The field of health literacy has evolved from early efforts that focused on individuals to its current recognition that health literacy is a multidimensional team and system function. Health literacy includes system demands and complexities as well as individual skills and abilities. While communicating in a health-literate manner is truly important for everyone, it can be especially important for those with mental or behavioral health issues and for the systems and teams that interact with them and treat these individuals. The purpose of the workshop, which was held on July 11, 2018, in Washington, DC, was to explore issues associated with effective communication with individuals with mental or behavioral health issues and to identify ways in which health literacy approaches can facilitate communication. In particular, the workshop aimed to gain a better understanding of how behavioral health and mental health concerns can adversely affect communications between providers and patients and their families. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 The Personal Experience 3 Setting the Stage 4 Exploring Innovative Approaches 5 Where Do We Go from Here? 6 Reflections of the Day Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Moderators, Speakers, and Panelists

Solving the world's health challenges requires multidisciplinary collaborations that bring together the talents, experiences, resources, and ideas from multiple sectors. These collaborations in global health frequently occur through public?private partnerships (PPPs) in which public and private parties share risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. However, these numerous stakeholders bring varying strengths and resources to global health partnerships, but they also bring their own organizational cultures, regulations, and expectations. Managing partnerships among them is complex and requires intentional and thoughtful governance. Over the last several decades, as the number of interested stakeholders, resources invested, and initiatives launched within the global health field has grown, effective governance of global health PPPs has become increasingly critical. To explore the role of governance in PPPs for global health, the Forum on Public?Private Partnerships for Global Health and Safety convened a workshop. Participants explored best practices, common challenges, and lessons learned in the varying approaches to partnership governance. They also highlighted key issues in the governance of PPPs for global health with the goal of increasing their effectiveness in improving health outcomes. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Global Health and Governance of PublicPrivate Partnerships in the Current Context 3 Legal Considerations for PublicPrivate Partnership Governance in Global Health 4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance 5 Evaluating and Reporting on PublicPrivate Partnerships in Global Health 6 Identifying Key Issues in the Governance of PublicPrivate Partnerships in Global Health Appendix A: Commissioned Paper: The Core Roles of Transparency and Accountability in the Governance of Global Health PPPs Appendix B: World Caf Reports on Internal Governance of Individual Partners and Impacts on Approaches to PublicPrivate Partnerships Appendix C: Speaker and Moderator Biographical Sketches Appendix D: Workshop Agenda Appendix E: References

In the last few decades great strides have been made in chemistry at the nanoscale, where the atomic granularity of matter and the exact positions of individual atoms are key determinants of structure and dynamics. Less attention, however, has been paid to the mesoscale-it is at this scale, in the range extending from large molecules (10 nm) through viruses to eukaryotic cells (10 microns), where interesting ensemble effects and the functionality that is critical to macroscopic phenomenon begins to manifest itself and cannot be described by laws on the scale of atoms and molecules alone. To further explore how knowledge about mesoscale phenomena can impact chemical research and development activities and vice versa, the Chemical Sciences Roundtable of the National Research Council convened a workshop on mesoscale chemistry in November 2014. With a focus on the research on chemical phenomena at the mesoscale, participants examined the opportunities that utilizing those behaviors can have for developing new catalysts, adding new functionality to materials, and increasing our understanding of biological and interfacial systems. The workshop also highlighted some of the challenges for analysis and description of mesoscale structures. This report summarizes the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Growing (Up) from the Nanoscale to the Mesoscale 3 Catalysis 4 Membrane Behavior and Microchemical Systems 5 Biomineralization and Geochemical Processes 6 Computational/Chemical Processes in Self-Assembly References Appendix A: Workshop Agenda Appendix B: About the Chemical Sciences Roundtable Appendix C: Biographical Sketches of Workshop Speakers and Organizing Committee Members Appendix D: Workshop Attendees

