Milbank Quarterly最新文献

{"title":"Trends in Long-Term Care Ombudsman Program Funding and Its Relationship to Nursing Home Resident Care.","authors":"Katherine A Kennedy, Cyrus Kosar, Madison S Williams, Kali S Thomas","doi":"10.1111/1468-0009.70061","DOIUrl":"https://doi.org/10.1111/1468-0009.70061","url":null,"abstract":"<p><p>Policy Points Funding that states' Long-Term Care Ombudsman Programs (LTCOPs) receive must cover all activities in that state related to the care of all individuals in nursing homes (NHs) and board and care (i.e., residential care communities, assisted living, and similar care homes); over time, duties and demands have expanded without similar increases in funding. States are contributing more to their federally mandated LTCOPs than they have historically. Evidence from this study suggests that increased spending on LTCOPs is associated with improved NH resident care, supporting the National Academies of Sciences, Engineering, and Medicine's recent call for increased funding to LTCOPs.</p><p><strong>Context: </strong>Funded partially by the Older Americans Act, state Long-Term Care Ombudsman Programs (LTCOPs) provide a critical role in serving as advocates for older adults in long-term care (LTC) facilities. Ombudsmen regularly visit residents, resolve disputes, and assist with discharge planning. In 2022, the National Academies of Sciences, Engineering, and Medicine called for increased LTCOP funding to improve nursing home (NH) quality. However, it is unclear how changes in program funding are associated with the care provided to NH residents. Based on the functions that the LTC Ombudsmen are intended to provide, we hypothesized that increases in LTCOP spending would be associated with improved care in NHs.</p><p><strong>Methods: </strong>We examined 20-year trends in funding for the LTCOP (2000 to 2019). Using 2011-2019 data from the National Ombudsman Reporting System, LTCFocus.org, Centers for Medicare & Medicaid Services Care Compare, and the Area Health Resource File, we examined the relationship between LTCOP spending per LTC bed at the state level and NH outcomes, controlling for year, state, facility, and market characteristics.</p><p><strong>Findings: </strong>Overall, LTCOP funding increased over 20 years. However, the share of federal contributions to the LTCOP has decreased from 58.8% in 2000 to 46.9% of the total program's budget in 2019. The LTCOP spent an average of $37.30 per LTC bed in 2019, with wide state variation. In 2011, the average share of residents receiving antipsychotics was 25.4%, the share of those who were physically restrained was 2.9%, and the share of those with low-care needs was 13.5%. For every $100 annual increase in total spending per bed, there was a statistically significant 1.32, 1.13, and 2.95 percentage-point decrease in the share of residents receiving antipsychotics, those who were physically restrained, and those who with low-care needs, respectively.</p><p><strong>Conclusions: </strong>States that have increased funding for their LTCOP observe better NH resident care. These findings support calls to increase funding for LTCOPs.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356514","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":"Racial and Ethnic Differences in the Effects of Prescription Drug Monitoring Program Laws on Overdose Deaths in the United States.","authors":"Spruha Joshi, Victoria A Jent, Sneha M Sunder, Katherine Wheeler-Martin, Magdalena Cerdá","doi":"10.1111/1468-0009.70057","DOIUrl":"https://doi.org/10.1111/1468-0009.70057","url":null,"abstract":"<p><p>Policy Points State \"must-query\" prescription drug monitoring programs (PDMPs) were associated with increased overdose deaths, suggesting these policies may have unintended consequences. Black and Hispanic populations experienced disproportionately higher increases in overdose deaths following must-query PDMP adoption, highlighting that these policies may contribute to health disparities. Addressing systemic inequities in health care access and substance use treatment may help supplement the effective components of PDMPs, ensuring that these policies reduce rather than exacerbate overdose deaths.</p><p><strong>Context: </strong>Despite recent declines in national overdose deaths, these reductions have not been equitably experienced. Black and Hispanic communities continue to face rising rates of opioid-related mortality, even as overdose death rates among White individuals have begun to decline. One of the most widely implemented policy responses to the overdose crisis has been the adoption of prescription drug monitoring programs (PDMPs), particularly \"must-query\" mandates requiring prescribers to consult the PDMP before issuing controlled substances. However, limited research has examined whether the impact of these mandates varies by race and ethnicity.</p><p><strong>Methods: </strong>We used restricted-use National Vital Statistics System data from 2013 to 2020 to estimate county-level overdose mortality stratified by drug type and race and ethnicity. We categorized deaths as follows: (1) all drug overdoses, (2) all opioid overdoses, and (3) natural/semisynthetic opioid overdoses. Exposure to must-query mandates was modeled as the proportion of the prior year during which mandates were in effect. Using Bayesian spatiotemporal models with county random effects and spatial autocorrelation, we estimated relative rates (RRs) for each outcome overall and by race and ethnicity, adjusting for state policies and sociodemographic characteristics.</p><p><strong>Findings: </strong>Must-query mandates were associated with increases in overdose deaths across all groups, with the largest relative increases among Hispanic (RR = 1.32, 95% credible interval [CrI]: 1.21-1.44) and Black individuals (RR = 1.23, 95% CrI: 1.14-1.33) compared with White individuals (RR = 1.14, 95% CrI: 1.10-1.19). These increases were also observed among Black and Hispanic individuals for natural/semisynthetic opioid overdoses.