Community Impact

In recent years, policy makers, payers, and providers have increasingly focused on resolving health-related social needs (HRSNs). The authors evaluated a private payer–led program, Community Connected Care (CCC), which integrates screening and addressing of social needs to enhance members’ overall health, and assessed the impact on health care costs among referred Medicaid beneficiaries with high clinical risks. The authors used adjusted difference-in-differences analyses with generalized estimating equation regression models to estimate the average effect of the CCC program intervention on per-member per-month (PMPM) total allowed health care costs among referred high clinical risk Medicaid beneficiaries from January 1, 2022 to December 31, 2022. Differences in average PMPM cost outcomes between an intervention group (referred members who were successfully reached and assessed by program staff) and a control group (referred members who could not be reached) across pre- and postintervention periods (6 months before to 6 months after the index referral date) were compared after baseline covariate adjustment. Additional stratified subgroup analyses were conducted based on additional presence or absence of high social risk. There was a statistically significant decline in PMPM total allowed costs across all high clinical risk Medicaid beneficiaries referred to the CCC model (−US$85 [95% confidence interval (CI), −US$167 to −US$3], P=0.0421). In subgroup analysis, there was a larger and statistically significant decline in total allowed costs (PMPM reduction of −US$181 [95% CI, −US$329 to –US$33], P=0.0163) among the subset of high clinical risk Medicaid beneficiaries with known high social risk at the time of referral. In addition, there were statistically significant reductions in emergency department allowed costs and increases in primary care costs for this high clinical and high social risk Medicaid cohort after referral. By contrast, there was no statistically significant impact on PMPM total allowed costs for Medicaid members who only had high clinical risks without having additional high social risk (−US$40 [95% CI, −US$139 to US$59], P=0.4284). This study suggests that addressing HRSNs among Medicaid members with high clinical needs can lead to lower health care allowed costs. However, the health care industry should adopt a broader framework beyond medical cost reduction when evaluating the returns on addressing HRSNs. Metrics should also reflect nonmonetary values such as improved patient experience, enhanced quality of life, and the potential to reduce health disparities.

Community health worker (CHW) programmes are central to primary healthcare (PHC) in sub-Saharan Africa (SSA). Yet who pays for them, how much, and whether funds favour vertical (single-disease) or horizontal (broader-focus) programmes remains unclear. This study examined trends in donor and government financing for CHW programmes across SSA. We conducted a secondary analysis of publicly available data. Organisation for Economic Co-operation and Development Creditor Reporting System (2002-2022) projects were screened and classified as vertical or horizontal through standard definitions and manual review. Government spending in 37 SSA countries (using WHO Global Health Expenditure Database (2016-2022) was estimated by applying maturity-based allocation percentages to preventive and outpatient curative functions. We described trends, donor composition, vertical-horizontal shares and the annual financing gap against published cost benchmarks. Between 2002 and 2022, global external assistance for CHW programmes totalled US$14.4 billion, SSA receiving 76% (US$11.0 billion). Of donor funds to SSA, 76.4% supported vertical programmes, although these made up fewer than 20% of projects; horizontal programmes received just 14.7%. Annual external assistance rose from ~US$0.28 billion (2016-2019) to ~US$1.83 billion (2020-2022), with over 90% directed to vertical or COVID-19-related efforts. Government spending across 37 SSA countries totalled ~US$1.4 billion (2016-2022). This represented less than 20% of total CHW funding but a greater share directed to horizontal services (54.6%). The annual financing gap remained between US$4.7 billion and US$4.3 billion. CHW financing in SSA is donor-dominant and vertically oriented; domestic allocations are limited but relatively more horizontal. Closing the funding gap will require larger, predictable government budgets for CHWs, better-aligned partner support and stronger expenditure tracking to sustain PHC and advance universal health coverage.

Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented. We performed a scoping review, searching ten databases and the grey literature for original studies published between August 2015 and July 2024. Recognized search terms related to "Community Health Workers" and "Economic Evaluation(s)" in LMICs were utilized. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form, and analysed using Microsoft Excel. Thirty-three studies representing 106 scenarios were included, predominantly from sub-Saharan Africa (61%). Over half the scenarios provide evidence about malaria (n = 59), followed by HIV (n = 31) and TB (n = 24). CHWs performed diverse roles, including delivering preventive education, case finding, diagnosis, treatment adherence support, counselling and referrals. The majority demonstrated that CHW programs were cost-effective compared to alternative service delivery models, most commonly facility-based care. These programs were particularly effective in improving treatment adherence and targeting high-priority populations. Costs per beneficiary ranged widely, from $1.20 to $26,556. This review highlights significant heterogeneity in methodologies and reporting, impeding comprehensive comparisons. Future research should emphasize standardized reporting, assess affordability, explore integrated CHW roles across multiple disease groups, and focus on generating evidence that supports priority-setting and resource allocation at the health system level.

Cholera continues to be a global public health problem and a sign of societal inequality and underdevelopment, despite the fact that it may be predicted and avoided. Cholera is a severe diarrheal infection caused by eating food or water infected with Vibrio cholera bacterium. Only two of V. cholerae's serogroups, O1 and O139, are known to generate outbreaks. Nigeria leads Africa in documented cholera cases, a pandemic that has increased since 2020. In 2021, Nigeria accounted for 88% of documented deaths and 78% of reported cases in Africa, indicating no significant improvement. Local communities in Nigeria accounted for 80% of deaths, according to recently released World Health Organization data. Long-term solutions to the cholera epidemic include economic growth, universal access to clean water, and basic sanitation. The primary methods for preventing cholera are to immunize people against the disease with oral cholera vaccinations and to give clean water and proper sanitation to communities that do not already have access to these essentials. The ongoing cholera outbreak in Nigeria can be attributed to a lack of clean water and sanitation infrastructure, open defecation, and poor hygiene practices. This report gives a synopsis of the epidemiology of cholera in Nigeria based on available relevant scientific literature.

Recently, there has been increased scientific and clinical interest in the potential harms associated with ultra-processed foods, including poor mental health, aggression, and antisocial behavior. Research spanning epidemiology, mechanistic pre-clinical work, addiction science, microbiome and exposome science, and human intervention trials has underscored that nutrition is of relevance along the criminal justice continuum. As such, the emerging dietetics research is salient to the thousands of international psychologists and allied mental health professionals that are engaged in justice work, including forensics, prevention, and intervention. In addition, relationships between nutrition and behavior relate to “food crime”, an emergent area unifying criminal justice researchers with psychology, public health, and other interdisciplinary sectors. Food crime scrutinizes the vast harms, including non-communicable diseases and adverse behavioral outcomes, as influenced by the distribution of addictive ultra-processed food products. Here, we examine the emergent research, including biophysiological mechanisms, and evidence indicating that dietary patterns/components intersect with psychosocial vulnerabilities linked with risks of antisocial behavior and justice involvement. Viewed through a prevention lens, the study of nutrition and aggressive behavior should be prioritized, especially if the outcomes emerge as externalities of the global consumption of ultra-processed food. In the context of criminal justice and behavior, there is a need for forensic examination of how industry influence and power structures can undermine matters of food justice.

Climate change is projected to alter rainfall patterns in many parts of the US and around the world, highlighting the importance of stormwater management systems within resiliency efforts. Stormwater systems typically are designed based on historical rainfall records with the assumption of climate stationarity. This assumption is no longer valid for many locations, leaving a gap in the knowledge about how to ensure that these systems will meet the desired level of service over their design life. Researchers and practitioners have begun exploring how to incorporate future climate scenarios into the design of stormwater systems to maintain the current level of function well into the future. Despite this, uncertainty remains about how to manage cloudburst events, the water quality implications of climate change, and how to incorporate uncertainty in climate model outputs into engineering designs. In the absence of unifying design criteria for incorporating climate change into infrastructure design, communities have begun to form their strategies, from updating intensity–duration–frequency curves to characterizing rainfall based solely on “recent” historical data. As the debate continues regarding how to best protect communities against uncertain future weather patterns, a set of critical considerations has emerged. There is a dire need to explicitly define what resiliency means for stormwater management systems under a climate change paradigm to allow for clear design criteria that incorporate uncertainty and can achieve favorable outcomes at the system scale. There also is ample opportunity to develop new approaches and technologies that allow communities to optimize their infrastructure in terms of water management and an array of other ecosystem services. Thus, despite the current and future challenges of climate change, opportunities exist to develop the next generation of stormwater management systems that serve as multifunctional community assets.

School closures in March 2020 due to the COVID-19 pandemic precipitated losses of critical student resources as physical, mental, emotional, and social needs escalated. Identifying the challenges, strategies, and changes in school nurse (SN) practice in Massachusetts during this pandemic is fundamental to understanding how to manage future anticipated pandemics while protecting children, communities, and SNs. The purpose of this mixed-methods descriptive study in the second year of the global pandemic was to (a) listen to SN voices through a novel online survey including the prompts of challenges, strategies, and practice changes and (b) describe the SN experience of COVID-19 response in Massachusetts schools, including identification of intent to leave school nursing. Responses were analyzed using descriptive qualitative analysis (n = 73). The prompts each elicited subthemes that coalesced to a cohesive theme: Finding one's way required the support of others to pave untraversed roads.

A substantial literature exists examining access to preventive health services for those with physical or intellectual disabilities versus the non-disabled [1] . We used a large all payer claims data set to explore this question. The data accessed was from the Colorado All Payer Claims Database with dates of service from 1/1/2017 to 6/30/2020. Based on CMS guidelines for disabling conditions, we identified patients with ICD10 codes for the following conditions: cerebral palsy, cystic fibrosis, mobility impairment, multiple sclerosis, muscular dystrophy, spina bifida, traumatic brain injury. CPT codes specifying 4 non gender specific preventive healthcare procedures of varying degrees of mechanical performance difficulty (levels 1-4) were selected as follows: level 1-alcohol misuse screening and consulting, level 2-pneumococcal vaccine, level 3-cholesterol screening, level 4 -colorectal cancer screen.