On July 30-31, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Continuous Manufacturing for the Modernization of Pharmaceutical Production. This workshop discussed the business and regulatory concerns associated with adopting continuous manufacturing techniques to produce biologics such as enzymes, monoclonal antibodies, and vaccines. The participants also discussed specific challenges for integration across the manufacturing system, including upstream and downstream processes, analytical techniques, and drug product development. The workshop addressed these challenges broadly across the biologics domain but focused particularly on drug categories of greatest FDA and industrial interest such as monoclonal antibodies and vaccines. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Workshop Agenda Appendix B: Biographies of Planning Committee Members, Speakers, and National Academies of Sciences, Engineering, and Medicine Staff Appendix C: Running Themes Across Workshop Sessions

Genomic medicine is defined as the routine use of genomic information about an individual as part of his or her clinical care as well as the health outcomes and policy implications of that clinical use. It is one approach that has the potential to improve the quality of health care by allowing practitioners to tailor prevention, diagnostic, and treatment strategies to individual patients. In recent years, research breakthroughs, technological advances, and the decreasing cost of DNA sequencing have led to the wider adoption of genomic medicine. However, as with the introduction of new technologies into health care, there are concerns that genetic and genomic testing and services will not reach all segments of the population both now and in the near future, and there remains a gap in knowledge regarding potential health care disparities in genomic medicine and precision health approaches. On June 27, 2018, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to examine the gaps in knowledge related to access to genomic medicine and to discuss health care disparities and possible approaches to overcoming the disparate use of genomic medicine among populations. Workshop participants discussed research on access to genetics and genomics services in medically underserved areas, model programs of care for diverse patient populations, and current challenges and possible best practices for alleviating health care disparities as they relate to genomics-based approaches. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Exploring the Barriers to Accessing Genomic and Genetic Services 3 The Role of Health Systems in Delivering Equitable Access 4 How Can Providers and Payers Make Genomic Medicine More Accessible? 5 Exploring Innovative Solutions and Models of Success 6 Considering Unmet Needs to Alleviate Disparities in Genomic Medicine References Appendix A: Summary of the Pre-Workshop Twitter Chat Appendix B: Workshop Agenda Appendix C: Speaker Biographical Sketches Appendix D: Statement of Task Appendix E: Registered Attendees

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Setting the Stage 3 Housing Interventions 4 Interventions Addressing Food Insecurity 5 Interventions Addressing Multiple Social Needs 6 Return on Investment 7 Research Gaps 8 Reflections on the Day References Appendix A: Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker Biographical Sketches

Poor health literacy has many negative consequences for achieving the quadruple aim of better care, improving the health of the community and the population, providing affordable care, and improving the work life of health care providers, and those consequences disproportionately affect those individuals with disabilities and those who experience health disparities. To better understand how health literacy, health equity, and health disparities intersect for individuals living with disabilities, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities and the Roundtable on Health Literacy jointly sponsored a workshop that was held on June 14, 2016, in Washington, DC. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Overview 3 Voices of the Community 4 Provider and System Barriers 5 Exploring Models and Best Practices 6 Reflections on the Day References Appendix A: Workshop Agenda Appendix B: Workshop Speaker and Moderator Biographical Sketches

In its landmark report, Health Literacy: A Prescription to End Confusion, the Institute of Medicine noted that there are 90 million adults in the United States with limited health literacy who cannot fully benefit from what the health and health care systems have to offer. Since the release of that report, health literacy has become a vibrant research field that has developed and disseminated a wide range of tools and practices that have helped organizations, ranging in size from large health care systems to individual health care providers and pharmacists, to engage in health literate discussions with and provide health literate materials for patients and family members. Improving the health literacy of organizations can be an important component of addressing the social determinants of health and achieving the triple aim of improving the patient experience, improving the health of populations, and reducing the cost of care. However, the focus on organizations does not address the larger issue of how to improve health literacy across the U.S. population. To get a better understanding of the state of community-based health literacy interventions, the Roundtable on Health Literacy hosted a workshop on July 19, 2017 on community-based health literacy interventions. It featured examples of community-based health literacy programs, discussions on how to evaluate such programs, and the actions the field can take to embrace this larger view of health literacy. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Presentation and Discussion on the Commissioned Paper 3 Examples of Community-Based Health Literacy Programs 4 Evaluating Community-Based Health Literacy Interventions 5 Where Do We Go from Here? 6 Reflections on the Day References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Moderators, Speakers, and Panelists Appendix C: A Review and Report of Community-Based Health Literacy Interventions - by Cynthia Baur, Lourdes M. Martinez, Nedelina Tchangalova, and Don Rubin

The increasingly diverse ethnic composition of the United States population has created a profound and ongoing demographic shift, and public health and health care organizations face many challenges as they move to address and adapt to this change. To better understand how the public health and health care communities can meet the challenges of serving an increasingly diverse population, the Roundtable on Health Literacy conducted a public workshop on facilitating health communication with immigrant, refugee, and migrant populations through the use of health literate approaches. The goal of the workshop was to identify approaches that will enable organizations that serve these ethnically and culturally diverse populations in a manner that allows all members of these communities to obtain, process, and understand basic health information and the services needed to make appropriate health and personal decisions. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Issues and Challenges in Facilitating Health Communication with Immigrant, Refugee, and Migrant Populations 3 Accessing and Using Health Care Services 4 Health Literacy Considerations for Outreach 5 Application of Health Literacy to Communication with Immigrants, Refugees, and Migrants 6 Where Do We Go from Here? References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Moderators, Speakers, and Panelists

Research conducted over the past two decades has shown that poor patient understanding of medication instructions is an important contributor to the more than 1 million medication errors and adverse drug events that lead to office and emergency room visits, hospitalizations, and even death. Patients who have limited literacy skills, who have multiple comorbidities, and who are elderly face the greatest risk, and limited literacy skills are significantly associated with inadequate understanding and use of prescription instructions and precautions. The Agency for Healthcare Research and Quality notes that only 12 percent of U.S. adults have proficient health literacy that allows them to interpret a prescription label correctly. Given the importance of health literacy to the proper use of medications, and the apparent lack of progress in improving medication adherence, the Roundtable on Health Literacy formed an ad hoc committee to plan and conduct a 1-day public workshop that featured invited presentations and discussion of the role and challenges regarding clarity of communication on medication. Participants focused on using health literacy principles to address clarity of materials, decision aids, and other supportive tools and technologies regarding risks, benefits, alternatives, and health plan coverage. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Workshop Overview 2 Patient and Caregiver Perspectives 3 Approaches to Health-Literate Medication Instructions 4 Translating Research into Practice: Case Studies 5 Exploring the Future of Health-Literate Design 6 Reflections on the Day References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers, Moderators, and Reactors

On June 16, 2016, the Roundtable on Population Health Improvement held a workshop at the Lutheran Church of the Good Shepherd in Brooklyn, New York, to explore the influence of trauma and violence on communities. The workshop highlighted examples of community-based organizations using trauma-informed approaches to treat violence and build safe and healthy communities. Presentations showcased examples that can serve as models in different sectors and communities and shared lessons learned. This publication summarizes the presentation and discussion of the event. Table of Contents Front Matter 1 Introduction 2 The Impact of Racism and Violence on Communities 3 Changing Landscapes of Violence Through Social and Physical Interventions 4 Local Strategies to Build Community Resilience and Safety 5 Lessons Learned: Evaluating Community- and Hospital-Based Models and Initiatives 6 Public Health and Law Enforcement Collaborations 7 Reflections on the Day Appendix A: References Appendix B: Workshop Agenda Appendix C: Biographical Sketches of Workshop Speakers and Moderators

As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population's demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful. To better understand how the increasing demand for supports and services will affect the nation's workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Characterizing the Users and Providers of Long-Term Services and Supports 3 Enabling Community Participation Through Workforce Training, Education, and Development 4 Perspectives on Coordination Across the Spectrum of Caregivers, Providers, Services, and Supports 5 Harnessing the Potential of Technology to Enable Community Living and Participation and Optimize Person-Centered Services 6 Facilitated Table Discussions 7 Closing Remarks References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Moderators