</p><p><strong>Conclusions: </strong>PDMP must-query mandates are not uniformly protective across racial and ethnic groups. Increases in overdose mortality following adoption, particularly among Black and Hispanic populations, underscore the need to evaluate drug policies through an equity lens and consider broader structural determinants of health that shape their effectiveness.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281600","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":"Correlations Between Flavored E-Cigarette Use and Tobacco and Substance Use Among US Youth, 2021 to 2023.","authors":"Louisiana M Sanchez, Junhan Cho, Alyssa F Harlow, Richard A Miech, Steven Sussman, Hongying D Dai, Abigail Adjei, Dae-Hee Han, Ming Li, Leah Meza, Adam M Leventhal, Dayoung Bae","doi":"10.1111/1468-0009.70051","DOIUrl":"https://doi.org/10.1111/1468-0009.70051","url":null,"abstract":"<p><p>Policy Points Menthol-flavored e-cigarettes are disproportionately used by youth who co-use other substances; allowing menthol sales may undermine efforts to reduce poly-tobacco and poly-substance use. Fruit/ice-fruit flavors are most common among lower-risk youth (those not engaged in other substance use), and banning these flavors could help prevent nicotine initiation. Because nearly all youth who vape use non-tobacco-flavored e-cigarettes, comprehensive policies that eliminate access to all non-tobacco-flavored e-cigarettes, including menthol, may be more effective than selective bans. Stronger enforcement and broader flavor restrictions could help prevent initiation and reduce sustained use, particularly among youth who co-use menthol-flavored e-cigarettes and other substances.</p><p><strong>Context: </strong>The specific nontobacco e-cigarette flavors used by US youth who exclusively vape e-cigarettes compared with youth who engage in poly-tobacco or poly-substance use can help identify the populations most likely to be impacted by e-cigarette flavor policies. This study examines correlations between e-cigarette flavor use and past 30-day tobacco and substance use among US youth who vape.</p><p><strong>Methods: </strong>We analyzed the Monitoring the Future survey data (2021-2023), a nationally representative annual study of US eighth, tenth, and 12th graders. Among 14,675 participants who vaped nicotine in the past year, we assessed their most frequently used e-cigarette flavor: fruit/ice-fruit, menthol, mint, sweet, tobacco, or unflavored. Log-binomial regression models estimated adjusted prevalence ratios (APRs) for correlations between e-cigarette flavor use and past 30-day tobacco and substance use, adjusting for sociodemographic characteristics and e-cigarette use.</p><p><strong>Findings: </strong>Few youth predominately vaped tobacco-flavored (1.3%) or unflavored (3.6%) e-cigarettes, regardless of whether they did or did not use other tobacco products or nontobacco substances. Menthol-flavored (12.1%) e-cigarette use was correlated with past 30-day cigarette (APR 1.53, 95% CI 1.29-1.81), smokeless tobacco (APR 1.53, 95% CI 1.24-1.89), cigars/hookah tobacco products (APR 1.51, 95% CI 1.13-2.02), and alcohol (APR 1.16, 95% CI 1.02-1.32) use. In contrast, fruit/ice-fruit-flavored (72.3%) e-cigarettes were less commonly used among youth who smoked cigarettes (APR 0.83, 95% CI 0.76-0.90), used smokeless tobacco (APR 0.83, 95% CI 0.75-0.91), or reported noncannabis illicit drug use (APR 0.89, 95% CI 0.80-0.98).</p><p><strong>Conclusions: </strong>Closing federal regulatory loopholes and implementing state and local bans on all non-tobacco-flavored e-cigarettes may support efforts to reduce youth nicotine uptake. Policies that limit access and sales to menthol-flavored e-cigarettes could be particularly relevant for youth at risk of poly-tobacco or poly-substance use.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082011","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":"Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross-Sector Initiatives.","authors":"Michael J Yedidia, Joel C Cantor","doi":"10.1111/1468-0009.70056","DOIUrl":"https://doi.org/10.1111/1468-0009.70056","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points Initiatives that effectively bridge health care and housing sectors in serving people experiencing homelessness (PEH) shared four dimensions: success in matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Analyses of accounts of those with firsthand experience implementing cross-sector programs yielded valuable guidance on strategies for incorporating these dimensions. Changes in policies associated with the new federal administration may pose new challenges but are unlikely to alter the relevance of accumulated experience in making use of available resources to effectively engage PEH in health care and housing services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Cross-sector collaborations among health care and housing services organizations promise more efficient use of resources and delivery of more coherent and effective services to people experiencing homelessness (PEH). This study analyzes challenges and strategies reported by those currently implementing cross-sector programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected through in-depth interviews with staff of health care and housing services at eight programs systematically selected to typify the scope and nature of cross-sector collaborations in New Jersey. Respondents included administrators (n = 14) and frontline providers (n = 10). Questions focused on motivations to collaborate, approaches to sustaining partnerships and managing operations, mechanisms for financing services across sectors, and strategies for effectively engaging PEH in health care services. Interviews were audio-recorded and inductively analyzed