A major challenge in prevention campaigns is that the positive product or outcome is essentially“nothing.” For example, terminology and imagery such as “drug-free lifestyle” and “abstinence”have not been overwhelmingly effective in the alcohol, tobacco, and drug domains because “non-use” is not an appealing option—creative labeling and packaging is necessary in these instances.

The next step is to assess the model from a communicative perspective, specifying intended audi-ences and intended responses that can be directly influenced by campaign messages. The communicationcampaign can then be designed to influence the most promising pathways, and measurable campaignobjectives can then be created to inform further planning, implementation, and later evaluation ofeffects. For example, to get women of reproductive age to take folic acid, researchers would prior-itize them as the intended audience, and then they would create objectives and campaign messagesthat promote the ease and attractiveness of taking a daily multivitamin that has the medically recom-mended amount of folic acid to reduce neural tube defects (Lindsey et al., 2009). A comprehensiveplan is necessary so that strategic decisions can be made about different campaign components

Functional health literacy describes basic-level skills that are sufficient for individuals to obtainrelevant health information (for example, on health risks and on how to use the health system) andto apply that knowledge to a range of prescribed activities. Individuals with these basic health lit-eracy skills are generally able to respond well to education and communication that are directedto clearly defined goals and specific contexts, such as medication adherence, participation in pre-vention activities, and some behavioral change

mprovements in life expectancy in the past century have generally had more to do with im-provements to the social determinants than with medical therapies, though both are important.The continuing significance of the social determinants of health has been strongly illustratedthrough the work, published in 2008 (18), of the World Health Organization (WHO) Commis-sion on the Social Determinants of Health and the interconnectedness of the United NationsSustainable Development Goals adopted in 2015 (https://sdgs.un.org/)

Studies of individual nonhealth social policies, such as policies affecting education, unemploy-ment insurance, and old-age pensions, have also found robust relationships with health outcomes(e.g., Arno et al. 2011, Balaj et al. 2021, Chriqui et al. 2011, Etile 2014, Kuhn et al. 2020, Lundberget al. 2008, Meghir et al. 2018, Shahidi & Parnia 2021, Sjöberg 2014)

ublic health systems are organized and financed differently in different countries (as well as,often, different substate polities). But there has been little attention to the sources of variation inpublic health systems (as distinct from the literature on medical care systems), or indeed to theirimpact on population health. In a 2012 systematic review of the literature on public health systemsin the United States, Hyde & Shortell (2012) found that most studies evaluated the organizationalcharacteristics related to provision of ten Essential Public Services laid out by the WHO (WHOEurope 2012) but only rarely studied how these organizational characteristics were related to thesystems’ performance in terms of service delivery or public health outcomes.

One geographically based metric is the rate differencebetween the highest and lowest county life expectan-cies or age-adjusted mortality rates in a state. America’sHealth Rankings introduced a measure in 2008 on thevariation in mortality among counties in each state (27)

The age-adjusted mortality rate allowscomparison of mortality across different populations. Onemay also calculate mortality rate for a group in a popula-tion on the basis of a specific characteristic, such as age,sex, or geographic area, to yield a characteristic-specificmortality rate.

Population health aims to support the health of people through diverseactivities, including care coordination, health care research, population-level data analysis, and healthprogramming. Activities carried out to improve population health generally support the health status and healthoutcomes of groups of people rather than one client at a time

Nurses play a central role in advancing population health; however, many nurses and the public may be unaware ofthe vital contributions of population health to client well-being.

On February 22, 2010, the White House released President Obama’s proposal for health carereform. This reform bill includes elements of House and Senate bills passed in the last months of2009. On March 21, the House of Representatives passes the Patient Protection and AffordableCare Act, sending it to President Obama for his signature. The Health Care and EducationReconciliation Act of 2010 was also passed, reflecting amendments and including a reform ofthe national student loan system.