With the amount of data in the world exploding, big data could generate significant value in the field of infectious disease. The increased use of social media provides an opportunity to improve public health surveillance systems and to develop predictive models. Advances in machine learning and crowdsourcing may also offer the possibility to gather information about disease dynamics, such as contact patterns and the impact of the social environment. New, rapid, point-of-care diagnostics may make it possible to capture not only diagnostic information but also other potentially epidemiologically relevant information in real time. With a wide range of data available for analysis, decision-making and policy-making processes could be improved. While there are many opportunities for big data to be used for infectious disease research, operations, and policy, many challenges remain before it is possible to capture the full potential of big data. In order to explore some of the opportunities and issues associated with the scientific, policy, and operational aspects of big data in relation to microbial threats and public health, the National Academies of Sciences, Engineering, and Medicine convened a workshop in May 2016. Participants discussed a range of topics including preventing, detecting, and responding to infectious disease threats using big data and related analytics; varieties of data (including demographic, geospatial, behavioral, syndromic, and laboratory) and their broader applications; means to improve their collection, processing, utility, and validation; and approaches that can be learned from other sectors to inform big data strategies for infectious disease research, operations, and policy. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Big Data and Global Health 3 Opportunities and Challenges for Big Data and Analytics 4 Case Studies in Big Data and Analysis 5 Closing Remarks and General Discussion References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers Appendix C: Statement of Task

The U.S. Environmental Protection Agency (EPA) defines PM as a mixture of extremely small particles and liquid droplets comprising a number of components, including "acids (such as nitrates and sulfates), organic chemicals, metals, soil or dust particles, and allergens (such as fragments of pollen and mold spores)". The health effects of outdoor exposure to particulate matter (PM) are the subject of both research attention and regulatory action. Although much less studied to date, indoor exposure to PM is gaining attention as a potential source of adverse health effects. Indoor PM can originate from outdoor particles and also from various indoor sources, including heating, cooking, and smoking. Levels of indoor PM have the potential to exceed outdoor PM levels. Understanding the major features and subtleties of indoor exposures to particles of outdoor origin can improve our understanding of the exposure?response relationship on which ambient air pollutant standards are based. The EPA's Indoor Environments Division commissioned the National Academies of Sciences, Engineering, and Medicine to hold a workshop examining the issue of indoor exposure to PM more comprehensively and considering both the health risks and possible intervention strategies. Participants discussed the ailments that are most affected by particulate matter and the attributes of the exposures that are of greatest concern, exposure modifiers, vulnerable populations, exposure assessment, risk management, and gaps in the science. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Sources of Indoor Particulate Matter 3 Particle Dynamics and Chemistry 4 Characterizing Indoor Exposure Levels 5 Exposure Mitigation 6 Discussion and Summary of Day 1 7 Potential Health Concerns 8 Interventions and Risk Communication References Appendix A: Workshop Agenda Appendix B: Biographical Information: Workshop Speakers Appendix C: Biographical Information: Planning Committee and Staff

In 2004, the Institute of Medicine released Health Literacy: A Prescription to End Confusion, a report on the then-underappreciated challenge of enabling patients to comprehend their condition and treatment, to make the best decisions for their care, and to take the right medications at the right time in the intended dose. That report documented the problems, origins, and consequences of the fact that tens of millions of U.S. adults are unable to read complex texts, including many health-related materials, and it proposed possible solutions to those problems. To commemorate the anniversary of the release of the 2004 health literacy report, the Institute of Medicine's Roundtable on Health Literacy convened a 1-day public workshop to assess the progress made in the field of health literacy over the past decade, the current state of the field, and the future of health literacy at the local, national, and international levels. Health Literacy: Past, Present, and Future summarizes the presentation and discussion of the workshop. Table of Contents Front Matter 1 Introduction 2 Health Literacy at the U.S. Department of Health and Human Services: Progress and Possibilities 3 Health Literacy and Medications 4 Use and Delivery of Health Care 5 Education 6 Looking to the Future 7 Where Do We Go from Here? References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers