research topics on health system

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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What has the pandemic revealed about the US health care system — and what needs to change?

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With vaccinations for Covid-19 now underway across the nation, MIT SHASS Communications asked seven MIT scholars engaged in health and health care research to share their views on what the pandemic has revealed about the U.S. health care system — and what needs to change. Representing the fields of medicine, anthropology, political science, health economics, science writing, and medical humanities, these researchers articulate a range of opportunities for U.S. health care to become more equitable, more effective and coherent, and more prepared for the next pandemic.

Dwaipayan Banerjee , associate professor of science, technology, and society

On the heels of Ebola, Covid-19 put to rest a persistent, false binary between diseases of the rich and diseases of the poor. For several decades, health care policymakers have labored under the impression of a great epidemiological transition. This theory holds that the developed world has reached a stage in its history that it no longer needs to worry about communicable diseases. These "diseases of the poor" are only supposed to exist in distant places with weak governments and struggling economies. Not here in the United States.

On the surface, Covid-19 made clear that diseases do not respect national boundaries. More subtly, it tested the hypothesis that the global north no longer need concern itself with communicable disease. And in so doing, it undermined our assumptions about global north health-care infrastructures as paradigmatically more evolved. Over the last decades, the United States has been focused on developing increasingly sophisticated drugs. While this effort has ushered in several technological breakthroughs, a preoccupation with magic-bullet cures has distracted from public health fundamentals. The spread of the virus revealed shortages in basic equipment and hospitals beds, the disproportionate effects of disease on the marginalized, the challenge of prevention rather than cure, the limits of insurance-based models to provide equitable care, and our unacknowledged dependence on the labor of underpaid health care workers.

To put it plainly, the pandemic did not create a crisis in U.S. health care. For many in the United States, crisis was already a precondition of care, delivered in emergency rooms and negotiated through denied insurance claims. As we begin to imagine a "new normal," we must ask questions about the old. The pandemic made clear that the "normal" had been a privilege only for a few well-insured citizens. In its wake, can we imagine a health-care system that properly compensates labor and recognizes health care as a right, rather than a privilege only available to the marginalized when an endemic crisis is magnified by a pandemic emergency? 

Andrea Campbell , professor of political science

No doubt, the pandemic reveals the dire need to invest in public-health infrastructure to better monitor and address public-health threats in the future, and to expand insurance coverage and health care access. To my mind, however, the pandemic’s greatest significance is in revealing the racism woven into American social and economic policy.

Public policies helped create geographic and occupational segregation to begin with; inadequate racist and classist public policies do a poor job of mitigating their effects. Structural racism manifests at the individual level, with people of color suffering worse housing and exposure to toxins, less access to education and jobs, greater financial instability, poorer physical and mental health, and higher infant mortality and shorter lifespans than their white counterparts. Residential segregation means many white Americans do not see these harms.

Structural racism also materializes at the societal level, a colossal waste of human capital that undercuts the nation’s economic growth, as social and economic policy expert Heather McGhee shows in her illuminating book, "The Sum of Us." These society-wide costs are hidden as well; it is difficult to comprehend the counterfactual of what growth would look like if all Americans could prosper. My hope is that the pandemic renders this structural inequality visible. There is little point in improving medical or public-health systems if we fail to address the structural drivers of poor health. We must seize the opportunity to improve housing, nutrition, and schools; to enforce regulations on workplace safety, redlining, and environmental hazards; and to implement paid sick leave and paid family leave, among other changes. It has been too easy for healthy, financially stable, often white Americans to think the vulnerable are residual. The pandemic has revealed that they are in fact central. It’s time to invest for a more equitable future.

Jonathan Gruber , Ford Professor of Economics

The Covid-19 pandemic is the single most important health event of the past 100 years, and as such has enormous implications for our health care system. Most significantly, it highlights the importance of universal, non-discriminatory health insurance coverage in the United States. The primary source of health insurance for Americans is their job, and with unemployment reaching its highest level since the Great Depression, tens of millions of workers lost, at least temporarily, their insurance coverage.

Moreover, even once the economy recovers, millions of Americans will have a new preexisting condition, Covid-19. That’s why it is critical to build on the initial successes of the Affordable Care Act to continue to move toward a safety net that provides insurance options for all without discrimination.

The pandemic has also illustrated the power of remote health care. The vast majority of patients in the United States have had their first experience with telehealth during the pandemic and found it surprisingly satisfactory. More use of telehealth can lead to increased efficiency of health care delivery as well as allowing our system to reach underserved areas more effectively.

The pandemic also showed us the value of government sponsorship of innovation in the health sciences. The speed with which the vaccines were developed is breathtaking. But it would not have been possible without decades of National Institute of Health investments such as the Human Genome Project, nor without the large incentives put in place by Operation Warp Speed. Even in peacetime, the government has a critical role to play in promoting health care innovation

The single most important change that we need to make to be prepared for the next pandemic is to recognize that proper preparation is, by definition, overpreparation. Unless we are prepared for the next pandemic that doesn’t happen, we won’t possibly be ready for the next pandemic that does.

This means working now, while the memory is fresh, to set up permanent, mandatorily funded institutions to do global disease surveillance, extensive testing of any at-risk populations when new diseases are detected, and a permanent government effort to finance underdeveloped vaccines and therapeutics.

Jeffrey Harris , professor emeritus of economics and a practicing physician The pandemic has revealed the American health care system to be a non-system. In a genuine system, health care providers would coordinate their services. Yet when Elmhurst Hospital in Queens was overrun with patients, some 3,500 beds remained available in other New York hospitals. In a genuine system, everyone would have a stable source of care at a health maintenance organization (HMO). While our country has struggled to distribute the Covid-19 vaccine efficiently and equitably, Israel, which has just such an HMO-based system, has broken world records for vaccination.

Germany, which has all along had a robust public health care system, was accepting sick patients from Italy, Spain, and France. Meanwhile, U.S. hospitals were in financial shock and fee-for-service-based physician practices were devastated. We need to move toward a genuine health care system that can withstand shocks like the Covid-19 pandemic. There are already models out there to imitate. We need to strengthen our worldwide pandemic and global health crisis alert systems. Despite concerns about China’s early attempts to suppress the bad news about Covid-19, the world was lucky that Chinese investigators posted the full genome of SARS-CoV-2 in January 2020 — the singular event that triggered the search for a vaccine. With the recurrent threat of yet another pandemic — after H1N1, SARS, MERS, Ebola, and now SARS-Cov-2 — along with the anticipated health consequences of global climate change, we can’t simply cross our fingers and hope to get lucky again.

Erica Caple James , associate professor of medical anthropology and urban studies The coronavirus pandemic has revealed some of the limits of the American medical and health care system and demonstrated many of the social determinants of health. Neither the risks of infection nor the probability of suffering severe illness are equal across populations. Each depends on socioeconomic factors such as type of employment, mode of transportation, housing status, environmental vulnerability, and capacity to prevent spatial exposure, as well as “preexisting” health conditions like diabetes, obesity, and chronic respiratory illness.

Such conditions are often determined by race, ethnicity, gender, and “biology,” but also poverty, cultural and linguistic facility, health literacy, and legal status. In terms of mapping the prevalence of infection, it can be difficult to trace contacts among persons who are regular users of medical infrastructure. However, it can be extraordinarily difficult to do so among persons who lack or fear such visibility, especially when a lack of trust can color patient-clinician relationships.

One’s treatment within medical and health care systems may also reflect other health disparities — such as when clinicians discount patient symptom reports because of sociocultural, racial, or gender stereotypes, or when technologies are calibrated to the norm of one segment of the population and fail to account for the severity of disease in others.

The pandemic has also revealed the biopolitics and even the “necropolitics” of care — when policymakers who are aware that disease and death fall disproportionately in marginal populations make public-health decisions that deepen the risks of exposure of these more vulnerable groups. The question becomes, “Whose lives are deemed disposable?” Similarly, which populations — and which regions of the world — are prioritized for treatment and protective technologies like vaccines and to what degree are such decisions politicized or even racialized?

Although no single change will address all of these disparities in health status and access to treatment, municipal, state, and federal policies aimed at improving the American health infrastructure — and especially those that expand the availability and distribution of medical resources to underserved populations — could greatly improve health for all.

Seth Mnookin , professor of science writing

The Covid-19 pandemic adds yet another depressing data point to how the legacy and reality of racism and white supremacy in America is lethal to historically marginalized groups. A number of recent studies have shown that Black, Hispanic, Asian, and Native Americans have a significantly higher risk of infection, hospitalization, and death compared to white Americans.

The reasons are not hard to identify: Minority populations are less likely to have access to healthy food options, clean air and water, high-quality housing, and consistent health care. As a result, they’re more likely to have conditions that have been linked to worse outcomes in Covid patients, including diabetes, hypertension, and obesity.

Marginalized groups are also more likely to be socioeconomically disadvantaged — which means they’re more likely to work in service and manufacturing industries that put them in close contact with others, use public transportation, rely on overcrowded schools and day cares, and live in closer proximity to other households. Even now, more vaccines are going to wealthier people who have the time and technology required to navigate the time-consuming vaccine signup process and fewer to communities with the highest infection rates.

This illustrates why addressing inequalities in Americans’ health requires addressing inequalities that infect every part of society. Moving forward, our health care systems should take a much more active role in advocating for racial and socioeconomic justice — not only because it is the right thing to do, but because it is one of the most effective ways to improve health outcomes for the country as a whole.

On a global level, the pandemic has illustrated that preparedness and economic resources are no match for lies and misinformation. The United States, Brazil, and Mexico have, by almost any metric, handled the pandemic worse than virtually every other country in the world. The main commonality is that all three were led by presidents who actively downplayed the virus and fought against lifesaving public health measures. Without a global commitment to supporting accurate, scientifically based information, there is no amount of planning and preparation that can outflank the spread of lies.

Parag Pathak , Class of 1922 Professor of Economics   The pandemic has revealed the strengths and weaknesses of America’s health care systems in an extreme way. The development and approval of three vaccines in roughly one year after the start of the pandemic is a phenomenal achievement. At the same time, there are many innovations for which there have been clear fumbles, including the deployment of rapid tests and contact tracing.   The other aspect the pandemic has made apparent is the extreme inequality in America’s health systems. Disadvantaged communities have borne the brunt of Covid-19 both in terms of health outcomes and also economically. I’m hopeful that the pandemic will spur renewed focus on protecting the most vulnerable members of society. A pandemic is a textbook situation in economics of externalities, where an individual’s decision has external effects on others. In such situations, there can be major gains to coordination. In the United States, the initial response was poorly coordinated across states. I think the same criticism applies globally. We have not paid enough attention to population health on a global scale. One lesson I take from the relative success of the response of East Asian countries is that centralized and coordinated health systems are more equipped to manage population health, especially during a pandemic. We’re already seeing the need for international cooperation with vaccine supply and monitoring of new variants. It will be imperative that we continue to invest in developing the global infrastructure to facilitate greater cooperation for the next pandemic.

Prepared by MIT SHASS Communications Editor and designer: Emily Hiestand Consulting editor: Kathryn O'Neill

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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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Building the Field of Health Policy and Systems Research: Framing the Questions

* E-mail: [email protected]

Affiliation Public Health Foundation of India, New Delhi, India

Affiliations School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

Affiliation Ghana Health Service/University of Ghana School of Public Health, Accra, Ghana

Affiliation Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

Affiliation School of Public Health, Makerere University, Kampala, Uganda

Affiliation Health Systems Programme, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

• Kabir Sheikh, 
• Lucy Gilson, 
• Irene Akua Agyepong, 
• Kara Hanson, 
• Freddie Ssengooba, 
• Sara Bennett

Published: August 16, 2011

• https://doi.org/10.1371/journal.pmed.1001073
• Reader Comments

Citation: Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F, Bennett S (2011) Building the Field of Health Policy and Systems Research: Framing the Questions. PLoS Med 8(8): e1001073. https://doi.org/10.1371/journal.pmed.1001073

Copyright: © 2011 Sheikh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: No specific funding was received for writing this article.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: HPSR, Health Policy and Systems Research; LMIC, low- and middle-income country

Provenance: Commissioned; externally peer reviewed.

PLoS Medicine Series on HPSR

Following the First Global Symposium on Health Systems Research in Montreux in November 2010, PLoS Medicine commissioned three articles on the state-of-the-art in Health Policy and Systems Research (HPSR). Three Policy Forum articles, authored by a diverse group of global health academics, critically examine the current challenges to the field and lay out what is needed to build capacity in HPSR and support local policy development and health systems strengthening, especially in low- and middle-income countries.

Paper 1 . Kabir Sheikh and colleagues. Building the Field of Health Policy and Systems Research: Framing the Questions.

Paper 2 . Lucy Gilson and colleagues. Building the Field of Health Policy and Systems Research: Social Science Matters.

Paper 3 . Sara Bennett and colleagues. Building the Field of Health Policy and Systems Research: An Agenda for Action.

Summary Points

• This is the first of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). HPSR is a multidisciplinary and interdisciplinary field identified by the topics and scope of questions asked rather than by methodology. The focus of discussion is HPSR in low- and middle-income countries.
• Topics of research in HPSR include international, national, and local health systems and their interconnectivities, and policies made and implemented at all levels of the health system. Research questions in HPSR vary by the level of analysis (macro, meso, and micro) and intent of the question (normative/evaluative or exploratory/explanatory).
• Current heightened attention on HPSR contains significant opportunities, but also threats in the form of certain focus areas and questions being privileged over others; “disciplinary capture” of the field by the dominant health research traditions; and premature and inappropriately narrow definitions.
• We call for greater attention to fundamental, exploratory, and explanatory types of HPSR; to the significance of the field for societal and national development, necessitating HPSR capacity building in low- and middle-income countries; and for greater literacy and application of a wide spectrum of methodologies.

Introduction

The field of Health Policy and Systems Research (HPSR) is currently experiencing an unprecedented level of interest. The First Global Symposium on Health Systems Research, held in Montreux, Switzerland, in November 2010, is the most recent of a succession of conferences and task force deliberations that have spun off a series of debates about the nature of the field and the future directions it should take. Establishing the identity and terrain of HPSR is part of these debates, which is made difficult by the fact that it is an essentially multidisciplinary field delimited not by methodology but by the topic and scope of research questions asked. In this paper, the first of a series of three addressing the current challenges and opportunities for the development of HPSR, we introduce and map the types of research questions that it has addressed over its natural course of evolution, analyze the nature of current heightened attention, and highlight emerging opportunities and challenges for the development of the field.

We use the extended term Health Policy and Systems Research for a field that is often referred to simply as Health Systems Research. For us, the broader term better captures the terrain of work it encompasses because it explicitly identifies the interconnections between policy and systems, and highlights the social and political nature of the field. The geographical focus of our concern is low- and middle-income countries (LMICs) [1] , but we suggest that our approach also has value for high-income countries. Our understanding of the evolution of HPSR draws primarily from the English language literature, which we acknowledge as a limitation. However, this reflects global discussion about the field, which has tended to neglect literature in other languages.

Evolution of a Question-Driven Field

Compared to other health research traditions, HPSR has a short but eclectic history. Many of the researchers who have led its development have brought social science perspectives, including health economics, sociology, political science, and anthropology, complementing the contributions of individuals and institutions engaged in delivering health services. A rearview look at these diverse antecedents reveals that HPSR has taken form from, and continues to be shaped by, questions bubbling up from the field—whether those asked by curious social scientists and observers drawn to the complexity of health systems and seeking to support change within them, or by public health specialists and health systems actors impelled to resolve practical concerns of service delivery. The state of HPSR in terms of methodological sophistication and advances results both from the independent contributions of discrete traditions of enquiry, as well as from the mixing of disciplinary influences—it is simultaneously, therefore, a multidisciplinary and interdisciplinary field.

Focus Areas in HPSR

Figure 1 illustrates how understanding of subjects of inquiry in HPSR varies depending on the perspective taken [2] . Health policy is commonly seen as the formal written documents, rules, and guidelines that present policy makers' decisions about what actions are deemed legitimate and necessary to strengthen the health system and improve health. Increasingly, however, it has been understood to encompass, importantly, the processes of decision-making at all levels of the health system and the wider influences that underpin the prioritisation of policy issues, the formulation of policy, the processes of bringing them alive in practice, and their evaluation [3] .

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https://doi.org/10.1371/journal.pmed.1001073.g001

Definitions of health systems, meanwhile, have been based mainly on their utility in the achievement of health outcomes. The World Health Organization (WHO) building blocks approach is one such popular classification, which conceptualizes health systems in the functional or instrumental terms of its constituent “hardware”—finance, medical products, information systems, levels and types of human resources, forms of service delivery, and governance understood as organizational structures and legislation, for example. [4] . It also recognises that the system encompasses both the suppliers of policy, services, and interventions, and the communities and households intended to benefit from them who, as citizens, also play important roles in policy change. However, in addition to these concrete and tangible expressions of health systems, the “software”—by which we mean the ideas and interests, values and norms, and affinities and power that guide actions and underpin the relationships among system actors and elements—are also critical to overall health systems performance. Alternative formulations of complex health systems have been influenced by economic theories of markets and political institutionalism, drawing attention to non-linear and dynamic relationships between different parts of health systems, and to the role of software and its interplay with the visible and quantifiable hardware of systems [5] , [6] . Finally, the influence of discursive and critical theory, through contributions from policy analysis and sociology, have brought an emerging recognition that health systems and policies are artifices of human creation, embedded in social and political reality and shaped by particular, culturally determined ways of framing problems and solutions [7] , [8] . Acknowledgement of these influences was another reason for our choice of field name, and has radical implications for research, and also for how we envision change in systems.

International, national, subnational (provincial), and local arenas, as well as their respective intersections, are each equally part of this broader conception of the constructed reality of health systems, with the local arena encompassing not only delivery of services, but also the worlds of health providers; activities of provision, protection, and promotion of health in local communities and households; and systems of local health governance.

