The United States faces an alarmingly high rate of maternal morbidity and mortality, distinguishing it from other high-income countries that have achieved decreases in these rates in recent years. U.S. maternal morbidity and mortality rates are disproportionate across racial, ethnic, socioeconomic, and geographic groups. Statistics on maternal health outcomes reveal that there are challenges to protecting both the lives and future health of birthing people and their children. Recognizing the urgency of this growing problem, the National Academies Board on Population Health and Public Health Practice convened a 2-day virtual workshop, Advancing Maternal Health Equity and Reducing Maternal Mortality. The workshop examined the current state of maternal health in the United States and explored the factors needed to help communities and health care systems become more effective in reducing maternal morbidity and mortality and improving health outcomes through the fourth trimester. This publication summarizes the presentations and discussions of the workshop. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers, Moderators, and Planning Committee Members

Sickle cell disease (SCD) is a genetic condition that affects approximately 100,000 people in the United States and millions more globally. Individuals with SCD endure the psychological and physiological toll of repetitive pain as well as side effects from the pain treatments they undergo. Some adults with SCD report reluctance to use health care services, unless as a last resort, due to the racism and discrimination they face in the health care system. Additionally, many aspects of SCD are inadequately studied, understood, and addressed. Addressing Sickle Cell Disease examines the epidemiology, health outcomes, genetic implications, and societal factors associated with SCD and sickle cell trait (SCT). This report explores the current guidelines and best practices for the care of patients with SCD and recommends priorities for programs, policies, and research. It also discusses limitations and opportunities for developing national SCD patient registries and surveillance systems, barriers in the healthcare sector associated with SCD and SCT, and the role of patient advocacy and community engagement groups. Table of Contents Front Matter Summary 1 Introduction 2 Societal and Structural Contributors to Disease Impact 3 Screening, Registries, and Surveillance 4 Complications of Sickle Cell Disease and Current Management Approaches 5 Health Care Organization and Use 6 Delivering High-Quality Sickle Cell Disease Care with a Prepared Workforce 7 Developing and Delivering the Next Generation of Therapies 8 Community Engagement and Patient Advocacy 9 Strategic Plan and Blueprint for Sickle Cell Disease Action Appendix A: Public Meeting Agendas and Submissions to the Committee Appendix B: Literature Search Terms and Strategy Appendix C: Committee and Staff Biographies Appendix D: Newborn Screening Results Reporting Protocols for Sickle Cell Disease and Sickle Cell Trait Appendix E: Sickle Cell Data Collection Program Appendix F: Georgia Comprehensive Sickle Cell Center: A Case Study Appendix G: Emory Adult Cystic Fibrosis Program Appendix H: Health Resources and Services Administration Sickle Cell Disease Programs Appendix I: Select Treatments Currently Under Development for Sickle Cell Disease Appendix J: Other Training Models for Hematologists Appendix K: Sickle Cell Community-Based Organizations and Patient Groups in the United States Appendix L: Summary Table of Strategic Plan and Blueprint for Sickle Cell Disease Action Appendix M: Summary Table of Sickle Cell Trait Discussion in Report Appendix N: Glossary

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

The staggering number of deaths and emergency department visits caused by firearm injuries has only grown with time. Costs associated with firearm related injuries amount to over a billion dollars annually in the United States alone, not including physician charges and postdischarge costs. To address this epidemic, in April of 2022, the National Academies of Sciences, Engineering, and Medicine's Board on Population Health and Public Health Practice, in collaboration with Northwell Heath and the PEACE Initiative, brought together firearm injury prevention thought leaders to explore how health systems can integrate interventions for firearm injury prevention into routine care for the purpose of improving the health of patients and communities. The workshop speakers discussed strategies for firearm injury and mortality prevention and its integration into routine care. Speakers also explored facilitators and barriers to implementation strategies, and how health systems might work to overcome those barriers. Table of Contents Front Matter 1 Introduction 2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis 3 Health Care Strategies to Reduce Firearm Injury and Mortality 4 Barriers and Facilitators to Implementing Hospital-Based Firearm Injury Prevention Strategies in Urban and Rural Communities 5 Collaborating with Communities to Improve Health Care System Implementation Success and Destigmatize Gun Violence Prevention 6 Defining a Firearms Violence Prevention Road Map for Hospital and Health Systems 7 Closing Comments Appendix A: References Appendix B: Workshop Agenda Appendix C: Statement of Task Appendix D: Biographical Sketches of the Speakers and Moderators

Approximately 7.4 million people in the United States live with an intellectual or developmental disability (IDD), defined by the Centers for Disease Control and Prevention as "a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person?s lifetime." Individuals with IDD and their caretakers face exceptional barriers to staying healthy and accessing appropriate health services. Among these barriers are difficulty finding care providers that are adequately trained in meeting their specialized needs, unwieldy payment structures, and a lack of coordination between the various systems of care with which patients with IDD may interact (e.g., education, social work, various segments of the health care system). The National Academies of Sciences, Engineering, and Medicine hosted a workshop to discuss promising innovations in (1) workforce development, (2) financing and payment, and (3) care coordination; and to share visions for improved systems of care. Participants noted that while many existing approaches could serve as models for improving care, large changes will need to be made in these 3 facets of the care system in order to make them accessible to all IDD patients. This publication summarizes the presentations and discussions of the workshop. Table of Contents Front Matter Proceedings of a Workshop References Appendix A: Workshop Agenda Appendix B: Statement of Task Appendix C: Biographical Sketches of the Speakers and Moderators

SMART Vaccines - Strategic Multi-Attribute Ranking Tool for Vaccines - is a prioritization software tool developed by the Institute of Medicine that utilizes decision science and modeling to help inform choices among candidates for new vaccine development. A blueprint for this computer-based guide was presented in the 2012 report Ranking Vaccines: A Prioritization Framework: Phase I. The 2013 Phase II report refined a beta version of the model developed in the Phase I report. Ranking Vaccines: Applications of a Prioritization Software Tool: Phase III: Use Case Studies and Data Framework extends this project by demonstrating the practical applications of SMART Vaccines through use case scenarios in partnership with the Public Health Agency of Canada, New York State Department of Health, and the Serum Institute of India. This report also explores a novel application of SMART Vaccines in determining new vaccine product profiles, and offers practical strategies for data synthesis and estimation to encourage the broader use of the software. Table of Contents Front Matter Summary 1 Introduction: SMART Vaccines and Smart Priorities 2 Data Synthesis and Framework 3 Use Case Scenarios and Design Enhancements 4 Reflections and Looking Forward References Appendix A: Use Case Scenarios Report for SMART Vaccines Appendix B: Committee's Response to the Use Case Scenarios Report Appendix C: SMART Vaccines Software Updates Appendix D: Stakeholder Speakers Appendix E: Biographical Information

"Understanding the Connections Between Coastal Waters and Ocean Ecosystem Services and Human Health" discusses the connection of ecosystem services and human health. This report looks at the state of the science of the role of oceans in ensuring human health and identifies gaps and opportunities for future research. The report summarizes a workshop convened by the Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine. Participants discussed coastal waters and ocean ecosystem services in the United States in an effort to understand impacts on human health. "Understanding the Connections Between Coastal Waters and Ocean Ecosystem Services and Human Health" focuses on key linkages by discussing the ecosystem services provided by coastal waterways and oceans that are essential for human health and well-being; examining the major stressors that affect the ability of coastal waterways and ocean systems to provide essential services; and considering key factors that can enhance the resiliency of these systems.

Natural gas extraction from shale formations, which includes hydraulic fracturing, is increasingly in the news as the use of extraction technologies has expanded, rural communities have been transformed seemingly overnight, public awareness has increased, and regulations have been developed. The governmental public health system, which retains primary responsibility for health, was not an early participant in discussions about shale gas extraction; thus public health is lacking critical information about environmental health impacts of these technologies and is limited in its ability to address concerns raised by regulators at the federal and state levels, communities, and workers employed in the shale gas extraction industry. Health Impact Assessment of Shale Gas Extraction is the summary of a workshop convened in 2012 by the Institute of Medicine (IOM) Roundtable on Environmental Health Sciences, Research, and Medicine to discuss the human health impact of shale gas extraction through the lens of a health impact assessment. Eminent scientists, physicians, public health experts, and representatives from government agencies at federal and state levels, from nongovernment organizations, from the business sector, and from interest groups representing the interests of the citizens met to exchange ideas and to inform on hydraulic fracturing as a means of extraction of natural gas. This report examines the state of the science regarding shale gas extraction, the direct and indirect environmental health impacts of shale gas extraction, and the use of health impact assessment as a tool that can help decision makers identify the public health consequences of shale gas extraction. Table of Contents Front Matter 1 Introduction 2 Opening Session 3 Geographic Footprint of Shale Gas Extraction 4 Occupational Health and Community Impacts 5 Air Quality 6 Water Quality 7 Sustainable Energy 8 Research Opportunities: Research Community 9 Research Opportunities: Federal Representatives Appendix A: Agenda Appendix B: Speaker Biosketches Appendix C: Acronyms

SMART Vaccines-Strategic Multi-Attribute Ranking Tool for Vaccines-is a prioritization software tool developed by the Institute of Medicine that utilizes decision science and modeling to help inform choices among candidates for new vaccine development. A blueprint for this computer-based guide was presented in the 2012 report Ranking Vaccines: A Prioritization Framework: Phase I. Ranking Vaccines: A Prioritization Software Tool,Phase II extends the proof-of-concept presented in the Phase I report, which was based on multi-attribute utility theory. This report refines a beta version of the model developed in the Phase I report and presents its next iteration, SMART Vaccines 1.0. Ranking Vaccines: Phase II discusses the methods underlying the development, validation, and evaluation of SMART Vaccines 1.0. It also discusses how SMART Vaccines should-and, just as importantly, should not-be used. The report also offers ideas for future enhancements for SMART Vaccines as well as for ideas for expanded uses and considerations and possibilities for the future. Table of Contents Front Matter Summary 1 Introduction: New Vaccines and SMART Vaccines 2 Refinements to the SMART Vaccines Model 3 Data Synthesis, Software Redesign, and Evaluation 4 Observations and Looking Forward References Appendix A: Computational Modeling for SMART Vaccines Appendix B: Candidate Disease Profiles Appendix C: Data Sources and Methodology for SMART Vaccines Appendix D: Verification and Analyses of the SMART Vaccines Computational Model Appendix E: Stakeholder Speakers Appendix F: Biographical Information

As a number of diseases emerge or reemerge thus stimulating new vaccine development opportunities to help prevent those diseases, it can be especially difficult for decision makers to know where to invest their limited resources. Therefore, it is increasingly important for decision makers to have the tools that can assist and inform their vaccine prioritization efforts. In this first phase report, the IOM offers a framework and proof of concept to account for various factors influencing vaccine prioritization-demographic, economic, health, scientific, business, programmatic, social, policy factors and public concerns. Ranking Vaccines: A Prioritization Framework describes a decision-support model and the blueprint of a software-called Strategic Multi-Attribute Ranking Tool for Vaccines or SMART Vaccines. SMART Vaccines should be of help to decision makers. SMART Vaccines Beta is not available for public use, but SMART Vaccines 1.0 is expected to be released at the end of the second phase of this study, when it will be fully operational and capable of guiding discussions about prioritizing the development and introduction of new vaccines. Table of Contents Front Matter Summary 1 Introduction: From Smallpox to SMART Vaccines 2 Modeling Strategy: From Single Attribute to Multiple Attributes 3 Data Evaluation and Software Development 4 Observations and Looking Forward References Appendix A: Mathematical Functions Appendix B: Candidate Disease Profiles and Data Appendix C: Stakeholder Speakers Appendix D: Biographical Information