using standard qualitative techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Collaborations were motivated by the impact of housing on health, the ineffectiveness and costs of attempting to address unmet health care needs in the absence of providing shelter, and the promise of harnessing resources from both sectors. Accounts of successful approaches for engaging PEH in health care services had four fundamentals in common: establishing rapport through matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Favored policies for promoting effective implementation included financing case management services through contract or capitation arrangements, resolving ambiguities in licensing regulations and reimbursement practices that impede co-location of services, securing direct financing for delivery of nursing services at shelters, and providing greater support for frontline providers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The programs' accumulated experiences in successfully implementing cross-sector programs yielded valuable insights for other organizations seeking to mount similar initiatives and for creating a more ho","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070900","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 Impact of Medical Cannabis Laws on Cannabis and Opioid Use Disorder Treatment and Overdose-Related Health Care Utilization Among Adults With Chronic Noncancer Pain.","authors":"Emma E McGinty, Pradyhumna Wagle, Christie Lee Luo, Nicholas J Seewald, Elizabeth A Stuart, Kayla N Tormohlen","doi":"10.1111/1468-0009.70052","DOIUrl":"https://doi.org/10.1111/1468-0009.70052","url":null,"abstract":"<p><p>Policy Points Among patients with chronic noncancer pain, state medical cannabis laws did not impact health care use for opioid use disorder. There were no changes in health care use for opioid overdose attributable to medical cannabis laws. Medical cannabis laws do not appear to lead to reductions in adverse opioid-related outcomes.</p><p><strong>Context: </strong>State medical cannabis laws, currently in place in 39 states and Washington, DC, provide an avenue for therapeutic use of cannabis to manage chronic noncancer pain stemming from conditions such as arthritis and low back pain. These laws may also influence cannabis and opioid addiction and overdose, for example, if people substitute cannabis in place of opioids to manage pain. No studies, to our knowledge, have examined how state medical cannabis laws influence health care use related to addiction to or overdose from cannabis or opioids among people with chronic noncancer pain.</p><p><strong>Methods: </strong>We used a difference-in-differences design and augmented synthetic control analyses comparing changes in cannabis use disorder (CUD) and opioid use disorder (OUD) treatment and cannabis and opioid overdose-related health care use before and after medical cannabis law implementation among Medicare beneficiaries with chronic noncancer pain in seven states (Florida, Maryland, Minnesota, New Hampshire, New York, Oklahoma, and Pennsylvania) relative to changes in outcomes over the same period in 17 comparison states (Alabama, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Mississippi, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming) without medical cannabis laws.</p><p><strong>Findings: </strong>State medical cannabis laws had an estimated average effect of less than 0.005 percentage points on the overall proportion of patients receiving any CUD or OUD treatment, less than 0.009 percentage points on the proportion of patients newly initiating CUD or OUD treatment, and less than 0.0005 percentage points on the proportion of patients receiving overdose-related health care for cannabis or opioid overdoses (p > 0.05 for all findings).</p><p><strong>Conclusions: </strong>Our study did not identify effects of state medical cannabis laws on health care use related to CUD or OUD treatment or overdose among Medicare beneficiaries younger than age 65 years with chronic noncancer pain.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016582","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 Ongoing Assault on Science and Truth.","authors":"Alan B Cohen","doi":"10.1111/1468-0009.70054","DOIUrl":"10.1111/1468-0009.70054","url":null,"abstract":"","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":"103 3","pages":"643-651"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070911","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":"No Data, No Problem: Quantifying Latine Individuals Eligible for but Not Enrolled in Medicaid or Affordable Care Act Marketplace-Based Insurance in North Carolina.","authors":"Gabriela Plasencia, Kamaria Kaalund, Olurotimi Kukoyi, Viviana Martinez-Bianchi, Andrea Thoumi","doi":"10.1111/1468-0009.70030","DOIUrl":"10.1111/1468-0009.70030","url":null,"abstract":"<p><p>Policy Points Latine communities in the United States experience disproportionately high uninsurance rates because of systemic barriers, including limited language equity, lack of provider (clinical or nonclinical) concordance, discrimination, misinformation, and immigration-related fears. Data on individuals eligible for but not enrolled in insurance programs are lacking, which prevents the identification of barriers, population impacted, and tailored approaches to meet specific needs of vulnerable communities. We propose community-informed policy strategies, including culturally tailored outreach, involvement of trusted community health workers, and improved health equity data collection. Framing data in terms of eligible but not enrolled individuals shifts the focus to existing coverage gaps and the potential for improvement, encouraging states to take more proactive enrollment actions.