A Typology of Questions

The range of questions encompassed by HPSR is broad. In the first place, there are different levels of analysis—macro-level analysis analyzes the architecture and oversight of systems, meso-level analysis focuses on the functioning of organizations and systemic interventions, and micro-level analysis considers the roles of individuals involved in activities of health provision, utilization, and governance, and how systems respectively shape and are shaped by their decisions and behaviour. Research questions can also be classified by their intent , which may broadly be seen to be either 1) normative/evaluative or 2) exploratory/explanatory in nature [9] . Table 1 maps types of questions, with indicative examples, according to the level and intent of analysis—this may be seen as a step towards constructing a broad church (or mosque, or temple) for HPSR.

https://doi.org/10.1371/journal.pmed.1001073.t001

The New Interest in HPSR

The recent upsurge of interest in HPSR, whilst partly a culmination of the efforts of earlier generations of researchers, owes much to recognition of its importance for the success of health interventions and programmes, and the changing macroeconomic environment of international health. As funding for health scaled up during the period 2000–2008, it became evident that Millennium Development Goal targets would not be achieved due to weak health systems. This catalyzed interest in the health systems field by international alliances and donors, as well as a nascent advocacy movement, partly synergistic also with HIV/AIDS advocacy. Specific departments within international organizations, such as the Health Systems and Services cluster at WHO, were established and new research organizations focusing on health systems research, such as the Alliance for Health Policy and Systems Research and the Institute for Health Metrics and Evaluation, emerged. During the past decade a series of conferences and task forces on health research, including the International Conference on Health Research for Development, Bangkok, 2000, and ministerial meetings in Mexico City in 2004 and Bamako in 2008, had a strong focus on practical, operational questions, and this was frequently framed as health systems research. In addition to these global trends, innovative health reforms in emerging economies such as Brazil, China, India, and Thailand have created enthusiasm around the scope for system-level interventions.

The upsurge in interest is a reflection of the wide-ranging relevance of HPSR, as well as a commentary on the overdue need for the elevation of this research field to the stature of the dominant traditions of health research. There are numerous potential benefits of the current concern, for the future of the field:

• New insights into key problems and focus areas, particularly resulting from the participation of actors representing the clinical and epidemiological sciences, and from reflection on operational and service delivery experiences.
• Opportunities for development of a range of new research methodologies drawing from diverse disciplinary perspectives.
• Expansion of funding platforms and increased funding for HPSR in LMIC contexts.

However, the combination of heightened attention in a short span of time with the differing interests of involved actors has altered how HPSR is perceived and framed in the present day. In itself this presents significant threats for the balanced and holistic development of the field—three of the most important threats are discussed here.

Skewed Balance in Focus Areas and Questions

HPSR has previously played an important role in exploring the societal relevance and purpose of systems and interventions, and helping shape systems values [10] , [11] . Another important potential function of HPSR is to examine software elements such as power and trust that have been demonstrated to be key determinants of health systems performance, and success of health policies [12] , [13] . However, the current focus of the field of research is frequently framed around the hardware of health systems, and less around its software (See Figure 1 ). This is underpinned by the dominance of the positivist paradigm of knowledge which, with its claims to value-neutrality, has led to health systems being seen primarily as vehicles for technological solutions rather than being grounded in political and social contexts with underlying power structures, interests, and interdependencies.

Secondly, particular arenas of health policy and systems remain poorly addressed. The current framing of HPSR has tended to foreground issues around the delivery of specific interventions and services (often specific programmes of disease control, and often driven by global actors and agendas) rather than the existing national and sub-national systems and institutions through which they are administered. The influence of local political cultures and practices over system performance is another critical area of neglect in HPSR—yet organizational ethos and inter-organizational relationships are key determinants of how and whether policies get implemented.

Finally, the current framing of HPSR has broadly been skewed towards short-term pragmatic and operational questions, rather than being oriented towards theoretical development. Within the predominantly normative/evaluative focus of current questions there has also been a particular emphasis on deriving generalizable solutions that can be applied internationally, rather than working towards resolving specific societal problems through engagement with national and subnational policy planners. The dominant trend of donor-driven HPSR with an emphasis on addressing operational needs could have the effect of undermining the capabilities of research and academic organizations to address more fundamental, exploratory, and explanatory questions around the character and relevance of health policies and systems in real-world social and political contexts [14] .

“Disciplinary Capture”

The stakeholders—including researchers, funders, and journal editors—who are converging on HPSR, come from diverse disciplinary backgrounds. In this plural field, probably the most significant risk to its development lies in the lack of mutual understanding and respect across the range of contributory disciplines. In HPSR, as in health research in general, the dominant group of actors (in terms of both volume and influence) are those involved in the delivery of health services (primarily medical professionals). These actors work mainly in the frame of the dominant health research traditions—including epidemiological, biomedical, and clinical research—and commonly employ a positivist paradigm of knowledge [15] .

Disciplinary capture may occur if this knowledge frame, with its attendant criteria of research quality, is superimposed on the entire field for want of a wider understanding of alternative paradigms of knowledge. The quantitative methods and measures commonly used in these dominant health research fields may be over-utilised in the service of HPSR questions, where qualitative, inductive, or participatory methods may work better. Frequently too, the rigour of HPSR is assessed with inappropriate standards, extrapolated from the dominant research traditions [15] .

Inappropriate Definitions

As HPSR is beginning to take shape from its multitude of influences, there is an undoubted and widely acknowledged need to enhance clarity and consensus on research methods, and deepen the theoretical foundations of the field. Prevailing attempts to characterize the field have broadly focused on offering definitions of HPSR, sometimes seeking to distinguish it from related areas of research [16] . It is argued that these definitional attempts have utility in guiding the allocation of global funds. However, for much the same reason, they risk constraining the understanding and natural development of the field, and may lead to the neglect and “crowding out” of particular types of HPSR that do not fit neatly into popular definitions, such as the examples of overlooked focus areas and types of questions cited above. In addition to militating against the hitherto inclusive, question-driven ethos of the field, such territorial approaches also present significant problems when definitions are inappropriately narrow or incomplete (Box 1).

Box 1. Narrow Definitions: Two Case Studies.

• Implementation Research: In the world of public policy analysis, research on implementation is a far-reaching terrain of work synonymous with the study of governance, clearly a central element of HPSR. Implementation research in this understanding is a four-decade-old field built on a wide foundation of empirical and theoretical work, propelled by vibrant debates between top-down and action-centered (or bottom-up) thinking. While top-down approaches analyze the ineffectiveness of public policies at all levels [22] , and aim to diagnose and resolve implementation deficits, action-centred theorists see implementation as a relationship between policy and action, involving negotiations and interactions in social and political contexts, and use social science research methods to understand “what actually happens, how and why” [23] . However, current definitions of Implementation Research (IR) in recent influential articles appear to overlook this entire paradigm and the extensive body of research within it [16] . IR in this interpretation focuses on the concerns of programme managers regarding the effectiveness of specific health interventions. In restricting IR to the objective of facilitating predetermined programmatic solutions, a broad terrain of understanding and research is effectively reduced to a topic area with a predominant top-down focus. The narrow enunciation of delivery of health interventions or programmes also excludes an understanding of implementation of other levels (e.g., global, sectoral, institutional) and domains of policy (e.g., health workforce, regulation, financing), each a significant area of research enquiry.
• Impact Evaluation: A related movement is the current ascendance of the field of “impact evaluation”, with its emphasis on a narrow range of “robust” methods that are believed to ensure an unbiased measure of intervention impact. This restriction on admissible study designs is also seen in Cochrane reviews of health system interventions undertaken through the Effective Practice and Organisation of Care (EPOC) group, which also holds the randomised design as the “gold standard”. Yet, such methods are often ill-suited to the evaluation of complex interventions (which would include many, if not all, health system strengthening interventions) where the causal mechanism is multifaceted and contextual factors play an important role. For instance, when there is a change in policy at the national level, there may be no obvious group against which change can be assessed, nor the opportunity to randomize units to intervention or control group. Even where it is possible to introduce variation in policy at the local level, reliance on randomised methods to rule out confounders in the measurement of impact may lead to a neglect of understanding of the specific elements of the context that are responsible for programme success or failure. For these interventions, it would seem wise to admit a wider variety of study designs for examining and interpreting programme impact, and for generating knowledge that can be generalised to other contexts.

Furthermore, LMIC health systems are also changing rapidly, and moves to delimit the field with narrow definitions may well be short-sighted. Emerging phenomena such as the changing roles of health care professionals, increasing health literacy, commercialization of health, and technological innovation—for information and communication, diagnosis, and treatment—will each pose new questions, necessitating a relatively open-ended outlook on the topics and approaches of enquiry constituting HPSR [17] – [20] .

Framing HPSR: A Balanced Agenda

HPSR owes much of its present-day prominence to its utility in supporting the effective implementation of health interventions and programmes. The key underlying assumption in this popular use of HPSR is that scientific-technical solutions for health concerns have previously been proven through epidemiological, biomedical, or clinical research, and the problem lies in actualization due to deficiencies in how the solution is administered by the health system, and necessitating enquiry into system “bottlenecks”. Consequently, in the broader schema of health research, research questions pertaining to health policy and systems have tended to occupy the position of being secondary or subsequent to the primary scientific-technical question.

It is important to recognize that HPSR does not exist only for reasons of its usefulness in addressing the constraints of specific health interventions, nor does it need to mimic the systems of knowledge generation prevalent in the dominant health research traditions. HPSR may logically be conceptualised in a complementary and equivalent , not subordinate, position to the other health research traditions in the quest for solutions to health concerns. It is a free-standing field of research with diverse, serious goals including supporting societal development and self-sufficiency of nations and communities in the long term, and examining the appropriateness of scientific-technical solutions when applied in real-world contexts [21] .

