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'all of us' research project diversifies the storehouse of genetic knowledge.

Results from a DNA sequencer used in the Human Genome Project. National Human Genome Research Institute hide caption

Results from a DNA sequencer used in the Human Genome Project.

A big federal research project aimed at reducing racial disparities in genetic research has unveiled the program's first major trove of results.

"This is a huge deal," says Dr. Joshua Denny , who runs the All of Us program at the National Institutes of Health. "The sheer quantify of genetic data in a really diverse population for the first time creates a powerful foundation for researchers to make discoveries that will be relevant to everyone."

The goal of the $3.1 billion program is to solve a long-standing problem in genetic research: Most of the people who donate their DNA to help find better genetic tests and precision drugs are white.

"Most research has not been representative of our country or the world," Denny says. "Most research has focused on people of European genetic ancestry or would be self-identified as white. And that means there's a real inequity in past research."

For example, researchers "don't understand how drugs work well in certain populations. We don't understand the causes of disease for many people," Denny says. "Our project is to really correct some of those past inequities so we can really understand how we can improve health for everyone."

But the project has also stirred up debate about whether the program is perpetuating misconceptions about the importance of genetics in health and the validity of race as a biological category.

New genetic variations discovered

Ultimately, the project aims to collect detailed health information from more than 1 million people in the U.S., including samples of their DNA.

In a series of papers published in February in the journals Nature , Nature Medicine , and Communications Biology , the program released the genetic sequences from 245,000 volunteers and some analysis of those data.

"What's really exciting about this is that nearly half of those participants are of diverse race or ethnicity," Denny says, adding that researchers found a wealth of genetic diversity.

"We found more than a billion genetic points of variation in those genomes; 275 million variants that we found have never been seen before," Denny says.

"Most of that variation won't have an impact on health. But some of it will. And we will have the power to start uncovering those differences about health that will be relevant really maybe for the first time to all populations," he says, including new genetic variations that play a role in the risk for diabetes .

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Researchers gather health data for 'all of us'.

But one concern is that this kind of research may contribute to a misleading idea that genetics is a major factor — maybe even the most important factor — in health, critics say.

"Any effort to combat inequality and health disparities in society, I think, is a good one," says James Tabery , a bioethicist at the University of Utah. "But when we're talking about health disparities — whether it's black babies at two or more times the risk of infant mortality than white babies, or sky-high rates of diabetes in indigenous communities, higher rates of asthma in Hispanic communities — we know where the causes of those problem are. And those are in our environment, not in our genomes."

Race is a social construct, not a genetic one

Some also worry that instead of helping alleviate racial and ethnic disparities, the project could backfire — by inadvertently reinforcing the false idea that racial differences are based on genetics. In fact, race is a social category, not a biological one.

"If you put forward the idea that different racial groups need their own genetics projects in order to understand their biology you've basically accepted one of the tenants of scientific racism — that races are sufficiently genetically distinct from each other as to be distinct biological entities," says Michael Eisen , a professor of molecular and cell biology at the University of California, Berkeley. "The project itself is, I think, unintentionally but nonetheless really bolstering one of the false tenants of scientific racism."

While Nathaniel Comfort, a medical historian at Johns Hopkins, supports the All of Us program, he also worries it could give misconceptions about genetic differences between races "the cultural authority of science."

Denny disputes those criticisms. He notes the program is collecting detailed non-genetic data too.

"It really is about lifestyle, the environment, and behaviors, as well as genetics," Denny says. "It's about ZIP code and genetic code — and all the factors that go in between."

And while genes don't explain all health problems, genetic variations associated with a person's race can play an important role worth exploring equally, he says.

"Having diverse population is really important because genetic variations do differ by population," Denny says. "If we don't look at everyone, we won't understand how to treat well any individual in front of us."

• genetic research
• human genome
• diversity in medicine

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2022 National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Oct.

2022 National Healthcare Quality and Disparities Report [Internet].

Portrait of american healthcare.

Healthcare quality assessments evaluate health systems’ effectiveness to provide patient care that is timely, affordable, and based on reliable evidence. This section of the report provides a broad portrait of U.S. healthcare in consideration of those fundamental measures as well as additional factors that influence disparities in care. This information is provided to support contextual understanding of the structural factors, including societal inequities, that affect how today’s healthcare is organized, financed, and delivered.

• Demographics: trends in median age, race and ethnicity, and population density.
• Health Measures: trends in life expectancy, mortality, and premature death.
• Social Determinants of Health: prevalence of social, economic, environmental, and community conditions affecting health outcomes.
• Healthcare Delivery Systems: capacities of the healthcare workforce and organizations.
• Personal Healthcare Expenditures: estimates on spending for medical goods and services.
• Geographic Variations in Care: state-level data on quality and disparities.
• Demographics

Healthcare systems and providers in the United States serve a large and growing population. Over the 10 years between the 2010 Census and the 2020 Census, i the U.S. population increased 7.4% to 331,449,281 people, split nearly evenly between females (50.5%) and males (49.5%). 1

The following demographic data describe emerging trends related to the aging population, increased racial and ethnic diversity, and more Americans living in metropolitan areas.

The U.S. population is aging. Five-year estimates from the American Community Survey (ACS) show the median age increased from 36.9 years to 38.2 years between 2010 and 2020. Fewer babies being born and the oldest adults living longer account for much of this increase.

Distribution of people in the United States by 10-year age groups in 2010 and 2020.

• In 2020, 6.0% of the population was under 5 years old, 12.6% was 5-14 years old, 13.2% was 15-24 years old, 13.9% was 25-34 years old, 12.7% was 35-44 years old, 12.7% was 45-54 years old, 12.9% was 55-64 years old, 9.4% was 65-74 years old, 4.7% was 75-84 years old, and 2.0% was 85 years and over in 2020 ( Figure 1 ).
• By comparison, in 2010, 6.6% was under 5 years old, 13.4% was 5-14 years old, 14.3% was 15-24 years old, 13.2% was 25-34 years old, 13.9% was 35-44 years old, 14.6% was 45-54 years old, 11.3% was 55-64 years old, 6.7% was 65-74 years old, 4.3% was 75-84 years old, and 1.7% was 85 years and over.
• American Indian or Alaska Native (AI/AN). A person who has origins in any of the original peoples of North and South America (including Central America) and maintains tribal affiliation or community attachment.
• Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
• Black or African American. A person having origins in any of the Black racial groups of Africa. Terms such as “Haitian” can be used in addition to “Black or African American.”
• Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race. The term “Spanish origin” can be used in addition to “Hispanic or Latino.”
• Native Hawaiian/Pacific Islander (NHPI). A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
• White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Much of the recent growth in racial and ethnic diversity can be attributed to a rise in the number of people who self-identify as two or more races, which increased 7.3 percentage points between 2010 and 2020. The percentage of people who identify as Asian alone also increased by 1.2 percentage points over the past decade, while the percentage of people who identify as Black, AI/AN, or NHPI remained at similar levels.

Distribution of people in the United States, by race, 2010 to 2020.

• In the 2020 Census, 1.1% of people identified as AI/AN, 6.0% as Asian alone, 12.4% as Black or African American alone, 0.2% as NHPI alone, 61.6% as White alone, 10.2% as Two or More Races, and 8.4% as Some Other Race ( Figure 2 ).
• The 2010 Census reported percentages of racial and ethnic groups as 0.9% AI/AN alone, 4.8% Asian alone, 12.6% Black or African American alone, 0.2% NHPI alone, 72.4% White alone, 2.9% Two or More Races, and 6.2% Some Other Race.

Distribution of people in the United States, by ethnicity, 2010 to 2020.

• The 2020 Census estimates that 18.7% of the population identify as Hispanic, while 81.3% identify as non-Hispanic ( Figure 3 ).
• In the 2010 Census, 16.3% identified as Hispanic and 83.7% identified as non-Hispanic.

A growing percentage of people resides in metropolitan communities. The Census Bureau reports that between 2010 and 2020, the percentage of people who live in metropolitan areas increased by 1.1 percentage points, while the percentage of people in nonmetropolitan counties decreased by the same amount.

Distribution of people in the United States, by location of residence, 2010 to 2020.

• In the 2020 Census, 13.9% of people lived in nonmetropolitan counties and 86.1% lived in metropolitan counties ( Figure 4 ).
• In the 2010 Census, 15.0% of people lived in nonmetropolitan counties and 85.0% lived in metropolitan counties.

The NHQDR examines differences in health outcomes by rural-urban location of residence using the 2013 National Center for Health Statistics (NCHS) classification. Data on state-based rural-urban metrics are also available through the QDR State Snapshots .

• That contain the entire population of the largest principal city of the MSA, or
• Whose entire population is contained within the largest principal city of the MSA, or
• That contain at least 250,000 residents of any principal city in the MSA.
• Large Fringe Metropolitan: Counties in MSAs of 1 million or more population that do not qualify as large central areas. iii Large fringe metropolitan areas are also described as suburban areas. Examples of large fringe metro areas are San Bernardino County, California; Broward County, Florida; and Bergen County, New Jersey.
• Medium Metropolitan: Counties in MSAs of 250,000 to 999,999 population. Examples of medium metro areas are Scott County, Kentucky; York County, Maine; and Douglas County, Nebraska.
• Small Metropolitan: Counties in MSAs of less than 250,000 population. Examples of small metro areas are Baldwin County, Alabama; Wayne County, North Carolina; and Allen County, Ohio.
• Micropolitan: Nonmetropolitan counties in a “micropolitan statistical area,” which OMB defines as counties that are less densely populated than MSAs and centered around smaller urban clusters with 2,500-49,999 inhabitants. Examples of micropolitan areas are Woodward County, Oklahoma; Cherokee County, South Carolina; and Harrison County, West Virginia.
• Noncore: Nonmetropolitan counties that are outside of a micropolitan statistical area. Noncore counties are also described as rural. Examples of noncore areas are Wallowa County, Oregon; Bedford County, Pennsylvania; and Crane County, Texas.

Figure 5 shows a map of U.S. county classifications according to the 2013 NCHS Urban-Rural Classification Scheme. iv

Map showing 2013 NCHS Urban-Rural County Classifications in the United States.

• Health Measures

Measures of life expectancy and premature death have worsened in recent decades, suggesting that the United States has fallen farther away from its potential to promote and protect health. The following data quantify those trends.

Life expectancy has not kept pace with other nations. Life expectancy for the overall U.S. population decreased by 1.5 years, from 78.8 years in 2019 to 77.3 years in 2020. Much of this decline was attributable to the global COVID-19 public health emergency. The decline in life expectancy was greater in Hispanic (decrease by 3.0 years) and non-Hispanic Black (decrease by 2.9 years) groups than in non-Hispanic White groups (decrease by 1.2 years), widening an existing health disparity. v

U.S. life expectancy at birth lags behind the average life expectancy of 11 comparable Organisation for Economic Co-operation and Development (OECD) countries. vi The gap had grown steadily since 1980 and widened markedly in 2020, when life expectancy decreased more steeply in the U.S. than it had in comparable industrialized countries. The United States similarly lags behind peer OECD countries in mortality rates and premature death rates. 3

Life expectancy in United States vs. comparable OECD countries, 1980-2020. Note: Data are from the Centers for Disease Control and Prevention (CDC), Australian Bureau of Statistics, and Organization of Economic Co-operation and Development data. The 2019 (more...)

• In 2019, before the COVID-19 global pandemic, average life expectancy in the United States was 78.8 years vs. 82.6 years in comparable OECD countries ( Figure 6 ).
• In 2020, average life expectancy in the United States was 77.0 years vs. 82.1 years in comparable OECD countries.

Exploring the reasons for this trend can provide insights for where the United States can improve healthcare delivery and associated outcomes, particularly trends in premature death and disease-related death, which are explored below.

Ten leading causes of death, based on age-adjusted mortality, United States, 2016-2020. Note: Suicide was one of the 10 leading causes of death from 2016 to 2019 but was replaced by COVID-19 in 2020.

• Heart disease and cancer remained the leading causes of death in 2020, accounting for 168.2 deaths and 144.1 deaths per 100,000 population, respectively) ( Figure 7 ).
• In 2020, COVID-19 became the third leading cause of death, accounting for 85.0 deaths per 100,000 population.
• Drug overdose and other unintentional poisonings accounted for 41.0% of the 57.6 deaths per 100,000 population that were due to unintentional injury. Other prevalent conditions contributing to unintentional injury deaths include accidental falls followed by motor vehicle accidents, unintentional suffocation, and drowning. vii
• Death rates from heart disease, which had been in decline, rose between 2019 and 2020. Death rates from unintentional injury, Alzheimer’s disease, and diabetes also increased.

Opioid use and violence have been powerful contributors to premature deaths. Years of potential life lost (YPLL) is a measure of premature death. It adjusts mortality statistics for age at death, estimating the average time that a person would have lived had she or he not died prematurely. Thus, YPLL highlights conditions that affect younger populations and accounts for the social and economic costs of premature death.

Ten leading causes of years of potential life lost, 2016-2020.

• Unintentional injury (a plurality is due to opioid overdose) is by far the leading contributor to YPLL, due to its prevalence and effects on people across the age spectrum ( Figure 8 ).
• After reaching the United States in 2020, COVID-19 became the seventh leading contributor to YPLL (248.0 years per 100,000 population in 2020).
• The effects of increased violence and lethality of violent means on younger populations are reflected in rising rates of YPLL due to unintentional injury (1,021.8 to 1,271.2 years per 100,000 population between 2016 and 2020) and homicide (225.3 to 286.0 years per 100,000 population between 2016 and 2020).
• YPLL rates have also increased for deaths caused by heart disease, liver disease, and diabetes.
• Maternal/infant health (deaths due to perinatal events and congenital anomalies).
• Mental illness and substance use disorders.
• Deaths due to unintentional poisonings.
• Liver disease (often resulting from alcohol use or hepatitis infections caused by injection drug use).
• Chronic lung disease.
• Alzheimer’s disease.
• Influenza and pneumonia.
• Kidney disease.

Chronic diseases contribute to many of the leading causes of death and years of potential life lost. Chronic diseases are conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. viii Six in 10 adults in the United States have a chronic disease, and 4 in 10 have two or more chronic conditions. 4 Chronic conditions contribute to 7 of the 10 leading causes of death and 6 of the 10 leading causes of premature death. 5

• Avoiding or reducing tobacco use and exposure to secondhand smoke.
• Eating a healthy diet.
• Engaging in regular physical activity.
• Avoiding or reducing use of alcohol, illicit opioids, and other substances.
• Getting adequate sleep.
• Getting screened for preventable diseases.

Communities, healthcare delivery organizations, and providers can also build capacity to serve the specific needs of people with chronic diseases. People with a chronic disease typically require ongoing support to monitor and, if needed, adjust treatment during their lifetime. When people have multiple chronic diseases, each may interact with others in complex ways.

For example, hypertension and chronic kidney disease both increase risk for developing heart disease. However, hypertension also increases the risk for developing chronic kidney disease and complicates its management if it develops. Likewise, chronic kidney disease exacerbates high blood pressure and complicates the management of hypertension. Thus, people with multiple chronic diseases often benefit from interdisciplinary, coordinated healthcare services that can address their clinical needs as well as their health priorities, social needs, and health-related behaviors. 6

Experts have noted that acute, episodic healthcare services, such as those typically delivered in hospitals, are often inadequate to prevent and mitigate the impact of chronic disease on the nation’s health. 7 , 8 They instead point to primary care and community-based strategies as having the greater potential to meet the challenges posed by these conditions. 9 , 10

• Social Determinants of Health

Considerable evidence indicates that social determinants of health (SDOH)—social, economic, environmental, and community conditions—may have a stronger influence on people’s health outcomes than clinical services provided by healthcare delivery systems. 11 Healthcare delivery systems and healthcare workers must account for SDOH when addressing patients’ health concerns.

This section describes the extent to which SDOH factors are present among people in the United States, thus providing estimates for issues healthcare delivery systems must address to produce optimal health outcomes.

The importance of understanding SDOH is underscored in Healthy People 2030 , which sets national objectives for improving health and well-being. Healthy People 2030 describes five SDOH domains that can influence health outcomes ( Figure 9 ). One of the domains— Health Care Access and Quality —accounts for a population’s ability to receive healthcare services when needed. That includes having healthcare services nearby and having insurance to cover the cost of receiving services. The NHQDR summarizes multiple measures related to the Healthcare Access and Quality domain later in this report.

Social Determinants of Health.

• Increased financial security,
• Access to primary care,
• Adherence to prescription medications,
• Screening for treatable health conditions (such as diabetes, cholesterol, HIV, and breast, prostate, and colon cancer),
• Improved perceptions of health,
• Reduced depression symptoms, and
• Earlier detection of cancer. 12 , 13

The NHQDR mostly reports on disparities related to insurance status among people ages 0-64 years. It focuses on people less than age 65 years because more than 98% of Americans 65 years and over have Medicare. 14 Thus, almost no older adults lack insurance coverage since almost all are covered, at minimum, by public insurance (Medicare).

• Private Insurance: Person has access to insurance from a private insurer.
• Public Insurance: Person receives insurance from one or more government-sponsored sources, including Medicaid, State Children’s Health Insurance Program (S-CHIP), state sponsored or other government-sponsored health plans, Medicare, and military and veteran health plans.
• Uninsured: Person does not have any health insurance.

People under 65 years of age with public, private, or no health insurance, 2020.

• In 2020, an estimated 88.5% of people under age 65 had some form of health insurance ( Figure 10 ).
• Of those who had health insurance, approximately 27% had public insurance (Medicaid or a combination of Medicare and Medicaid), while just under three-fourths had private insurance, often from an employer.

The distribution of people who have health insurance varies by demographic factors, including race, location, and other characteristics.

People with any health insurance, by race, ethnicity, and location of residence, 2020.

• Among racial and ethnic groups, non-Hispanic Asian groups (92.4%) were the most likely to have any health insurance, followed by non-Hispanic White (92.2%), non-Hispanic Multiracial (89.7%), non-Hispanic Black (88.1%), non-Hispanic NHPI (85.6%), Hispanic (77.6%), and non-Hispanic AI/AN (72.9%) groups ( Figure 11 ).
• Among location of residence, people in large fringe metro counties (i.e., “suburbs,” 90.1%) were most likely to have any health insurance, followed by people in medium metro areas (89.3%), small metro areas (88.5%), large central metro areas (i.e., “cities,” 88.0%), noncore counties (i.e., “rural,” 85.9%) and micropolitan areas (i.e., “small towns,” 84.5%).

Economic stability is associated with better health. The Economic Stability domain accounts for a population’s ability to maintain steady employment and afford items needed to remain healthy, such as housing, utilities, food, and medications. It also considers how health issues, such as arthritis or health-related disabilities, can limit a person’s ability to work, earn income, and accumulate wealth. Employment, income (the amount a person earns each year), and wealth (their net worth and assets) all enhance health.

The relationship between income and healthcare outcomes has been studied for many years, and researchers have shown the positive relationship between more income and better health outcomes. 15 , 16 , 17 , 18 Income is not the same as wealth, which can include assets other than income. Wealth is disproportionately dispersed among higher income categories, and research also shows a positive association between greater wealth and better health outcomes.

Federal guidelines defining the poverty level are issued annually in the Federal Register by the Department of Health and Human Services, Assistant Secretary for Planning and Evaluation. ix The poverty guideline (PG) (or poverty threshold) varies by family size and there are different family income criteria for the contiguous 48 states, Alaska, and Hawaii. The poverty guidelines are not defined for Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam, the Republic of the Marshall Islands, the Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, or Palau. 19

For most measures, the NHQDR tracks disparities data based on the ratio of household income to the PG for the household’s size. For measures drawn from AHRQ’s Healthcare Cost and Utilization Project (HCUP), income is defined using the median income of the patient’s residential ZIP Code. x

U.S. household Income distribution by percent population, 2020. Note: Percentiles add to 100. Ranges represent quartiles but each quartile may represent less than or more than 25% of the population. The last quartile is divided into two groups, showing (more...)

• In 2020, the median household income was $64,994 (data not shown). The lowest quartile of individual households earned less than $35,000 annually, while the highest quartile of households earned $120,000 or more each year ( Figure 12 ).
• More than one-quarter of households (26.2%) earned less than $35,000 per year; the top 10% of households earned $200,000 or more per year.

The Census estimates that 12.8% of the population lives in poverty. Poverty is a state in which a person or household lacks sufficient financial resources to afford basic needs, such as food, shelter, or clothing. Poverty also hinders people from participating in community life, engaging in healthy activities, or accessing healthcare services when needed. Thus, people who live in poverty are particularly at risk for poor quality of care and undesirable health outcomes.

In 2020, the PG, which is used to determine income-to-PG ratios, was $12,760 for a one-person household, $17,240 for a two-person household, $21,720 for a three-person household, and $26,200 for a four-person household.

Cumulative percentage of U.S. households with different ratios of income to poverty, 2020.

• In 2020, 12.8% of the population had annual household incomes equal to or lower than the poverty threshold ( Figure 13 ).
• Approximately 17% had household incomes between 100% and 199% of the poverty threshold.
• Almost 30% (29.7%) had household incomes between 200% and 399% of the poverty threshold.
• Almost 60% (59.5%) of the population had household incomes at or lower than 400% of the poverty threshold (meaning that more than 40% percent had household incomes at or higher than 400% of the poverty threshold).

Social connectedness is associated with better health. The Social and Community Context domain accounts for the influence that positive and negative relationships with family, friends, coworkers, and the broader community can have on health. This domain includes the ability to communicate with healthcare providers and navigate social norms in healthcare delivery processes. Interpersonal relationships and rapport with clinicians are difficult to measure in a population. However, a few statistics provide a window on this domain.

Five-year estimates from the American Community Survey report that 86.5% of the population were born in the United States, and 93.0% of the population are U.S. citizens. Of the 13.5% who were born outside the United States, 6.9% are naturalized U.S. citizens and 6.6% are not naturalized U.S. citizens. 20

Nearly four-fifths (78.5%) of the population 5 years and over speak English as their primary language at home. Spanish is the second most spoken language in the United States (13.2%). Asian and Pacific Island languages account for 3.5%, other Indo-European languages for 3.7%, and other languages for 1.1%. 21

• 7.7% moved within the same county.
• 3.2% moved to a different county but remained in the same state.
• 2.3% moved to a different state.
• 0.6% moved abroad.

Access to high quality education is associated with better health. The Education Access and Quality domain accounts for the association between having a higher level of education and living a longer, healthier life. Access to high-quality formal education can improve economic stability, enhance the likelihood of engaging in healthy behaviors, and improve a person’s ability to understand and adhere to medical treatment.

Percentage of people in the United States enrolled in school, by age, 2020.

• Just under half (47.3%) of children between 3 and 4 years old are enrolled in school. Nearly all children (94.6%) between 5 and 17 years are enrolled in school. School enrollment declines steadily after age 18 years ( Figure 14 ).
• 7.5% are enrolled in kindergarten,
• 29.8% are enrolled in grade 1 to grade 4,
• 31.1% are enrolled in grade 5 to grade 8, and
• 31.6% are enrolled in grade 9 to grade 12 (data not shown).
• Most adults age 25 years and over in the United States (88.5%) have a high school diploma. Approximately one-third have a bachelor’s degree, and about 13% have a graduate or professional degree. About 20% of adults attended college but did not get a degree, and about 9% have an associate’s degree. About 5% of the adult population did not attend school beyond eighth grade (data not shown). 22

Health quality is influenced by community characteristics. The Neighborhood and Built Environment domain accounts for the influence that physical infrastructure (e.g., access to transportation, access to healthy food options, spaces for engaging in physical activity, and access to high-speed internet) and the environment (e.g., air quality, water quality) have on a population’s health.

Broadband internet access is an example of the built environment as a social determinant of health. With healthcare delivery organizations expanding telehealth-based services, patients’ access to healthcare services may come to depend on access to high-speed internet. Currently, about 85.0% of people in the United States have a broadband internet subscription. However, access varies by a person’s household income. Nearly 15% have no internet, and less than 1% have dial-up only. 23 AHRQ has a data visualization on poverty and broadband access.

• Healthcare Delivery Systems

The United States must have an adequate healthcare delivery infrastructure to meet population needs. Americans receive healthcare from a complex ecosystem of people, institutions, organizations, and resources. The healthcare workforce includes more than 60 occupations that provide direct care to patients, as well as many other administrative, technological, and support occupations.

Healthcare infrastructure includes diverse organizations, such as hospitals; long-term care facilities; home care services; ambulatory surgery centers; clinics; public health departments; health insurance plans; and various industries that produce medications, medical devices, and healthcare technological applications.

Staffing shortages may compromise the capacity to care for patients. Delivering high-quality care often requires that the right number and combination of healthcare workers are available and can work together effectively. For example, routine surgical procedures can be delayed if only a surgeon is present. Safe, high-quality procedures may require anesthesiologists, nurses, pharmacy staff, laboratory technicians, staff who clean operating rooms, staff to sterilize and safely store instruments, and other professions.

Reports of hospital and nursing home staff shortages due to increased healthcare worker turnover, burnout, prioritization of family obligations, illness, and death during the COVID-19 public health emergency have raised concerns about whether the United States has the capacity to deliver safe, high-quality care. Data from the Bureau of Labor Statistics (BLS) offers support for these concerns but also highlight important nuances.

The BLS classifies healthcare delivery “establishments” into major types of settings: ambulatory healthcare, hospitals, and nursing and residential care facilities. Its Standard Occupational Classifications lists more than 60 different healthcare occupations that provide direct care services in those settings. Other, non-direct-care occupations, such as office managers, security personnel, and catering, also work in healthcare settings.

This section uses data from the BLS Current Employment Survey and BLS Current Population Survey to describe overall workforce trends and trends for several types of healthcare occupations: physicians, registered nurses, advanced practice registered nurses (APRNs), and three sets of other groups of healthcare occupations, classified by level of education needed to enter their profession. xi , 24

Healthcare workers are diverse in terms of race and ethnicity. However, diversity varies among different types of occupations ( Figure 15 ).

Percent distribution of race and ethnicity in different healthcare occupations.

The healthcare workforce included approximately 16.1 million workers as of January 2022, which was approximately 2% lower than it had been in January 2020 (immediately before the COVID-19 public health emergency). BLS data indicate worker experiences varied widely by which sector of healthcare delivery they worked in.

Number of workers employed and at work in ambulatory healthcare, hospitals, and nursing and residential care facilities, January 2020-January 2022.

• The number of employed and at work ambulatory healthcare workers decreased by 16.2% in April 2020, near the beginning of the COVID-19 public health emergency ( Figure 16 ). However, employment in this setting quickly recovered and returned to higher levels than reported in January 2020. In January 2022, there were 8,023,100 workers in this setting.
• The number of workers employed and at work in hospitals decreased by 3.2% between March 2020 and May 2020. Employment in this setting has since increased but remained 2% below levels reported in January 2020, a statistically significant difference. In January 2022, there were 5,126,100 workers in this setting.
• The number of workers employed in the nursing and residential care facilities setting decreased steadily from 2020 to 2022. In January 2022, it was 12.1% lower than it had been in January 2020, a statistically significant decrease. In January 2022, there were 2,968,500 workers in this setting.

Data from the BLS Current Population Survey provide less statistically stable estimates due to smaller sample sizes. However, they allow examination of employment trends by occupation and worker demographic characteristics. The findings suggest that loss of workers in less highly educated professions explains most of the decrease in healthcare workforce size.

Number of nurses, advanced practice registered nurses, and physicians employed and at work in any healthcare setting, January 2020-January 2022.

• The number of nurses employed and at work exhibited time-limited swings of up to 15.3% between September 2020 and May 2021, but the overall workforce size has not changed significantly since January 2020 ( Figure 17 ).
• There were no statistically significant changes in the overall number of APRNs and physicians employed and at work from January 2020 through January 2022.

Number of workers in other healthcare occupations employed and at work in any healthcare setting, by education needed to enter the occupation, January 2020-January 2022.

• Since then, employment for workers in this group only partially recovered. At the end of January 2022, the number remained 10.2% lower than it had been in January 2020, a statistically significant decrease.
• At the end of January 2022, there were 2,029,000 healthcare workers in this category employed and at work.
• By comparison, between January 2020 and the end of January 2022, there were no statistically significant changes in employment levels for healthcare workers in professions requiring a bachelor’s degree or higher level of education. At the end of January 2022, there were 1,399,000 healthcare workers in occupations requiring bachelor’s or master’s degrees and 765,000 workers in occupations requiring doctorate degrees.

In a complex U.S. healthcare system, medical offices remain by far the setting most commonly visited for care. In any given year, most people in the United States interact with healthcare delivery systems through routine office-based physician visits. A smaller percentage of people seek emergency care services, and even fewer require hospitalization. In 2020, 83.4% of adults and 94.0% of children had an office visit with a doctor or other healthcare professional in the past year. 25 For comparison, 19.0% of adults had an emergency department visit that year. 25 In 2018, only 7.4% of people in the United States required an overnight hospital stay. 26

Ambulatory Medical and Surgical Offices

In 2018, there were 860.4 million medical physician office visits, or 267.1 visits per 100 people. Just over half (136.6 visits per 100 person) were with a primary care provider. Approximately one-quarter of encounters (67.1 visits per 100 people) were with medical specialists, and just under one-quarter (63.3 visits per 100 people) were with surgical specialists. 27

Major reasons for office-based physician visits, by patient age, 2018.

• Overall, most office visits (39.0%) were for managing one or more chronic conditions, followed by evaluating a new problem (24.0%), providing preventive care services (23.0%), and performing pre- or postoperative evaluation (8%) ( Figure 19 ).
• Only 6.0% of ambulatory healthcare visits were for evaluation or management of an injury.
• Among children less than 18 years old, this overall pattern of visits differs, giving greater emphasis to visits for new problems and preventive services.

The 10 leading principal reasons for visits account for less than half (41.6%) of all reasons for all office visits. The list illustrates the wide scope of healthcare services delivered in ambulatory settings. It also highlights primary care offices’ counseling, medication maintenance, and followup activities, which are central to successfully managing chronic diseases. Error! Bookmark not defined .

• Progress visit, not otherwise specified (17.6%). xii
• General medical examination (6.3%).
• Postoperative visit (3.1%).
• Other and unspecified test results (2.3%).
• Prenatal examination, routine (2.3%).
• Knee symptoms (2.2%).
• Cough (2.1%)
• Medication (prescribing or refill), other and unspecified kinds (2.0%).
• Hypertension (1.9%).
• Counseling, not otherwise specified (1.8%).

Living in proximity to primary care services could improve a person’s likelihood of receiving high-quality care for chronic disease. However, many communities in the United States report limited or no access to primary care, especially nonmetropolitan communities. The Health Resources and Services Administration (HRSA) has designated 7,955 locations, population groups, and healthcare facilities as Primary Care Health Professional Shortage Areas (HPSAs). More equitable distribution of primary care providers may reduce the number of primary care HPSAs. HRSA reports that there were 256,220 full-time-equivalent primary care providers in 2018 28 and estimates that 16,461 additional practitioners would fulfill the needs of existing HPSAs. 29

Counties where all, part, or none of the county is a Primary Care HPSA.

• Overall, 1,963 (62.5%) of 3,141 counties and county equivalents are classified as “whole county shortage areas.” Of these, 562 (28.6%) are metropolitan counties and 1,401 (71.4%) are nonmetropolitan counties ( Figure 20 ).
• In contrast, only 169 (5.4%) counties and county equivalents are classified as having “no primary care shortage area.” Approximately two-thirds (112 or 66.3%) are metropolitan counties while only 57 (33.7%) are nonmetropolitan counties.
• Of the approximately 79 million people who live in counties where the entire county has been designated a primary care HPSA, 51 million (64.6%) are in metropolitan counties and 28 million (35.4%) are in nonmetropolitan counties. 30
• Of the approximately 226 million people who live in counties where part of the county has been designed a primary care HPSA, 210 million (92.9%) are in metropolitan counties, and 16 million (7.0%) live in nonmetropolitan counties. 29
• Approximately 22.6 million people live in counties where none of the county has been designated a primary care HPSA. Nearly all (21 million or 92.9%) live in metropolitan counties. 29

Emergency Departments

Emergency departments (EDs) play a critical role in healthcare delivery systems as a provider of acute care and an important gateway for hospitalization. 31 Their central role in healthcare delivery is supported in part by the Emergency Medical Treatment and Labor Act, which requires hospitals to provide acute medical care to all patients, regardless of their demographic characteristics or ability to pay. 32 In 2019, there were approximately 151 million ED visits, or 46.6 visits per 100 people. 33

Triage status of emergency department visits, 2019.

• Among visits with triage data available, nearly two-thirds (65.7%) of visits were classified as “urgent” or higher acuity, 30.3% were classified as “semiurgent,” and only a few (3.9%) were deemed “nonurgent” ( Figure 21 ).
• Symptoms, signs, and abnormal clinical laboratory findings, not classified elsewhere (25.9%).
• Injury, poisoning, and certain other consequences of external causes (17.4%).
• Diseases of the respiratory system (10.5%).
• Diseases of the musculoskeletal system and connective tissue (7.4%).
• Diseases of the digestive system (6.0%).

Although the number of freestanding EDs (defined as EDs that are not physically attached to a hospital) has increased in recent years, most EDs are located within hospitals. 34

Hospitals are organizations that bring together different types of healthcare professionals, diagnostic and therapeutic equipment, and services, typically to provide medical and surgical care for short-term (acute) illnesses. 35 In 2022, the American Hospital Association (AHA) counted 6,093 hospitals with a total of 920,531 staffed beds in the United States. 36 Most are community hospitals.

• Nearly half (48.6%) are not-for-profit, nongovernment community hospitals,
• About one-fifth (20.2%) are for-profit, nongovernment community hospitals,
• Close to one-sixth (15.6%) are state and local government community hospitals,
• About one-tenth (10.4%) are nonfederal psychiatric hospitals,
• A small portion (3.4%) are federal government hospitals, and the remaining 1.8% are other types. 36

Most hospitals (3,483 or 57.2%) are affiliated with a health system, which the AHA defines as “a central organization linking either two or more hospitals, or a hospital and three or more non-acute care entities, such as a multispecialty outpatient office or a skilled nursing facility.” xiii Health systems have the potential to extend the efficiencies hospitals offer by linking them to a broader network of resources and services than any individual hospital can provide onsite.

Hospitals Serving Communities That Experience Higher Risk for Poor Health Outcomes

The NHQDR focuses additional attention to care delivered by three types of hospitals that play an important role in rural areas and other at-risk communities. The Healthcare Cost and Utilization Project (HCUP), which supplies data for many NHQDR measures, defines minority-serving hospitals (MSHs) as hospitals with the 25% highest number of discharges for people who are not identified as non-Hispanic White race/ethnicity. HCUP similarly defines safety net hospitals (SNHs) as hospitals that have the highest 25% of hospital discharges paid for by Medicaid or uninsured. (It should be noted, however, that academic literature offers varying definitions for SNHs.)

MSHs and SNHs are often large, located in metropolitan centers, and classified as teaching hospitals. Although the MSH and SNH designations do not confer additional resources on hospitals, they provide a useful window for understanding differences in hospital performance.

Critical Access Hospitals (CAHs) are facilities that meet certain statutory and regulatory criteria. Such criteria include having fewer than 25 acute care inpatient beds, providing 24/7 emergency care services, being located more than 35 miles from another hospital or CAH (with exceptions), and maintaining an annual average length of stay of 96 hours or less. 37 CAHs are thus smaller than most hospitals, and most are located in rural communities ( Figure 22 ). The Centers for Medicare & Medicaid Services (CMS) certifies a facility as a CAH if it (1) is located in a state that has established a Medicare rural hospital flexibility program; (2) is designated as a CAH by the State in which it is located; and (3) meets other criteria CMS may require.

Distribution of critical access hospitals in the United States, 2022.

Hospital availability in nonmetropolitan (rural) communities is of particular interest to the nation’s health. In sparsely populated communities, hospitals may be the only source for routine and specialized services that would otherwise be unavailable. They also are often the only source of emergency and after-hours care. Thus, when rural hospitals are unavailable or stop providing services, access to healthcare services may be hindered.

For example, 135 rural hospitals closed between 2010 and 2020. The Government Accountability Office (GAO) recently examined the effects of rural hospital closures on healthcare services and found people who lived in a closed hospital’s service area had to travel considerably farther to access dental, mental health, substance use, and obstetric services, as well as services typically associated with hospital care ( Figure 23 ). 38

Median distance people in the service area of a rural hospital that offered a selected healthcare service in 2012 traveled to receive the service after the hospital closed, 2018.

Data from the North Carolina Rural Health Research Program suggests that rural hospitals have closed at an accelerating pace. Although concern was heightened during the early phases of the COVID-19 public health emergency, data point to a trend that preceded the emergency ( Figure 24 ). The NHQDR team continues to monitor this trend.

Number of rural hospital closures by year, 2005-2020.

Hospital Bed Capacity

Although hospitals provide a wide range of services, not every hospital provides every service, and not every staffed bed may be appropriate for every need. The AHA notes that 789,354 (85.7%) staffed beds are in community hospitals, 36 and 696,233 (76%) beds are in hospitals affiliated with health systems. 39 However, only some support general healthcare activities, while many staffed beds are intended for specialized purposes, such as intensive care, care for children, or labor and delivery.

For example, the AHA estimates that 112,359 (12.2%) staffed hospital beds are designated for providing intensive care services. 36 However, the specific types of critical care services they provide vary ( Figure 25 ). While a hospital where the need for medical-surgical intensive care beds has exceeded capacity may realistically reallocate a cardiac intensive care bed to treat an adult with pneumonia-induced respiratory failure, it would be much more challenging to reallocate neonatal intensive care beds for the same purpose.

Types of staffed intensive care beds in community hospitals, 2019.

The number and type of hospital beds available in a community, especially in relation to specific needs, may provide a more meaningful way to assess the United States’ capacity to anticipate and meet demand for hospital services. During the COVID-19 public health emergency, the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network established a system for estimating general medical and intensive care bed capacity at national and state levels. The system allowed estimates to be updated biweekly to provide federal decision makers with timely guidance. Although no longer updated after July 2020, the hospital capacity dashboard ( https://www.cdc.gov/nhsn/covid19/report-overview.html ) still provides valuable information about the distribution of acute care services in the United States.

• Personal Healthcare Expenditures

“Personal healthcare expenditures” measures the total amount spent to treat individuals with specific medical conditions. It includes all the medical goods and services used to treat or prevent a specific disease or condition in a specific person. These include hospital care; professional services; other health, residential, and personal care; home healthcare; nursing care facilities and continuing care retirement communities; and retail outlet sales of medical products. 40

Hospital care accounted for nearly 40 percent of healthcare spending ( Figure 26 ). Although relatively few people in the United States require hospitalization, the people who do often need care that is complex, labor intensive, and expensive. Thus, acute and post-acute care services account for almost half of the nation’s personal healthcare expenditures.

Distribution of personal healthcare expenditures by type of expenditure, 2020. Key: CCRCs = continuing care retirement communities. Note: Personal healthcare expenditures are outlays for goods and services related directly to patient care. These expenditures (more...)

Private insurance paid for more healthcare than any other source ( Figure 27 ).

Personal healthcare expenditures, by source of funds, 2020. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Personal healthcare (more...)

• Private insurance accounted for 32% of hospital, 37% of physician, 13% of home health, 9% of nursing home, 42% of dental, and 40% of prescription drug expenditures (data not shown).
• Medicare accounted for 25% of hospital, 24% of physician, 34% of home health, 20% of nursing home, 2.0% of dental, and 32% of prescription drug expenditures (data not shown).
• Medicaid accounted for 17% of hospital, 11% of physician, 33% of home health, 27% of nursing home, 9% of dental, and 10% of prescription drug expenditures (data not shown).
• Out-of-pocket payments accounted for 3% of hospital, 7% of physician, 10% of home health, 23% of nursing home, 37% of dental, and 13% of prescription drug expenditures (data not shown).
• Hospital care accounted for the most expenditures in all insurance categories.

Private health insurers covered more prescription drug expenditures than other payers.

Prescription drug expenditures, by source of funds, 2020. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Personal healthcare (more...)

• Private health insurance companies accounted for 40.4% of retail drug expenses ($140.9 billion in 2020).
• Medicare accounted for 31.5% of retail drug expenses ($109.9 billion).
• Medicaid accounted for 9.9% of retail drug expenses ($34.5 billion).
• Other health insurance programs accounted for 3.5% of retail drug expenses ($12.3 billion).
• Other third-party payers had the smallest percentage of costs (1.3%), which represented $4.4 billion in retail drug costs.
• Geographic Variations in Care

States have been described as “laboratories of democracy” 41 ; variations in quality of care and health disparity measures provide indicators to guide efforts to improve state-specific healthcare delivery.

State-level data show that healthcare quality and disparities vary widely depending on state and region. Although a state may perform well in overall quality, the same state may face significant disparities in healthcare access or disparities within specific areas of quality.

State-level analysis included 179 measures for which state data were available. Of these measures, 137 are core measures and 42 are supplemental measures from the National CAHPS xiv Benchmarking Database, which provides state data for core measures with Medical Expenditure Panel Survey national data only. The state healthcare quality analysis included all 179 measures, and the state disparities analysis included 110 measures for which state-by-race or state-by-ethnicity data were available.

State-level data are also available for 110 supplemental measures. These data are available from the Data Query tool on the NHQDR website but are not included in data analysis.

Quality varied between States, but in some regions nearby States had similar quality scores.

Overall quality of care, by state, 2016-2021. Note: All state-level measures with data were used to compute an overall quality score for each state based on the number of quality measures above, at, or below the average across all states. States were (more...)

• Five states in the Northeast region (Maine, Massachusetts, New Hampshire, Pennsylvania, and Rhode Island), four in the Midwest region (Iowa, Minnesota, North Dakota, and Wisconsin), and two states in the West region (Colorado and Utah) had the highest overall quality scores.
• Seven states in the West region (Alaska, Arizona, California, Montana, Nevada, New Mexico, and Wyoming), five states in the South region (District of Columbia, xv Georgia, Mississippi, Oklahoma, and Texas), and New York had the lowest overall quality scores.
• More information about healthcare quality in each state can be found on the NHQDR Data Tools website, https://datatools ​.ahrq.gov/nhqdr .

The disparities map ( Figure 30 ) shows average differences in quality of care for AI/AN, Asian, Black, Hispanic, NHPI, and multiracial people compared with the reference group, non-Hispanic White or White people. States with fewer than 50 data points are excluded. Racial and ethnic disparities varied across the United States.

Many factors may account for the variation in disparities between states. Factors may include differences in prevalence of chronic conditions, policies that limit care for behavioral risk factors, and lack of availability of infrastructure that allows easy access to quality healthcare.

Average differences in quality of care for American Indian or Alaska Native, Asian, Black, Hispanic, Native Hawaiian/Pacific Islander, and multiracial people compared with non-Hispanic White or White people, by state, 2018-2021. Note: All measures in (more...)

• Five states in the West region (Arizona, Hawaii, Idaho, Oregon, and Washington), four states in the South region (Arkansas, Kentucky, Virginia, and West Virginia), Kansas, and New Jersey had the fewest racial and ethnic disparities overall ( Figure 30 ).
• Four states in the North region (Connecticut, Massachusetts, New York, and Pennsylvania), three states in the Midwest region (Illinois, Minnesota, and Ohio), and three states in the South region (District of Columbia, North Carolina, and Texas) had the most racial and ethnic disparities overall.

In this report, “Census” refers to the decennial census.

For more information, refer to Dobis EA, Krumel Jr TP, Cromartie J, Conley KL, Sanders A, Ortiz R. Rural America at a Glance: 2021 Edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service. EIB-230. https://www ​.ers.usda ​.gov/webdocs/publications ​/102576/eib-230.pdf?v=4409 . Accessed October 13, 2022.

For comparisons across residence locations, large fringe MSAs (large city suburbs) are used as the reference group since these counties have the lowest levels of poverty and typically have the best quality and access to healthcare.

Readers examining long-term trends should note that the 2013 NCHS Urban-Rural Classification scheme is similar to the 2006 version that preceded it. Although minor differences between the two classification schemes may result in counties being classified in different categories, a 2014 analysis comparing the two classification schemes found that only 286 of 3,143 counties (9.1%) had different category assignments. (See Ingram DD, Franco SJ. 2013 NCHS Urban-Rural Classification Scheme for Counties. Vital Health Stat 2. 2014 Apr;166:1–73. https://www ​.cdc.gov/nchs ​/data/series/sr_02/sr02_166.pdf [ PubMed : 24776070 ].)

In August 2022, the National Center for Health Statistics released Provisional Life Expectancy Estimates for 2021 . Although the final data were not released in time to include in the 2022 NHQDR, the provisional estimates indicate that overall life expectancy in the United States declined for a second consecutive year, from 77.0 years in 2020 to 76.1 years in 2021. Excess deaths due to COVID-19 accounted for most of the decrease in life expectancy, followed by excess deaths due to unintentional injuries, heart disease, liver disease, and suicide.

Compared with averaged data for Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom.

The Centers for Disease Control and Prevention National Center for Health Statistics distinguishes unintentional causes of death from deaths due to self-injury (Suicide) and deaths due to intentional violence (Homicide). In 2020, suicide was the 12 th leading cause of death and homicide was the 16 th leading cause of death.

Examples of chronic diseases include: diseases of the brain , such as stroke and traumatic brain injury; affective disorders , such as depression, anxiety, bipolar disorder, and schizophrenia; vascular diseases , such as high blood pressure, high cholesterol, heart disease, and stroke; metabolic disorders , such as diabetes and thyroid disease; digestive diseases , such as Crohn’s disease; liver diseases , such as cirrhosis; kidney diseases , such as chronic kidney disease; diseases of the joints , such as arthritis; and diseases of the blood , such as thalassemia and sickle cell disease.

Federal guidelines for determining poverty thresholds based on income, size of household, and other considerations are available online at https://aspe ​.hhs.gov ​/topics/poverty-economic-mobility ​/poverty-guidelines ​/prior-hhs-poverty-guidelines-federal-register-references ​/2020-poverty-guidelines .

Measures using data from the Healthcare Cost and Utilization Project analyze health outcomes by community-level household income. In 2020, the median households in the lowest earning quartile of ZIP Codes earned $49,999 or less each year, while the median household in the highest earning quartiles of ZIP Codes earned $86,000 or more. More detail can be found at https://www ​.hcup-us.ahrq ​.gov/db/vars/zipinc_qrtl/nisnote.jsp .

Our analysis grouped healthcare occupations into three categories according to the level of education typically required to enter a profession. Examples of occupations requiring an associate’s degree or less education are dental hygienist, medical assistant, phlebotomist, emergency medical technician (EMT), licensed practical nurse (LPN), and licensed vocational nurse (LVN). Examples of occupations requiring a bachelor’s or master’s degree are occupational therapist, dietitian, and laboratory technician. Examples of occupations requiring a doctorate or equivalent training are pharmacist and podiatrist.

Terms in this list are based on the National Ambulatory Medical Care Survey’s Reason for Visit Classification for Ambulatory Care, defined in the 2018 Public Use File Documentation. https://ftp ​.cdc.gov/pub ​/Health_Statistics ​/NCHS/Dataset_Documentation ​/NAMCS/doc2018-508.pdf .

The AHRQ Comparative Health System Performance Initiative similarly defines a health system as “an organization that includes at least one hospital and at least one group of physicians that provides comprehensive care (including primary and specialty care) who are connected with each other and with the hospital through common ownership or joint management.” More information and additional resources for examining health systems may be found in the AHRQ Compendium of Health Systems: https://www ​.ahrq.gov ​/chsp/data-resources/compendium.html .

CAHPS is the Consumer Assessment of Healthcare Providers and Systems.

For purposes of this report, the District of Columbia is treated as a state.

This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated.

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• NATURE INDEX
• 13 March 2024

Numbers highlight US dominance in clinical research

As the leading country in health-sciences output in the Nature Index, the United States’ Share is almost 8,500, higher than the next 10 leading countries combined. As a result, US institutions feature prominently among the leading research organizations for the subject, with 30 of the top 50 being based there.

The country’s dominance means that it comes top for Share in all but seven of the journals tracked by the Nature Index in the subject. This includes large general journals such as Nature Communications and specialist medical publications such as The New England Journal of Medicine . PLOS Medicine and Gut are two examples where authors based elsewhere (the United Kingdom and China) made the largest contribution.

Source: Nature Index. Data analysis by Aayush Kagathra. Infographic by Simon Baker, Bec Crew and Tanner Maxwell.

The United States is the clear frontrunner among the leading five countries for health-sciences research, with a Share almost four times higher than China, in second place. The United Kingdom is third, with a Share of almost 1,500, a higher placing than its fourth position overall in the Nature Index.

Out of the top 25 countries for health-sciences articles in the Nature Index, five nations have a Share that makes up at least 29% of their overall footprint in the database across all subjects. Denmark, whose research is boosted by the success of companies such as Novo Nordisk, has the highest ratio in this regard at almost 40%.

As Harvard University, in Cambridge, Massachusetts, is the leading institution for high-quality health-sciences research, its involvement in the top institutional partnership in the field is no surprise. But its dominance does not extend to all the other leading collaborations, some of which involve institutions outside the United States.

The difference in Nature Index health-sciences output between the leading academic institution, Harvard University in Cambridge, Massachusetts, and other top institutions is a Share of more than 600. Compared with Harvard, most of the leading institutions also have a lower proportion of their overall Nature Index output in health sciences.

The University of Toronto in Canada and Johns Hopkins University in Baltimore, Maryland, are the only other academic institutions with a health-sciences Share of over 200. They also have a relatively strong focus on health sciences, with over 35% of their overall Nature Index research output in the subject area.

Nature 627 , S14-S15 (2024)

doi: https://doi.org/10.1038/d41586-024-00755-9

This article is part of Nature Index 2024 Health sciences , an editorially independent supplement. Advertisers have no influence over the content.

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March 8, 2023: Today the FDA announced that 19 women were reported in medical publications who developed squamous cell carcinoma (SCC) in the capsule around breast implants. This is more than the 10 women that FDA reported in September. Several of the women died.  It is important to know that 24 cases of SCC have been reported to the FDA, but it is not known if these cases overlap with the 19 that were published or if some of the 24 cases were reported more than once. Some of the women had silicone gel implants, some had saline implants, some textured, some smooth.  Some of the women got breast implants for augmentation, others for reconstruction after mastectomy.  That means that all women with breast implants need to be aware of this risk, even though it may be rare.

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The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds

• Roderik F. Viergever 1 &
• Thom C. C. Hendriks 2  

Health Research Policy and Systems volume  14 , Article number:  12 ( 2016 ) Cite this article

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Little is known about who the main public and philanthropic funders of health research are globally, what they fund and how they decide what gets funded. This study aims to identify the 10 largest public and philanthropic health research funding organizations in the world, to report on what they fund, and on how they distribute their funds.

The world’s key health research funding organizations were identified through a search strategy aimed at identifying different types of funding organizations. Organizations were ranked by their reported total annual health research expenditures. For the 10 largest funding organizations, data were collected on (1) funding amounts allocated towards 20 health areas, and (2) schemes employed for distributing funding (intramural/extramural, project/‘people’/organizational and targeted/untargeted funding). Data collection consisted of a review of reports and websites and interviews with representatives of funding organizations. Data collection was challenging; data were often not reported or reported using different classification systems.

Overall, 55 key health research funding organizations were identified. The 10 largest funding organizations together funded research for $37.1 billion, constituting 40% of all public and philanthropic health research spending globally. The largest funder was the United States National Institutes of Health ($26.1 billion), followed by the European Commission ($3.7 billion), and the United Kingdom Medical Research Council ($1.3 billion). The largest philanthropic funder was the Wellcome Trust ($909.1 million), the largest funder of health research through official development assistance was USAID ($186.4 million), and the largest multilateral funder was the World Health Organization ($135.0 million). Funding distribution mechanisms and funding patterns varied substantially between the 10 largest funders.

Conclusions

There is a need for increased transparency about who the main funders of health research are globally, what they fund and how they decide on what gets funded, and for improving the evidence base for various funding models. Data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are reported using different classification systems. To start increasing transparency in health research funding, we have established www.healthresearchfunders.org that lists health research funding organizations worldwide and their health research expenditures.

Peer Review reports

Approximately 40% of all health research in high-income countries is funded by public and philanthropic funding organizations [ 1 ]. These organizations play a central role in the development of new knowledge and products, particularly in areas that are not sufficiently profitable [ 2 ]. For example, the involvement of public and philanthropic funding organizations has been key in the development of new medical products to combat neglected diseases [ 1 , 2 ] and, since recently, these organizations are increasingly taking action to address the lack of development of new antibiotics [ 3 – 5 ].

Transparency on who the main funding organizations of health research are, on what they fund (their funding patterns) and on how they decide on what gets funded (their priority setting mechanisms and funding distribution mechanisms) can help funding organizations to synchronize their efforts, potentially preventing the duplication of research and improving collaboration on research priorities, and has various other strategic and practical benefits for funders [ 2 , 6 – 12 ]. Such transparency also allows for external evaluation of funding organizations’ portfolios and decision-making processes [ 7 , 13 ]. This is particularly important for public funding organizations, since they distribute public funds. For philanthropic funders, such accountabilities are less clear, but given the substantial impact of some of these funders on the global landscape for health research, it might be reasonable to make similar demands from this group of funders [ 14 , 15 ].

Although substantial insight has been created in recent years into countries’ expenditures on health research [ 1 , 16 – 20 ], there has been relatively little scrutiny of the funding patterns and mechanisms of individual funding organizations. Mappings of individual funding organizations’ expenditures on health research are often limited to one or several countries [ 7 , 10 , 21 – 26 ] or to a select group of diseases [ 25 , 27 – 29 ]. To increase the available information on major public and philanthropic funders of health research, we present a mapping in this article that had a simple target: to identify the 10 largest public and philanthropic funders of health research in the world, to report on what they fund, and on their mechanisms for distributing these funds (funding organizations’ priority setting mechanisms were beyond the scope of this study – see Limitations section for more detail).

Here, we outline the methods used to identify the 10 largest funding organizations of health research in the world, and to assess the funding patterns and funding distribution mechanisms of these organizations. A more detailed description of these methods is provided in Additional file 1 . All data were collected from November 4, 2013, to August 12, 2014.

Identifying the 10 largest funders of health research

Search strategy.

This study distinguished between four types of public and philanthropic health research funders: (1) public national or regional funders (excluding funders of official development assistance (ODA) and multilateral funders), (2) philanthropic funders, (3) ODA funders, and (4) multilateral funders. The mandate of the funding body did not need to be limited to funding health research. Funding organizations were identified through a search strategy that had several components: key funding organizations in the 20 countries with the highest spending on health research [ 1 ] were identified, membership lists of collaborative groups of funders (i.e. groups where major funders of health research collaborate on a global or regional level) were reviewed, publicly available lists of funding organizations that included annual spending on health research were searched, and data on Development Assistance for Health were used to identify key ODA funders. For every funder type, a specific search strategy was used to identify the largest funders of health research (Additional file 1 ). Private for-profit funding organizations were not included in our analysis; we only aimed to map public and philanthropic funders (private for-profit health research funders are mapped elsewhere [ 30 ]). Product development partnerships (PDPs) and other public private partnerships (PPPs) were also excluded because they are intermediate funding organizations, who are funded in turn by governments, philanthropies and the for-profit sector. Furthermore, we excluded single disease funders; although the majority of philanthropic funders of health research focuses on one disease [ 21 ], the largest philanthropic funders of health research tend to fund across multiple disease areas (with some exceptions [ 31 , 32 ]). We note that the annual health research expenditures of the largest PDP, PPP and single-disease funders that we are aware of are lower than the annual expenditures of the 10 largest public and philanthropic funders reported in this study (see Additional file 1 ). Finally, in two cases (the United States Department of Defense (US DoD) and the European Commission (EC)) we included both the overarching organization at its largest sub-organizations or sub-programmes, because of the substantial differences between the funding distribution mechanisms of these sub-organizations and sub-programmes.

To aid future analyses of this kind, we provide an overview of various sources that helped us identify the main public and philanthropic funders of health research globally in Additional file 2 .

Assessing health research expenditures

For all the funding organizations that followed from our search, publicly available data were collected on the organizations’ annual health research expenditures (from annual reports and websites). Data were collected for the most recent year available. When we were not able to find data on organizations’ annual expenditures in the public domain, we contacted funders to ask if they could provide us with their annual expenditures on health research.

Funding organizations differ on at least three aspects in terms of how they report their annual health research expenditures. First, expenditures can be reported as actual expenditures, commitments or budgets. Second, there can be differences in terms of what the expenditures cover. They can cover the organization’s total expenditures on health research excluding operational costs (for managing the funding organization), its total expenditures including operational costs, or its total overall turnover over a single fiscal year (this was only collected if the funding organization exclusively funded health research). Third, there can be differences in terms of the research areas that the reported expenditures pertain to: only health research, or broader categories such as health and biological research or life sciences research. For each funder we extracted data on annual health research expenditures in a step-wise manner, always reporting the actual expenditures excluding operational costs in the area of health research when possible. When these numbers were not available, we reported the next best available number, following the order in the categories provided above. We note that the data from the funding organizations in the top 10 all relate only to health research, all concern actual expenditures or commitments, and for all, except one, operational costs were excluded.

