1. Pfeifer, Gail M. MA, RN

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Global health insecurity. Climate change and new, rapidly spreading diseases like COVID-19 are likely to continue to disrupt global health. Devastating floods, such as those in Pakistan last August, are believed to have been influenced by climate change. The Pakistan floods were instigated by torrential rainfall that inundated a third of the country, killed more than 1,500 people, and left more than 6 million in "dire need of humanitarian aid," according to the Center for Strategic and International Studies. Climate change in various forms is expected to increase annual global death rates, especially in developing countries with already weak health infrastructures. Conflict around the globe, such as in Ukraine, sub-Saharan Africa, and Haiti has had a profound impact on physical, mental, and social well-being. And food insecurity is on the rise. The United Nations, World Health Organization, and other global agencies issued a joint warning last July of worsening food insecurity due to fertilizer and energy costs, climate change, and supply chain disruptions related to the war in Ukraine. Finally, outbreaks of vaccine preventable illnesses, such as polio and measles, present challenges to public health worldwide.

Figure. Floodwater e... - Click to enlarge in new windowFigure. Floodwater entered riverside settlements in Sukkur, Pakistan, in August. Photo (C) Shutterstock.

Telehealth. The use of telehealth services, which had been hampered by restrictive state licensure and reimbursement policies, boomed during the early months of the pandemic, when stay-at-home advisories for patients were initiated to stem COVID-19 transmission. To substitute telehealth for in-person health care, government agencies took steps to loosen restrictions in order to expand the network of providers. It remains to be seen whether this expansion can be sustained after the COVID public health emergency subsides. The Census Bureau's Household Pulse Survey found that use of telehealth dropped between April and October of 2021, and while telehealth likely won't go away entirely, federal officials have already announced the phaseout of payment for certain kinds of remote care, such as physical therapy. Another area of telehealth that will need attention is the online infrastructure; disparities in access persist in populations with limited internet service.


Health and human rights legislation. The effect of new laws, such as the Inflation Reduction Act (IRA) of 2022, will become apparent over the course of this year. Among other provisions, the IRA allows for Medicare drug price negotiation and the extension of tax subsidies for Affordable Care Act marketplace plans. The effects of the Supreme Court's decision to end federal protection of abortion access in favor of state-by-state regulation is sure to reverberate throughout 2023. In addition to abortion access limitations already passed in some states, proposed criminal penalties for providers are wending their way through state legislatures. These could jeopardize access to lifesaving care for women experiencing miscarriage or ectopic pregnancy, and also have an adverse effect on maternal morbidity and mortality. And, in the wake of last November's midterm elections, other human rights legislation faces an uncertain future, for example, proposals affecting access to gender-affirming care such as hormone therapy for transgender youth.


The CDC aims to regain public trust. In response to heavy criticism of its response during the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) announced an overhaul directed at rebuilding public trust in the agency. The announcement followed a commissioned outside review of CDC performance during the pandemic that was described as "scathing." Summarizing the report in a video message to staff, CDC director Rochelle P. Walensky said, "To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications." The overhaul, entitled "CDC Moving Forward," which launched in August, will implement changes to speed up the sharing of science and data, provide clear communication with the American public, and create a workforce capable of responding rapidly to future disease threats. It will be guided by recommendations of the Health Resources and Services Administration and senior CDC leadership.-Gail M. Pfeifer, MA, RN