Public Policy Interventions Research Articles

The interconnected dynamics of social practices and their implications for transformative change: A review

This review article analyses the interconnectedness of different fields of social practice. Our aim is to understand if and how the literature using social practice theory addresses these interrelations and how this is linked to questions of sustainability transformations. Based on our review, we suggest a framework that conceives everyday-life practices of working, dwelling, mobility, eating, and recreation as closely intertwined and not changing independently of each other. As our analysis demonstrates, such a framing also contributes to better understanding the dynamics of (un)sustainable transformative change. Greater sustainability cannot be achieved by technological fixes or changes in individual behaviour alone but requires comprehensive interventions that address the interactions between practices, as these often co-evolve and co-locate, and changes need to be aligned between different practice fields. This has high relevance for understanding the development of public policy interventions that aim to increase the sustainability of everyday life. Our review shows a significant value of social practice research on the interconnectedness of different practice fields, although certain areas still appear to be somewhat neglected, such as the interconnectedness of work-related practices with other practices of everyday life. It furthermore points to the potential contribution of studies of interconnected practices to the literature on sustainability transitions, a perspective otherwise neglected in transition studies focusing on organisational actors and institutional dimensions of socio-technical change.

What evidence exists on the effects of public policy interventions for achieving environmentally sustainable food consumption? A systematic map protocol

BackgroundThe global food system is causing considerable environmental harm. A transition towards more sustainable consumption is needed. Targeted public policy interventions are crucial for stimulating such transition. While there is extensive research about the promotion of more environmentally sustainable food consumption, this knowledge is scattered across different sources. This systematic map aims to collate and describe the available evidence on public policy interventions such as laws, directives, taxes and information campaigns, for achieving sustainable food consumption patterns.MethodsWe will search bibliographic databases, specialist websites, Google Scholar and bibliographies of relevant reviews. Searches for academic literature will be performed in English, while searches for grey literature will be performed in English, Swedish, Danish and Norwegian. Screening, including consistency checking exercises, will be done at two levels: title and abstract, and full text. We will use machine learning algorithms to support screening at the title and abstract level. Coding and meta-data extraction will include bibliographic information, policy details and context, and measured environmental outcome(s). The evidence base will be summarised narratively using tables and graphs and presented as an online interactive searchable database and a website that will allow for visualisation, filtering and exploring systematic map findings, knowledge gaps and clusters.

The Effects of Prenatal Exposure to Neighborhood Crime on Neonatal Functional Connectivity

BackgroundMaternal exposure to adversity during pregnancy has been found to affect infant brain development; however, the specific effect of prenatal crime exposure on neonatal brain connectivity remains unclear. Based on existing research, we hypothesized that living in a high-crime neighborhood during pregnancy would affect neonatal frontolimbic connectivity over and above other individual- and neighborhood-level adversity and that these associations would be mediated by maternal psychosocial stress. MethodsParticipants included 399 pregnant women, recruited as part of the eLABE (Early Life Adversity, Biological Embedding, and Risk for Developmental Precursors of Mental Disorders) study. In the neonatal period, 319 healthy, nonsedated infants were scanned using resting-state functional magnetic resonance imaging (repetition time = 800 ms; echo time = 37 ms; voxel size = 2.0 × 2.0 × 2.0 mm3; multiband = 8) on a Prisma 3T scanner and had at least 10 minutes of high-quality data. Crime data at the block group level were obtained from Applied Geographic Solution. Linear regressions and mediation models tested associations between crime, frontolimbic connectivity, and psychosocial stress. ResultsLiving in a neighborhood with high property crime during pregnancy was related to weaker neonatal functional connectivity between the thalamus–anterior default mode network (aDMN) (β = −0.15, 95% CI = −0.25 to −0.04, p = .008). Similarly, high neighborhood violent crime was related to weaker functional connectivity between the thalamus-aDMN (β = −0.16, 95% CI = −0.29 to −0.04, p = .01) and amygdala-hippocampus (β = −0.16, 95% CI = −0.29 to −0.03, p = .02), controlling for other types of adversity. Psychosocial stress partially mediated relationships between the thalamus-aDMN and both violent and property crime. ConclusionsThese findings suggest that prenatal exposure to crime is associated with weaker neonatal limbic and frontal functional brain connections, providing another reason for targeted public policy interventions to reduce crime.

