30 days). The main independent variable is an index that summarizes states' overarching policy contexts, on a liberal-to-conservative continuum, annually from 1993-2020. Two additional indices summarize states' COVID-19 policies, one on in-person restrictions and a second on economic supports, monthly from March 2020 to December 2022. We estimate the association between states' overarching policy contexts and mental health, net of covariates, fixed differences between states, and COVID-19 policies.</p><p><strong>Findings: </strong>During the study period, each unit increase toward state policy conservatism was associated with 0.26 additional days of poor mental health and a 7% higher probability of extreme distress. The pandemic did not disrupt these associations. State policy contexts were a stronger predictor of poor mental health among adults without a college degree than adults with a degree.</p><p><strong>Conclusions: </strong>States' overarching policy contexts are an important yet understudied predictor of mental health. Current and proposed changes in state policies may have important consequences for mental health among working-age adults, their families, and communities.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Community Power as a Structural Determinant of Health for Latino Communities.","authors":"Julianna Pacheco, Nicole Novak, Samantha Deragon, Stephanie Schmitt","doi":"10.1111/1468-0009.70072","DOIUrl":"10.1111/1468-0009.70072","url":null,"abstract":"<p><p>Policy Points Voting rights are the most common measure of power when studying structural determinants of health. Voting is a narrow conceptualization of community power and irrelevant for noncitizen populations who are vitally affected by health policymaking despite not being able to vote. We measure six factors related to community power, including laws, policies, and practices/norms at the county level that are applicable to counties with significant populations who identify as Latino. These measures act to either overcome or exacerbate historical power imbalances based on race, ethnicity, and citizenship status. These findings contribute to our understanding of the structural determinants of health and highlight the important ways that community power can be conceptualized and measured for specific racial or ethnic groups.</p><p><strong>Context: </strong>We broaden our understanding of community power by going beyond traditional measures of voting and voting rights. Our objectives are to (1) create county-level measures of community power that are more expansive than voting and (2) explore the descriptive and geographic patterns of community power.</p><p><strong>Methods: </strong>Six novel measures of community power were developed at the county level. Three were indicators of power-building activities that overcome historic power imbalances faced by Latino populations. These include measures on political representation, immigrant incorporation, and language accessibility for elections. We also measured three indicators related to immigration enforcement that act to exacerbate historical power disparities. Correlational and spatial analyses were conducted to better understand descriptive and geographic patterns.</p><p><strong>Findings: </strong>We found little evidence that our measures are correlated; spatial analyses largely confirmed this. There was evidence of regional spatial autocorrelation, but inferences depended largely on the measure used. We generally found that counties with more than 10% of residents who identify as Latino have higher values on our power-building measures, suggesting that these areas are especially primed to amplify the voices of Latino residents. Interestingly, our measures related to immigration enforcement were largely unrelated to recent Latino population growth (e.g., \"new destination counties\").</p><p><strong>Conclusions: </strong>Power is a fundamental driver of the conditions that produce or mitigate health disparities, but the process by which communities influence decision making may be difficult to measure. This work provides a blueprint for future scholars studying the link between community power and health equity across different races, ethnicities, and citizenship statuses.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"153-170"},"PeriodicalIF":4.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}