HPSR should have room for multiple foci of enquiry and types of research questions, and a wide spectrum of methodological approaches. The normative and evaluative functions of HPSR are well established, but there is also scope in HPSR for more fundamental, exploratory, and explanatory questions. Acceptance of and support for fundamental research is an important signifier of the maturation and wholeness of a field. Fundamental research has instrumental value in aiding health systems performance, and also serves long-term developmental goals. It is essential in shaping policy, and is the basis for a body of reference knowledge and a firm theoretical platform—baselines on which future researchers can build.

While the awakening of interest in HPSR contains great opportunities, we are also concerned that the disciplinary biases, premature enunciation of definitions, and the skewed balance of questions currently prioritised within HPSR weakens rather than strengthens the field, and so could undermine its potential to facilitate long-term goals of societal development. The practical challenges ahead, particularly as we seek to build capacity for HPSR in LMICs, include balanced growth and promoting wider literacy of the inherent diversity and varied potentialities of the field. These questions are addressed in the two forthcoming papers in this series.

Author Contributions

Wrote the first draft of the manuscript: KS LG IAA KH FS SB. Contributed to the writing of the manuscript: KS LG IAA KH FS SB. ICMJE criteria for authorship read and met: KS LG IAA KH FS SB. Agree with manuscript‚s results and conclusions: KS LG IAA KH FS SB.

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2021 National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Dec.

2021 National Healthcare Quality and Disparities Report [Internet].

Overview of u.s. healthcare system landscape.

The National Academy of Medicine defines healthcare quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Many factors contribute to the quality of care in the United States, including access to timely care, affordability of care, and use of evidence-based guidelines to drive treatment.

This section of the report highlights utilization of healthcare services, healthcare workforce statistics, healthcare expenditures, and major contributors to morbidity and mortality. These factors help paint an overall picture of the U.S. healthcare system, particularly areas that need improvement. Quality measures show whether the healthcare system is adequately addressing risk factors, diseases, and conditions that place the greatest burden on the healthcare system and if change has occurred over time.

• Overview of the U.S. Healthcare System Infrastructure

The NHQDR tracks care delivered by providers in many types of healthcare settings. The goal is to provide high-quality healthcare that is culturally and linguistically sensitive, patient centered, timely, affordable, well coordinated, and safe. The receipt of appropriate high-quality services and counseling about healthy lifestyles can facilitate the maintenance of well-being and functioning. In addition, social determinants of health, such as education, income, and residence location can affect access to care and quality of care.

Improving care requires facility administrators and providers to work together to expand access, enhance quality, and reduce disparities. It also requires coordination between the healthcare sector and other sectors for social welfare, education, and economic development. For example, Healthy People 2030 includes 5 domains (shown in the diagram below) and 78 social determinants of health objectives for federal programs and interventions.

Healthy People 2030 social determinants of health domains.

The numbers of health service encounters and people working in health occupations illustrate the large scale and inherent complexity of the U.S. healthcare system. The tracking of healthcare quality measures in this report iii attempts to quantify progress made in improving quality and reducing disparities in the delivery of healthcare to the American people.

Number of healthcare service encounters, United States, 2018 and 2019.

• In 2018, there were 860 million physician office visits ( Figure 1 ).
• In 2019, patients spent 149 million days in hospice.
• In 2019, there were 100 million home health visits.
• Overview of Disease Burden in the United States

The National Institutes of Health defines disease burden as the impact of a health problem, as measured by prevalence, incidence, mortality, morbidity, extent of disability, financial cost, or other indicators.

This section of the report highlights two areas of disease burden that have major impact on the health system of the United States: years of potential life lost and leading causes of death. The NHQDR tracks measures of quality for most of these conditions. Variation in access to care and care delivery across communities contributes to disparities related to race, ethnicity, sex, and socioeconomic status.

The concept of years of potential life lost (YPLL) involves estimating the average time a person would have lived had he or she not died prematurely. This measure is used to help quantify social and economic loss from premature death, and it has been promoted to emphasize specific causes of death affecting younger age groups. YPLL inherently incorporates age at death, and its calculation mathematically weights the total deaths by applying values to death at each age. 1

According to the Centers for Disease Control and Prevention (CDC), unintentional injuries include opioid overdoses (unintentional poisoning), motor vehicle crashes, suffocation, drowning, falls, fire/burns, and sports and recreational injuries. Overdose deaths involving opioids, including prescription opioids , heroin , and synthetic opioids (e.g., fentanyl ), have been a major contributor to the increase in unintentional injuries. Opioid overdose has increased to more than six times its 1999 rate. 2

Age-adjusted years of potential life lost before age 65, by cause of death, 2010–2019. Key: YPLL = years of potential life lost. Note: The perinatal period occurs from 22 completed weeks (154 days) of gestation and ends 7 completed days after (more...)

• From 2010 to 2019, there were no changes in the ranking of the top 10 leading diseases and injuries contributing to YPLL. The top 5 were unintentional injury, cancer, heart disease, suicide, and complications during the perinatal period ( Figure 2 ). The remaining 5 were homicide, congenital anomalies, liver disease, diabetes, and cerebrovascular disease.
• Unintentional injury increased from 791.8 per 100,000 population in 2010 to 1,024.3 per 100,000 population in 2019.
• Cancer decreased from 635.2 per 100,000 population in 2010 to 533.3 per 100,000 population in 2019.
• Heart disease decreased from 474.3 per 100,000 population in 2010 to 453.2 per 100,000 population in 2019.

Age-adjusted years of potential life lost before age 65, by cause of death and race, 2019. Key: AI/AN = American Indian or Alaska Native; PI = Pacific Islander.

• In 2019, among American Indian and Alaska Native (AI/AN) people, the top five contributing factors for YPLL were unintentional injuries (1,284.6 per 100,000 population), suicide (457.7 per 100,000 population), liver disease (451.6 per 100,000 population), heart disease (399.8 per 100,000 population), and cancer (339.6 per 100,000 population) ( Figure 3 ).
• In 2019, among Asian and Pacific Islander people, the top five contributing factors for YPLL were cancer (375.7 per 100,000 population), unintentional injuries (299.4 per 100,000 population), complications in the perinatal period (203.4 per 100,000 population), suicide (198.5 per 100,000), and heart disease (197.7 per 100,000 population).
• In 2019 among Black people, the top five contributing factors for YPLL were unintentional injuries (1,085.8 per 100,000 population), heart disease (843.5 per 100,000 population), homicide (801.7 per 100,000 population), cancer (652.7 per 100,000 population), and complications in the perinatal period (560.4 per 100,000 population).
• In 2019, among White people, the top five contributing factors for YPLL were unintentional injuries (1,080.0 per 100,000 population), cancer (530.1 per 100,000 population), heart disease (406.6 per 100,000 population), suicide (387.6 per 100,000 population), and complications in the perinatal period (215.7 per 100,000 population).

Leading causes of death for the total population, United States, 2018 and 2019.

• In 2019, heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, and diabetes were among the leading causes of death for the overall U.S. population ( Figure 4 ).
• Overall, kidney disease moved from the 9 th leading cause of death in 2018 to the 8 th leading cause of death in 2019.
• Suicide remained the 10 th leading cause of death in 2018 and 2019.

The years of potential life lost, years with disability, and leading causes of death represent some aspects of the burden of disease experienced by the American people. Findings highlighted in this report attempt to quantify progress made in improving quality of care, reducing disparities in healthcare, and ultimately reducing disease burden.

• Overview of U.S. Community Hospital Intensive Care Beds

The United States has almost 1 million staffed hospital beds; nearly 800,000 are community hospital beds and 107,000 are intensive care beds. Figure 5 shows the numbers of different types of staffed intensive care hospital beds.

Medical-surgical intensive care provides patient care of a more intensive nature than the usual medical and surgical care delivered in hospitals, on the basis of physicians’ orders and approved nursing care plans. These units are staffed with specially trained nursing personnel and contain specialized equipment for monitoring and supporting patients who, because of shock, trauma, or other life-threatening conditions, require intensified comprehensive observation and care. These units include mixed intensive care units.

Pediatric intensive care provides care to pediatric patients that is more intensive in nature than that usually provided to pediatric patients. The unit is staffed with specially trained personnel and contains monitoring and specialized support equipment for treating pediatric patients who, because of shock, trauma, or other life-threatening conditions, require intensified, comprehensive observation and care.

Cardiac intensive care provides patient care of a more specialized nature than the usual medical and surgical care, on the basis of physicians’ orders and approved nursing care plans. The unit is staffed with specially trained nursing personnel and contains specialized equipment for monitoring, support, or treatment for patients who, because of severe cardiac disease such as myocardial infarction, open-heart surgery, or other life-threatening conditions, require intensified, comprehensive observation and care.

Neonatal intensive care units (NICUs) are distinct from the newborn nursery and provide intensive care to sick infants, including those with the very lowest birth weights (less than 1,500 grams). NICUs may provide mechanical ventilation, care before or after neonatal surgery, and special care for the sickest infants born in the hospital or transferred from another institution. Neonatologists typically serve as directors of NICUs.

Burn care provides care to severely burned patients. Severely burned patients are those with the following: (1) second-degree burns of more than 25% total body surface area for adults or 20% total body surface area for children; (2) third-degree burns of more than 10% total body surface area; (3) any severe burns of the hands, face, eyes, ears, or feet; or (4) all inhalation injuries, electrical burns, complicated burn injuries involving fractures and other major traumas, and all other poor risk factors.

Other intensive care unit beds are in specially staffed, specialty-equipped, separate sections of a hospital dedicated to the observation, care, and treatment of patients with life-threatening illnesses, injuries, or complications from which recovery is possible. This type of care includes special expertise and facilities for the support of vital functions and uses the skill of medical, nursing, and other staff experienced in the management of conditions that require this higher level of care.

U.S. community hospital intensive care staffed beds, by type of intensive care, 2019. Note: Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; (more...)

• In 2019, of the more than 900,000 staffed hospital beds in the United States, 86% were in community hospitals (data not shown).
• Most of the more than 107,000 intensive care beds in community hospitals were medical-surgical intensive care (51.9%) and neonatal intensive care beds (21.1%) ( Figure 5 ).

Critical access hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services. As of July 16, 2021, 1,353 CAHs were located throughout the United States. 3 , iv

Distribution of critical access hospitals in the United States, 2021.

• According to CMS, CAHs must be located in a rural area or an area that is treated as rural, v so the number of CAHs varies by state ( Figure 6 ).
• In 2019, California had a population of 39.5 million and 36 CAHs compared with Iowa, which had a population of only 3.2 million but 82 CAHs.
• U.S. Healthcare Workforce

Healthcare access and quality can be affected by workforce shortages, particularly in rural areas. In addition, lack of racial, ethnic, and gender concordance between providers and patients can lead to miscommunication, stereotyping, and stigma, and, ultimately, suboptimal healthcare.

Healthcare Workforce Availability

Improving quality of care, increasing access to care, and controlling healthcare costs depend on the adequate availability of healthcare providers. 4 Physician shortages currently exist in many states across the nation, with relatively fewer primary care and specialty physicians available in nonmetropolitan counties compared with metropolitan counties. 5

The Health Resources and Services Administration (HRSA) further projects that the supply of key professions, including primary care providers, general dentists, adult psychiatrists, and addiction counselors, will fall short of demand by 2030. 6 These concerns have the potential to influence the delivery of healthcare and negatively affect patient outcomes.

Number of people working in health occupations, United States, 2019. Key: EMT = emergency medical technician. Note: Doctors of medicine also include doctors of osteopathic medicine. Active physicians include those working in direct patient care, administration, (more...)

• In 2019, there were 3.7 million registered nurses ( Figure 7 ).
• In 2019, there were 2.4 million healthcare aides, which includes nursing, psychiatric, home health, and occupational therapy aides and physical therapy assistants and aides.
• In 2019, there were 2.1 million health technologists.
• In 2019, 2.0 million other health practitioners provided care, including more than 145,000 physician assistants (PAs).
• In 2019, there were 972,000 active medical doctors in the United States, which include doctors of medicine and doctors of osteopathy.
• In 2019, there were 183,000 dentists.

In recent decades, promising approaches that address the supply-demand imbalance have emerged as alternatives to simply increasing the number of physicians. One strategy relies on telehealth technologies to improve physicians’ efficiency or to increase access to their services. For example, Project ECHO is a telehealth model in which specialists remotely support multiple rural primary care providers so that they can treat patients for conditions that might otherwise require traveling to distant specialty centers. 7

Another strategy relies on peer-led models, in which community-based laypeople receive the training and support needed to deliver care for a (typically) narrow range of conditions. Successful examples of this approach exist, including the deployment of community health workers to manage chronic diseases, 8 promotoras to provide maternal health services, 9 peer counselors for mental health and substance use disorders, 10 and dental health aides to deliver oral health services in remote locations. 11

The National Institutes of Health, HRSA, and the Agency for Healthcare Research and Quality (AHRQ) have sponsored formative research to examine key issues that must be addressed to further develop these models, but all show promise for expanding access to care and increasing overall diversity within the healthcare workforce.

Workforce Diversity

The number of full-time, year-round workers in healthcare occupations has almost doubled since 2000, increasing from 5 million to 9 million workers, according to the U.S. Census Bureau’s American Community Survey .

A racially and ethnically diverse health workforce has been shown to promote better access and healthcare for underserved populations and to better meet the health needs of an increasingly diverse population. People of color, however, remain underrepresented in several health professions, despite longstanding efforts to increase the diversity of the healthcare field. 12

Additional research has found that physicians from groups underrepresented in the health professions are more likely to serve minority and economically disadvantaged patients. It has also been found that Black and Hispanic physicians practice in areas with larger Black and Hispanic populations than other physicians do. 13

Gender diversity is also important. Women currently account for three-quarters of full-time, year-round healthcare workers. Although the number of men who are dentists or veterinarians has decreased over the past two decades, men still make up more than half of dentists, optometrists, and emergency medical technicians/paramedics, as well as physicians and surgeons earning over $100,000. 14

Women working as registered nurses, the most common healthcare occupation, earn on average $66,000. Women working as nursing, psychiatric, and home health aides, the second most common healthcare occupation, earn only $27,000. 14

The impact of unequal gender distribution in the healthcare workforce is observed in the persistence of gender inequality in heart attack mortality. Most physicians are male, and some may not recognize differences in symptoms in female patients. The fact that gender concordance correlates with whether a patient survives a heart attack has implications for theory and practice. Medical practitioners should be aware of the possible challenges male providers face when treating female heart attack patients. 15

Research has shown that some mental health workforce groups, such as psychiatrists, are more diverse than many other medical specialties, and this diversity has improved over time. However, this diversity has not translated as well to academic faculty or leadership positions for underrepresented minorities. It was found that there was more minority representation among psychiatry residents (16.2%) compared with faculty (8.7%) and practicing physicians (10.4%). This difference results in minority students and trainees having fewer minority mentors to guide them in the profession.

Racial and Ethnic Diversity Among Physicians

Diversification of the physician workforce has been a goal for several years and could improve access to primary care for underserved populations and address health disparities. Family physicians’ race/ethnicity has become more diverse over time but still does not reflect the national racial and ethnic composition. 16 , vi

Racial and ethnic distribution of all active physicians (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due (more...)

• In 2019, White people were 60% of the U.S. population and approximately 64% of physicians ( Figure 8 ).
• Asian people were about 6% of the U.S. population and approximately 22% of physicians.
• Black people were 12% of the U.S. population but only 5% of physicians.
• Hispanic people were 18% of the U.S. population but only 7% of physicians.
• People of more than race made up about 3% of the U.S. population but less than 2% of physicians.
• AI/AN people and Native Hawaiian/Pacific Islander (NHPI) people accounted for 1% or less of the U.S. population and 1% or less of physicians (data not shown).

Preventive care, including screenings, is key to reducing death and disability and improving health. Evidence has shown that patients with providers of the same gender have higher rates of breast, cervical, and colorectal cancer screenings. 17

Physicians by race/ethnicity and sex, 2018. Key: AI/AN = American Indian or Alaska Native; NHPI = Native Hawaiian/Pacific Islander. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working (more...)

• In 2018, among Black physicians, females (53.0%) constituted a larger percentage than males (47.0%) ( Figure 9 ).
• Among White physicians, 65.5% were male.
• Among Asian physicians, 55.7% were male.
• Among AI/AN physicians, 60.1% were male.
• Among Hispanic physicians, 59.5% were male.

White physicians by age and sex, 2018. Note : Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

• In 2018, among White physicians, males were the vast majority of those age 65 years and over (79.3%) and of those ages 55–64 years (71.5%) ( Figure 10 ).
• A little more than half of White physicians age 34 and younger were females (50.6%).
• Among White physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Black physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

• In 2018, among Black physicians under age 55, females made up a larger percentage of the workforce than males. This percentage decreased with increasing age ( Figure 11 ).
• Females were 44.2% of Black physicians ages 55–64 and 34.9% of Black physicians age 65 and over.

Asian physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

• In 2018, among Asian physicians, males were the vast majority of those age 65 years and over (72.7%) and of those ages 55–64 years (66.3%) ( Figure 12 ).
• Among Asian physicians age 34 and younger, there were more females (52.0%) than males (48.0%).
• Among Asian physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

American Indian or Alaska Native physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, (more...)

• In 2018, among AI/AN physicians, males were the vast majority of those age 65 years and over (73.2%) and of those ages 55–64 years (62.6%) ( Figure 13 ).
• Among AI/AN physicians age 34 and younger, there were more females (57.9%) than males (42.1%).
• Among AI/AN physicians age 45 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Hispanic physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

• In 2018, most Hispanic physicians age 65 years and over (77.5%) and ages 55–64 years (67.5%) were males ( Figure 14 ).
• Among Hispanic physicians age 34 and younger, there were more females (55.3%) compared with males (44.7%).
• Among Hispanic physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Racial and Ethnic Diversity Among Dentists

The racial and ethnic diversity of the oral healthcare workforce is insufficient to meet the needs of a diverse population and to address persistent health disparities. 18 However, among first-time, first-year enrollees in dental school, improved diversity has been observed. The number of African American enrollees nearly doubled and the number of Hispanic enrollees has increased threefold between 2000 and 2020. 19 Increased diversity among dentists may improve access and quality of care, particularly in the area of culturally and linguistically sensitive care.

Dentists by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and Other are non-Hispanic. If estimates for certain racial and ethnic groups meet data suppression criteria, they are recategorized into (more...)

• In 2019, the vast majority of dentists (70%) were non-Hispanic White ( Figure 15 ).
• Asian people, 18%,
• Hispanic people, 6%
• Black people, 5%, and
• Other (multiracial and AI/AN people), 1.0%.

Racial and Ethnic Diversity Among Registered Nurses

Ensuring workforce diversity and leadership development opportunities for racial and ethnic minority nurses must remain a high priority in order to eliminate health disparities and, ultimately, achieve health equity. 20

Registered nurses by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and (more...)

• In 2019, the vast majority of RNs (69%) were non-Hispanic White ( Figure 16 ).
• Black people, 11%,
• Asian people, 9%,
• Hispanic people, 8%,
• Multiracial people, 2%, and
• Other (AI/AN and NHPI people), 1%.

Racial and Ethnic Diversity Among Pharmacists

Most healthcare diagnostic and treating occupations such as pharmacists, physicians, nurses, and dentists are primarily White while healthcare support roles such as dental assistants, medical assistants, and personal care aides are more diverse. To decrease disparities and enhance patient care, racial and ethnic diversity must be improved on all levels of the healthcare workforce, not just in support roles. 21

Progress has been made toward increased racial and ethnic diversity, but more work is needed. As Bush notes in an article on underrepresented minorities in pharmacy school, “If we are determined to reduce existing healthcare disparities among racial, ethnic, and socioeconomic groups, then we must be determined to diversify the healthcare workforce.” 22

Pharmacists by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the exclusion of groups (more...)

• In 2019, the vast majority of pharmacists (65%) were non-Hispanic White ( Figure 17 ).
• Asian people, 20%,
• Black people, 7%,
• Hispanic people, 5%, and
• Multiracial people, 2%.

Racial and Ethnic Diversity Among Therapists

Occupational therapists, physical therapists, radiation therapists, recreational therapists, and respiratory therapists are classified as health diagnosing and treating practitioners. Hispanic people are significantly underrepresented in all of the occupations in the category of Health Diagnosing and Treating Practitioners. Among non-Hispanic people, Black people are underrepresented in most of these occupations.

Asian people are underrepresented among speech-language pathologists, and AI/AN people are underrepresented in nearly all occupations. To the extent they can be reliably reported, data also show that NHPI people are underrepresented in all occupations in the Health Diagnosing and Treating Practitioners group. 21

Therapists include occupational therapists, physical therapists, radiation therapists, recreational therapists, respiratory therapists, speech-language pathologists, exercise physiologists, and other therapists.

Therapists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the exclusion (more...)

• In 2019, the vast majority of therapists (74%) were non-Hispanic White ( Figure 18 ).
• Black people, 8%,
• Asian people, 8%,
• Hispanic people, 8%, and

Racial and Ethnic Diversity Among Advanced Practice Registered Nurses

The adequacy and distribution of the primary care workforce to meet the current and future needs of Americans continue to be cause for concern. Advanced practice registered nurses are increasingly being used to fill this gap but may include clinicians in areas beyond primary care, such as clinical nurse specialists, nurse-midwives, and nurse anesthetists.

Advanced practice registered nurses are registered nurses educated at the master’s or post-master’s level who serve in a specific role with a specific patient population. They include certified nurse practitioners, clinical nurse specialists, certified nurse anesthetists, and certified nurse-midwives.

While physicians continue to account for most of the primary care workforce (74%) in the United States, nurse practitioners represent nearly one-fifth (19%) of the primary care workforce, followed by physician assistants, accounting for 7%. 23

Nurse practitioners provide an extensive range of services that includes taking health histories and providing complete physical exams. They diagnose and treat acute and chronic illnesses, provide immunizations, prescribe and manage medications and other therapies, order and interpret lab tests and x rays, and provide health education and supportive counseling.

Nurse practitioners deliver primary care in practices of various sizes, types (e.g., private, public), and settings, such as clinics, schools, and workplaces. Nurse practitioners work independently and collaboratively. They often take the lead in providing care in innovative primary care arrangements, such as retail clinics. 24

Advanced practice registered nurses by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

• In 2019, the vast majority of advanced practice registered nurses (78 %) were non-Hispanic White ( Figure 19 ).
• Asian people, 6%,
• Hispanic people, 6%, and

Racial and Ethnic Diversity Among Emergency Professionals

Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings such as emergency departments, where time pressure and incomplete information may worsen the effects of implicit biases. The racial and ethnic makeup of the paramedic and emergency medical technician workforce indicates that concerted efforts are needed to encourage students of diverse backgrounds to pursue emergency service careers. 25

Emergency medical technicians and paramedics by race (left), and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages do not add to 100 due to rounding. In addition, (more...)

• In 2019, the vast majority of emergency medical technicians (EMTs) and paramedics (72%) were non-Hispanic White ( Figure 20 ).
• Hispanic people, 13%
• Asian people, 3%,

Racial and Ethnic Diversity Among Other Health Practitioners

Other health practitioners include physician assistants, medical assistants, dental assistants, chiropractors, dietitians and nutritionists, optometrists, podiatrists, and audiologists, as well as massage therapists, medical equipment preparers, medical transcriptionists, pharmacy aides, veterinary assistants and laboratory animal caretakers, phlebotomists, and healthcare support workers.

Other health practitioners by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

• In 2019, the distribution of other health practitioners closely aligned with the racial and ethnic distribution of the U.S. population ( Figure 21 ).
• In 2019, 58% of other health practitioners were non-Hispanic White.
• In 2019, Hispanic people accounted for 20% of other health practitioners.
• Black people, 12%,
• Asian people, 7%,

Racial and Ethnic Diversity Among Physician Assistants

Physician assistants (PAs) are included in the Other Health Practitioners workforce group but are highlighted because they play a critical role in frontline primary care services in many settings, especially medically underserved and rural areas. With the demand for primary care services projected to grow and PAs’ roles in direct care, understanding this occupation’s racial and ethnic diversity is important.

Studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, and patient and staff satisfaction. These providers can also enhance the educational experience of residents and fellows. 26 However, a lack of workforce diversity has detrimental effects on patient outcomes, access to care, and patient trust, as well as on workplace experiences and employee retention. 27

Physician assistants by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

• In 2019, the vast majority of physician assistants (73%) were non-Hispanic White ( Figure 22 ).
• Black people, 6%,
• Multiracial people, 3%, and

Racial and Ethnic Diversity Among Other Health Occupations

Other health occupations include veterinarians, acupuncturists, all other healthcare diagnosing or treating practitioners, dental hygienists, and licensed practical and licensed vocational nurses.

Other health occupations by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

• In 2019, the vast majority of staff in other health occupations (61%) were non-Hispanic White ( Figure 23 ).
• Black people, 19%,
• Hispanic people, 11%
• Asian people, 6 %,

Racial and Ethnic Diversity Among Health Technologists

Health technologists include clinical laboratory technologists and technicians, cardiovascular technologists and technicians, diagnostic medical sonographers, radiologic technologists and technicians, magnetic resonance imaging technologists, nuclear medicine technologists and medical dosimetrists, pharmacy technicians, surgical technologists, veterinary technologists and technicians, dietetic technicians and ophthalmic medical technicians, medical records specialists, and opticians (dispensing), miscellaneous health technologists and technicians, and technical occupations.

Health technologists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the (more...)

• In 2019, the vast majority of health technologists (63%) were non-Hispanic White ( Figure 24 ).
• Black people, 14%,
• Hispanic people, 13%,
• Asian people, 8%, and

Racial and Ethnic Diversity Among Healthcare Aides

Healthcare aides include nursing, psychiatric, home health, occupational therapy, and physical therapy assistants and aides.

Healthcare aides by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and (more...)

• In 2019, 41% of healthcare aides were non-Hispanic White ( Figure 25 ).
• Black people, 32%,
• Hispanic people, 18%,

Racial and Ethnic Diversity Among Psychologists

The United States has an inadequate workforce to meet the mental health needs of the population, 28 , 29 , 30 and it is estimated that in 2020, nearly 54% of the U.S. population age 18 and over with any mental illness did not receive needed treatment. 31 This unmet need is even greater for racial and ethnic minority populations. Nearly 80% of Asian and Pacific Islander people, vii 63% of African Americans, and 65% of Hispanic people with a mental illness do not receive mental health treatment. 29 , 32 , 33 , 34

These gaps in mental health care may be attributed to a number of reasons, including stigma, cultural attitudes and beliefs, lack of insurance, or lack of familiarity with the mental health system. 35 , 36 , 37 However, a significant contributor to this treatment gap is the composition of the workforce.

The current mental health workforce lacks racial and ethnic diversity. 34 , 38 Research has shown that racial and ethnic patient-provider concordance is correlated with patient engagement and retention in mental health treatment. 39 In addition, racial and ethnic minority providers are more likely to serve patients of color than White providers. 34 , 36

Among psychologists, a key practitioner group in the mental health workforce, 37 , 40 minorities are significantly underrepresented. Psychologists in the United States are predominantly non-Hispanic White, while all racial and ethnic minorities represented only about one-sixth of all psychologists from 2011 to 2015.

Reducing the serious gaps in mental health care for racial and ethnic minority populations will require a significant shift in the workforce. Workforce recruitment, training, and education of more racially, ethnically, and culturally diverse practitioners will be essential to reduce these disparities.

Psychologists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Psychologists include practitioners of general psychology, developmental and child (more...)

• In 2019, the vast majority of psychologists (79%) were non-Hispanic White ( Figure 26 ).
• Hispanic people,10%,
• Asian people, 4%, and
• Multiracial people, 2.0%.

Although the outpatient substance use treatment field has seen an increase in referrals of Black and Hispanic clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. 41

Substance abuse and behavioral disorder counselors by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Key: AI/AN = American Indian/Alaska Native. Note: White, Black, Asian, AI/AN, and >1 Race are non-Hispanic. (more...)

• In 2019, the majority of substance abuse and behavioral disorder counselors (58%) were non-Hispanic White ( Figure 27 ).
• Black people, 18%,
• Hispanic people, 16 %,
• Asian people, 4%,
• AI/AN people, 1%.
• Overview of Healthcare Expenditures in the United States
• Hospital care expenditures grew by 6.2% to $1.2 trillion in 2019, faster than the 4.2% growth in 2018.
• Physician and clinical services expenditures grew 4.6% to $772.1 billion in 2019, a faster growth than the 4.0% in 2018.
• Prescription drug spending increased by 5.7% to $369.7 billion in 2019, faster than the 3.8% growth in 2018.
• In 2019, the federal government (29%) and households (28%) each accounted for the largest shares of healthcare spending, followed by private businesses (19%), state and local governments (16%), and other private revenues (7%). Federal government spending on health accelerated in 2019, increasing 5.8% after 5.4% growth in 2018.

Personal Healthcare Expenditures

“Personal healthcare expenditures” measures the total amount spent to treat individuals with specific medical conditions. It comprises all of 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 health care; nursing care facilities and continuing care retirement communities; and retail outlet sales of medical products. 43

Distribution of personal healthcare expenditures by type of expenditure, 2019. Key: CCRCs = continuing care retirement communities. Note: Percentages do not add to 100 due to rounding. Personal healthcare expenditures are outlays for goods and services (more...)

• In 2019, hospital care expenditures were $1.192 trillion, nearly 40% of personal healthcare expenditures ( Figure 28 ).
• Expenditures for physician and clinical services were $772.1 billion, almost one-fourth of personal healthcare expenditures.
• Prescription drug expenditures were $369.7 billion, 10% of personal healthcare expenditures.
• Expenditures for dental services were $143.2 billion, 5% of personal healthcare expenditures.
• Nursing care facility expenditures were $172.7 billion and home health care expenditures were $113.5 billion, 5% and 4% of personal healthcare expenditures, respectively.

Personal healthcare expenditures, by source of funds, 2019. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Personal healthcare (more...)

• In 2019, private insurance accounted for 33% of personal healthcare expenditures, followed by Medicare (23%), Medicaid (17%), and out of pocket (13%) ( Figure 29 ).
• Private insurance accounted for 37% of hospital, 40% of physician, 15% of home health, 10% of nursing home, 43% of dental, and 45% of prescription drug expenditures.
• Medicare accounted for 27% of hospital, 25% of physician, 39% of home health, 22% of nursing home, 1.0% of dental, and 28% of prescription drug expenditures.
• Medicaid accounted for 17% of hospital, 11% of physician, 32% of home health, 29% of nursing home, 10% of dental, and 9% of prescription drug expenditures.
• Out-of-pocket payments accounted for 3% of hospital, 8% of physician, 11% of home health, 26% of nursing home, 42% of dental, and 15% of prescription drug expenditures.

Prescription drug expenditures, by source of funds, 2019. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Percentages do (more...)

• Private health insurance companies accounted for 44.5% of retail drug expenses ($164.6 billion in 2019).
• Medicare accounted for 28.3% of retail drug expenses ($104.6 billion).
• Medicaid accounted for 8.5% of retail drug expenses ($31.4 billion).
• Other health insurance programs accounted for 3.0% of retail drug expenses ($11.0 billion).

Other third-party payers had the smallest percentage of costs (1.2%), which represented $4.3 billion in retail drug costs.

• Variation in Healthcare Quality

State-level analysis included 182 measures for which state data were available. Of these measures, 140 are core measures and 42 are supplemental measures from the National CAHPS Benchmarking Database (NCBD), which provides state data for core measures with MEPS national data only.

The state healthcare quality analysis included all 182 measures, and the state disparities analysis included 108 measures for which state-by-race or state-by-ethnicity data were available. State-level data are also available for 136 supplemental measures. These data are available from the Data Query tool on the NHQDR website but are not included in data analysis.

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.

Overall quality of care, by state, 2015–2020. 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 (more...)

• Some states in the Northeast (Maine, Massachusetts, New Hampshire, and Rhode Island), some in the Midwest (Iowa, Minnesota, North Dakota, and Wisconsin), two states in the West (Colorado and Utah), and North Carolina and Kentucky had the highest overall quality scores.
• Some Southern and Southwestern states (District of Columbia, viii Florida, Georgia, New Mexico, and Texas), two Western states (California and Nevada), some Northwestern states (Montana, Oregon, Washington, and Wyoming), and New York and Alaska had the lowest overall quality scores.
• More information about the measures and data sources included in the creation of this map can be found in Appendix C .
• More information about healthcare quality in each state can be found on the NHQDR website, https://datatools ​.ahrq.gov/nhqdr .
• Variation in Disparities in Healthcare

The disparities map ( Figure 32 ) shows average differences in quality of care for Black, Hispanic, Asian, NHPI, AI/AN, and multiracial people compared with the reference group, non-Hispanic White or White people. States with fewer than 50 data points are excluded.

Average differences in quality of care for Black, Hispanic, Asian, Native Hawaiian/Pacific Islander, American Indian or Alaska Native, and multiracial people compared with White people, by state, 2018–2019. Note: All measures in this report that (more...)

• Some Western and Midwestern states (Idaho, Iowa, Kansas, Montana, Nevada, New Mexico, Oregon, Utah, and Washington), several Southern states (Kentucky, Mississippi, Virginia, and West Virginia), and Maine had the fewest racial and ethnic disparities overall.
• Several Northeastern states (Massachusetts, New York, and Pennsylvania), two Midwestern states (Illinois and Ohio), two Southern States (Louisiana and Tennessee), and Texas had the most racial and ethnic disparities overall.

Major updates made to three data sources since 2018, specifically the Medical Expenditure Panel Survey, Healthcare Cost and Utilization Project, and National Health Interview Survey, have had an outsized impact on what the 2021 NHQDR can include. Trend data were provided in prior versions of the NHQDR but were not directly comparable for almost half of the core measures at the time this report was developed. Therefore, the 2021 NHQDR does not include a summary figure showing all trend measures or all changes in disparities. The report includes summary figures for trends and change in disparities for some populations and the results for individual measures.

More information on providers that may be eligible to become CAHs and the criteria a Medicare-participating hospital must meet to be designated by CMS as a CAH can be found at https://www ​.cms.gov/Medicare ​/Provider-Enrollment-and-Certification ​/CertificationandComplianc/CAHs .

All the criteria for a Medicare-participating hospital to be designated by CMS as a CAH can be found at https://www ​.cms.gov/Medicare ​/Provider-Enrollment-and-Certification ​/CertificationandComplianc/CAHs .

The most recent data year available is 2018 from the Association of American Medical Colleges, the current source for workforce data broken down by both race/ethnicity and sex.

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Climate change is the single biggest health threat facing humanity, and health professionals worldwide are responding to the health harms caused by this unfolding crisis. The phenomenon poses many threats to the health and well-being of humanity, from increasing the risk of extreme heat events and heavy ...

Keywords : Climate Change, Health Policy, Health Services, Climate-informed Decision, Indigenous Health, Local Communities, Governance

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IHSP’s research contributes to health system improvements worldwide by emphasizing six interrelated areas of focus.  The combination of operations and academically-oriented research allow the findings and methodologies of Program members’ research to reach a wide audience and inform policymaking.  A listing of peer-reviewed journal articles, project-related technical analyses and reports, and other material emanating from IHSP member research activities can be found on the publications  page.

The six areas of IHSP research include the most relevant issues for low- and middle-income countries. These areas include :

• Institutional reforms and capacity building.   Many challenges faced by governments around the world center around the management, organization and effectiveness of their health systems.  IHSP’s research in this area emphasizes decentralization, organizational reform of ministries of health, human resource strategic planning, and case method management training.
• Politics and governance. Technical solutions to health systems deficiencies must take the political and governmental contexts into account to be effective and sustainable.  IHSP’s research in this area emphasizes political strategies, advocacy and approaches to working in fragile states.
• Sustainability and Implementation Science. Pioneers in the study of sustainability and leaders in the new field of implementation science, IHSP faculty are involved in several projects to assess the sustainability of projects funded by donors and to provide effective recommendations to strengthen sustainability as well as develop useful evaluation research on the implementation of scale up and replication of innovations
• Health system financing:  Strengthening the financial resources and reducing the financial risks of illness that drive many into poverty requires innovative approaches in different country contexts. IHSP’s research in this area emphasizes social health insurance, community financing and national health accounts.
• Public/Private partnerships:  Involving and working with the private sector is crucial to long-term improvements in health systems quality and efficiency. IHSP’s research in this area emphasizes assessments of private markets and public/private partnerships.
• Building community capacities.   Community involvement in delivery of health services is a key to promoting healthy behaviors and utilization of the health system.  IHSP’s research in this area emphasizes the role of social capital in improving health systems delivery and innovative ways to make community health workers more effective.
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Current Research Decentralization Human Resources Strategic Planning Politics of the Policy Process Health Sector Reform Sustainability and Implementation Science

Additional Research Topics Making Health Care Work Better through Reforms to Health Care Public and Private Provision Assessing the Impact of Aging Populations in Developing Countries on Health Expenditures Health Expenditures and the Elderly: A Survey of Issues in Forecasting, Methods Used, and Relevance for Developing Countries Developing National Health Accounts in Turkey The Role of Private Health Care Providers in Priority Public Health Programs Health Systems Resource Center Health System Reform Strategy for Andhra Pradesh State, India Executive Summary of India Andhra Pradesh Report Phase I HIV/AIDS and Health Expenditures in Nigeria Nigeria HIV/AIDS Accounts Report Out-of-pocket Payments and Informal Payments for Health in Middle Income European Countries

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New glioblastoma treatment reaches human brain tumor and helps immune cells recognize cancer cells

by Northwestern University

In a major advance for the treatment of the deadly brain cancer glioblastoma, Northwestern Medicine scientists have used ultrasound technology to penetrate the blood-brain barrier and provide a small dose of a chemotherapy and immunotherapy drug cocktail. The study found that this treatment boosted the immune system's recognition of the cancer cells and could lead to a new treatment approach.

The scientists made several breakthroughs reported in a new study published in Nature Communications .

Scientists showed for the first time that a skull-implantable ultrasound device can enhance the penetration of the chemotherapy drug doxorubicin and immune checkpoint blockade antibodies—a novel immunotherapy treatment combination—into the human brain. The device produces microbubbles that temporarily open the blood-brain barrier , allowing the immunotherapy to enter the brain.

The scientists also showed for the first time that a small dose of doxorubicin (smaller than the dose used for traditional chemotherapy regimens) delivered with the immune checkpoint antibodies can boost the recognition of malignant glioblastoma cells by the immune system and reinvigorate the lymphocytes ( immune cells ) that are in charge of attacking the cancer cells .

An immune checkpoint blockade antibody blocks the deactivation of the immune system by the cancer cells. The immune system has built-in brakes—called immune checkpoints—so that it doesn't overdo it and injure the body when attacking cancer and infections. Glioblastoma evolves to activate the brakes, and therefore, the immune system (i.e., lymphocytes) won't attack it.

In addition to the tumor cells , glioblastoma contains other cell populations called macrophages and microglia. These are the most abundant components of the tumor microenvironment and the cells that glioblastoma modulates to inhibit lymphocytes. The study showed that the chemo and antibody cocktail altered these cells, enabling the lymphocytes to recognize and kill the cancer cells.

"This is the first report in humans where an ultrasound device has been used to deliver drugs and antibodies to glioblastoma to change the immune system, so it can recognize and attack the brain cancer," said co-corresponding author Dr. Adam Sonabend, associate professor of neurological surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurosurgeon. "This could be a major advance for the treatment of glioblastoma, which has been a frustratingly difficult cancer to treat, in part due to poor penetration of circulating drugs and antibodies into the brain."

The study was conducted on four patients who had advanced progression of their tumors. They had already been treated with conventional chemotherapy for their tumors as well as an experimental treatment in a clinical trial, but both times, the tumors returned.

"This is a great example of translational bench-to-bedside-back-to-bench research, which sets an exceptional scenario to learn about the ability of the immune system to kill brain tumors in real-time upon treatment," said co-corresponding author Catalina Lee-Chang, assistant professor of neurological surgery at Northwestern University Feinberg School of Medicine. "Given the lack of effective immune response against these deadly tumors, these findings encourage us to envision a potential new treatment approach."

Clinical trial launched with new treatment

These new findings are the basis for a novel clinical trial that was just launched at Northwestern using ultrasound to deliver immunotherapy for glioblastoma. The trial will initially enroll 10 participants to determine the safety of the treatment, followed by 15 additional to measure whether the treatment can prolong survival.

Previous large clinical trials have failed to show that this type of immunotherapy can prolong survival in glioblastoma patients. Sonabend, however, believes that by enhancing the delivery of these antibodies and drugs into the brain and relying on biomarkers that indicate which tumors are most susceptible to immunotherapy, this treatment might be shown to be effective for some glioblastoma patients.

"Here we show in a small cohort of patients that when you use this technology, you can enhance the delivery of the chemotherapy and the antibodies, and change the tumor's microenvironment, so the immune system can recognize the tumor," Sonabend said.

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Cannabis use common among patients, with most using it to manage a symptom or health condition

One in six patients in primary care reported cannabis use, with 35% of those using at levels indicating moderate- to high-risk for cannabis use disorder, new UCLA research finds.

The findings, to be published June 5 in JAMA Network Open , suggest that most patients reported using cannabis for symptom management, despite identifying as recreational users, indicating the need for routine cannabis screening. Currently few healthcare systems offer this screening in primary care settings.

"Patients may not tell their primary care providers about their cannabis use, and their doctors may not ask about it," said lead author Dr. Lillian Gelberg, professor of family medicine at the David Geffen School of Medicine at UCLA and of health policy and management at the UCLA Fielding School of Public Health "Not asking patients about their cannabis use results in a missed opportunity for opening up doctor-patient communication regarding use of cannabis generally and for management of their symptoms. "

Thirty-eight states, three US territories and the District of Columbia allow cannabis for medical use, and 24 of these states also permit recreational use. Stigma over cannabis use has fallen likely due to these legal moves. While there has been an increased perception that its use is risk free, cannabis potency has increased.

The U.S. Preventive Services Task Force recommended in 2020 that primary care physicians screen their adult patients for use of cannabis and other substances. The following year the investigators implemented the UCLA universal electronic health record-based, self-administered survey on cannabis use and medical cannabis use. Patients complete this survey as pre-visit screening prior to their primary care visits as sent to them via the Epic patient portal.

The researchers used patients' de-identified electronic health records at UCLA collected from January 2021 to May 2023 to determine the prevalence, correlates and reasons for current cannabis use. The UCLA Health system is one of the few to ask patients to voluntarily complete cannabis use surveys during pre-appointment check-ins. The survey used the WHO Alcohol Substance Involvement Screening Test (ASSIST) to assess cannabis use.

Nearly 176,000 patients completed surveys. Of those, nearly 30,000 (17%) reported cannabis use among whom 35% had results suggesting moderate- to high-risk for a cannabis use disorder, defined as a score of 8 or higher on the screening survey. Among users, 40% used cannabis once or twice in the previous three months, 17% used monthly, 25% used weekly and 19% used it daily or almost daily.

Other findings included:

• Cannabis use was lowest among people living in the most disadvantaged neighborhoods (14%), yet the risk for disordered use was highest among this group
• Inhaled modes of cannabis use were as common as ingestion (65.0% and 64.7%), including 29% who vaped
• 47% used cannabis for medical reasons
• 76% used it to manage symptoms such as mental health symptoms or stress (56%), sleep (56%), and pain (37%). Further, most patients who reported using cannabis only for recreational reasons had also used it at some point to manage a symptom.

The study has some limitations. The findings are based on patients' self-reported use and though cannabis is legal in California, some patients may still have been reluctant to disclose using it. Much of the data were from screenings taken during the COVID-19 lockdown, during which cannabis use may have been higher than it might have been otherwise. In addition, the findings may not be applicable to other health systems, particularly in states where cannabis use is still illegal.

However, "given the high rates of cannabis use and medical cannabis use that we found in this large urban healthcare system, it is essential that healthcare systems implement routine screening of all primary care patients," the researchers write. "Integrating screening efforts to include information regarding cannabis use for symptom management could help enhance the identification and documentation of medical cannabis usage, particularly in the healthcare context."

Study co-authors are Dana Beck, PhD, MSN; Julia Koerber, MPH; Whitney N. Akabike, PMP, MSPH; Lawrence Dardick, MD; Clara Lin, MD; Steve Shoptaw, PhD; and Marjan Javanbakht, MPH, PhD.

The study was funded by the University of California Tobacco-Related Disease Research Program (grant #T29IR0277) and the National Institutes of Health National Center for Advancing Translational Science (NCATS) UCLA CTSI (grant #UL1TR001881).

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Materials provided by University of California - Los Angeles Health Sciences . Note: Content may be edited for style and length.

Journal Reference :

• Lillian Gelberg, Dana Beck, Julia Koerber, Whitney N. Akabike, Lawrence Dardick, Clara Lin, Steve Shoptaw, Marjan Javanbakht. Cannabis Use Reported by Patients Receiving Primary Care in a Large Health System . JAMA Network Open , 2024; 7 (6): e2414809 DOI: 10.1001/jamanetworkopen.2024.14809

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