We present in this review the current state of disaster mental health research. In particular, we provide an overview of research on the presentation, burden, correlates, and treatment of mental ...disorders following disasters. We also describe challenges to studying the mental health consequences of disasters and discuss the limitations in current methodologies. Finally, we offer directions for future disaster mental health research.
Summary Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income ...Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution—ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.
Population health is driven by the forces in the world around us. Those forces, in turn, are determined by a national and global conversation about priorities and values.This highlights the ...challenges public health faces to achieve its broader aspirations. The long-drawn national and global debates about what to prioritize and how collective resources should be invested are influenced, both positively and negatively, by a wide variety of factors. Political considerations about where resources should be deployed and who benefits from them and who does not, are a central part of any national or global conversation. Similarly, commercial stakeholders have a particular and legitimate interest in a broader conversational environment, given the impact this topic can have on their commercial viability. Additionally, broader public conversations depend on the millions of small-scale conversations at the proverbial kitchen table that, together, lead to change and form the national and global consensus. This essay establishes the need to catalize, on small and large scales, the underpinnings of public health on an ongoing basis.
This argument rests on how we define public health. Fundamentally public health is a collective act, aimed at assuring that populations are as healthy as possible (Institute of Medicine, 1998). This ...then requires a reckoning with what it is that makes populations healthy to begin with. The health of populations is a product of multiple levels of influence. Political decisions begat policies that ultimately affect health. Our health is influenced by the conditions of the cities in which we live and by the state of our neighborhoods and the places where we live, work, and play. While our behaviors, whether we exercise, eat healthy foods, or refrain from risky behaviors, clearly have a role in shaping our health, many of these behaviors are constrained and are shaped by these same environments. We are more likely to exercise if we are living in a safe neighborhood where we can walk without fear of personal harm. Therefore, the health of populations is a product as much of the world around us, the conditions that characterize where we live and how we live, than it is about personal characteristics or, certainly, genetic predispositions.
Participation rates for epidemiologic studies have been declining during the past 30 years with even steeper declines in recent years. This wholesale decrease in participation rate, or at the very ...least the increase in refusal, has, quite understandably, occasioned some concern among epidemiologists who have long considered a high study participation rate as one of the hallmarks of a “good” epidemiologic study. In this review we synthesize the issues that are central to epidemiologic thinking around declining study participation rates. We consider the reasons why study participation has been declining, summarize what we know about who does participate in epidemiologic studies, and discuss the implications of declining participation rates. We conclude with a discussion of methods that may help improve study participation rates.
Universities and other academic spaces are social institutions that exist primarily for ideas-to generate, curate, and transmit ideas to students and to the world. Academic spaces cannot carry out ...that function without supporting a diversity of perspectives. At the same time, universities must reckon-as must all social institutions-with changing norms around how to engage with ideas that challenge, provoke, even anger members of the communities dedicated to their discussion. It is on these institutions to listen to and learn from these ideas, consistent with their core function, while engaging pragmatically with the challenges and controversies that can arise whenever ideas are regularly and freely aired. While there should indeed be limits to the range of tolerable expression within universities, the imposition of these limits should happen rarely, with caution and humility. It is important that academic institutions recognize that while contemporary preoccupations that influence our engagement with speech may change, the secret to universities' durability over the centuries is that our core purpose-the generation and exploration of ideas-does, and should, not. This inherent value for societies is worth preserving, even, and particularly, in the face of societal pressure and change.
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