New issue of The Milbank Quarterly

September 2015 Issue of The Milbank Quarterly


The September issue of The Milbank Quarterly features the following studies and op-eds.

From the Editor-in-Chief/Howard Markel on Wash Your Hands! At this late date, it seems almost superfluous to assert the efficacy of proper hand hygiene against gastrointestinal and, to a lesser extent, respiratory infections. But it is no exaggeration to proclaim that hand hygiene ranks as one of the top ten discoveries in the history of preventive medicine, public health, and patient care. Incorporating the habit of frequently washing our hands in our daily lives is a simple but powerful health policy we can all wrap our hands around.

Our September studies:

Sari Reisner, et al., on Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender Nonconforming People  Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, public education, and business. However, the law does not protect against discrimination in places open to the public, such as transportation, retail stores, restaurants, health care facilities, and bathrooms. Sixty-five percent of adults surveyed experienced discrimination since the law was passed—and had a greater risk of adverse health outcomes.

Jason Schnittker, et al., on The Institutional Effects of Incarceration: Spillovers from Criminal Justice to Health Care  The consequences of incarceration on former inmates and their families are well known. But along with the steady increase in incarceration in the United States comes a negative effect on the quality and functioning of the health care system. The health care system and the criminal justice system are related in real but underappreciated ways.

Bradley Stein, et al., on Where is Buprenorphine Dispensed to Treat Opioid Use Disorders?  In 2002, the FDA approved Buprenorphine for opioid use disorder when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients—and now Congress is considering increasing the limits again as well as extending the prescribing privileges to nonphysicians. Relaxing patient limits may be more effective in increasing buprenorphine use than alternatives, such as opening new substance abuse facilities or increasing the number of waivered physicians.

Benjamin Sommers and Maria Portela on On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States  Puerto Rico, the largest US territory, is home to nearly four million US citizens—yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). Despite its poorer population, Puerto Rico outperforms the mainland on several measures of health care coverage and access to care. Ongoing congressional restrictions on Medicaid funding and premium tax credits in Puerto Rico pose health policy challenges in the territory.

Karen Ladin, et al., on Does Social Capital Explain Community-Level Differences in Organ Donor Designation?  The growing shortage of life-saving organs has reached unprecedented levels. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. But community-level factors, including “social capital,” a perspective through which organ donation can be viewed as a form of civic engagement and social altruism, could predict the variation in donor designation, and future interventions could tailor strategies to specific communities.

Our op-ed contributors in this issue: