The perspective article explores systemic issues in psychiatric care, particularly the barriers to timely treatment and the ethical dilemmas involved in involuntary interventions. It further examines the impact of anosognosia—lack of disease insight—on treatment, noting the difficulties in managing care for those unaware of their illness, and scrutinizes training materials from international organizations that might mislabel necessary psychiatric practices as human rights violations, thereby complicating the care landscape. The discussion extends to the legal and societal implications of psychiatric interventions, using Massachusetts’ Rogers Guardianship as a case study to highlight the consequences of legalistic approaches to mental health treatment.

The article calls for destigmatizing psychiatric treatment and integrating robust, evidence-based practices to improve patient outcomes and healthcare equity. The global mental health policy landscape is urged to recognize the critical role of psychiatric care in restoring health and dignity to individuals with serious mental illnesses, advocating for a more nuanced understanding and application of human rights in mental health.

Mental health is deteriorating quickly and significantly globally post-COVID. Though there were already over 1 billion people living with mental disorders pre-pandemic, in the first year of COVID-19 alone, the prevalence of anxiety and depression soared by 25% worldwide. In light of the chronic shortages of mental health provider and resources, along with disruptions of available health services caused by the pandemic and COVID-related restrictions, technology is widely believed to hold the key to addressing rising mental health crises. However, hurdles such as fragmented and often suboptimal patient protection measures substantially undermine technology’s potential to address the global mental health crises effectively, reliably, and at scale. To shed light on these issues, this paper aims to discuss the post-pandemic challenges and opportunities the global community could leverage to improve society’s mental health en masse.

There has been an erosion of trust in medical care and clinical research, and this has raised issues about whether institutions and investigators conducting clinical research are worthy of trust. We review recent literature on research on trust and trustworthiness in the clinical research enterprise and identify opportunities to enhance trustworthiness, which will likely increase participant trust in clinical research. In addition, we review materials reporting the results of national polls related to the public’s trust in different occupations. The literature on trustworthiness and trust is complex and suffers from a lack of agreement on definitions of trust and trustworthiness and actions to enhance trustworthiness. Nonetheless, institutions need to take action to address the many elements that contribute to being perceived as trustworthy. As a complementary approach, since nurses have consistently ranked highest on trust by the public for twenty-two straight years, we analyze the features that likely account for the public’s uniform high regard for nurses. We propose specific actions to enhance the role of research nurses in the research enterprise, without compromising their primary role as participant advocates, that we have adopted at Rockefeller University to gain the benefits of the public’s trust in nurses in building trustworthiness.

Vaccination is the most important method to control the spread of SARS-CoV-2, the virus that causes COVID-19, and vaccination is key to this goal. This paper highlights considerations for policy development around vaccination attestation and proof requirements, specifically in rural Appalachia. Migrant and immigrant farmworkers are integral to the food and goods supply chain globally; they have been disproportionately impacted by COVID-19, therefore these policies need to take extensive precautions for farmworkers to systematically and easily comply with vaccination status submission procedures. In this paper, we present steps to equitably manage and implement vaccine mandates: (1) Develop and establish policies to support safe workplace standards for everyone, including vaccination policies; (2) Utilize equitable methods to collect vaccine verification; (3) Use effective and inclusive methods to implement the policies by using these techniques; (4) Integrate key populations to develop and strengthen policies to improve health equity.

There is a growing awareness that diversity, health equity, and inclusion play a significant role in improving patient outcomes and advancing knowledge. The Pediatric Heart Network launched an initiative to incorporate diversity, health equity, and inclusion into its 2021 Scholar Award Funding Opportunity Announcement. This manuscript describes the process of incorporating diversity, health equity, and inclusion into the Pediatric Heart Network Scholar Award and the lessons learned. Recommendations for future Pediatric Heart Network grant application cycles are made which could be replicated by other funding agencies.

Translational research needs to show value through impact on measures that matter to the public, including health and societal benefits. To this end, the Translational Science Benefits Model (TSBM) identified four categories of impact: Clinical, Community, Economic, and Policy. However, TSBM offers limited guidance on how these areas of impact relate to equity. Central to the structure of our Center for American Indian and Alaska Native Diabetes Translation Research are seven regional, independent Satellite Centers dedicated to community-engaged research. Drawing on our collective experience, we provide empirical evidence about how TSBM applies to equity-focused research that centers community partnerships and recognizes Indigenous knowledge. For this special issue – “Advancing Understanding and Use of Impact Measures in Implementation Science” – our objective is to describe and critically evaluate gaps in the fit of TSBM as an evaluation approach with sensitivity to health equity issues. Accordingly, we suggest refinements to the original TSBM Logic model to add: 1) community representation as an indicator of providing community partners “a seat at the table” across the research life cycle to generate solutions (innovations) that influence equity and to prioritize what to evaluate, and 2) assessments of the representativeness of the measured outcomes and benefits.

