Domestic violence: prevention past due.

In May 2023, the White House released the National Plan to End Gender-Based Violence, which includes intimate partner or domestic violence (DV). Based on 20 years of experience in California, this commentary provides detailed examples of 2 DV prevention strategies: interrupting intergenerational transmission and addressing macrolevel drivers. Family-strengthening approaches to prevention and justice and increasing economic security are key. Insight into regional policies and programs can inform implementation of the national plan and DV prevention in other states and localities.

Accelerating efforts to prevent childhood obesity: spreading, scaling, and sustaining healthy eating and physical activity.

During the past decade, progress has been made in addressing childhood obesity through policy and practice changes that encourage increased physical activity and access to healthy food. With the implementation of these strategies, an understanding of what works to prevent childhood obesity is beginning to emerge. The task now is to consider how best to spread, scale, and sustain promising childhood obesity prevention strategies. In this article we examine a project led by Nemours, a children's health system, to address childhood obesity. We describe Nemours's conceptual approach to spreading, scaling, and sustaining a childhood obesity prevention intervention. We review a component of a Nemours initiative in Delaware that focused on early care and education settings and its expansion to other states through the National Early Care and Education Learning Collaborative to prevent childhood obesity. We also discuss lessons learned. Focusing on the spreading, scaling, and sustaining of promising strategies has the potential to increase the reach and impact of efforts in obesity prevention and help ensure their impact on population health.

Applying a 3.0 transformation framework to guide large-scale health system reform.

Implementation of the Affordable Care Act is unleashing historic new efforts aimed at reforming the US health system. Many important incremental improvements are under way, yet there is a growing recognition that more transformative changes are necessary if the health care system is to do a better job of optimizing population health. While the concept of the Triple Aim-dedicated to improving the experience of care, the health of populations, and lowering per capita costs of care-has been used to help health care providers and health care systems focus their efforts on costs, quality, and outcomes, it does not provide a roadmap for a new system. In this article we describe the 3.0 Transformation Framework we developed to stimulate thinking and support the planning and development of the new roadmap for the next generation of the US health care system. With a focus on optimizing population health over the life span, the framework suggests how a system designed to better manage chronic disease care could evolve into a system designed to enhance population health. We describe how the 3.0 Transformation Framework has been used and applied in national, state, and local settings, and we suggest potential next steps for its wider application and use.

A statewide strategy to battle child obesity in Delaware.

In 2006, approximately 37 percent of Delaware's children were overweight or obese. To combat Delaware's childhood obesity epidemic, Nemours, a leading child health care provider, launched a statewide program to improve child health. The "social-ecological" strategy reaches beyond clinical encounters to promote better health and behavior at multiple levels. Early results show that the initiative halted the increase in the prevalence of overweight and obese children, since no statistically significant change occurred during the two-year span between administrations of the Delaware Survey on Children's Health. The initiative also spurred increased knowledge of healthy eating and awareness of the need for increased physical activity in school, child care, and primary care settings.

Beyond medical care: how health systems can address children's needs through health promotion strategies.

This paper describes an innovative approach that integrates community-based health promotion and disease prevention into a well-established pediatric medical care system. System components include a population-level focus in multiple service sectors, community coalitions, knowledge dissemination, and social marketing. The combination of these components is intended to bring about widespread changes in health/social policy and professional practice, which, in turn, should improve health behavior and outcomes. Early lessons are discussed.

Applying lessons learned in communities to programs and policies at the federal level.

As solutions to the problems of the uninsured are debated, there are lessons to be learned from community-based initiatives. Such efforts can provide information on different models as well as key political lessons. Defining the specific role that community efforts play is also critical. Actively involving community stakeholders of such community initiatives in health care policy debates will result in more workable policies.

Americans' views about the adequacy of health care for children and the elderly.

Recent attempts to increase health coverage for specific populations incrementally have been more successful than efforts to dramatically reconfigure the health care system. We present findings from a survey to assess support for programs for children compared with those for the elderly, as well as the public's desire to prioritize whether the needs of one should be addressed over the needs of the other. Americans believe that the health care needs of both children and the elderly are not being met, and there is clear and widespread support for a government role in ensuring adequate health care.

The State Children's Health Insurance Program: successes, shortcomings, and challenges.

This paper examines successes and shortcomings of the State Children's Health Insurance Program (SCHIP). SCHIP is a source of coverage for millions of children, improving their access to health care and sparking innovation in program design and improvements in Medicaid. However, SCHIP adds to the complexity of the insurance system and introduces new inequities in access to insurance; it is imperfectly targeting eligible children who are uninsured; and its financing is problematic because of the block-grant funding structure and use of SCHIP funds to cover adults. These issues need to be addressed during the SCHIP reauthorization process.