Training support and research education were not included in the overall amount for health research expenditures. In addition, for government ministries, we excluded two types of funding flows. First, when funding was provided by ministries to funding agencies for distribution, we included the funding for the funding agencies, but not for the ministries. Second, for government ministries, such as ministries of education or health, we excluded block funding to universities or hospitals (similar to other initiatives that have reported on health research funding flows [ 24 ]). For funding agencies, we did include institutional funding.

Finally, organizations’ expenditures were made comparable using methods by Young et al. [ 17 , 20 ]. To do so, we first deflated organizations’ expenditures in the national currency to the year 2013 using Gross Domestic Product deflators from the International Monetary Fund World Economic Outlook Database of April 2014 [ 33 ]. Second, we converted the inflation-corrected expenditures to US dollars using the World Bank Official exchange rates for the year 2013. As a secondary outcome, we calculated funding organizations’ health research expenditures as 2013 purchasing power parity-adjusted US dollars (these are not reported in this article, but are available on www.healthresearchfunders.org ) [ 17 , 20 ].

Assessing the funding patterns and funding distribution mechanisms of the 10 largest funders of health research

After the 10 largest funding organizations of health research were identified, data were collected on their funding patterns and funding distribution mechanisms. For each organization, data were collected on:

The funding mechanisms used to distribute funding: intramural funding or extramural funding. For extramural funding, we distinguished between project grants, ‘people grants’, programme grants, funding distributed to organizations and other extramural research funding. For project grants, data were collected to assess if the distribution was untargeted, targeted or highly targeted (for definitions see Additional file 1 ).

The amount of funding allocated to a list of 20 key health areas from the Global Burden of Disease classification [ 34 ].

Funding for operational expenditures was excluded.

Finally, we denoted whether funding organizations used a classification system to classify funding to various health areas and whether they reported statistics on funding for various research types (e.g. biomedical research, clinical research, epidemiological research or health systems research [ 35 ]) and recipient countries or regions.

All data were collected from online reporting databases, annual reports, official websites, or other information sources. After this, each funder was invited to participate in an interview. Before the interview, a document with collected data was made available to a representative of the funder. Before and during the interviews, representatives were asked to add, amend or confirm the data.

Identifying the 10 largest funding organizations of health research

Public and philanthropic funding organizations.

Our search identified 55 public and philanthropic funders that were candidates for being one of the 10 largest funders of health research in the world (Table  1 ), excluding ODA funders and multilaterals (we searched separately for these and report on them later). For 41 organizations, data on the organizations’ annual health research expenditures were available. For five of these organizations, this information was received through personal communications (not publicly reported). Fourteen funders did not provide figures about their annual health research expenditures. Often, these organizations were general funders of research and did provide overall expenditure data but not for health research specifically.

For the 10 largest funders, health research funding totalled to $ 37.1 billion, approximately 40% of all spending on health research globally by public and philanthropic sources [ 1 ]. The United States National Institutes of Health (NIH) contributed the largest part of this amount, with $ 26.1 billion in health research funding in 2013. The largest philanthropic funder was the Wellcome Trust ($ 909.1 million). The Wellcome Trust and the Howard Hughes Medical Institute (HHMI) were the only two philanthropic funders among the 10 largest funders of health research; the other eight organizations were public funding bodies. All 10 funders came from Northern America, Europe or Oceania. The largest Asian funding organization identified was the National Natural Science Foundation of China (NSFC) ($ 621.3 million), the largest funder from Latin America and the Caribbean was Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) from Argentina ($ 184.4 million), and the largest African funder was the South African Medical Research Council (SA MRC) ($ 63.2 million).

ODA-agencies and multilaterals

The expenditures of ODA-agencies and multilaterals on health research were substantially smaller than the expenditures of the largest public and philanthropic funding organizations (Tables  2 and 3 ). The largest funder of health research through ODA was USAID ($ 186.4 million) and the largest multilateral funder was WHO ($ 135.0 million).

Assessing the funding patterns and funding distribution mechanisms of the 10 largest funding organizations of health research

Funding mechanisms used to distribute funding.

There was considerable diversity in organizations’ funding distribution mechanisms (Table  4 ). Five funders funded research fully extramurally, five allocated at least a proportion of their funding to intramural research institutes, and one funder, the Institut national de la santé et de la recherche médicale (Inserm), funded research (almost) exclusively intramurally (total is 11 because for the EC and the US DoD we analysed the sub-organizations or sub-programmes: the US Congressionally Directed Medical Research Program (CDMRP), the Health theme of the EC FP7 Cooperation programme and the European Research Council (ERC)).

Of the 10 funding organizations that provided extramural funding, for six, the main mechanism for extramural funding distribution was the allocation of funding through untargeted competitive project or investigator grants (often, there were also some smaller programmes that used a more targeted distribution). Two funders, the Health theme of the European Commission FP7 Cooperation programme and the US CDMRP, used a more targeted approach and issued calls under prioritized areas. Funders also made use, in varying degrees, of highly targeted funding schemes, such as research contracts, tenders or prizes, but this was never the dominant form of funding distribution. The last two funders, the United Kingdom Medical Research Council (MRC) and the Deutsche Forschungsgemeinschaft (DFG), used a mixed approach to allocate funding, with substantial contributions made through different funding distribution mechanisms. Lastly, the funding model of the NIH and the untargeted part of the MRC deserve separate mentioning because, although they adhered largely to an untargeted model and research funding was available for all areas of health research, the amounts of funding available for various broad research areas were earmarked (in the case of the NIH, for example, through budgets for the NIH institutes). This differs from targeted approaches, where not all areas have to be funded and the prioritization is often more specific, but it is also not completely untargeted.

Finally, most funders mainly dispensed funding via project grants, with smaller programmes that provide grants to excellent individual researchers. However, others put more focus on individual excellence. The HHMI has traditionally been a proponent of such people-focused funding. Since recently, other funders, such as the Wellcome Trust and the NIH, are increasingly making use of ‘people grants’ as well [ 36 ].

Funding patterns towards diseases

The funding organizations’ research expenditures towards 20 specific health areas are shown in Table  5 . We could report data for at least one health area for seven funders. However, as the table makes clear, these data were often not available.

Funding patterns varied, with some funders showing preferences for investing in non-communicable over communicable diseases and others showing the opposite. For example, the NIH spent less on infectious disease research in total than on cancer research alone, while the Wellcome Trust spent 14 times more on infectious disease research than on cancer research. Similar variations arose when comparing more specific disease areas within the non-communicable or communicable diseases. For example, the NIH spent almost three times more on cancer research than on cardiovascular research while the EC under the FP7 programme spent roughly equal amounts on both, and while HIV/AIDS funding comprised more than half of the infectious disease research funding at the US NIH, it comprised less than 10% of that funding at the Australian National Health and Medical Research Council (NHMRC).

Six funders used classification systems to classify their funding to health areas (Table  6 ); five different classification systems were used by these funders (the two funders from the United Kingdom used the same system). Besides using different categories for health problems, these systems also varied on other aspects, such as who enters the data (e.g. the researcher or a specialist employed by the funder) and whether grants can be indexed as belonging to one or multiple health problems. Seven funders reported amounts of funding allocated to various research types and the same seven reported how much funding was allocated to various recipient countries or regions.

In this article, we have identified the 10 largest funding organizations of health research globally and shed more light on their funding distribution mechanisms and funding patterns. Two main conclusions can be drawn from this mapping of influential funders of health research.

Differences between funding organizations: the need for more evaluation of funding distribution models

First, there is considerable diversity between funding organizations in terms of what they fund and how they distribute those funds. This begs the question: do some funding distribution models have more impact than others? The impact of different approaches to funding health research is regularly discussed in the literature, for example, for intramural versus extramural funding [ 23 ], for targeted versus untargeted funding [ 37 ], for ‘people grants’ versus project grants [ 36 , 38 ], for small grants versus large grants [ 10 ], and for competitive versus non-competitive research funding [ 39 ]. However, comparative evaluations of the impact of various funding models are scarce [ 10 , 23 , 38 ], even though approaches to measure the impact of health research are available [ 40 ]. An exception has been the recent comparisons of ‘people grants’ versus projects grants in the United States, which compared HHMI with NIH researchers and NIH Pioneer Awards with NIH project grants [ 36 , 41 – 43 ]. These comparisons have led the NIH to consider a broad shift toward ‘people grants’, demonstrating the value and potential impact of such evaluations [ 36 ]. Evaluations of this kind provide new insights when comparing funding models across funding organizations, but given the different contexts in which funders operate, comparing the impact of different models within one funding organization is perhaps particularly valuable and should become more common practice.

There is also a need for more debate about where the power to decide priorities for publicly funded health research should lie (with parliaments, ministries, funding agencies, or independent committees of experts). Such debate is needed because there are finite resources for investing in health research and thus priorities need to be set using fair and legitimate methods and using the best possible evidence [ 44 ]. In practice, public sector health research funding decisions are not only made on the basis of what research is needed, but are regularly influenced by other factors, such as political interests, advocacy and lobbying [ 2 ]. Thus, there is a need for transparency on who makes those decisions and to debate who should make them [ 2 , 13 , 45 – 47 ]. Analysis of funding organizations’ priority setting processes was not part of this study (see Limitations) but deserves to be a more frequent subject of research studies in the future.

Improving publicly available data on health research funding

Second, to enable evaluation and debates as noted above, it is necessary to have a map of the health research funding landscape: to know who the main funders of health research are, what they fund, and how they decide what gets funded [ 2 , 6 – 11 , 13 ]. Yet, this study shows that these data are often not available. Through our study, we did not find a list of all public or philanthropic health research funders worldwide that included their annual health research expenditures (Additional file 1 ). Therefore, we have now established such a list ourselves at www.healthresearchfunders.org . On this website, we provide access to the data collected for this article and to information on more than 200 other public and philanthropic funders of health research that we have added to this website since the mapping for this article was completed.

Besides the absence of a global listing of funding organizations, we found that data on organizations’ funding patterns and funding distribution mechanisms are often not available, and when they are, they are difficult to aggregate, owing to differences in funders’ data classification systems. Notably, we only collected these data for the 10 largest funding organizations of health research. The absence of such information, and the difficulties in aggregating the data across funders, are likely to be more prominent when smaller funders are also included. There is currently no consensus on a framework for producing descriptive data on funders’ funding patterns (both in terms of health areas and research types) nor on a framework for describing their funding distribution mechanisms [ 6 , 8 , 37 ]. In this article, we have proposed three frameworks for reporting data on health research funding: for reporting data on funding distribution mechanisms (Table  4 ), for reporting data on funding patterns in terms of health problems (the Global Burden of Disease classification [ 34 ]), and for reporting data on funding patterns in terms of research types (biomedical research, clinical research, epidemiological research or health systems research, as proposed by Frenk [ 35 ]). The adoption of standards for reporting funding data, including guidance on what data classification systems to use, by funding organizations, for example through collaborative initiatives such as the Heads of International Research Organizations, would substantially improve the quality and comparability of reported funding data [ 9 ].

Funding organizations are starting to support the goal of transparency and are increasingly recognizing the problems noted above and addressing them. At the 2014 World Health Summit in Berlin, several major funders of health research expressed interest to work together toward developing a common approach for mapping health research funding flows [ 12 ]. Another good example of a multi-funder collaboration to increase insight in health research investments is the World RePORT website [ 48 ]. On a national level, the United Kingdom has led the way in terms of harmonized reporting by showing it is feasible to collect comparable data on health research funding from all major public funding bodies and charities in a country [ 22 ]. Besides initiatives from funders themselves, there are also several promising initiatives from other parties to address the lack of data on global health research funding [ 1 , 16 , 49 – 51 ]. The recent decision to establish a Global Observatory on Health R&D at WHO in particular may help to improve transparency in this area [ 1 ].

Limitations

Finally, we note that the mapping conducted for this article has had several limitations. First, we have excluded funding organizations in the private for-profit sector (these are listed elsewhere [ 30 ]). Second, national systems for funding health research vary. In many countries, a large amount of health funding is dispersed directly from governments to universities or research institutes via block grants. We excluded these block grants and therefore the public funding organizations that we report on do not all contribute the same share of all health research that is publicly funded in a country. Third, we had to make several generalizations in order to be able to report data across funders that were diverse in their funding distribution mechanisms and reporting systems. For instance, what we have termed ‘targeted’ research funding, is a grey area that ranges from broad prioritized research areas to specific research topics or questions [ 52 ]. Also, funders reported on their expenditures on health research in various formats. Although we have kept track of these varying reporting formats, they decrease comparability across funders. Fourth, we would have liked to exclude overhead costs within project funding (not operational costs of the funder, which we did exclude where possible, but overhead costs of the research organization), to measure only the amount of funding that went to research, but this was not feasible because it was mostly not reported. Fifth, our proposed framework for reporting on funders’ funding distribution mechanisms (Table  4 ) lacks detail. It would have been interesting to also report on more detailed mechanisms, such as funders’ grants for businesses and PDPs/PPPs, but we did not include such analyses because of a lack of comparable data across funders. Sixth, funding organizations frequently make adaptations to their funding strategies, and therefore our findings should be viewed as a snapshot of funders’ expenditures, funding distribution mechanisms and funding patterns during the time of our data collection [ 53 ]. Seventh, in addition to reporting about funding organizations’ funding distribution mechanisms and patterns, we would have liked to report on funding organizations’ priority setting processes as part of this work (another important aspect of how funders decide what gets funded). However, we found that priority setting processes were generally not well-described and highly variable across funders, making it difficult to analyse and report our data. It deserves recommendation that such an analysis is conducted in the future, but the development of a framework for assessing priority setting processes at funders is needed first, potentially based on existing guidance for health research priority setting [ 44 ]. Lastly, and most importantly, our search strategy was limited in scope (see for more detail Additional file 1 ), was aimed only at finding the 10 largest funding organizations of health research in the world, and detailed data were only collected for those 10 organizations.

This study identified the 10 largest funding organizations of health research in the world and showed that these organizations together fund research for $37.1 billion, 40% of all public and philanthropic health research spending globally. It also mapped the funding patterns and funding distributions mechanisms of these funders and showed that there is considerable diversity between organizations in terms of what they fund and how they distribute those funds, highlighting the need for comparative evaluations of the impact of different funding distribution models. Moreover, because many of the data we tried to collect were not available, our study demonstrates that there is a need for increased transparency on who the largest funding organizations of health research are, what they fund, and how they decide what gets funded. As a first step in improving transparency in this area, we have proposed frameworks for reporting on funding patterns (in terms of health problems and research types) and for reporting on funding distribution mechanisms in this article and have established www.healthresearchfunders.org , where we list more than 250 public and philanthropic funders of health research and their annual health research expenditures. We will further expand and update this list of funding organizations in the future and welcome both suggestions and data from all who wish to help us make this database more accurate and more inclusive.

Røttingen J-A, Regmi S, Eide M, Young AJ, Viergever RF, Årdal C, et al. Mapping available health R&D data: what’s there, what’s missing and what role for a Global Observatory. Lancet. 2013;382:1286–307.

Article   PubMed   Google Scholar  

Viergever RF. The mismatch between the health research and development (R&D) that is needed and the R&D that is undertaken: an overview of the problem, the causes, and solutions. Glob Health Action. 2013;6:22450.

PubMed   Google Scholar  

Power E. Impact of antibiotic restrictions: the pharmaceutical perspective. Clin Microbiol Infect. 2006;12 Suppl 5:25–34.

Spellberg B, Bartlett JG, Gilbert DN. The future of antibiotics and resistance. N Engl J Med. 2013;368:299–302.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Head MG, Fitchett JR, Cooke MK, Wurie FB, Atun R, Hayward AC, et al. Systematic analysis of funding awarded for antimicrobial resistance research to institutions in the UK, 1997–2010. J Antimicrob Chemother. 2014;69:548–54.

Article   CAS   PubMed   Google Scholar  

Chalmers I, Bracken MB, Djulbegovic B, Garattini S, Grant J, Gülmezoglu AM, et al. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383:156–65.

Sampat BN, Buterbaugh K, Perl M. New evidence on the allocation of NIH funds across diseases. Milbank Q. 2013;91:163–85.

Article   PubMed   PubMed Central   Google Scholar  

Terry RF, Allen L, Gardner C, Guzman J, Moran M, Viergever RF. Mapping global health research investments, time for new thinking – A Babel Fish for research data. Health Res Policy Syst. 2012;10:28.

Viergever RF. Aid alignment for global health research: the role of HIROs. Health Res Policy Syst. 2011;9:12.

Couzin-Frankel J. Chasing the money. Science. 2014;344:24–5.

Track and trace. Nature. 2014;507:8.

World Health Summit. Workshop: global health research & development: mapping funding flows – working towards a common approach. Geneva: WHO; 2014.

Google Scholar  

Gillum LA, Gouveia C, Dorsey ER, Pletcher M, Mathers CD, McCulloch CE, et al. NIH disease funding levels and burden of disease. PLoS One. 2011;6:e16837.

What has the Gates Foundation done for global health? Lancet. 2009;373:1577.

Matthews KR, Ho V. The grand impact of the Gates Foundation. Sixty billion dollars and one famous person can affect the spending and research focus of public agencies. EMBO Rep. 2008;9:409–12.

World Health Organization. WHO informal workshop – monitoring financial flows in support of health research & development. Geneva: WHO; 2013.

Young AJ, Terry RF, Røttingen J-A, Viergever RF. Global biomedical R&D expenditures. N Engl J Med. 2014;370:2451.

Chakma J, Sun GH, Steinberg JD, Sammut SM, Jagsi R. Asia’s ascent--global trends in biomedical R&D expenditures. N Engl J Med. 2014;370:3–6.

Sun GH, Steinberg JD, Jagsi R. The calculus of national medical research policy--the United States versus Asia. N Engl J Med. 2012;367:687–90.

Young AJ, Terry RF, Røttingen J-A, Viergever RF. Global trends in health research and development R&D expenditures – the challenge of making reliable estimates for international comparison. Health Res Policy Syst. 2015;13.

Myers ER, Alciati MH, Ahlport KN, Sung NS. Similarities and differences in philanthropic and federal support for medical research in the United States: an analysis of funding by nonprofits in 2006–2008. Acad Med. 2012;87:1574–81.

Reports & Downloads: Health Research Analysis Data. http://www.hrcsonline.net/pages/data . Accessed 13 January 2016.

Braun D. Structure and dynamics of health research and public funding: an international institutional comparison. Dordrecht: Kluwer Academic Publishers; 1994.

UK Clinical Research Collaboration. UK health research analysis 2009/2010. London: UKCRC; 2010.

Head MG, Fitchett JR, Cooke MK, Wurie FB, Hayward AC, Atun R. UK investments in global infectious disease research 1997–2010: a case study. Lancet Infect Dis. 2013;2013(13):55–64.

Article   Google Scholar  

Dorsey ER, de Roulet J, Thompson JP, Reminick JI, Thai A, White-Stellato Z, et al. Funding of US biomedical research, 2003–2008. JAMA. 2010;303:137–43.

Moran M, Guzman J, Henderson K, Liyanage R, Wu L, Chin E, et al. G-FINDER 2012 – neglected disease research & development: a five year review. Sydney: Policy Cures; 2012.

Frick M, Jiménez-Levi E. Tuberculosis Research and Development. Report on tuberculosis research funding trends, 2005–2012. New York: Treatment Action Group; 2013.

Head MG, Fitchett JR, Cooke GS, Foster GR, Atun R. Systematic analysis of funding awarded for viral hepatitis-related research to institutions in the United Kingdom. J Viral Hepat. 2015;22(3):230–7. doi: 10.1111/jvh.12300 .

The EU Industrial R&D Investment Scoreboard. http://iri.jrc.ec.europa.eu/scoreboard.html . Accessed 13 January 2016.

Saving Lives through Research: Annual Report and Accounts 2012/13. London: Cancer Research UK; 2013.

Research Facts 2012–13. American Heart Association; 2014. https://my.americanheart.org/idc/groups/ahamahpublic/@wcm/@sop/@rsch/documents/downloadable/ucm_317600.pdf . Accessed 13 January 2016.

International Monetary Fund (IMF) World Economic Outlook Database. https://www.imf.org/external/pubs/ft/weo/2014/01/weodata/index.aspx . Accessed 13 January 2016.

World Health Organization: Global Health Estimates. http://www.who.int/healthinfo/global_burden_disease/en/ . Accessed 13 January 2016.

Frenk J. The new public health. Annu Rev Public Health. 1993;14:469–90.

Kaiser J. Funding. NIH institute considers broad shift to “people” awards. Science. 2014;345:366–7.

Callahan D. Shaping biomedical research priorities: the case of the National Institutes of Health. Health Care Anal. 1999;7:115–29.

Ioannidis JPA. More time for research: fund people not projects. Nature. 2011;477:529–31.

Research funding needs overhaul. Science (80-) 2014, 345:122.

Banzi R, Moja L, Pistotti V, Facchini A, Liberati A. Conceptual frameworks and empirical approaches used to assess the impact of health research: an overview of reviews. Health Res Policy Syst. 2011;9:26.

Lal B, Wilson A, Jonas S, Lee E, Richards A, Peña V. An outcome evaluation of the national institutes of health (NIH) Director’s pioneer award (NDPA) program, FY 2004–2006. Washington: Ida Science & Technology Policy Institute; 2012.

Collins FS, Wilder EL, Zerhouni E. NIH roadmap/common fund at 10 years. Science. 2014;345:274–6.

Azoulay P, Graff Zivin JS, Manso G. Incentives and creativity: evidence from the academic life sciences. RAND J Econ. 2011;42:527–54.

Viergever RF, Olifson S, Ghaffar A, Terry RF. A checklist for health research priority setting: nine common themes of good practice. Health Res Policy Syst. 2010;8:36.

Hegde D, Sampat BN. Can private money buy public science? Disease group lobbying and federal funding for biomedical research. https://www8.gsb.columbia.edu/faculty-research/sites/faculty-research/files/canprivate.pdf . Accessed 13 January 2016.

Reardon S. Lobbying sways NIH grants. Nature. 2014;515:19.

Viergever RF, Hendriks TCC. Targeted public funding for health research in the Netherlands. Ned Tijdschr Geneeskd. 2014;159:A8174.

Collins F, Beaudet A, Draghia-Akli R, Gruss P, Savill J, Syrota A, et al. A database on global health research in Africa. Lancet Glob Heal. 2013;1:e64–5.

Rani M, Bekedam H, Buckley BS. Improving health research governance and management in the Western Pacific: a WHO expert consultation. J Evid Based Med. 2011;4:204–13.

Research classification in practice: Stamping or Understanding! http://www.uberresearch.com/uberresWP/wp-content/uploads/CASRAI-ReConnect-Research-Classification-2-UberResearch_March-2014.pdf . Accessed 13 January 2016.

Erawatch: Platform on Research and Innovation policies and systems. http://erawatch.jrc.ec.europa.eu/ . Accessed 15 August 2014.

The National Institute of Allergy and Infectious Diseases (NIAID): Choose Approach and Find FOAs. http://www.niaid.nih.gov/researchfunding/grant/strategy/pages/2choosefoa.aspx . Accessed 13 January 2016.

Wilkinson E. Wellcome Trust overhauls its funding framework. Lancet. 2014;384:1913.

G-FINDER public search tool. http://g-finder.policycures.org/gfinder_report/ . Accessed 13 January 2016.

Terry RF, van der Rijt T. Overview of research activities associated with the World Health Organization: results of a survey covering 2006/07. Health Res Policy Syst. 2010;8:25.

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Acknowledgements

We would like to thank Alison Young, Koos van der Velden, Rob Terry, Noor Tromp, Leon Bijlmakers, Sanne van Kampen and Eric Budgell for reviewing drafts of this article.

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RV conceived the idea for the study, RV and TH developed the study methods, TH conducted most data collection and analysis, RV conducted additional data collection and analysis, and RV and TH wrote the article. Both authors read and approved the final manuscript.

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Viergever, R.F., Hendriks, T.C.C. The 10 largest public and philanthropic funders of health research in the world: what they fund and how they distribute their funds. Health Res Policy Sys 14 , 12 (2016). https://doi.org/10.1186/s12961-015-0074-z

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Leading Change in Cancer Clinical Research, Because Our Patients Can’t Wait

May 31, 2024 , by W. Kimryn Rathmell, M.D., Ph.D., and Shaalan Beg, M.D.

Greater use of technologies that can increase participation in cancer clinical trials is just one of the innovations that can help overcome some of the bottlenecks holding up progress in clinical research. 

Thanks to advances in technology, data science, and infrastructure, the pace of discovery and innovation in cancer research has accelerated, producing an impressive range of potential new treatments and other interventions that are being tested in clinical studies . The extent of the innovative ideas that might help people live longer, improve our ability to detect cancer early, or otherwise transform care is staggering. 

Our understanding of tumor biology is also evolving, and those gains in knowledge are being translated into the continued discovery of targets for potential interventions  and the development of novel types of treatments. Some of these therapies are producing unprecedented clinical responses  in studies, including in traditionally difficult-to-treat cancers. 

These advances have contributed to a record number of Food and Drug Administration (FDA) approvals in recent years with, arguably, the most notable approvals being those for drugs that can be used for any cancer, regardless of where it is in the body . 

In some instances, the activity of new agents has been so profound that clinical investigators are having to rethink their criteria for implementation in patient care and their definitions of treatment response. 

For example, although HER2 has been a known therapeutic target in breast cancer for many decades, the new antibody-drug conjugates  (ADCs) that target HER2 have proven to be vastly more effective than the original HER2-targeted therapies. This has forced researchers to rethink fundamental questions about how these ADCs are used in patient care: Can they be effective in people whose tumors have lower expression of HER2 than we previously thought was needed ? And, if so, do we need to redefine how we classify HER2-positive cancer? 

As more innovative therapies like ADCs hit the clinic at a far more rapid cadence than ever before, the research community is being inundated with such fundamentally important questions.

However, the remarkable progress we're experiencing with novel new therapies is tempered by a critical bottleneck: the clinical research infrastructure can’t be expected to keep pace in this new landscape. 

Currently, many studies struggle to enroll enough participants. At the same time, there are patients who don’t have ready access to studies from which they might benefit. Furthermore, ideas researchers have today for studies of innovative new interventions might not come to fruition for 2 or 3 years, or even longer—years that people with cancer don’t have. 

The key to overcoming this bottleneck is to invite innovation to help reshape our clinical trials infrastructure. And here’s how we plan to accomplish that.

Testing Innovation in Cancer Clinical Trials

A transformation in cancer clinical research is already underway. That transformation has been led in part by the success of novel precision oncology approaches, such as those tested in the NCI-MATCH trial .

This innovative study ushered in novel ways of recruiting participants and involving oncologists at centers big and small. And NCI-MATCH has spawned several successor studies that are incorporating and building on its innovations and achievements.

An innovation that emerged from the COVID pandemic was the increase of remote work, even in the clinical trials domain. Indeed, staffing shortages have caused participation in NCI-funded trials to decline. In response, NCI is piloting a Virtual Clinical Trials Office to offer remote support staff to participating study sites. This support staff includes research nurses, clinical research associates, and data specialists, all of whom will help NCI-Designated Cancer Centers and community practices engaged in clinical research activities.

Such technology-enabled services can allow us to reimagine how clinical trials are designed and run. This includes developing technologies and processes for remotely identifying clinical trial participants, shipping medications to participants at home, having imaging performed in the health care settings where our patients live, and empowering local physicians to participate in clinical trials.

We also need mechanisms to test and implement innovations in designing and conducting clinical studies. 

For example, NCI recently established the Clinical Trials Innovation Unit (CTIU) to pressure test a variety of innovations. One of the first trials to emerge from the CTIU’s initial efforts was the Pragmatica-Lung Cancer Treatment Trial , a phase 3 study designed to be easy to launch, enroll, and interpret its results. 

The CTIU, which includes leadership from FDA and NCI’s National Clinical Trials Network , is already working on future innovations, including those that will streamline data collection and apply innovative approaches for other cancers, all with the goal of making cancer clinical studies less burdensome to run and easier for patients to participate.

Data-Driven Solutions

The era of data-driven health care is here, providing still more opportunities to transform cancer clinical research. 

The emergence of artificial intelligence (AI) solutions, large language models, and informatics brings real potential for wholesale changes in how we match patients to clinical studies, assess side effects, and monitor events like disease progression. 

Recognizing this potential, NCI is offering funding opportunities and other resources that will fuel the development of AI tools for clinical research, allow us to carefully test their usefulness, and ultimately deploy them across the oncology community. 

Creating Partnerships and Expanding Health Equity

To be sure, none of this will be, or can be, done by NCI alone. All these innovations require partnerships. We will increase our engagement with partners in the public- and private-sectors, including other government agencies and nonprofits. 

That includes high-level engagement with the Office of the National Coordinator for Health Information Technology (ONC), with input from FDA, Centers for Medicare & Medicaid Services, and Centers for Disease Control and Prevention.

Dr. W. Kimryn Rathmell, M.D., Ph.D.

NCI Director

One example of such a partnership is the USCDI+ Cancer program . Conducted under the auspices of the ONC, this program will further the aims of the White House's reignited Cancer Moonshot SM by encouraging the adoption and utilization of interoperable cancer health IT standards, providing resources to support cancer-specific use cases, and promoting alignment between federal partners. 

And just as importantly, the new partnerships we create must include those with patients, advocates, and communities in ways we have never considered before.

A central feature of this community engagement must involve intentional efforts to expand health equity, to create study designs that are inclusive and culturally appropriate. Far too many marginalized communities and populations today are further harmed by studies that fail to provide findings that apply to their unique situations and needs.

Very importantly, the future will require educating our next generation of clinical investigators and empowering them with the tools that enable new ways of managing clinical studies. By supporting initiatives spearheaded by FDA and professional groups like the American Society of Clinical Oncology, NCI is making it easier for community oncologists to participate in clinical trials and helping clarify previously misunderstood regulatory requirements. 

These efforts must also ensure that we have a clinical research workforce that is representative of the people it is intended to serve. Far too many structural barriers have prevented this from taking place in the past, and it’s time for that to change. 

Expanding our capacity doesn’t mean doing more of the same, it means challenging ourselves to work differently. This will let us move forward to a new state, one in which clinical research is integrated in everyday practice. It is only with more strategic partnerships and increased inclusivity that we can open the doors to seeing clinical investigation in new ways, with new standards for success.

A Collaborative Effort

Shaalan Beg, M.D.

Senior Advisor for Clinical Research

To make the kind of progress we all desire, we have to recognize that our clinical studies system needs to evolve.

There was a time when taking years to design, launch, and complete a clinical trial was acceptable. It isn’t acceptable anymore. We are in an era where we have the tools and the research talent to make far more rapid progress than we have in the past. 

And we can do that by engaging with many different communities and stakeholders in unique and dynamic ways—making them partners in our effort to end cancer as we know it.

Together, our task is to capitalize on this work so we can move faster and enable cutting-edge research that benefits as many people as possible. 

We also know that there are more good ideas in this space, and part of this transformation includes grass roots efforts to drive systemic change. So, we encourage you to share your ideas on how we can transform clinical research. Because achieving this goal can’t be done by any one group alone. We are all in this together. 

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Reality Meets Research: ARM 2024 Exploration of Disability and Complex Conditions

ARM 2024 Theme Leader Christine Von Raesfeld highlights sessions to attend in her theme Individuals Living with Disability or Other Complex Conditions.

As both a patient and a health care professional, I am eagerly anticipating the AcademyHealth Annual Research Meeting (ARM 2024). This is a pivotal meeting for the research community, and this year I am grateful for the opportunity to co-chair one of the many themes " Individuals Living with Disability or Other Complex Conditions " with Dr. Shriram Parashuram from NORC at the University of Chicago. Our planning discussions were intense, covering diverse perspectives, but with a shared, unwavering commitment to the community. We hope to expand on those conversations and to foster a meaningful dialogue that merges personal experiences with scientific research.  

The Centers for Disease Control and Prevention (CDC) reports that an estimated 61 million adults in the U.S. live with a disability. Furthermore, around 129 million individuals have at least one major chronic illness, such as heart disease, cancer, diabetes, obesity, or hypertension. These figures represent about 51.8 percent of the civilian, noninstitutionalized adult population, with 24.6 percent having one chronic condition and 27.2 percent having multiple conditions, underscoring the significance of our topic.  

My personal journey, marked by multiple disabilities and chronic conditions, has profoundly influenced my perspective on health care and strengthened my resolve in advocacy.  

Selecting from a plethora of insightful submissions was challenging for Dr. Parashuram and me. Each submission reflected a researcher's commitment to enhancing lives and offered hope for patients like myself. Through collaboration with a dedicated team, we have crafted a program that spotlights innovative research and the multifaceted challenges faced by individuals with complex health conditions. These submissions are more than academic studies; they are narratives that emphasize the need for empathy and advocacy in health care.  

Care for Individuals with Complex Conditions   

Monday, July 1, 2024 8:00 - 9:15 AM EDT  

Led by Dr. Parashuram, this session will explore the lifelong challenges faced by individuals with complex conditions. Highlights include the SEER-CAHPS study by Kim Danforth's team, examining the care experiences of those newly diagnosed with cancer, especially the complexities of managing concurrent health conditions. Seyeon Jang's analysis will shed light on the financial impact of prescription drug costs for patients with Alzheimer's Disease and Related Dementias (ADRD), informing policy decisions with data spanning 2003-2021.  

Care for Individuals with Disabilities   

Sunday, June 30, 2024, 1:45 - 3:00 PM EDT  

This session, which I have the honor of chairing, will focus on the obstacles to accessible care. Discussions will include the challenges faced by Medicare beneficiaries with disabilities, as presented by Emma Achola's team. Additionally, Megan Morris's comparative effectiveness trial seeks to improve communication between health care providers and patients with communication disabilities, a vital component of patient-centered care.  

Implementation of the NIH Disability Inclusion Recommendations 2024 Progress Report Monday, July 1, 2024, 11:00 - 12:15 PM EDT  

This session will present the NIH Disability Inclusion Recommendations 2024 Progress Report by Dr. Jae Kennedy, Dr. Bonnielin Swenor, and Dr. Alison Cernich. It will examine the impact of these recommendations on health research and policy, aiming to connect empirical data with the realities of lived experiences.  

Poster Session: Individuals Living with Disability or Other Complex Conditions  

Sunday, June 30, 2024, 8:00 - 9:15 AM EDT  

The poster session will complement the main events, presenting a tapestry of research that reflects the field's diversity. It offers a chance to engage with cutting-edge findings and network with peers.  

The theme of our meeting is not merely theoretical; it mirrors the daily challenges of those living with chronic illnesses and disabilities.  

Our goal is to dissect and discuss the barriers to care for individuals with disabilities. We will not only spotlight the hurdles but also present innovative solutions that envision a more inclusive future, where health care fully embraces the individual and the nuances of living with a disability or other complex conditions   

To find the agenda and a more in-depth summary of our theme (including location for those attending) check out https://academyhealth.org/page/2024-arm-agenda      

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The Politics of Health Care and the 2024 Election

Published: May 28, 2024

KFF Author:

Larry Levitt

Table of Contents

Introduction.

Health policy and politics are inextricably linked. Policy is about what the government can do to shift the financing, delivery, and quality of health care, so who controls the government has the power to shape those policies. 

Elections, therefore, always have consequences for the direction of health policy – who is the president and in control of the executive branch, which party has the majority in the House and the Senate with the ability to steer legislation, and who has control in state houses. When political power in Washington is divided, legislating on health care often comes to a standstill, though the president still has significant discretion over health policy through administrative actions. And, stalemates at the federal level often spur greater action by states. 

Health care issues often, but not always, play a dominant role in political campaigns. Health care is a personal issue, so it often resonates with voters. The  affordability  of health care, in particular, is typically a top concern for voters, along with other pocketbook issues, And, at  17% of the economy , health care has many industry stakeholders who seek influence through lobbying and campaign contributions. At the same time, individual policy issues are rarely decisive in elections. 

Health Reform in Elections

Health “reform” – a somewhat squishy term generally understood to mean proposals that significantly transform the financing, coverage, and delivery of health care – has a long history of playing a major role in elections. 

Harry Truman campaigned on universal health insurance in 1948, but his plan went nowhere in the face of opposition from the American Medical Association and other groups. While falling short of universal coverage, the creation of Medicare and Medicaid in 1965 under Lyndon Johnson dramatically reduced the number of uninsured people. President Johnson signed the Medicare and Medicaid legislation at the Truman Library in Missouri, with Truman himself looking on. 

Later, Bill Clinton campaigned on health reform in 1992, and proposed the sweeping Health Security Act in the first year of his presidency. That plan went down to defeat in Congress amidst opposition from nearly all segments of the health care industry, and the controversy over it has been cited by many as a factor in Democrats losing control of both the House and the Senate in the 1994 midterm elections. 

For many years after the defeat of the Clinton health plan, Democrats were hesitant to push major health reforms. Then, in the 2008 campaign, Barack Obama campaigned once again on health reform, and proposed a plan that eventually became the Affordable Care Act (ACA). The ACA ultimately passed Congress in 2010 with only Democratic votes, after many twists and turns in the legislative process. The major provisions of the ACA were not slated to take effect until 2014, and opposition quickly galvanized against the requirement to have insurance or pay a tax penalty (the “individual mandate”) and in response to criticism that the legislation contained so-called  “death panels”  (which it did not). Republicans took control of the House and gained a substantial number of seats in the Senate during the 2010 midterm elections, fueled partly by opposition to the ACA. 

The ACA took full effect in 2014, with millions gaining coverage, but more people  viewed the law  unfavorably than favorably, and repeal became a rallying cry for Republicans in the 2016 campaign. Following the election of Donald Trump, there was a high profile effort to repeal the law, which was ultimately defeated following a public backlash. The ACA repeal debate was a good example of the trade-offs inherent in all health policies. Republicans sought to reduce federal spending and regulation, but the result would have been fewer people covered and weakened protections for people with pre-existing conditions. KFF polling showed that the ACA repeal effort led to increased public support for the law, which persists today. 

In the 2020 campaign, health reform was a major issue in the Democratic primaries, with a number of prominent candidates supporting a Medicare for All plan. Joe Biden’s platform was centered instead on building upon the ACA. 

Health Care and the 2024 Election

The 2024 election presents the unusual occurrence of two candidates – current president Joe Biden and former president Donald Trump – who have already served in the White House and have detailed records for comparison, as  explained in this JAMA column .  

The Affordable Care Act (Obamacare)

While Trump failed as president to repeal the ACA, his administration did make significant changes to it, including repealing the individual mandate penalty, reducing federal  funding  for consumer assistance (navigators) by 84% and outreach by 90%, and expanding short-term insurance plans that can exclude coverage of preexisting conditions. 

In a strange policy twist, the Trump administration ended payments to ACA insurers to compensate them for a requirement to provide reduced cost sharing for low-income patients, with Trump saying it would cause Obamacare to be  “dead” and “gone .” But, insurers responded by increasing premiums, which in turn increased federal premium subsidies and federal spending, likely  strengthening  the ACA. 

In the 2024 campaign, Trump has  vowed  several times to try again to repeal and replace the ACA, though not necessarily using those words, saying instead he would create a plan with “much better health care.” 

Although the Trump administration never issued a detailed plan to replace the ACA, Trump’s  budget proposals  as president included plans to convert the ACA into a block grant to states, cap federal funding for Medicaid, and allow states to relax the ACA’s rules protecting people with preexisting conditions. Those plans, if enacted, would have reduced federal funding for health care by more than $1 trillion over a decade. 

In contrast, the Biden administration has reinvigorated the ACA by restoring funding for consumer assistance and outreach and by increasing premium subsidies to make coverage more affordable, resulting in  record enrollment in ACA Marketplace plans  and historically low uninsured rates. The increased premium subsidies are currently slated to expire at the end of 2025, so the next president will be instrumental in determining whether they get extended. 

Abortion and Reproductive Health

The health care issue most likely to figure prominently in the general election is abortion rights, with sharp contrasts between the presidential candidates and the potential to affect voter turnout. In all the states where voters have been asked to weigh in directly on abortion so far (California, Kansas, Kentucky, Michigan, Montana, Ohio, and Vermont), abortion rights have been  upheld . 

Trump paved the way for the US Supreme Court to overturn  Roe v Wade  by appointing judges and justices opposed to abortion rights. Trump recently  said , “for 54 years they were trying to get  Roe v Wade  terminated, and I did it and I’m proud to have done it.” During the current campaign, Trump has said that abortion policy should now be left to the states. 

As president, Trump had also  cut off family planning funding  to Planned Parenthood and other clinics that provide or refer for abortion services, but this policy was  reversed  by the Biden administration. 

Addressing the High Price of Prescription Drugs and Health Care Services

Trump has often spotlighted the high price of prescription drugs, criticizing both the pharmaceutical industry and pharmacy benefit managers. Although he kept the issue of drug prices on the political agenda as president, in the end, his administration accomplished little to contain them. 

The Trump administration created a  demonstration program , capping monthly co-pays for insulin for some Medicare beneficiaries at $35. Late in his presidency, his administration issued a  rule  to tie Medicare reimbursement of certain physician-administered drugs to the prices paid in other countries, but it was blocked by the courts and never implemented. The Trump administration also issued  regulations  paving the way for states to import lower-priced drugs from Canada. The Biden administration has followed through on that idea and recently approved Florida’s plan to buy drugs from Canada, though  barriers  still remain to making it work in practice. 

President Biden signed the  Inflation Reduction Act , far-reaching legislation that requires the federal government to negotiate the prices of certain drugs in Medicare, which was previously banned. The law also guarantees a $35 co-pay cap for insulin for all Medicare beneficiaries, and caps out-of-pocket retail drug costs for the first time in Medicare. 

How Trump would approach drug price negotiations if elected is unclear. Trump  supported  federal negotiation of drug prices during his 2016 campaign, but he did not pursue the idea as president and  opposed  a Democratic price negotiation plan. During the current campaign, Trump  said  he “will tell big pharma that we will only pay the best price they offer to foreign nations,” claiming that he was the “only president in modern times who ever took on big pharma.” 

Beyond drug prices, the Trump administration issued regulations requiring hospitals and health insurers to be transparent about prices, a policy that is still in place and attracts bipartisan support. 

Future Outlook

Ultimately, irrespective of the issues that get debated during the campaign, the outcome of the 2024 election – who controls the White House and Congress – will have significant implications for the future direction of health care, as is almost always the case. 