In 2009, President Obama established the Office of Health Reform to coordinate administrativeefforts on a national health reform. The Children’s Health Insurance Program (CHIP) isreauthorized, and provides states with additional funding, tools, and fiscal incentives to heapreach an estimated 4.1 million children who would be otherwise uninsured by Medicaid andCHIP. President Obama’s fiscal year budget for 2010 includes out principles for health reformand proposes $634 billion to be placed in a health reform reserve fund.

nconveniently, however, the public quickly came to detest HMOs, withtheir limited networks of physicians, their various restrictions, and the generalperception that care was being unfairly rationed. By the late 1990s, someof the big insurers like Aetna that had enthusiastically embraced the HMOmodel were facing financial crisis of their own, and began responding with newinsurance products

As the health economist John Nyman (who later helped thrash much of theeconomic thinking behind these models) would later explain in an article titled“American Health Policy: Cracks in the Foundation,” these views quickly becamethe dominant paradigm in American health economics, reinforced in healtheconomics textbooks from the 1970s onward: “If health insurance is prob-lematic and may even make consumers and society worse off, then there isalso little reason to implement a national health insurance program. As a result,few American health economists during this period called for the creation of anational health insurance program.”

By the late 1920s and the Depression, it was apparent that millions of individuals were not in the laborforce through no fault of their own, and they certainly were unable to afford private health insurance.Their need for health care services was high, but they were unable to pay for the services. Hospitals andphysicians sometimes provided care without getting paid

Today, there are over 900 private (commercial) health insurance companies in the United States(although the largest five—Anthem, Centene, UnitedHealthcare, Humana, and Health Care ServiceCorp.—control 44 percent of the market). Some commercial companies offer only health insurancewhile others also offer life, homeowners, automobile, and other types of insurance. These are prof-it-making companies whose intention is to set premiums at a level that will allow them to pay out allclaims, pay for administrative expenses, and have money left over for profit for investors

I focus on the United States’ acceptance, which was both necessary to open the WHOand the greatest stretch ideologically. It is perhaps not self-explanatory why defininghealth as more than the absence of disease in itself constitutes a progressive and con-troversial political choice. Nevertheless, the WHO’s founders did see their health def-inition as a springboard for the reorganization of both international and domestic healthsystems

Sigerist rephrases the definition in Socialized Medicine in the Soviet Union (1937),where he praises the Soviet approach for being rational, scientific, future-oriented, andthe first to fully integrate prevention and treatment. He concludes that ‘in such a society[i.e. socialist], health means more than the absence of disease. It has become somethingpositive, a joyful attitude toward life’ (Sigerist, 1937: 97–8). Here, the health definitionhas both a political meaning referring to socialism and a historical meaning concerningthe progress of medicine.

This research also describes how people strug-gle to make sense of their illness and reclaim asense of self. People endeavor to endow their ill-ness with meaning within the context of their per-sonal and social relationships, employment status,health insurance coverage, religious and culturalbeliefs, and the like

For example, if anillness such as epilepsy or HIV/AIDS has a power-ful stigma, it can make people less likely to seektreatment for fear of being mistreated by healthcare providers and publicly associated with atainted condition. Obese women report avoidingroutine gynecological exams, despite havinghigher rates of gynecological cancers than non-obese women, because of the stigma of obesityand the corresponding negative attitudes of healthcare professionals toward overweight people (Amy,Aalborg, Lyons, and Keranen 2006). Therefore, aneffective policy based on early

Issues Related to Medical Ethics. Many technological advancements in medicine raise impor-tant and provocative ethical questions. Sociological analysis and insights are extremely important ingenuinely understanding these matters (DeVries et al. 2007). In recent years, medical sociologists havebecome more active in studying (1) values, attitudes, and behaviors of people relative to ethical issuesin medicine (e.g., attitudes about genetic research and human cloning) and how they are influenced byvarious social factors, (2) social policy questions (e.g., on assisted reproductive technologies or the ter-mination of treatment for the terminally ill), and (3) social movements (e.g., the pro-life and pro-choicemovements) that have developed around these ethical issues. DeVries and Subedi (1998:xiii) describesociology’s role as “lifting bioethics out of its clinical setting, examining the way it defines and solvesethical problems, the modes of reasoning it employs, and its influence on medical practice.”

For example, persons who believe vac-cines are unsafe are significantly more likely than those who don’t hold such a belief to have householdincomes under US$25,000, to live in rural areas, and to have just a high school education or less (Kric-orian, Civen, and Equils 2022