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"707-723"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530738","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":"A Framework for Assessing the Permissibility of Academic Leaders' Outside Activities.","authors":"Matthew S McCOY, Martha E Gaines, Steven Joffe, Genevieve P Kanter, Emily A Largent, Bernard Lo, Holly Fernandez Lynch, Allison M Whelan, Michelle M Mello","doi":"10.1111/1468-0009.70024","DOIUrl":"10.1111/1468-0009.70024","url":null,"abstract":"<p><p>Policy Points Many have urged academic institutions to rethink conflict of interest policies governing leaders' outside activities, which pose not only individual conflicts for leaders themselves but institutional conflicts for their academic employers. Although the American Association of Medical Colleges and Association of American Universities have provided guidance on managing such conflicts, neither offer a structured approach for determining when and under what conditions it is appropriate for a leader to engage in specific outside activities. To address this gap, this article develops a decision-making framework that institutional oversight bodies can use to assess the permissibility of academic leaders' proposed outside activities.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"755-778"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227328","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":"Advancing Equity: Lean Leader Practices and a Path Forward.","authors":"Dorothy Y Hung, Lillian C Levy, Thomas G Rundall, Elina Reponen, William Huen, Stephen M Shortell","doi":"10.1111/1468-0009.70037","DOIUrl":"10.1111/1468-0009.70037","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points This study highlights health care leaders' use of lean management practices to advance equity and scale initiatives supporting the delivery of high-quality care for all patients. As a next step in this work, there is a need to develop new measurement systems with clearly defined performance metrics that ensure accountability to equity standards. Standards can be reinforced by government agencies, professional associations, and accrediting bodies. Examples include building equity-specific metrics into Centers for Medicare and Medicaid Services' Medicare Advantage STAR ratings, American Medical Group Association and America's Physician Groups recognition programs, National Committee for Quality Assurance certification criteria for health plans, and Joint Commission accreditation for hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Lean management is a sociotechnical approach to quality improvement that aims for consistency in work processes and outcomes. This can be leveraged to reduce inequities by ensuring delivery of high-quality care to meet the needs of patients with diverse backgrounds. Despite recent efforts in the field, there is limited study on how managers implement health equity and workforce diversity goals as strategies to improve patient care. Given the important role of leadership in fostering workplace culture, we examined leader activities and specifically their use of lean management practices to support equity initiatives in health care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted in-depth interviews with 67 leaders ranging from C-suite executives to frontline managers in five US hospital-health systems. Interview transcripts were analyzed and validated via parallel coding, yielding an interrater agreement of 92.6%. We identified cross-cutting themes on how leaders use lean methods to promote equity in care settings, and elicited insights regarding barriers, facilitators, and recommendations for continuous improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Leaders highlighted the lean daily management system (DMS) as a robust platform to introduce and scale systemwide equity initiatives. The DMS consists of standardized practices including tiered huddles, leader rounding, and problem-solving that enable employees to accomplish daily tasks in alignment with organizational priorities. Humble inquiry was also cited as an effective way to address patient safety issues while fostering cultural humility and learning. Leaders strongly recommend integrating equity into other strategic goals (quality, affordability, patient/employee experience) and stratifying data to inform key performance indicators. Recommendations to strengthen accountability include setting equity goals and building them into performance evaluations, clearly communicating cultural norms and expectations, and creating equity-focused data reporting systems as the next step or evolution in this work.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Health care leaders can","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"918-939"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795925","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":"Changing the Story on Health and Racial Equity: Why Public Health Needs an Infrastructure for Building Narrative Power.","authors":"Lori Dorfman, Sarah E Gollust, Makani Themba, Pritpal S Tamber, Anthony Iton","doi":"10.1111/1468-0009.70047","DOIUrl":"10.1111/1468-0009.70047","url":null,"abstract":"<p><p>Policy Points One form of power that is required for advancing health and racial equity is narrative power: the ability to shift the stories we use to make sense of the world. Building this form of power requires the field of public health to strategically work to connect institutions and organizations to align in complementary ways to create, build, and sustain new narratives-what we refer to as narrative infrastructure. We illustrate these ideas using real-world examples drawn from work in tobacco control and emerging work in addressing structural racism in public health.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"724-754"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12438444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976171","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}