However, even with changes in party control of the federal government, only incremental movement to the left or the right is the norm. Sweeping changes in health policy, such as the creation of Medicare and Medicaid or passage of the ACA, are rare in the U.S. political system. Similarly, Medicare for All, which would even more fundamentally transform the financing and coverage of health care, faces long odds, particularly in the current political environment. This is the case even though most of the public  favors  Medicare for All, though attitudes shift significantly after hearing messages about its potential impacts. 

Importantly, it’s politically difficult to take benefits away from people once they have them. That, and the fact that seniors are a strong voting bloc, has been why Social Security and Medicare have been considered political “third rails.” The ACA and Medicaid do not have quite the same sacrosanct status, but they may be  close . 

•   Election 2024 Resources
• What Would Another Trump Presidency Mean for Health Care?  
• The Implications of the Public’s Preexisting Condition—Amnesia   

Levitt, Larry, The Politics of Health Care and the 2024 Election. In Altman, Drew (Editor), Health Policy 101, (KFF, May 28, 2024) https://www.kff.org/health-policy-101-the-politics-of-health-care-and-the-2024-election/ (date accessed).

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Nih research matters.

December 22, 2021

2021 Research Highlights — Promising Medical Findings

Results with potential for enhancing human health.

With NIH support, scientists across the United States and around the world conduct wide-ranging research to discover ways to enhance health, lengthen life, and reduce illness and disability. Groundbreaking NIH-funded research often receives top scientific honors. In 2021, these honors included Nobel Prizes to five NIH-supported scientists . Here’s just a small sample of the NIH-supported research accomplishments in 2021.

Printer-friendly version of full 2021 NIH Research Highlights

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Advancing COVID-19 treatment and prevention

Amid the sustained pandemic, researchers continued to develop new drugs and vaccines for COVID-19. They found oral drugs that could  inhibit virus replication in hamsters and shut down a key enzyme that the virus needs to replicate. Both drugs are currently in clinical trials. Another drug effectively treated both SARS-CoV-2 and RSV, another serious respiratory virus, in animals. Other researchers used an airway-on-a-chip to screen approved drugs for use against COVID-19. These studies identified oral drugs that could be administered outside of clinical settings. Such drugs could become powerful tools for fighting the ongoing pandemic. Also in development are an intranasal vaccine , which could help prevent virus transmission, and vaccines that can protect against a range of coronaviruses .

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Developments in Alzheimer’s disease research

One of the hallmarks of Alzheimer’s is an abnormal buildup of amyloid-beta protein. A study in mice suggests that antibody therapies targeting amyloid-beta protein could be more effective after enhancing the brain’s waste drainage system . In another study, irisin, an exercise-induced hormone, was found to improve cognitive performance in mice . New approaches also found two approved drugs (described below) with promise for treating AD. These findings point to potential strategies for treating Alzheimer’s. Meanwhile, researchers found that people who slept six hours or less per night in their 50s and 60s were more likely to develop dementia later in life, suggesting that inadequate sleep duration could increase dementia risk.

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New uses for old drugs

Developing new drugs can be costly, and the odds of success can be slim. So, some researchers have turned to repurposing drugs that are already approved for other conditions. Scientists found that two FDA-approved drugs were associated with lower rates of Alzheimer’s disease. One is used for high blood pressure and swelling. The other is FDA-approved to treat erectile dysfunction and pulmonary hypertension. Meanwhile, the antidepressant fluoxetine was associated with reduced risk of age-related macular degeneration. Clinical trials will be needed to confirm these drugs’ effects.

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Making a wireless, biodegradable pacemaker

Pacemakers are a vital part of medical care for many people with heart rhythm disorders. Temporary pacemakers currently use wires connected to a power source outside the body. Researchers developed a temporary pacemaker that is powered wirelessly. It also breaks down harmlessly in the body after use. Studies showed that the device can generate enough power to pace a human heart without causing damage or inflammation.

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Fungi may impair wound healing in Crohn’s disease

Inflammatory bowel disease develops when immune cells in the gut overreact to a perceived threat to the body. It’s thought that the microbiome plays a role in this process. Researchers found that a fungus called  Debaryomyces hansenii  impaired gut wound healing in mice and was also found in damaged gut tissue in people with Crohn’s disease, a type of inflammatory bowel disease. Blocking this microbe might encourage tissue repair in Crohn’s disease.

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Nanoparticle-based flu vaccine

Influenza, or flu, kills an estimated 290,000-650,000 people each year worldwide. The flu virus changes, or mutates, quickly. A single vaccine that conferred protection against a wide variety of strains would provide a major boost to global health. Researchers developed a nanoparticle-based vaccine that protected against a broad range of flu virus strains in animals. The vaccine may prevent flu more effectively than current seasonal vaccines. Researchers are planning a Phase 1 clinical trial to test the vaccine in people.

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A targeted antibiotic for treating Lyme disease

Lyme disease cases are becoming more frequent and widespread. Current treatment entails the use of broad-spectrum antibiotics. But these drugs can damage the patient’s gut microbiome and select for resistance in non-target bacteria. Researchers found that a neglected antibiotic called hygromycin A selectively kills the bacteria that cause Lyme disease. The antibiotic was able to treat Lyme disease in mice without disrupting the microbiome and could make an attractive therapeutic candidate.

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Retraining the brain to treat chronic pain

More than 25 million people in the U.S. live with chronic pain. After a treatment called pain reprocessing therapy, two-thirds of people with mild or moderate chronic back pain for which no physical cause could be found were mostly or completely pain-free. The findings suggest that people can learn to reduce the brain activity causing some types of chronic pain that occur in the absence of injury or persist after healing.

2021 Research Highlights — Basic Research Insights >>

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Purdue Public Health research affirms salon workers key in identifying victims of sex trafficking, intimate partner violence

Alexandra Hughes-Wegner (MPH ’24) presents her research on March 22 at the 2024 HHS Life Inspired Week Three Minute Thesis competition. Her project, “Exploring the Role of Salon Professionals in Interacting and Intervening with Victims of Violence,” won top top honors. Tim Brouk

Written by: Tim Brouk, [email protected]

The fight against sex trafficking and intimate partner violence (IPV) has an unexpected ally in salon professionals across Indiana and beyond, according to new work by Purdue University College of Health and Human Sciences researchers.

Drawing in student researchers from the departments of Public Health and Psychological Sciences as well as Purdue’s College of Agriculture and Polytechnic Institute, the study led by Alexandra Hughes-Wegner, a May 2024 Master of Public Health graduate, found a striking number of Indiana salon workers — estheticians, massage therapists, nail technicians, barbers and hair stylists — have come into contact with people who were victims of sex trafficking and IPV during appointments.

“Salon professionals serve as touch points for victims of sex trafficking, as they are often brought there (to a salon) for grooming purposes,” said Hughes-Wegner, whose initial research started in 2021 during her junior year of her undergraduate studies. “No state has mandatory training of salon professionals for sex trafficking, and very few have it for intimate partner violence. (The salon professionals) do not know how to identify, when to interact with victims of violence, or who to contact — specifically to get (their clients) help. By no means do we want salon professionals to put themselves in harm’s way, so who can they contact to help them help the victims?”

Hughes-Wegner and her team of undergraduate research assistants will present the data to Indiana agencies, policymakers and nonprofits in June and July. She hopes to get the work — organized in six modules or mini online classes — to be a part of the training or curriculum for a salon worker to obtain their license to work in Indiana. The modules give overviews on IPV, sex trafficking, law enforcement resources, why salon workers are needed to reduce sex trafficking and measures their salons can take when faced with clients who may be experiencing such abuse. The modules take about 90 minutes to complete in total, and they will be pilot tested by 10 Indiana salon professionals this summer. The researchers will do a couple follow-ups with them including a process and outcome evaluation.

The research was funded by a $75,000 award from the Purdue Honors College .

Strong response

Jason Harris, Purdue HHS associate dean for graduate programs and online education, poses with Alexandra Hughes-Wegner after the then Purdue Public Health graduate student accepted her first place award at the 2024 HHS Life Inspired Week Three Minute Thesis competition. Tim Brouk

Working under Andrea DeMaria, former Purdue Public Health faculty member, and Kathryn Seigfried-Spellar of the Polytechnic Institute, Hughes-Wegner and the team first interviewed 10 salon professionals across Indiana, and nine responded they have been either told outright or suspected a client had been a victim of IPV and/or sex trafficking.

The researchers then developed an Indiana-wide survey. More than 400 salon workers responded. This data fueled the study titled “Exploring the Role of Salon Professionals in Interacting and Intervening with Victims of Violence.” The biggest takeaway from the survey responses: About 45% of the respondents were directly told by their clients that they are being trafficked. Other pertinent data included:

• 74 Indiana counties were represented.
• 80.1% suspected interaction with a victim of sex trafficking.
• 88% suspected interaction with a victim of IPV.
• 51% were told directly by a client they were a victim of IPV.

The survey provided a space for workers to write their thoughts, and the feedback was eye-opening. One salon professional stated, “Educate the community more on this topic.” Another opined, “The government should provide resources to affected individuals.”

“The salon professionals wanted a training, and they wanted it to be super-collaborative, super-dynamic in that policymakers, law enforcement, and salon professionals all come together to give their shared experiences and advice on tackling this problem,” Hughes-Wegner said.

Alexandria Bedard, a May 2024 psychological sciences graduate, capped off her Purdue undergraduate research career with this project. She said she found the subject extremely important, and it will help strengthen her next academic journey as a forensic psychology graduate student at Arizona State University.

One of Bedard’s favorite parts of the research process came this spring when she helped present the project at Purdue research poster competitions. She said the work was “very eye-opening” to judges and fellow students alike, from the amount of money generated by sex trafficking nationwide ($150 billion, according to her work) to how a nail technician could save someone’s life by adeptly noticing signs of abuse.

“This research needs to be done for salon professionals not just in Indiana but everywhere,” Bedard said. “Sex trafficking made more money in the U.S. than Starbucks and Nike. I think that’s mind-blowing to a lot of individuals. They just have no clue. They never hear of it happening here in Indiana.”

Stylists/therapists

Hughes-Wegner acknowledged that salon professionals can sometimes become almost therapists to their regular clients. In some communities, the stylist is a confidant and sounding board.

“The salon plays such a large role in their lives. It’s a very unique relationship that develops where I think clients feel comfortable talking to their salon professional,” she said. “Just the unique environment and the nuanced ways that these situations kind of come up. They talk about their partners and them fighting. And salon professionals do see the bruises.”

A part of the work acknowledged the mental health of salon professionals in these situations.

“So much gets dumped on them. In a day, they may see three or four people. They know everything about them and they’re sitting in a chair one-on-one for hours. A lot of people don’t get this much access to a therapist most times,” Hughes-Wegner explained. “I do think a heavy burden is placed on the salon professionals. We’ve tried to be cautious as we develop this material because we don’t want to put extra burdens or any extra weight on the salon professionals. They aren’t trained to intervene. We just want them to know the signs so they can contact law enforcement to intervene.” 

In 2021, more than 120 sex trafficking cases were logged in Indiana.

While the team received a strong response from its survey, some salon workers did not respond, and some respondents said they never heard of clients suffering from abuse and/or trafficking. But it’s possible these professionals did have such contact and just didn’t recognize signs or cues like the bruises, bite marks and scratches. 

“In Lafayette alone, we have I-65, which runs right through our backyard, and that’s known to be a facilitator of trafficking victims,” Hughes-Wegner said. “Law enforcement professionals we’ve spoken to in Lafayette get all kinds of reports and tips of this happening. I think it’s just important to be aware of it.”

Just one missed opportunity to recognize signs of abuse could put a client in danger. That’s one too many. The work of Hughes-Wegner and her team could reduce the number of missed opportunities for intervention and reduce the rates of abuse and sex trafficking in Indiana.

“I would like to see Indiana be a leader in this work and for other states to follow suit,” Hughes-Wegner said. “We know these acts of violence are very prevalent in cities all over America. With few policies in place overall, I’d like to see Indiana be a role model in this way. I would love to see a policy at the school level or at the licensing level put in place.”

Research puts dollar figure on climate savings from electric school buses

A substantial portion of the half-million school buses in the United States are “highly polluting old diesel vehicles,” the researchers write.

Switching to electric school buses could yield significant health and climate benefits, researchers suggest in a new analysis that seeks to quantify those gains in dollar terms.

Published in the journal PNAS, the study estimated the per-mile benefits of replacing diesel buses with electric ones in 3,108 U.S. counties. Researchers combined data about average diesel bus pollution with statistical estimates of the cost of maintenance and repair, the environmental impact of diesel emissions, and the dollar value of new childhood asthma cases and deaths that could be attributed to such pollution.

A substantial portion of the half-million school buses in the United States are “highly polluting old diesel vehicles,” the researchers write. Though emissions have fallen over time thanks to increased regulation, they add, older, more polluting diesel models are still common. As of June 2023, they write, just 2,277 electric school buses had been ordered or delivered, or were operating nationwide.

Replacing the average diesel bus would generate a benefit of $84,200 per bus, split nearly evenly between health and climate effects. Such a replacement would cut 181 metric tons of carbon dioxide emissions per bus and reduce childhood deaths and asthma cases from diesel emissions, the researchers conclude.

The benefits would vary depending on the location, with buses generating as much as $247,600 in benefits in dense metropolitan areas. Impacts would be smaller in rural areas because diesel emissions affect smaller populations there.

The benefits would come at a cost, the researchers acknowledge; they estimate an unsubsidized electric school bus costs an average of $156,000 more than a new diesel school bus over the vehicle’s lifetime. But in large metropolitan areas, they write, “replacing a relatively small number of miles driven by [diesel buses] could lead to substantial public health benefits.”

“In a dense urban setting where old diesel buses still comprise most school bus fleets, the savings incurred from electrifying these buses outweigh the costs of replacement,” Kari Nadeau, a professor of climate and population studies and environmental health at the Harvard T.H. Chan School of Public Health and the study’s senior author, said in a news release . “Not to mention how the tangible benefits of electric school buses can improve lives — especially for racial minorities and those living in low-income communities who are disproportionately impacted by the everyday health risks of air pollution.”

Black, Hispanic and low-income Americans would probably experience the greatest health benefits of large metropolitan areas electrifying their school bus fleet, the researchers write. They call for more research on the exposure of the children riding the buses to particulate pollution, because data on in-cabin pollution generated by newer buses is still unclear.