Educational opportunities for investigators and staff to promote inclusive research practices are a critical piece of the effort to increase diversity in study participation and promote health equity. However, few trainings to date have empirically been shown to result in behavior changes. We present preliminary evaluation findings for the Just Research workshop offered at the University of Wisconsin–Madison between October 2022 and August 2023. These sessions included 80 participants who made up 4 cohorts. Data was collected through a retrospective pre/post-test survey administered 0–7 days following the workshop (n = 70), and a follow-up survey administered 9–12 months following the workshop (n = 21). Participants demonstrate significant increases in knowledge and self-efficacy regarding implementing inclusive practices post-intervention (p < .001). 85.7% of participants who completed the follow-up survey reported implementing inclusive practices.

Multisector stakeholders, including, community-based organizations, health systems, researchers, policymakers, and commerce, increasingly seek to address health inequities that persist due to structural racism. They require accessible tools to visualize and quantify the prevalence of social drivers of health (SDOH) and correlate them with health to facilitate dialog and action. We developed and deployed a web-based data visualization platform to make health and SDOH data available to the community. We conducted interviews and focus groups among end users of the platform to establish needs and desired platform functionality. The platform displays curated SDOH and de-identified and aggregated local electronic health record data. The resulting Social, Environmental, and Equity Drivers (SEED) Health Atlas integrates SDOH data across multiple constructs, including socioeconomic status, environmental pollution, and built environment. Aggregated health prevalence data on multiple conditions can be visualized in interactive maps. Data can be visualized and downloaded without coding knowledge. Visualizations facilitate an understanding of community health priorities and local health inequities. SEED could facilitate future discussions on improving community health and health equity. SEED provides a promising tool that members of the community and researchers may use in their efforts to improve health equity.

The preventive services at the center of Braidwood Management, Inc. v. Becerra contribute to reducing inequities in life expectancy in the United States. Critical preventive are currently fully covered by insurance as preventive care under the Affordable Care Act. Reducing affordable access to such screenings and medicines is most likely to impact those with lower incomes and less education, and contribute to widening existing inequities in health outcomes.

Recent research has identified a large and growing mortality gap between those with and without college degrees. On average, individuals without college degrees are likely to die about 8.5 years earlier than those with such degrees. In recent decades, cancer death rates fell nearly two times faster among the college educated. Mortality from heart disease fell by nearly two-thirds among those with college degrees but by less than one-third for all others.

Disparities in life expectancy in the United States reflect the uneven progress against the leading causes of death among different populations. The Braidwood decision, if upheld, will raise the costs to patients for interventions that have contributed to recent gains in life expectancy. This Article analyzes the impact of Braidwood on preventive health interventions in the context of growing life expectancy gaps within the United States.

Braidwood Management, Inc. v. Becerra threatens the nationwide enforceability of the preventive care mandate of the Affordable Care Act (ACA) with respect to a variety of preventive health care services. The success of this lawsuit could have devastating repercussions. Not only would many current guidelines of the U.S. Preventive Services Task Force (USPSTF) be affected, but future preventive care recommendations would be as well, to the detriment of achieving health equity goals. This Article posits that the loss of guaranteed free preventive care could threaten current and future health equity gains. If preventive care is no longer offered without cost-sharing, research shows that many people, especially those with lower socioeconomic status, will not access the care. This decrease in access to recommended screenings and other preventive services would likely decrease uptake, over time impacting the stage at which diseases such as cancer are diagnosed, making late-stage diagnoses with poorer prognoses more common, and increasing transmission of other conditions such as HIV. At the population level, decreased access to free preventive care could hinder efforts to reduce entrenched inequalities associated with these conditions.

Moreover, these effects will be amplified as insured people lose access to preventive care recommendations that evolve in response to new research findings. In the years since the ACA’s passage, the USPSTF has brought a health equity lens to each step of its recommendation process, including how it chooses preventive services to study, how it designs and conducts its research plan, and its approach to issuing recommendations along with calls for more research. Although some have argued that the resulting shift in the USPSTF’s recommendations has not happened fast enough, the way in which the USPSTF structures its evidentiary reviews — with a focus on high-level literature reviews of medical studies — suggests that over time, as individual studies continue to examine the effectiveness of interventions in different populations and publish their results, the shift will become more dramatic and the resulting recommendations will be more effective at combating health care disparities. If Braidwood is successful, no-cost insurance coverage for these more responsive recommended services could be undermined.

This Article explores the potential impact Braidwood could have on existing and anticipated advances in preventive care through a focus on two life-threatening conditions: cancer and HIV. Both cancer and HIV preventive care recommendations have undergone significant changes since the implementation of the preventive care mandate. While the resulting recommendations remain imperfect, the Article shows the important and evolving relationship between these recommendations and efforts to overcome pervasive and entrenched disparities in health outcomes related to these conditions. If Braidwood is upheld, ongoing efforts to reduce disparities in cancer and HIV will be stymied.