Managers’ support for workplace innovation in the public sector: Wedged between expectations and conditions

Over the past few years, public policy interventions have been initiated to promote public sector innovation. These top-down initiatives have been aimed at generating bottom-up movement, and first-line managers are believed to play an important role in this transformation. However, little is known about the challenges first-line managers face in their role as agents of change. This article therefore explores the expectations and conditions that first-line managers face when innovation support is implemented in municipalities. The article draws on 23 interviews with participants from three Swedish cases where innovation support has been implemented in the municipal context. The findings reveal that a multitude of expectations pointing towards an explorative logic are placed on first-line managers to lead, dare and support in connection with employee-driven innovation, but the conditions under which they operate point towards an exploitative logic. The managers find themselves wedged between high expectations and a lack of mandate, resources and organisational support for workplace innovation in the public sector context.

Racial/ethnic health disparities among children with special health care needs in Boston, Massachusetts

BackgroundLittle is known about the factors that contribute to racial/ethnic disparities among children with special health care needs (CSHCN). ObjectiveTo quantify the contributions of determinants of racial/ethnic disparities in health and health care among CSHCN in Boston, Massachusetts. MethodsA sample of 326 Black, Latino, and white CSHCN was drawn from the Boston Survey of Children's Health, a city-wide representative sample of children. The study implemented Oaxaca–Blinder-style decomposition techniques to examine the relative contributions of health resources and child-, family-, and neighborhood-level factors to disparities in four outcomes: health status, barriers to medical care, oral health status, and utilization of preventive dental care. ResultsWhite CSHCN had a greater likelihood of having very good/excellent health and oral health and were less likely to experience barriers to care than Black CSHCN. Compositional differences on predictors explained 63%, 98%, and 80% of these gradients, respectively. Group variation in household income, family structure, neighborhood support, and exposure to adverse childhood experiences accounted for significant portions of the Black–white gaps in health and access. White CSHCN were also more likely to have very good/excellent health and oral health compared to Latino CSHCN. Differences on predictors accounted for about 86% and 80% of these gaps, respectively. Household income, adverse childhood experiences, and household language emerged as significant determinants of Latino–white disparities. ConclusionsRacial/ethnic health disparities among CSHCN are explained by relatively few determinants. Several of the contributing factors that emerged from the analysis and could be targeted by public health and policy interventions.

Financial resources for research and innovation in small and larger firms: Is it a case of the more you have, the more you do?

ABSTRACT Our study analyses how firms’ internal financial resources impact their engagement in scientific research, development, and five innovation activities. Furthermore, we investigate how firm-size moderates the impact of firms’ internal financial resources on scientific research, development, and innovation. Our approach provides novel insights regarding whether more money leads to more research and innovation, a topic that remains highly contested in the literature. Our analysis uses a novel unbalanced panel dataset of 1,446 firms in Ireland, over the period 2008–2016. Levels of internal financial resources are found to positively impact larger-sized firms’ (50+ employees) engagement in scientific research, process innovation and product innovation. However, such resources tend to hinder small-sized firms’ (less than 50 employees) engagement in service and organisational innovation. Our research refines innovation theory by reconciling contrasting views regarding the importance of financial resources for research and innovation, and offers novel insights for informing related public policy interventions.

Tobacco Couponing: A Systematic Review of Exposures and Effects on Tobacco Initiation and Cessation.

Tobacco couponing continues to be part of contemporary tobacco marketing in the United States. We performed a systematic review of the evidence of tobacco product coupon receipt and redemption to inform regulation. We searched EMBASE OVID and Medline databases for observational (cross-sectional and longitudinal) studies that examined the prevalence of tobacco coupon receipt and coupon redemption across different subpopulations, as well as studies of the association between coupon receipt and redemption with tobacco initiation and cessation at follow-up. We extracted unadjusted and adjusted odds ratios for the associations between coupon exposure (receipt, redemption) and tobacco use outcomes (initiation, cessation) and assessed each studies' potential risk of bias. Twenty-seven studies met the criteria for inclusion. Of 60 observations extracted, 37 measured coupon receipt, nine measured coupon redemption, eight assessed tobacco use initiation, and six assessed cessation. Tobacco product coupon receipt and redemption tended to be more prevalent among younger adults, women, lower education individuals, members of sexual and gender minorities, and more frequent tobacco users. Coupon receipt at baseline was associated with greater initiation. Coupon receipt and redemption at baseline were associated with lower cessation at follow-up among tobacco users. Results in high-quality studies did not generally differ from all studies. Tobacco product coupon receipt and redemption are often more prevalent among price-sensitive subpopulations. Most concerning, our results suggest coupon receipt may be associated with higher tobacco initiation and lower tobacco cessation. Couponing thereby increases the toll of tobacco use and could prove to be a viable public health policy intervention point. A systematic review was conducted of the scientific literature about the receipt, redemption, and effects on tobacco initiation and cessation of tobacco product couponing. This review found that tobacco coupons are more often received by price-sensitive persons and these coupons serve to increase tobacco initiation and decrease tobacco cessation. Policy efforts to address these consequences may help curb tobacco's harms and address health inequities.

