As always, in the January issue we summarize what our editorial board, contributors, and staff deem the major health care stories of the past year (see "The Year in Review," In the News). Many of the issues that topped the list this year are not unique to 2019-gun violence, for example-but we've made little progress in addressing them, and in some cases we may be near losing whatever gains we've made.
Disasters attributed to climate change have continued to wreak havoc and have prompted the Oxford Dictionaries to declare climate emergency the word of the year. Communities worldwide are facing challenges from fires, droughts, and floods, as warming temperatures continue to reshape our environment.
More Americans, including children, are uninsured than in prior years, and issues of cost and availability are putting lifesaving medications out of the reach of many. Access to care, even for those with insurance, isn't equitable, especially in rural areas where many hospitals have closed. This is especially concerning when coupled with the attempts by several states to decrease women's access to reproductive health care. Furthermore, the maternal mortality rate in the United States is dismal: the Centers for Disease Control and Prevention has reported that pregnancy-related deaths have more than doubled since 1987 (with the rate for black women more than triple that of white women between 2011 and 2016). What's especially disheartening is that many of the causes are preventable with prenatal care. And a recent study in JAMA suggests that U.S. life expectancy has not kept up with that of other wealthy countries and is, in fact, decreasing.
According to the Gun Violence Archive, a nonprofit that provides verified gun violence data, as of November 24, 2019, there were 35,159 deaths from guns, of which 21,648 were suicides. There were 377 mass shootings. The Republican-controlled Senate has yet to act on a bipartisan bill (HR 8, introduced February 28, 2019) to expand background checks, even though a September Quinnipiac poll shows that over 80% of Americans, including 71% of Republicans and 72% of gun owners, support them.
Over the past year, we've also dealt with public health crises, including opioid deaths, a measles epidemic, and a new spate of deaths from vaping. Social issues are still begging for realistic but humane and morally just solutions. Homelessness increased for the second consecutive year. The latest available FBI data show that hate crimes grew steadily from 2014 to 2017, increasing by more than 2,000 incidents and victims over the three years. And the Pew Research Center reports that while the global number of refugees is at its highest, U.S. acceptance of refugees is at its lowest and trails all other countries.
Despite these grim statistics, we're starting this year with an uplifting cover: a montage of photos showing nurses and midwives at work in different settings. The two professions together constitute half of the global health workforce, and by declaring 2020 the "Year of the Nurse and Midwife," the World Health Organization is recognizing their critical roles in achieving global health goals. (See AJN Reports in this issue for an in-depth look at the roles of nursing and midwifery.) This welcome focus on enabling nurses and midwives to practice to the full scope of their education and training comes at a pivotal time, as nations struggle with reconfiguring health systems to deliver care to older, sicker, and more diverse populations.
A 2019 survey of 2,000 adults conducted by the Commonwealth Fund, the New York Times, and the Harvard T.H. Chan School of Public Health, asking Americans what they value and who they trust to improve the U.S. health care system, found that, "when it comes to public trust in various groups trying to improve the U.S. health care system, Americans . . . generally do not trust any [major interest] groups, with the exception of nurses."
Once again, the public places its trust in us to do what's right. This is our time to earn that trust by pushing for the reforms people need to lead healthy lives. With elections around the corner, now is the time for nurses to become informed; question the candidates; and galvanize support for those whose plans lead to accessible, inclusive, and quality care for all.