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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Population Health Science in the United States: Trends, Evidence, and Implications for Policy: Proceedings of a Joint Symposium. Washington, DC: The National Academies Press. doi: 10.17226/25631.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Theresa M. Wizemann, Rapporteur Roundtable on Population Health Improvement Board on Population Health and Public Health Practice Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by contracts between the National Academy of Sci- ences and Aetna Foundation, The California Endowment, Department of Health and Human Services Program Support Center, The East Bay Community Foun- dation, Health Resources and Services Administration, The Kresge Foundation, New York State Health Foundation, and Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25631 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2021 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Population health science in the United States: Trends, evidence, and implica- tions for policy. Washington, DC: The National Academies Press. https://doi. org/10.17226/25631. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institu- tion to advise the nation on issues related to science and ­ echnology. Members t are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was estab­ished in 1970 under the charter of the National Academy of ­ ciences to l S advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, E ­ ngineering, and Medicine to provide independent, objective analysis and a ­ dvice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in ­ atters of science, engineering, and medicine. m Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engi­eering, and Medicine document the evidence-based consensus on the n study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opin- ions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE FOR POPULATION HEALTH SCIENCE IN THE UNITED STATES: TRENDS, EVIDENCE, AND EFFECTIVE POLICY1 ALLISON E. AIELLO, Professor of Epidemiology, Social Epidemiology Program Leader, Carolina Population Center; Fellow, Gillings School of Global Public Health, University of North Carolina at Chapel Hill ROBERT HUMMER, Odum Distinguished Professor of Sociology, College of Arts and Sciences, University of North Carolina DAVID KINDIG, Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences, School of Medicine and Population Health, University of Wisconsin–Madison PAULA LANTZ, Associate Dean for Academic Affairs, Professor of Public Policy, Gerald R. Ford School of Public Policy, University of Michigan SANNE MAGNAN, Senior Fellow, HealthPartners Institute; Adjunct Assistant Professor, University of Minnesota LOURDES J. RODRIGUEZ, Director, Center for Place-Based Initiatives, Associate Professor, Department of Population Health, Dell Medical School, The University of Texas at Austin 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees ­ are solely responsible for organizing the symposium, identifying topics, and choosing s ­ peakers. The responsibility for the published Proceedings of a Joint Symposium rests with the symposium rapporteur and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1 SANNE MAGNAN (Co-Chair), Adjunct Assistant Professor, Division of Medicine, University of Minnesota JOSHUA M. SHARFSTEIN (Co-Chair), Associate Dean for Public Health Practice and Training, Johns Hopkins Bloomberg School of Public Health PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges TERRY ALLAN, Health Commissioner, Cuyahoga County Board of Health JOHN AUERBACH, Executive Director, Trust for America’s Health CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance; Consultant for Health Strategy, The Dow Chemical Company DEBBIE I. CHANG, Senior Vice President, Policy and Prevention, Nemours KATHY GERWIG, Vice President, Employee Safety, Health and Wellness and Environmental Stewardship Officer, Kaiser Permanente MARTHE GOLD, Senior Scholar in Residence, The New York Academy of Medicine MARC N. GOUREVITCH, Professor and Chair, Department of Population Health, New York University Langone Health GARTH GRAHAM, President, Aetna Foundation GARY R. GUNDERSON, Vice President, Faith Health School of Divinity, Wake Forest University and Wake Forest Baptist Health WAYNE JONAS, Executive Director Integrative Health Programs, H&S Ventures ROBERT M. KAPLAN, Professor, Center for Advanced Study in the Behavioral Sciences, Stanford University DAVID A. KINDIG, Emeritus Professor of Population Health Sciences, Emeritus Vice Chancellor for Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison SALLY A. KRAFT, Vice President, Population Health, Dartmouth-Hitchcock PAULA M. LANTZ, Associate Dean for Academic Affairs and Professor of Public Policy, Gerald R. Ford School of Public Policy, University of Michigan 1The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Joint Symposium rests with the symposium rapporteur and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

MICHELLE LARKIN, Associate Vice President, Associate Chief of Staff, Robert Wood Johnson Foundation THOMAS A. LAVEIST, Dean, School of Public Health & Tropical Medicine, Tulane University JEFFREY LEVI, Professor, Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University SHARRIE MCINTOSH, Vice President for Programs, New York State Health Foundation PHYLLIS MEADOWS, Senior Fellow, Health Program, The Kresge Foundation BOBBY MILSTEIN, Director, ReThink Health JOSÉ T. MONTERO, Director, Office for State, Tribal, Local and Territorial Support, and Deputy Director, Centers for Disease Control and Prevention MARY PITTMAN, President and Chief Executive Officer, Public Health Institute PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation MYLYNN TUFTE, State Health Officer, Office of the Governor, State of North Dakota HANH CAO YU, Chief Learning Officer, The California Endowment Health and Medicine Division Staff ALINA B. BACIU, Roundtable Director CARLA ALVARADO, Program Officer KIMANI HAMILTON-WRAY, Senior Program Assistant (through May 2019) HOPE HARE, Administrative Assistant MISRAK DABI, Financial Associate ROSE MARIE MARTINEZ, Senior Board Director Rapporteur THERESA WIZEMANN viii PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This Proceedings of a Joint Symposium was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineer- ing, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review com- ments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: MERLIN CHOWKWANYUN, Mailman School of Public Health, Columbia University DENISE DOUGHERTY, AcademyHealth JEFFREY LEVI, Milken Institute School of Public Health, The George Washington University LOURDES RODRIGUEZ, Dell Medical School, The University of Texas at Austin Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH TILSON, ­Gillings School of Global Public Health, University of North Carolina. He was responsible for making certain that an independent examination of this ix PREPUBLICATION COPY—Uncorrected Proofs

x REVIEWERS proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs

Contents ACRONYMS AND ABBREVIATIONS xiii 1 INTRODUCTION 1 Symposium Objectives, 2 Organization of the Symposium and Proceedings, 2 2 POPULATION HEALTH IN THE UNITED STATES 5 Recent Trends in Population Health, 5 Racial, Ethnic, and Socioeconomic Status Disparities in Health, 9 Discussion, 15 3 POLICY-RELEVANT EVIDENCE FOR POPULATION HEALTH: PROMISE AND CHALLENGES, 17 Creating Policy-Relevant Evidence, 17 The Imperative to Stay Upstream, 24 Policy Evaluation and the Risk of Unintended Consequences, 26 Discussion, 29 4 EFFECTIVE POPULATION HEALTH POLICY AND SCIENCE: FINDING COMMON GROUND 33 Finding Common Ground, 33 Stakeholder Engagement, 36 Data Needs, 37 Discussion, 38 xi PREPUBLICATION COPY—Uncorrected Proofs

xii CONTENTS 5 CLOSING REMARKS 43 APPENDIXES A References 47 B Symposium Agenda 51 C Biosketches of Speakers and Moderators 55 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations ACA Patient Protection and Affordable Care Act BMI body mass index CDC Centers for Disease Control and Prevention CHD coronary heart disease CHIP Children’s Health Insurance Program CMMI Center for Medicare & Medicaid Innovation CMS Centers for Medicare & Medicaid Services HI-5 Health Impact in 5 Years IAPHS Interdisciplinary Association for Population Health Science MOMS Management of Maternal Smoking program xiii PREPUBLICATION COPY—Uncorrected Proofs

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On October 3, 2018, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine and the Interdisciplinary Association for Population Health Science convened a joint symposium in Washington, DC to consider the current state of population health science in the United States. At the symposium, speakers and participants reviewed the status of population health in the United States, including current trends in health and mortality, and racial, ethnic, and socioeconomic disparities; explored the complexities of policy implementation with attention to evidence generation and to surfacing and mitigating negative unintended consequences of policies for population health; and shared perspectives on finding common ground to move population health forward. This publication summarizes the presentation and discussion of the workshop.

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