Environmental and socio-economic implications of woody biomass co-firing at coal-fired power plants

We apply a detailed power sector model to explore the near-term role of woody biomass co-firing at existing coal facilities in the Eastern US in the decarbonization of US electricity generation. We evaluate five public policy interventions: a biomass co-firing subsidy, two carbon emissions fees, and two clean energy standards. Treating woody biomass as a carbon neutral feedstock, we find co-firing weakly supports decarbonization. However, policies subsidizing co-firing can delay retirement of coal facilities and reduce generation from nuclear, natural gas, wind and solar. Consequently, corresponding sector-wide emissions of CO2 and SO2 may increase (slightly) due to greater utilization of coal plants including relatively inefficient facilities. We assume NOX emissions increase due to generation efficiency losses, but this remains uncertain. Due to higher emissions, a biomass subsidy for co-firing yields small (near zero) economic welfare losses, while in contrast other policies advance decarbonization and yield significant welfare gains. We find justification for biomass use from a local perspective based on first-order impacts on employment and economy activity, but less so air quality.

Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students.

Objective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students’ perspectives. Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis. Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students. Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services.

Air Quality in Lombardy, Italy: An Overview of the Environmental Monitoring System of ARPA Lombardia

In this paper, we describe the structure and the features of the air quality and meteorological monitoring system adopted in the Lombardy region in Northern Italy. We are interested in describing which data the Regional Agency for Environmental Protection (ARPA Lombardia) must collect, how this process takes place and how they are disseminated to the public for institutional communication and research purposes. ARPA monitors the atmospheric conditions through a dense ground monitoring network composed mainly by permanent stations, but also by mobile samplers. We describe in a detailed fashion the structure of the network: how many stations the network consists of, their locations, which pollutants and weather events are monitored and with what frequency. Our main objective is to present to an international audience the case study of ARPA Lombardia and the main available public data, explicitly stating the sources of information and how to find them, and encouraging international researchers to deal with the subject. In spite of the significant and extensive efforts made to counteract the phenomenon of air pollution, the air quality recorded in the region is very poor, and the local authorities are struggling to comply with international regulations on the concentration of pollutants in the air, making Lombardy a relevant international case. In addition, we present in a synthetic and descriptive way, without any modeling ambition, some data observed in the last years in Lombardy regarding meteorology and the main pollutants (oxides and particulate matters). The empirical descriptive results have been obtained by analyzing sample data provided by ARPA Lombardia through the same sources described in the sections dedicated to the Agency. From the graphical analysis, it is noticeable that at aggregate (regional) level, the concentrations are affected by significant decreasing trends, but at a rather contained speed. This is particularly true for the concentrations of oxides (NO2 and NOX) in urban and industrial areas. However, particulate matters and ozone show a high persistence in the average concentrations, interrupted only by the alternation of climatic seasons. The data also show that the meteorology of the region does not seem favorable for the improvement of air quality, as the region is characterized by low precipitation, and wind almost everywhere is not very intense. This situation could be induced by the unfavorable geography of the area, which prevents adequate air recycling and facilitates the stagnation of pollutants. We suggest that any public policy intervention aimed at improving the air quality situation in the region should take into account this empirical evidence in the impact assessment phase.

Deforestation in South America's tri-national Paraná Atlantic Forest: Trends and associational factors

South America's Tri-national Paraná Atlantic Forest, an ecological region spanning across the nations of Argentina, Brazil and Paraguay, is one of the most diverse in the world but also one of the most vulnerable to deforestation. A review of public policy interventions shows all three governments have taken major legislative steps to protect remaining forests, but studies evaluating deforestation trends and associated factors in this region are scarce or non-existent. Here, we make a direct contribution to this knowledge gap by assessing deforestation trends within Paraná Atlantic forests of Argentina's Misiones, Brazil's Paraná, and Paraguay's Alto Paraná between 2000 and 2020. Over this period about 20% of forest cover was lost in Misiones, 13% in Paraná, and 18% in Alto Paraná. The odds of observed deforestation, else constant, showed nuanced associations with proximity to nearest roads, cities, and ports. Higher levels of economic growth were directly associated with deforestation, as were increases in population density over the entire period. Protected area designation between years 2000 and 2020 showed effectiveness in lowering odds of deforestation with heterogeneous associations across countries. Our results reflect associational inferences with estimated deforestation; future research should investigate causal effects of protected designation, and assess its role in avoided degradation and wider socio-economic impacts.

Impact of birth tourism on health care systems in Calgary, Alberta

BackgroundBirth tourism refers to non-resident women giving birth in a country outside of their own in order to obtain citizenship and/or healthcare for their newborns. We undertook a study to determine the extent of birth tourism in Calgary, the characteristics and rationale of this population, and the financial impact on the healthcare system.MethodsA retrospective analysis of 102 women identified through a Central Triage system as birth tourists who delivered in Calgary between July 2019 and November 2020 was performed. Primary outcome measures were mode of delivery, length of hospital stay, complications or readmissions within 6 weeks for mother or baby, and NICU stay for baby.ResultsBirth Tourists were most commonly from Nigeria (24.5%). 77% of Birth Tourists stated that their primary reason to deliver their baby in Canada was for newborn Canadian citizenship. The average time from arrival in Calgary to the EDD was 87 days. Nine babies required stay in the neonatal intensive care unit (NICU) and 3 required admission to a non NICU hospital ward in first 6 weeks of life, including 2 sets of twins. The overall amount owed to Alberta Health Services for hospital fees for this time period is approximately $694 000.00.ConclusionBirth Tourists remain a complex and poorly studied group. The process of Central Triage did help support providers in standardizing process and documentation while ensuring that communication was consistent. These findings provide preliminary data to guide targeted public health and policy interventions for this population.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research.

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

National identity predicts public health support during a global pandemic

Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1, N = 49,968 across 67 countries), we investigated self-reported factors associated with public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the COVID-19 pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N = 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r = −0.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.

Modal equity of accessibility to healthcare in Recife, Brazil

In the context of increasing urbanization and income inequality, transport professionals in the Global South need to be prepared to effectively plan for the needs of various groups within the population, particularly for those regarding health and well-being. Accessibility is widely used as a performance measure for land use and transport systems; it measures people’s ease of reaching desired destinations and incorporates mode, time, and/or cost constraints. Considerable differences exist in the level of accessibility experienced by different mode users in reaching healthcare facilities, which calls for additional equity considerations given the prevailing socio-demographic characteristics of the users of various modes and the importance of healthcare facilities as a destination. In this study, we explore the distribution of accessibility to healthcare facilities by public transport and by car in Recife, Brazil, through an equity assessment to identify areas with low accessibility using these modes at different times of day. In general, the higher accessibility of public transport as well as greater modal equity was observed in central regions of Recife, whereas the periphery, where many low-income census tracts can be found, experiences significant inequity when it comes to access by both modes to healthcare facilities. This analysis allowed us to classify locations to access impoverished, access absolutely impoverished, and access impoverished by public transport areas, which can be targeted with appropriate land use and public transport policy interventions. This paper can be of value to professionals and researchers working toward equitable land use and transport systems in the Global South.

“Are you safe to talk?”: Perspectives of Service Providers on Experiences of Domestic Violence During the COVID-19 Pandemic

This study aimed to better understand the factors driving reported trends in domestic violence during the COVID-19 pandemic, particularly the effect of the pandemic on survivors’ experiences of violence and ability to seek support. We conducted semi-structured qualitative interviews with 32 DV service providers operating in organizations across 24 U.S. cities. The majority of providers described a decrease in contact volume when shelter-in-place orders were first established, which they attributed to safety concerns, competing survival priorities, and miscommunication about what resources were available. For most organizations, this decrease was followed by an increase in contacts after the lifting of shelter-in-place orders, often surpassing typical contact counts from the pre-pandemic period. Providers identified survivors’ ability to return to some aspects of their pre-pandemic lives, increased stress levels, and increased lethality of cases as key factors driving this increase. In addition, providers described several unique challenges faced by DV survivors during the pandemic, such as the use of the virus as an additional tool for control by abusers and an exacerbated lack of social support. These findings provide insight into the lived experiences driving observed trends in DV rates during COVID-19. Understanding the impact of the pandemic on survivors can help to shape public health and policy interventions to better support this vulnerable population during future crises.

Inequities in the distribution of flood risk under floodplain restoration and climate change scenarios

Abstract The combined impacts of climate change and ecological degradation are expected to worsen inequality within society. These dynamics are exemplified by increases in flood risk globally. In general, low‐income and socially vulnerable populations disproportionately bear the cost of flood damages. Climate change is expected to increase the number of people exposed to fluvial flood risk and cause greater property damages. Floodplain restoration has the potential to mitigate these impacts, but the distribution of future risks among different types of property owners under these altered conditions is often unknown. Here, we develop a simple probabilistic approach for estimating flood risk to property owners under floodplain restoration and climate change scenarios for a range of flood recurrence intervals. We apply this approach in the Vermont, USA portion of the Lake Champlain Basin. Over a 100‐year time horizon, we estimate that the value of property damages caused by flood inundation is approximately $2.13 billion under the baseline scenario. Climate change is expected to increase damages to $5.29 billion, a 148% increase; however, floodplain restoration has the potential to reduce these impacts by approximately 20%. For all scenarios, a larger proportion of lower‐value properties, specifically mobile homes, face greater flood risk compared to higher‐value properties. Climate change is expected to cost higher‐value properties and commercial properties more than other types of properties, but these same groups are also expected to benefit most from floodplain restoration. In general, these results raise concern that those least able to prepare for and recover from flood damages are also the people who face the greatest threats. In response, public policy interventions must consider not only where flood risk is most severe, but also the vulnerability of people exposed to such risk. Read the free Plain Language Summary for this article on the Journal blog.

Factors Determining the Policy Implementation for Micro, Small, And Medium Enterprises (MSMES) Empowerment In Indonesia

A commitment to actualize Micro, Small, and Medium Enterprise (MSME) governance through public policy intervention is an approach to empower and improve the welfare of a community. The management of MSMEs is a form of policy that is expected to be effective in empowering MSMEs in Gorontalo City. This policy has been implemented annually by allocating resources and program assistance. However, the progress achieved by the MSME actors is still below expectation. This research aims to analyze factors determining the effectiveness of policy implementation for MSME empowerment in Gorontalo city between 2017 and 2019. Based on initial observation results, the research employs a descriptive qualitative method. Findings from the empirical evidence in the field show that seven factors determine the policy of MSME empowerment in Gorontalo City, including communication, resources, disposition, bureaucratic structure, capital, facility and infrastructure, and quality of human resources. In this research, the characteristics of MSMEs are equivalent to the public policyapplied by the government. Therefore, the research results provide a useful value as a reference for the government in implementing the policy for MSME empowerment at the regional and national levels.

Generating Political Commitment for Regulatory Interventions Targeting Dietary Harms and Poor Nutrition: A Case Study on Sugar-Sweetened Beverage Taxation in Australia.

Sugar-sweetened beverage (SSB) taxes are an effective public health policy intervention for improving nutrition and public health. Although implemented in over 50 jurisdictions worldwide, this intervention remains vastly underutilised, and in Australia political commitment for such a tax is low. The aim of this study is to understand the politics of SSB taxation in Australia, what factors have constrained political commitment for a tax, and what might enable such commitment in future. We adopted a case study design, guided by a theoretical framework developed from the political economy of nutrition literature. Data were collected from 16 interviews with informants from multiple sectors, supported by media articles, journal articles, and grey literature. Data were coded and organized by thematic analysis, and synthesised into the final results. Nutrition actors have made significant progress in generating commitment for a SSB tax by producing relevant evidence, raising awareness, advocating for action, employing resonating frames, collaborating with civil society organisations, and forming coalitions increasing their overall cohesion. Nevertheless, political commitment for a SSB tax is low and was found to be impeded by the powerful influence of the food, beverage, and sugar industries, opposition from both major Australian political parties, ideological resistance to regulation, a low quality monitoring and surveillance system for food and nutrition, and limited public advocacy. The influence of nutrition actors was also impeded by weak connections to key policy-makers and missed collaborative opportunities with pro-SSB tax organisations. The identification of several impediments provides an explanation for why political commitment for a SSB tax is low in Australia and reveals several opportunities for how it might be generated in the future. Political commitment may come about through, for example, actions to limit the influence of industry in policy decision-making, and by strengthening the existing pro-SSB tax coalition.

Clinical and public policy interventions to address food insecurity among children.

This article describes the impacts of food insecurity (FI) on child health, outlines clinical and public policy interventions to mitigate FI in children, and defines new paradigms in population health to ameliorate the harmful effects of FI in children. Rates of FI among children have dramatically increased with the onset of the COVID-19 pandemic, with particular adverse impact on low-income children. Population health innovations in screening, referral, and social service integration offer new opportunities to address FI. Despite advances in clinical practice and public policy, FI remains a persistent issue for many US children. Clinicians and policymakers have opportunities to leverage clinical and community-based integration to improve service delivery opportunities to ameliorate childhood hunger and racial and socioeconomic inequity in the United States.