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Purpose: We estimate national health expenditures on prevention using precise definitions, a transparent methodology, and a subdivision of the estimates into components to aid researchers in applying their own concepts of prevention activities.

Methodology/Approach: We supplemented the National Health Expenditure Accounts (NHEA) with additional data to identify national spending on primary and secondary prevention for each year from 1996 to 2004 across eight spending categories.

Findings: We estimate that NHEA expenditures devoted to prevention grew from $83.2 billion in 1996 to $159.8 billion in 2004, in current dollars. As a share of NHEA, this represents an increase from 7.8 percent in 1996 to 8.6 percent in 2004. This share peaked at 9 percent in 2002 and then declined due to reductions in public health spending as a percent of NHEA between 2002 and 2004. Primary prevention represents about half the expenditures, consisting largely of public health expenditures – the largest prevention element.

Originality/Value of Paper: Our 2004 estimate that 8.6 percent of NHEA goes to prevention is nearly three times as large as the commonly cited figure of 3 percent, but depends on the definitions used: our estimate falls to 8.1 percent when the research component is excluded, 5.1 percent when consideration is limited to primary prevention plus screening, 4.2 percent for primary prevention alone, and 2.8 percent if we count only public health expenditures. These findings should contribute to a more informed discussion of our nation's allocation of health care resources to prevention.

Older adults’ sexual health is becoming an increasingly important component of healthy aging in the wake of the HIV/AIDS epidemic and rising infection rates among this age cohort. The increase in HIV/AIDS diagnoses in the older adult population ignites the need to understand the reasons why older adults are omitted from HIV/AIDS prevention education policy.

This chapter examines the social forces that influence HIV/AIDS policy at the state and community levels. Through qualitative methodology and analysis, including interviews with state policymakers and managers of AIDS service organizations in four Midwestern states (n=31), I look for trends and patterns as to whether or not older adults are considered as an “at-risk” group for HIV infection.

Findings reveal that HIV/AIDS policy may be impacted by enduring sexual scripts about older adults. To some extent both state policymakers and AIDS service organization personnel adhere to stereotypes about older adults’ sexuality and sexual activity, which is then implemented in their health promotion activities. The result is that gaps exist in HIV/AIDS prevention education for older adults, despite the fact that current trends show an increase in new HIV infections and AIDS diagnoses among people over the age of 50.

While this is an exploratory study of the available HIV/AIDS prevention education and health promotion activities for older adults, as well as the viewpoints of state policymakers and AIDS service organization personnel, the findings do indicate the need for additional research on the potentially dangerous sexual behaviors – lack of HIV testing, low condom usage, multiple partners – exhibited by older adults. Future research involving interviews with older adults, physicians, and medical personnel may add new perspectives to the current research.

As the baby boomers continue to age and challenge cultural stereotypes of sexual behaviors among older adults, research in the area of sexual health and HIV/AIDS prevention education will remain an important component of healthy aging. This research begins what will ultimately be a necessary conversation.

This chapter depicts the burden of suicidal behavior among African American males. It describes the public health approach to preventing suicidal behavior among African American males. This approach includes assessing and describing the problem; identifying causes or risk and protective factors; developing and evaluating programs and policies; and implementing and disseminating findings and activities. The chapter provides a review of the epidemiology of fatal and non-fatal suicidal behavior; a summary of what is known about the risk and protective factors of the problem; and a descriptive analysis of the circumstances associated with suicides among young African American males is presented. Lastly, the authors give a summary of evidenced-based prevention programs which could be applied in preventing male suicidal behavior.

Building a culture of safety in transportation is not dissimilar from building a culture of safety in health. Public health is widely known for protecting the public from diseases through milk pasteurization and chlorination of drinking water, and from injuries by implementing environmental and occupational safeguards and fostering behavioral change. Lifestyle and environmental changes that have contributed to the reductions in smoking and heart disease can also help change driving, walking and cycling behaviors, and environments. Stimulating a culture of safety on the road means providing safe and accessible transportation for all. The vision for a culture of traffic safety is to change the public’s attitude about the unacceptable toll from traffic injuries and to implement a systems approach to traffic injury prevention as a means for improving public health and public safety. Framing the motor vehicle injury problem in this way provides an opportunity for partnerships between highway safety and public health to improve the culture of safety.

Purpose – This chapter argues that health care is best conceptualized as a complex adaptive system. Sustainable health care depends on harnessing the complexity of the system by building aligned purpose, flexible pathways to connect people, knowledge and resources, and the capacity for self-organization.

Design/methodology/approach – The case study of the Southern California Region of Kaiser Permanente is based on three years of interviews and archival data collection examining the system's transformational change that began in 2004 and has been aimed at building a sustainable health care system with the guiding principles of value and prevention. The case focuses primarily on the medical care delivery system designed by the Southern California Permanente Medical Group, the capabilities that have been built into the system to continually improve the quality of care and the outcomes of the system, and the results that have been achieved.

Findings – During the period from 2004 to 2011, the region improved significantly in slowing cost acceleration by significantly improving medical care. The implementation of an electronic medical records system and its integration with other clinical information technology systems have enabled: (1) truly integrated, well defined, and easily navigated care delivery systems that are based on evidence; (2) upstream focus on prevention, disease control, patient education, and population health; and (3) management accountability and organizational improvement systems based on transparency of data and feedback. Physician leadership and partnering with the region's administrative and hospital leadership have been critical change enablers.

Originality/value – Embracing the complexity of the system has led to the crafting of pathways and linkages that enable patients to move through the system to flexibly and efficiently connect to the knowledge and resources required to optimize their health. This requires continual self-organization based on well-defined roles and connections. Previous health care improvement approaches have stressed initiatives and organizational changes that may further fragment the health care system.

Public schools possess a unique constellation of opportunities and challenges for mental health service provision. Schools, as settings within a larger ecological context, can be a community institution that supports a child as s/he develops assets for resilient development while providing opportunities for a range of life choices. School is the setting where children can learn and practice peer relations and social norms, and it can be a refuge where children who have many environmental risks can find structure and effective methods of success (Doll, 1999). When Willie Horton, the infamous bank robber, was asked why he robbed banks, he responded, “Because that's where the money is.” At a most basic level, schools are where the children are. Every day more than 52 million students attend over 1,14,000 schools in the United States, and including the 6 million adult staff, this amounts to almost one-fifth of the population passing through the Nation's schools on any given weekday (New Freedom Commission on Mental Health, 2003).

The acceleration of Opioid deaths over the last decade has made it a serious national public health crisis. Alabama has not been immune to this epidemic, with dramatically increased age-adjusted drug overdose death rates. These increases have occurred in a state with limited resources for Opioid health prevention, treatment, and recovery services. This chapter introduces the term “o-CHIL” in order to better understand the multi-factorial layers of intertwining health injustices (in the plural) experienced in Alabama’s communities and their embedded public libraries. It highlights the complexities in Opioid consumer health information literacies, the culturally situated dimensions of the Opioid crisis in Alabama, and the uniquely relevant consumer health literacies in its public libraries. Findings are based on an empirical assessment of representative information support services identified in February 2020 on the websites of the 230 public libraries listed as members of the Alabama Public Library Service. The exploratory study applies website content analysis to identify seven examples of information offerings and to class offerings into three categories: (1) information sources (collections, resources); (2) information policy and planning (assigned Opioid-related role, strategic representation); and (3) connections (internal, external, news and events). The discussion potentially provides new directions, approaches, and opportunities to build collaborations of sharing within Alabama’s network of public libraries and beyond for them to better serve their local and regional communities impacted by the Opioid crisis.

The incipient HIV/AIDS epidemic in Chile poses challenges for responsiveness of the Chilean national health care system, Fondo Nacional de Salud (FONASA) (National Health Funds), especially given the sociocultural forces for inertia in FONASA. Thus, the issue is what is the nature of the forces for change. A grounded theory approach was applied to interview data from two qualitative studies, one with HIV/AIDS advocates and activists as interviewees and the other with Chilean low-income women. The stories of their experiences with and perceptions of FONASA revealed major issues facing FONASA, including quality of care and ethics. Ways in which these issues are being addressed by the activists result in constructed environmental dynamism. A conceptual model of the forces for change was developed including actors, strategies, and targets of change that constitutes organizational environmental dynamism. The construct of environmental dynamism has international applicability, particularly to governmental health systems, which are influenced by strong sociocultural forces.

To determine the health status of women before, during, and after the war, and to explore women’s perceived health needs and current access to healthcare.

Individual interviews and focus groups were conducted in urban and rural areas. A total of 52 women participated in the study (N = 52; Individual Interviews, n = 12; Focus Group Participants, n = 40).

Women’s health concerns and healthcare needs overlap between the rural and urban communities. The women reported the needs for empowerment in the forms of social support groups for health, specialists for women’s health, education, resources, prevention, financial support to look for medical services, and mental health issues.

Since these focus groups and interviews were conducted, the women have continued to meet. The strength of these meetings is represented in the forms of preparing a meal, eating, and socializing in unity. The social support experienced in these gatherings allows the women to openly express their issues, fears, concerns, joys, and successes. The CBPR approach is an important necessity when working with vulnerable populations. There were some inherent limitations due to economic issues to support the gatherings, transportation, and health-related complications that may have prevented women from attending.

Disparate health outcomes and biologic–environmental interactions are represented in female survivors of war. Their issues began or were exacerbated during war and continue today. In the future, we seek to identify and establish a culturally and gender-specific intervention for health access, prevention, maintenance, and improvements.