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Overview of the Problem-Solving Mental Process

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

• Identify the Problem
• Define the Problem
• Form a Strategy
• Organize Information
• Allocate Resources
• Monitor Progress
• Evaluate the Results

Frequently Asked Questions

Problem-solving is a mental process that involves discovering, analyzing, and solving problems. The ultimate goal of problem-solving is to overcome obstacles and find a solution that best resolves the issue.

The best strategy for solving a problem depends largely on the unique situation. In some cases, people are better off learning everything they can about the issue and then using factual knowledge to come up with a solution. In other instances, creativity and insight are the best options.

It is not necessary to follow problem-solving steps sequentially, It is common to skip steps or even go back through steps multiple times until the desired solution is reached.

In order to correctly solve a problem, it is often important to follow a series of steps. Researchers sometimes refer to this as the problem-solving cycle. While this cycle is portrayed sequentially, people rarely follow a rigid series of steps to find a solution.

The following steps include developing strategies and organizing knowledge.

1. Identifying the Problem

While it may seem like an obvious step, identifying the problem is not always as simple as it sounds. In some cases, people might mistakenly identify the wrong source of a problem, which will make attempts to solve it inefficient or even useless.

Some strategies that you might use to figure out the source of a problem include :

• Asking questions about the problem
• Breaking the problem down into smaller pieces
• Looking at the problem from different perspectives
• Conducting research to figure out what relationships exist between different variables

2. Defining the Problem

After the problem has been identified, it is important to fully define the problem so that it can be solved. You can define a problem by operationally defining each aspect of the problem and setting goals for what aspects of the problem you will address

At this point, you should focus on figuring out which aspects of the problems are facts and which are opinions. State the problem clearly and identify the scope of the solution.

3. Forming a Strategy

After the problem has been identified, it is time to start brainstorming potential solutions. This step usually involves generating as many ideas as possible without judging their quality. Once several possibilities have been generated, they can be evaluated and narrowed down.

The next step is to develop a strategy to solve the problem. The approach used will vary depending upon the situation and the individual's unique preferences. Common problem-solving strategies include heuristics and algorithms.

• Heuristics are mental shortcuts that are often based on solutions that have worked in the past. They can work well if the problem is similar to something you have encountered before and are often the best choice if you need a fast solution.
• Algorithms are step-by-step strategies that are guaranteed to produce a correct result. While this approach is great for accuracy, it can also consume time and resources.

Heuristics are often best used when time is of the essence, while algorithms are a better choice when a decision needs to be as accurate as possible.

4. Organizing Information

Before coming up with a solution, you need to first organize the available information. What do you know about the problem? What do you not know? The more information that is available the better prepared you will be to come up with an accurate solution.

When approaching a problem, it is important to make sure that you have all the data you need. Making a decision without adequate information can lead to biased or inaccurate results.

5. Allocating Resources

Of course, we don't always have unlimited money, time, and other resources to solve a problem. Before you begin to solve a problem, you need to determine how high priority it is.

If it is an important problem, it is probably worth allocating more resources to solving it. If, however, it is a fairly unimportant problem, then you do not want to spend too much of your available resources on coming up with a solution.

At this stage, it is important to consider all of the factors that might affect the problem at hand. This includes looking at the available resources, deadlines that need to be met, and any possible risks involved in each solution. After careful evaluation, a decision can be made about which solution to pursue.

6. Monitoring Progress

After selecting a problem-solving strategy, it is time to put the plan into action and see if it works. This step might involve trying out different solutions to see which one is the most effective.

It is also important to monitor the situation after implementing a solution to ensure that the problem has been solved and that no new problems have arisen as a result of the proposed solution.

Effective problem-solvers tend to monitor their progress as they work towards a solution. If they are not making good progress toward reaching their goal, they will reevaluate their approach or look for new strategies .

7. Evaluating the Results

After a solution has been reached, it is important to evaluate the results to determine if it is the best possible solution to the problem. This evaluation might be immediate, such as checking the results of a math problem to ensure the answer is correct, or it can be delayed, such as evaluating the success of a therapy program after several months of treatment.

Once a problem has been solved, it is important to take some time to reflect on the process that was used and evaluate the results. This will help you to improve your problem-solving skills and become more efficient at solving future problems.

A Word From Verywell​

It is important to remember that there are many different problem-solving processes with different steps, and this is just one example. Problem-solving in real-world situations requires a great deal of resourcefulness, flexibility, resilience, and continuous interaction with the environment.

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You can become a better problem solving by:

• Practicing brainstorming and coming up with multiple potential solutions to problems
• Being open-minded and considering all possible options before making a decision
• Breaking down problems into smaller, more manageable pieces
• Asking for help when needed
• Researching different problem-solving techniques and trying out new ones
• Learning from mistakes and using them as opportunities to grow

It's important to communicate openly and honestly with your partner about what's going on. Try to see things from their perspective as well as your own. Work together to find a resolution that works for both of you. Be willing to compromise and accept that there may not be a perfect solution.

Take breaks if things are getting too heated, and come back to the problem when you feel calm and collected. Don't try to fix every problem on your own—consider asking a therapist or counselor for help and insight.

If you've tried everything and there doesn't seem to be a way to fix the problem, you may have to learn to accept it. This can be difficult, but try to focus on the positive aspects of your life and remember that every situation is temporary. Don't dwell on what's going wrong—instead, think about what's going right. Find support by talking to friends or family. Seek professional help if you're having trouble coping.

Davidson JE, Sternberg RJ, editors.  The Psychology of Problem Solving .  Cambridge University Press; 2003. doi:10.1017/CBO9780511615771

Sarathy V. Real world problem-solving .  Front Hum Neurosci . 2018;12:261. Published 2018 Jun 26. doi:10.3389/fnhum.2018.00261

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Innovations in Teamwork for Health Care

Don’t leave teaming up to chance. Create better teamwork through science.

In this course, experts from Harvard Business School and the T.H. Chan School of Public Health teach learners to implement a strategy for organizational teamwork in health care.

What You'll Learn

Health care is a team effort. From the front desk administrators to the nurses, doctors, insurers, and even the patients and their families, there are many people involved in an individual’s care. To deliver quality care in today’s fast-paced environment, practitioners and caregivers must go beyond medical problem-solving and rely on effective collaboration and communication skills.

While other businesses may organize around a functional area or project, allowing team members to learn each other's working styles and strengths over time, health care workers often find themselves in ad hoc scenarios, coordinating with near-strangers on life and death situations. As a leader, how do you encourage trust and meet shared goals when teams are formed quickly? How do you strengthen flexibility and collaboration even as team membership and structures fluctuate across departments? 

In Innovations in Teamwork for Health Care, leaders in the field of organizational behavior and teamwork, Amy Edmondson, Professor at Harvard Business School, and Michaela Kerrissey, Assistant Professor at the Harvard T.H. Chan School of Public Health, share their latest research and present their concept of "teaming" as it relates to the health care and life science industries.

In this course, you will explore the complexities of collaboration in dynamic cross-functional teams and its impact on quality of care. You will examine the theory of teaming – where individuals join together to lend their expertise – to appreciate what enables effective teamwork and why teamwork fails; articulate the importance of psychological safety and a joint problem-solving orientation; understand the particular needs of time-limited teams; and rethink the role of hierarchy and leadership in the context of teaming.

You’ll hear firsthand from experts with experience inside and outside the health care industry, from CEO and President of the Cleveland Clinic, Tomislav Mihaljevic, to Andres Sougarret, the engineer who led the miraculous rescue of 33 Chilean miners in 2011. 

Ultimately, this course provides you with the tools needed to implement effective teaming strategies for patient-centered care and provides your organization with a framework to empower robust communication, improve efficiency, and elevate patient safety.

The course will be delivered via  HBS Online’s course platform  and immerse learners in real-world examples from experts at industry-leading organizations. By the end of the course, participants will be able to:

• Explore the science of teamwork, focusing on the psychological and sociological aspects of teaming, collaboration, and defining effective outcomes.
• Understand the complexity of building trust in ad hoc teams, including how to define purpose, build trust, and navigate interpersonal risks to reach common goals.
• Apply communication strategies that encourage psychological safety and create a safe space for all to contribute.
• Understand the value in adopting a model of joint problem-solving for patient care.
• Identify the distinct needs of time-limited project teams and how to incorporate effective and transparent feedback loops.
• Ensure accountability and identify leaders, breaking down hierarchy and encouraging the right person to step up at the right time.
• Implement a PDSA (Plan, Do, Study, and Act) framework for your organization.

Continuing Education Credits

In support of improving patient care, Harvard Medical School is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education.

The Harvard Medical School designates this enduring material for a maximum of 20 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Harvard Medical School is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity is approved for 20.00 contact hours. Contact hours are awarded commensurate with participation and completion of the online evaluation and attendance attestation. We suggest claiming your hours within 30 days of the activity date, after this time, the attendance attestation will still be required to claim your hours. 

Groups of 10 or more receive Amy Edmondson's latest book!

A free, hard copy of right kind of wrong: the science of failing well for each participant. .

Your Instructors

Amy C. Edmondson  is the Novartis Professor of Leadership and Management at Harvard Business School, a chair established to support the study of human interactions that lead to the creation of successful enterprises that contribute to the betterment of society. She has pioneered the concept of psychological safety for over 20 years and was recognized in 2021 as #1 on the Thinkers50 global ranking of management thinkers. 

She is the author of Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy (2012), The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth (2018), and Right Kind of Wrong: The Science of Failing Well (2023).

Michaela Kerrissey  is an Assistant Professor of Management at the Harvard T.H. Chan School of Public Health. She conducts research on how teams and organizations innovate, integrate, and perform, with a focus on health care.   Dr. Kerrissey has authored over 30 publications on these topics and has won numerous best-paper awards, such as from the Academy of Management. She designed the Management Science for a New Era course at Harvard’s School of Public Health. In 2023, she was listed on Thinkers50 Radar, a global listing of top management thinkers.

Real World Case Studies

Affiliations are listed for identification purposes only.

Tomislav Mihaljevic, MD

Learn from the President and CEO of the Cleveland Clinic about how to implement joint problem solving in complex care organizations.

Maya Rupert

Hear from a top political strategist and campaign manager about how she leads within a teaming structure.

Trishan Panch, MD, MPH

Learn from Harvard faculty and founder of Wellframe about the importance of team learning.

Available Discounts and Benefits for Groups and Individuals

Experience Harvard Online by utilizing our wide variety of discount programs for individuals and groups. 

Past participant discounts.

Learners who have enrolled in at least one qualifying Harvard Online program hosted on the HBS Online platform are eligible to receive a 30% discount on this course, regardless of completion or certificate status in the first purchased program. Past Participant Discounts are automatically applied to the Program Fee upon time of payment.  Learn more here .

Learners who have earned a verified certificate for a HarvardX course hosted on the  edX platform  are eligible to receive a 30% discount on this course using a discount code. Discounts are not available after you've submitted payment, so if you think you are eligible for a discount on a registration, please check your email for a code or contact us .

Nonprofit, Government, Military, and Education Discounts

For this course we offer a 30% discount for learners who work in the nonprofit, government, military, or education fields. 

Eligibility is determined by a prospective learner’s email address, ending in .org, .gov, .mil, or .edu. Interested learners can apply below for the discount and, if eligible, will receive a promo code to enter when completing payment information to enroll in a Harvard Online program. Click here to apply for these discounts.

Gather your team to experience Innovations in Teamwork for Health Care and other Harvard Online courses to enjoy the benefits of learning together: 

• Single invoicing for groups of 10 or more
• Tiered discounts and pricing available with up to 50% off
• Growth reports on your team's progress
• Flexible course and partnership plans 

Learn more and enroll your team ! 

Course Syllabus

Learning requirements: There are no prerequisites required to enroll in this course. In order to earn a Certificate of Completion from Harvard Online and Harvard Business School Online, participants must thoughtfully complete all 5 modules, including satisfactory completion of the associated assignments, by stated deadlines.

Download Full Syllabus

• Study the Mining Accident Rescue and Cleveland Clinic cases.
• Understand the concept of teaming and how it can be applied to the health care industry.
• Brainstorm how to organize with a team to rescue 33 trapped miners.
• Analyze the problems solved and new challenges created by organizational structures that were implemented to facilitate teamwork at the Cleveland Clinic.
• Outline and analyze an individualized teaming breakdown for your organization. 
• Study the NASA and Google cases on psychological safety.
• Collaborate with team members and leadership to create a space of psychological safety. 
• Identify the indicators of psychological safety in a group. Analyze data from Project Aristotle’s study of teams at Google.
• Consider how past experiences can affect current feelings of psychological safety.
• Study the Cleveland Clinic ,  Boehringer Ingelheim , and  Cincinnati Children’s Hospital Medical Center cases.
• Implement a joint problem-solving orientation in which team members view problems as shared and solutions as requiring collaboration.
• Match different types of diversity in the workplace with the interpersonal boundaries that they imply.
• Articulate what you bring to a team and what you might need from others.
• Walk down the ladder of inference to get to the root of a problem.
• Study the  Virginia Mason Medical Center and  Institute for Healthcare Improvement cases.
• Cultivate an organization where team learning is valued and mobilized for improved performance.  
• Identify different kinds of work on the process knowledge spectrum.
• Brainstorm how a nursing team could learn from an accidental morphine overdose.
• Study the cases of Julio Castro's Presidential Campaign and Wellframe . 
• Practice leadership skills that include coaching, enabling, and ensuring that the right voices are present or represented within the team structure. 
• Build a leadership workshop for your team using the concepts addressed in this course.
• Practice asking meaningful questions as a way to encourage input and express authentic humility.
• Learn the difference between confirmatory and exploratory responses.

Earn Your Certificate

Enroll today in this course.

Still Have Questions?

What are the learning requirements? How do I list my certificate on my resume? Learn the answers to these and more in our FAQs.

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• Mathematics
• High School

The problem solving method may be used by health assistants to find solutions for problems. However, there are several items that health assistants must remember before implementing a plan:

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Final answer:

The problem-solving method can be used by health assistants to find solutions for problems. They need to identify the problem, gather information, and generate potential solutions.

Explanation:

The problem-solving method can be used by health assistants to find solutions for various problems that may arise in their field. Before implementing a plan, health assistants must remember certain important factors:

• Identify the problem: Health assistants need to clearly define the problem they are trying to solve, such as improving patient care or streamlining administrative processes.
• Gather information: Assisting health professionals should gather relevant data and information related to the problem, such as medical records, research studies, or best practices.
• Generate potential solutions: Using the gathered information, health assistants can brainstorm different solutions or options to address the problem.

By following these steps, health assistants can apply the problem-solving method effectively and efficiently in their work.

Learn more about problem-solving method here:

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Disparities in Health and Health Care: 5 Key Questions and Answers

Nambi Ndugga and Samantha Artiga Published: Apr 21, 2023

Introduction

The COVID-19 pandemic and nationwide racial justice movement over the past several years have heightened the focus on health disparities and their underlying causes and contributed to the increased prioritization of health equity. These disparities are not new and reflect longstanding structural and systemic inequities rooted in racism and discrimination. Although growing efforts have focused recently on addressing disparities, the ending of some policies implemented during the COVID-19 pandemic, including continuous enrollment for Medicaid and the Children’s Health Insurance Program (CHIP), may reverse progress and widen disparities. Addressing health disparities is not only important from an equity standpoint, but also for improving the nation’s overall health and economic prosperity. This brief provides an introduction to what health and health care disparities are, why it is important to address disparities, what the status of disparities is today, recent federal actions to address disparities, and key issues related to addressing disparities looking ahead.

What are health and health care disparities?

Health and health care disparities refer to differences in health and health care between groups that stem from broader inequities . There are multiple definitions of health disparities. Healthy People 2030 defines a health disparity, as “a particular type of health difference that is linked with social, economic, and/or environmental disadvantage,” and that adversely affects groups of people who have systematically experienced greater obstacles to health. The Centers for Disease Control and Prevention (CDC) defines health disparities as, “preventable differences in the burden, disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.” A health care disparity typically refers to differences between groups in health insurance coverage, affordability, access to and use of care, and quality of care. The terms “health inequality” and “inequity” are also sometimes used to describe unjust differences. Racism, which the CDC defines as the structures, policies, practices, and norms that assign value and determine opportunities based on the way people look or the color of their skin, results in conditions that unfairly advantage some and disadvantage others, placing people of color at greater risk for poor health outcomes.

Health equity generally refers to individuals achieving their highest level of health through the elimination of disparities in health and health care. Healthy People 2030 defines health equity as the attainment of the highest level of health for all people and notes that it requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and health and health care disparities. The CDC describes health equity as when everyone has the opportunity to be as healthy as possible.

A broad array of factors within and beyond the health care system drive disparities in health and health care (Figure 1) .  Though health care is essential to health, research shows that health outcomes are driven by multiple factors, including underlying genetics, health behaviors, social and environmental factors, and access to health care. While there is currently no consensus in the research on the magnitude of the relative contributions of each of these factors to health, studies suggest that health behaviors and social and economic factors, often referred to as  social determinants of health , are the primary drivers of health outcomes and that social and economic factors shape individuals’ health behaviors. Moreover,  racism  negatively affects mental and physical health both directly and by creating inequities across the social determinants of health.

Health and health care disparities are often viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions.  For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults. Federal efforts to reduce disparities focus on  designated priority populations , including, “members of underserved communities: Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBT+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.” These groups are not mutually exclusive and often intersect in meaningful ways. Disparities also occur within subgroups of populations. For example, there are differences among Hispanic people in health and health care based on length of time in the country, primary language, and immigration status . Data often also mask underlying disparities among subgroups within the Asian population.

Why is it important to address disparities?

Addressing disparities in health and health care is important not only from an equity standpoint but also for improving the nation’s overall health and economic prosperity . People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the overall health of the nation. Research further finds that health disparities are costly, resulting in excess medical care costs and lost productivity as well as additional economic losses due to premature deaths each year.

What is the status of disparities today?

Disparities in health and health care are persistent and prevalent. Major recognition of health disparities began more than three decades ago with the Report of the Secretary’s Task Force on Black and Minority Health (Heckler Report) in 1985, which documented persistent health disparities that accounted for 60,000 excess deaths each year and synthesized ways to advance health equity. The Heckler Report led to the creation of the U.S. Department of Health and Human Services Office of Minority Health and influenced federal recognition of and investment in many aspects of health equity. In 2003, the Institute of Medicine’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care released the report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care , which identified systemic racism as a major cause of health disparities in the United States. Despite the recognition and documentation of disparities for decades and overall improvements in population health over time, many disparities have persisted, and, in some cases, widened over time.

Beyond coverage, people of color and other marginalized and underserved groups continue to experience many disparities in accessing and receiving care . For example, people in rural areas face barriers to accessing care due to low density of providers and longer travel times to care, as well as more limited access to health coverage. There also are inequities in experiences receiving health care across groups. For example, the KFF/The Undefeated 2020 Survey on Race and Health , found that one in five Black adults and one in five Hispanic adults report being treated unfairly treatment due to their race or ethnicity while getting health care for themselves or a family member in the past year. Nearly one-quarter (24%) of Hispanic adults and over one in three (34%) potentially undocumented Hispanic adults reported that it was very or somewhat difficult to find a doctor who explains this in a way that is easy to understand in a 2021 KFF survey.  Other KFF survey data from 2022 found that nearly one in ten (9%) of nonelderly adult women who visited a health care provider in the past two years said they experienced discrimination because of their age, gender, race, sexual orientation, religion, or some other personal characteristic during a health care visit. KFF data also showed that LGBT+ people were more likely than their non-LGBT+ counterparts to report certain negative experiences while getting health care, including a doctor not believing they were telling the truth, suggesting they are personally to blame for a health problem, assuming something about them without asking, and/or dismissing their concerns. The 2023 KFF/The Washington Post Trans Survey found that trans adults were more likely to report having difficulty finding affordable health care or a provider who treated them with dignity and respect compared to cisgender adults.

The COVID-19 pandemic has taken a disproportionate toll on the health and well-being of people of color and other underserved groups. Cumulative age-adjusted data showed that AIAN and Hispanic people have had a higher risk for COVID-19 infection and AIAN, Hispanic, and Black people have had a higher risk for hospitalization and death due to COVID-19. Beyond these direct health impacts, the pandemic has negatively impacted the mental health, well-being, and social and economic factors that drive health for people of color and other underserved groups, including LGBT+ people . As such, the pandemic may contribute to worsening health disparities going forward.

Concerns about mental health and substance use have increased since the onset of the pandemic, particularly among some groups. According to a 2022 KFF/CNN survey , 90% of the public think there is a mental health crisis in the U.S. today. Over the course of the pandemic, many adults reported symptoms consistent with anxiety and depression. Additionally, drug overdose deaths have sharply increased – largely due to fentanyl – and after a brief period of decline, suicide deaths are once again on the rise. These negative mental health and substance use outcomes have disproportionately affected some populations, particularly communities of color and youth. Drug overdose death rates were highest among AIAN and Black people as of 2021. Alcohol-induced death rates increased substantially during the pandemic, with rates increasing the fastest among people of color and people living in rural areas. From 2019 to 2021, many people of color experienced a larger growth in suicide death rates compared to their White counterparts. Additionally, self-harm and suicidal ideation has increased faster among adolescent females compared to their male peers. Findings from a 2023 KFF/The Washington Post survey found that more trans adults reported struggling with serious mental health issues compared to cisgender adults and were six times as likely as cisgender adults to have engaged in self-harm in the previous year (17% vs. 3%). There are also substantial disparities in mental health, including suicidality, among LGBT+ youth compared to their non-LGBT+ peers.

What are recent federal actions to address disparities?

In the wake of the COVID-19 pandemic, there has been a heightened awareness of and focus on addressing health disparities. The disparate impacts of COVID-19 and coinciding racial reckoning following the police killing of George Floyd contributed to a growing awareness of racial disparities in health and their underlying causes, including racism. Early in his presidency, President Biden issued a series of executive orders focused on advancing health equity, including orders that outlined equity as a priority for the federal government broadly and as part of the pandemic response and recovery efforts . Federal agencies were directed with developing Equity Action Plans that outlined concrete strategies and commitments to addressing systemic barriers across the federal government. In its Health Equity Plan, the Department of Health and Human Services (HHS) outlined a series of new strategies, including addressing increased pregnancy and postpartum morbidity and mortality among Black and AIAN women; addressing barriers that individuals with limited English proficiency face in obtaining information, services, and benefits from HHS programs; leveraging grants to incorporate equity consideration into funding opportunities, implementing equity assessments across its major policies and programs; investing in resources to advance civil rights; and expanding contracting opportunities for small, disadvantaged businesses. The plan builds on earlier efforts that included increasing stakeholder engagement, establishing the Office of Climate Change and Health Equity , and establishing the National Institutes of Health UNITE Initiative to address structural racism and racial inequities in biomedical research. Since the release of its Equity Action Plan, HHS has taken actions to extend postpartum coverage through Medicaid and CHIP; issued rules to strengthen patient protections, including nondiscrimination protections; and issued nondiscrimination guidance to ensure that telehealth services are accessible to people with disabilities and those with limited English proficiency.

The Centers for Medicare and Medicaid Services (CMS) released an updated framework to advance health equity, expand health coverage, and improve health outcomes for people covered by Medicare, Medicaid, CHIP, and the Health Insurance Marketplaces. The framework outlined five priorities including expanding the collecting, reporting, and analysis of standardized data on demographics and social determinants of health; assessing the causes of disparities within CMS programs and addressing inequities in policies and operations; building capacity of health care organizations and the workforce to reduce disparities; advancing language access, health literacy, and the provision of culturally tailored services; and increasing all forms of accessibility to health services and coverage. The Administration has also identified advancing health equity and addressing social determinants of health as key priorities within Medicaid and has encouraged states to propose Section 1115 Medicaid waivers that expand coverage, reduce health disparities, and/or advance “whole-person care.” States have increasingly requested and/or received approval for waivers that aim to advance equity . Further, a growing number of states have approved or pending waivers with provisions related to addressing health-related social needs , such as food and housing, often focused on specific populations with high needs or risks.

The Administration and Congress have taken a range of actions to stabilize and increase access to health coverage amid the pandemic. Early in the pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA), which included a temporary requirement that Medicaid programs keep people continuously enrolled during the COVID-19 Public Health Emergency in exchange for enhanced federal funds. Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic, and the  uninsured rate  has dropped with differences in uninsured rates between people of color and White people narrowing. Coverage gains also likely reflected enhanced ACA Marketplace subsidies made available by the American Rescue Plan Act (ARPA) of 2021 and renewed for another three years in the Inflation Reduction Act of 2022, boosted outreach and enrollment efforts, a Special Enrollment Period for the Marketplaces provided in response to the pandemic, and low Marketplace attrition . Additionally, in 2019, the Biden Administration reversed changes the Trump Administration had previously made to public charge immigration policies that increased reluctance among some immigrant families to enroll in public programs, including health coverage. Most recently, the Consolidated Appropriations Act of 2023 included a requirement for all states to implement 12 months of continuous coverage for children, supporting their coverage stability. However, it also set the end of the broader Medicaid continuous enrollment provision for March 31, 2023, which could lead to coverage losses for millions of people, reversing recent coverage gains.

There have been growing federal efforts to address disparities in maternal health. Over the past few years, the Administration launched several initiatives focused on addressing inequities in maternal health. In April 2021, President Biden issued a proclamation to recognize the importance of addressing the high rates of maternal mortality and morbidity among Black people. At the end of 2021, the White House hosted its inaugural White House Maternal Health Day of Action during which areas of concern in maternal health outcomes were identified and the Administration announced actions aimed at solving the maternal health crisis. In June 2022, the Biden Administration released the Blueprint for Addressing the Maternal Health Crisis . The Blueprint outlines priorities and actions across federal agencies to improve access to coverage and care, expand and enhance data collection and research, grow and diversify the perinatal workforce, strengthen social and economic support, and increase trainings and incentives to support women being active participants in their care before, during and after pregnancy. In July 2022, CMS announced a Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period. ARPA included an option, made permanent in the  Consolidated Appropriations Act , to allow states  to extend Medicaid postpartum coverage  from 60 days to 12 months. As of April 2023, the majority of states  have taken steps to extend postpartum coverage. The Human Resources and Services Administration also announced $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program (RMOMS), which is designed to develop models and implement strategies to improve maternal health in rural communities.

The Administration has also taken steps to address health disparities and discrimination experienced among LGBT+ people. On his first day in office, President Biden signed an Executive Order on “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation.” Since then, the Administration has taken multiple actions to address discrimination within health care specifically. In May 2021, the Biden Administration announced that the HHS Office for Civil Rights (OCR) would include gender identity and sexual orientation as it interprets and enforces the ACA’s prohibition against sex discrimination (Section 1557), reversing the approach taken by the Trump Administration. Additionally, the Administration has spoken out against state actions aimed at curtailing access to gender affirming care for transgender and gender nonconforming people, particularly policies targeting youth. In January 2023, the Administration released its Federal Evidence Agenda on LGBTQI+ Equity , a “roadmap for federal agencies as they work to create their own data-driven and measurable SOGI Data,” which the Administration views as central to understanding disparities and discrimination facing this community.

What are key issues related to health disparities looking ahead?

The end of the Medicaid continuous enrollment provision may lead to coverage losses and widening disparities. Following the ending of the Medicaid continuous enrollment provision on March 31, 2023, states resumed Medicaid redeterminations. KFF estimates that between 5 and 14 million people could lose Medicaid coverage, including many who newly gained coverage during the pandemic. Other research shows that Hispanic and Black people are likely to be disproportionately impacted by the expiration of the continuous enrollment provision. Moreover, some groups, such as individuals with limited English proficiency and people with disabilities may face increased challenges in completing the Medicaid renewal process increasing their risk of coverage loss even if they remain eligible for coverage. OCR has reminded states of their obligations under federal civil rights laws to take reasonable steps to provide meaningful language access for individuals with limited English proficiency and ensure effective communication with individuals with disabilities to prevent lapses in coverage amid the unwinding of the continuous enrollment provision. CMS issued guidance that provides a roadmap for states to streamline processes and implement strategies to reduce the number of people who lose coverage even though they remain eligible. The extent to which states simplify processes to renew or transition to other coverage and provide outreach and assistance to individuals more likely to face challenges completing renewal processes will impact coverage losses and potential impacts on coverage disparities.

The end of the COVID-19 Public Health Emergency (PHE) and the potential depletion of the federally purchased supply of COVID-19 vaccines, treatments, and tests may curtail access to these supplies for some individuals, particularly those who are uninsured. In response to the COVID-19 pandemic, the federal government spent billions of dollars in emergency funds to purchase COVID-19 vaccines, including boosters, treatments, and tests to provide free of charge to the public. In addition, Congress enacted legislation that included special requirements for their coverage by both public and private insurers, and the Administration issued guidance and regulations to protect patient access and promote equitable distribution. The upcoming end to the PHE on May 11, 2023, as well as the potential depletion of federally purchased supplies in the absence of any additional funding, could result in new or higher cost-sharing and/or reduced access to these products although these impacts may vary by product and the type of health coverage an individual has. People who are uninsured or underinsured face the greatest risk of access challenges, including limited access to free vaccines and no coverage for treatment or tests. Since people of color and people with lower incomes are more likely to be uninsured, they may be at a disproportionate risk of facing barriers to accessing COVID-19 vaccines, tests, and treatments once the PHE ends and the federal supply is depleted.

The  overturning of  Roe v. Wade may exacerbate the already large racial disparities in maternal and infant health. The decision to overturn the longstanding Constitutional right to abortion and elimination of federal standards on abortion access has resulted in growing variation across states in laws protecting or restricting abortion. These changes may disproportionately impact women of color, as they are more likely to obtain abortions, have more limited access to health care, and face underlying inequities that would make it more difficult to travel out of state for an abortion compared to their White counterparts. Restricted access to abortions may widen the already stark racial disparities in maternal and infant health, as some groups of color are at higher risk of dying from pregnancy-related reasons and during infancy and are more likely to experience birth risks and adverse birth outcomes compared to White people. It may also have negative economic consequences associated with the direct costs of raising children and impacts on educational and employment opportunities. Further, women from underserved communities may be at increased risk for criminalization in a post-Roe environment, as prior to the ruling, there were already cases of women being criminalized for their miscarriages, stillbirths, or infant death, many of whom were low-income or women of color.

Many states have implemented policies banning or limiting access to gender affirming care, especially for youth, as well as other legal actions that threaten access to care for LGBT+ people . Policies aimed at limiting access to gender affirming care may have significant negative implications for the health of trans and nonconforming people, particularly young people, including negative mental health impacts, and an increased risk of suicidality . Additionally, the recent Braidwood case on preventive care access directly affects LGBT+ people in its treatment of Pre-Exposure Prophylaxis (PrEP). It relies, in part, on religious protections arguments to limit access to the drug based on the plaintiff’s claim that it “facilitate[s] and encourage[s] homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” If PrEP use declines as a result of the Braidwood decision, HIV incidence could increase , likely disproportionally impacting people of color and LGBT+ people. Efforts to curtail access to gender affirming care and the Braidwood decision are at odds with the Administration’s stated approach to health equity for LGBT+ people. How such policies play out in the longer term will be determined largely by the courts.

Evolving immigration policies may impact the health and well-being of immigrant families. When the PHE ends on May 11, 2023, Title 42 restrictions that suspended the entry of individuals at the U.S. border to protect public health during the COVID-19 emergency are expected to terminate. It is anticipated that when the authority ends, there will be an increase in immigrant activity at the U.S. border. The Biden Administration has announced  plans  to increase security and enforcement at the border to reduce unlawful crossings, expand “legal pathways for orderly migration”, invest additional resources in the border region, and partner with Mexico to implement the aforementioned plans. However, it remains to be seen how shifting policies will impact trends at the border and health and health care in that region. The future of the Deferred Action for Childhood Arrivals (DACA) program remains uncertain, and its implementation is currently limited subject to court orders . If the DACA program is found to be unlawful in pending court rulings, individuals would lose their DACA status and subsequently their work authorizations. The loss of status and work authorization may result in loss of employer-based health coverage, leaving people uninsured and unable to qualify for Medicaid, CHIP, or to purchase coverage through the Marketplaces. Additionally, although the Biden Administration reversed public charge regulations implemented by the Trump Administration as part of an effort to address immigration-related fears that limited immigrant families’ participation in government assistance programs, including Medicaid and CHIP, many families continue to have fears and concerns about enrolling in these programs, contributing to ongoing gaps in coverage for immigrants and children of immigrants.

Growing mental health and substance use concerns and ongoing racism, discrimination, and violence may contribute to health disparities. As previously noted, mental health and substance use concerns have increased since the onset of the pandemic, with some groups particularly affected. These trends may lead to new and widening disparities. For example, people of color have experienced larger increases in drug overdose death rates than White people, resulting in the death rate for Black people newly surpassing that of White people by 2020. Further, Black and Asian people have reported negative mental health impacts due to heightened anti-Black and anti-Asian racism and violence in recent years. Research has documented the negative health impacts, including negative impacts on mental health and well-being, of exposure to violence, including police and violence. Research shows African American and AIAN men and women, and Latino men are at increased risk of being killed by police compared to their White peers. Black and Hispanic adults also are more likely than White adults to worry about gun violence according to 2023 KFF survey data . Other KFF analysis shows that firearm death rates increased sharply among Black and Hispanic youth during the pandemic driven primarily by gun assaults and suicide by firearm. Research further shows that repeated and chronic exposure to racism and discrimination is associated with negative physical and mental health outcomes , including premature aging and associated health risks, referred to as “ weathering ,” as well as higher mortality .

Despite growing mental health concerns, people of color continue to face disproportionate barriers to accessing mental health care. Research suggests that  structural inequities  may contribute to disparities in use of mental health care, including lack of health insurance coverage and financial and logistical barriers to accessing care, stemming from broader inequities in  social and economic factors . Lack  of a diverse mental health care workforce, the  absence of culturally informed treatment options, and stereotypes  and  discrimination  associated with poor mental health may also contribute to limited mental health treatment among people of color.   Amid the pandemic, many states implemented telehealth behavioral health services to expand access to behavioral health care, and most states intend to keep these services. States are also adopting strategies to address workforce shortages in behavioral health. As states seek to expand access to behavioral health care, it will be important to ensure that services address the cultural and linguistic needs of diverse populations. Further, in 2022, the federal government mandated the suicide and crisis lifeline number that provides a single three-digit number (988) to access a network of over 200 local and state-funded crisis centers. The 988 number is expected to improve the delivery of mental health crisis care; however, it is unknown how well it will address the needs of people of color and other underserved populations.

In sum, disparities in health and health care for people of color and other underserved groups are longstanding challenges, many of which are driven by underlying structural and economic disparities rooted in racism. Addressing disparities is key not only from an equity standpoint but for improving the nation’s overall health and economic prosperity. Amid the COVID-19 pandemic, the federal government identified health equity as a priority and has since launched initiatives to address disparities wrought by the COVID-19 pandemic and more broadly. Alongside the federal government, states, local communities, private organizations, and providers have engaged in efforts to reduce health disparities. Moving forward, a broad range of efforts both within and beyond the health care system will be instrumental in reducing disparities and advancing equity.

• Racial Equity and Health Policy
• Coronavirus (COVID-19)
• Women's Health Policy
• Access to Care
• American Indian/Alaska Native
• Race/Ethnicity

Also of Interest

• How History Has Shaped Racial and Ethnic Health Disparities: A Timeline of Policies and Events
• Key Data on Health and Health Care by Race and Ethnicity
• Health Coverage by Race and Ethnicity, 2010-2022

A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services

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Dealing with Drug Problems

Preventing and Treating Drug Abuse

Drug abuse can be a painful experience—for the person who has the problem, and for family and friends who may feel helpless in the face of the disease. But there are things you can do if you know or suspect that someone close to you has a drug problem.

Certain drugs can change the structure and inner workings of the brain. With repeated use, they affect a person’s self-control and interfere with the ability to resist the urge to take the drug. Not being able to stop taking a drug even though you know it’s harmful is the hallmark of addiction.

A drug doesn’t have to be illegal to cause this effect. People can become addicted to alcohol, nicotine, or even prescription drugs when they use them in ways other than prescribed or use someone else’s prescription.

People are particularly vulnerable to using drugs when going through major life transitions. For adults, this might mean during a divorce or after losing a job. For children and teens, this can mean changing schools or other major upheavals in their lives.

But kids may experiment with drug use for many different reasons. “It could be a greater availability of drugs in a school with older students, or it could be that social activities are changing, or that they are trying to deal with stress,” says Dr. Bethany Deeds, an NIH expert on drug abuse prevention. Parents may need to pay more attention to their children during these periods.

The teenage years are a critical time to prevent drug use. Trying drugs as a teenager increases your chance of developing substance use disorders. The earlier the age of first use, the higher the risk of later addiction. But addiction also happens to adults. Adults are at increased risk of addiction when they encounter prescription pain-relieving drugs after a surgery or because of a chronic pain problem. People with a history of addiction should be particularly careful with opioid pain relievers and make sure to tell their doctors about past drug use.

There are many signs that may indicate a loved one is having a problem with drugs. They might lose interest in things that they used to enjoy or start to isolate themselves. Teens’ grades may drop. They may start skipping classes.

“They may violate curfew or appear irritable, sedated, or disheveled,” says child psychiatrist Dr. Geetha Subramaniam, an NIH expert on substance use. Parents may also come across drug paraphernalia, such as water pipes or needles, or notice a strange smell.

“Once drug use progresses, it becomes less of a social thing and more of a compulsive thing—which means the person spends a lot of time using drugs,” Subramaniam says.

If a loved one is using drugs, encourage them to talk to their primary care doctor. It can be easier to have this conversation with a doctor than a family member. Not all drug treatment requires long stays in residential treatment centers. For someone in the early stages of a substance use problem, a conversation with a doctor or another professional may be enough to get them the help they need. Doctors can help the person think about their drug use, understand the risk for addiction, and come up with a plan for change.

Substance use disorder can often be treated on an outpatient basis. But that doesn’t mean it’s easy to treat. Substance use disorder is a complicated disease. Drugs can cause changes in the brain that make it extremely difficult to quit without medical help.

For certain substances, it can be dangerous to stop the drug without medical intervention. Some people may need to be in a hospital for a short time for detoxification, when the drug leaves their body. This can help keep them as safe and comfortable as possible. Patients should talk with their doctors about medications that treat addiction to alcohol or opioids, such as heroin and prescription pain relievers.

Recovering from a substance use disorder requires retraining the brain. A person who’s been addicted to drugs will have to relearn all sorts of things, from what to do when they’re bored to who to hang out with. NIH has developed a customizable wallet card to help people identify and learn to avoid their triggers, the things that make them feel like using drugs. You can order the card for free at drugpubs.drugabuse.gov/publications/drugs-brain-wallet-card .

“You have to learn ways to deal with triggers, learn about negative peers, learn about relapse, [and] learn coping skills,” Subramaniam says.

NIH-funded scientists are studying ways to stop addiction long before it starts—in childhood. Dr. Daniel Shaw at the University of Pittsburgh is looking at whether teaching healthy caregiving strategies to parents can help promote self-regulation skills in children and prevent substance abuse later on.

Starting when children are two years old, Shaw’s study enrolls families at risk of substance use problems in a program called the Family Check-Up. It’s one of several parenting programs that have been studied by NIH-funded researchers.

During the program, a parenting consultant visits the home to observe the parents’ relationship with their child. Parents complete several questionnaires about their own and their family’s well-being. This includes any behavior problems they are experiencing with their child. Parents learn which of their children’s problem behaviors might lead to more serious issues, such as substance abuse, down the road. The consultant also talks with the parents about possible ways to change how they interact with their child. Many parents then meet with the consultants for follow-up sessions about how to improve their parenting skills.

Children whose parents are in the program have fewer behavioral problems and do better when they get to school. Shaw and his colleagues are now following these children through their teenage years to see how the program affects their chances of developing a substance abuse problem. You can find video clips explaining different ways parents can respond to their teens on the NIH Family Checkup website at www.drugabuse.gov/family-checkup .

Even if their teen has already started using drugs, parents can still step in. They can keep closer tabs on who their children’s friends are and what they’re doing. Parents can also help by finding new activities that will introduce their children to new friends and fill up the after-school hours—prime time for getting into trouble. “They don’t like it at first,” Shaw says. But finding other teens with similar interests can help teens form new habits and put them on a healthier path.

A substance use problem is a chronic disease that requires lifestyle adjustments and long-term treatment, like diabetes or high blood pressure. Even relapse can be a normal part of the process—not a sign of failure, but a sign that the treatment needs to be adjusted. With good care, people who have substance use disorders can live healthy, productive lives. 

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Drug Allergies

Opioid Facts for Parents

How Much Alcohol Is Too Much?

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Improve your grades with Brainly! Use verified answers, tutor chat support, and textbook solutions to make the As start rolling in. Brainly, the AI Learning Companion. Learn with Brainly — the world’s most popular homework help app! Get quick solutions from students and Experts, while enjoying features that make studying fast, easy, and fun! In just seconds, you can find correct solutions with step-by-step explanations to help you understand concepts, boost your knowledge, and improve your grades. - Scan a pic of your math equation or word problem to get answers in seconds using Brainly’s Scan to Solve feature! - Improve your grades using 24/7 access to AI Tutor and Live Expert support. - Get Expert-Verified homework answers from Community Q&A. - Find personalized, in-depth answers powered by AI. Get ahead in school while earning points, finding study buddies, competing with other students, and climbing the leaderboards. – Do you struggle with math? Math Solver to the rescue! If you’re stuck and confused, just scan a pic of the question for a fast answer in seconds, plus a step-by-step explanation. Algebra, geometry, trigonometry, or calculus: no equation is too tough for Brainly! Solve math equations and word problems at any school level — including AP and college courses. – Why have just one study buddy when you can have millions? Never study alone again with Brainly Community Q&A, where you can ask any question for Expert-Verified answers from users around the world! Our large community of Experts is available 24/7 to help you with any question in math, science, history, English, & other subjects. Our network of reliable moderators ensures that all the answers you get are correct and easy to understand. We also allow parents and children to pair accounts as part of our commitment to safety. – Struggling with any particular subject or topic? A Live Expert* will help you get back on track! Get in-depth guidance and see all the steps to make homework easier and exams less stressful. Understand complex concepts in science & math with your own learning guide at your fingertips! And for personalized AI support, you can switch to the AI Tutor for on-demand help, available in seconds. *This feature is available if you have a Brainly Tutor Plan. – Do you spend a lot of time searching for textbook answers? Explore Brainly's library of solutions for structured, step-by-step answers written by Experts. Find explanations for practice questions in STEM textbooks and more by searching for your book's grade, title, author, or ISBN. – What if we told you that studying can be fun? Competition thrives on Brainly with learning-based leaderboards, badges, and achievements. Make tough questions a competition for others as you get rewards for answering the trickiest questions. Learning can take a lot of effort, but it doesn’t need to be all work and no play. – Get more out of Brainly with Brainly Plus & Brainly Tutor! Access to Brainly is 100% free. However, if you want to enjoy all of Brainly’s features without ads, upgrade to Brainly Plus or Brainly Tutor. *** Get fun updates from us on: Instagram @brainly Facebook @brainlygroup Tiktok @brainly For any problems, reach out to our support team: https://brainly.com/contact | [email protected] Marketing: https://brainly.com Terms of use: https://brainly.com/pages/terms_of_use Privacy policy: https://brainly.com/pages/privacy_policy

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Brainly is a lifesaver. It is SOOOO helpful and my grades definitely wouldn’t be where they are now if it weren’t for Brainly. I struggle a bit in certain subjects and so if I need help I just go to Brainly and ask a question or search for a question others have asked and read explanations. You see, Brainly doesn’t just give you the answer, they give you a thorough step-by-step explanation that really helps you understand how to get to the correct answer. Helps me every time. I have paid $0 and I can still get so much homework assistance. I also really love Brainly AI because all you do is ask/scan the question and the AI gives you a PERFECT step-by-step explanation. I’ve tried other online [math] calculators that also give step-by-step explanations, but sometimes I don’t understand and just ask Brainly AI and I understand it much better. The best part is that you can use their AI for free :) I also really enjoy answering other people’s questions and I like how Brainly incorporates points and badges into the app because it keeps you motivated to ask questions and help other people as well. Great work! ❤️📚📎✏️

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I have been using the tutors to help me with some challenging questions for my math homework. Many have been very helpful but you’re only able to ask 20 questions a month. I have used 12/20 mostly because the tutors take me in then say they can’t solve the question and end the session. Because of this it has been using up the questions I can ask for this month. And when you loose connection it gets rid of all the tutors work and you have to ask a new tutor. Its really upsetting when you have waited to find out how to solve the question your struggling on for 10 or minutes to see oh you lost connection go find a new tutor. It happened to me once and all the other tutors gave me the wrong answer or said they didn’t know how to do it. One tutor was convinced what they got was the right answer but my teacher gives us the correct answers so we can check our work. I would have made a comment on it but then it said I lost connection. Which is really weird because I have really good wifi and it doesn’t say or do this on other apps. If this happens I wish there was a reconnect option. Just know when you sign up for brainly plus there is a chance the tutors won’t give you the correct answer. They are real people and won’t know how to do everything and can make minor mistakes within the problems. Just make sure you go through and check everything and that it makes sense to you before you end the session.

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Center for Gun Violence Solutions

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A Bold New Goal: Reduce Gun Violence 30% By 2030

Bold new goal: reduce gun violence 30% by 2030.

The Center for Gun Violence Solutions at the Johns Hopkins Bloomberg School of Public Health has a bold new goal to reduce gun violence 30% by 2030. In 2022, more than 48,000 people died by firearms in the United States, a 30% reduction would mean 14,400 lives saved. To reach this important goal, the Center will work with states and localities to implement 5 priority solutions that reduce gun violence.   

These solutions are:   

Firearm Purchaser Licensing  

• Safe and secure gun storage  
• Firearm removal laws such as Extreme Risk Protection Orders (also known as “red flag laws”)  
• Community Violence Intervention   
• Regulating the public carry of firearms   

Research shows that not only do these 5 solutions save lives but they are broadly supported by Americans across the political spectrum and with gun owners and non-gun owners alike. While there will be challenges ahead in making this goal a reality, the Center’s team is committed to advancing these research-based gun policies in order to save lives nationwide.   

“We have witnessed unprecedented momentum at the state level in the last couple of years and now is the time to focus on those efforts that can truly save lives.” says Joshua Horwitz, JD, co-director of the Center for Gun Violence Solutions. “I am optimistic that we can get this done."   

These 5 Save Lives  

The Center urges policymakers to pass this suite of firearm regulations to save lives and effectively combat the public health epidemic of gun violence.   

"Our policy priorities are associated with significant drops in gun violence,” says Cass Crifasi, PhD ‘14, MPH, co-director of the Center for Gun Violence Solutions. "These solutions take a public health approach, backed by research, that focuses on both firearm access and underlying risk factors that contribute to gun violence.”  

The policies are further outlined below.  

Effective gun violence prevention starts with Firearm Purchaser Licensing , also known as permit-to-purchase. Research shows this policy is associated with reductions in firearms trafficking and multiple forms of violence. Firearm Purchaser Licensing requires a person to get a permit/license before buying a firearm. The policy addresses gaps in federal law by including an enhanced background check, safety training, and a waiting period while the application is processed.   

State success stories offer a glimpse into what a nationwide strategy to implement these policies at the state-level could accomplish. Research shows Connecticut’s 1995 Handgun Licensing law was associated with a 28% reduction in the state’s firearm homicide rate and a 33% reduction in the state’s firearm suicide rate from 1996 to 2017.   

On the other hand, Missouri repealed its Handgun Licensing in 2007. This repeal was associated with a 25% increase in the annual firearm homicide rate during the first three years after the repeal and a 16% increase in the firearm suicide rate during the five years after the repeal.   

Firearm Purchaser Licensing is also extremely popular. A 2023 nationally representative survey from our Center showed 72% of respondents support requiring a person to obtain a license before buying a gun. 64% of gun owners agree.   

As of May 2024, 11 states and Washington, D.C. have a Firearm Purchaser Licensing law on the books. Delaware is the latest state to pass a Handgun Purchaser Licensing law after Governor John Carney signed the bill into law on May 16. The Center worked for years with grassroots groups including the Coalition for a Safer Delaware to support the passage of the policy.   

72% of Americans support requiring a person to obtain a license before buying a gun.

64% of gun owners support requiring a person to obtain a license before buying a gun

Firearm Removal Laws  

Firearm removal laws include two categories of risk-based firearm prohibitions: Extreme Risk Protection Orders and Domestic Violence Protection Orders. These laws are in place to prevent people at high risk of harm to self or others from owning or purchasing firearms. The policies use history and threats of violence to indicate when the justice system needs to become involved.    

Extreme Risk Protection Orders (ERPO ), also known as “red flag laws,” are civil court orders that temporarily restrict firearm access for those at high risk. Law enforcement, and, depending on the state’s ERPO law, others such as family or household members, may petition the court to temporarily restrict a person’s access to firearms when they are at elevated risk of harming themselves or others. ERPO laws include due process protections including notice, court hearing, and penalties for abuse of the program.  

Evidence shows “red flag laws” effectively reduce firearm suicides and homicides. In a study of 762 ERPO-style orders in Connecticut, researchers calculated that for every 10-20 orders issued, one suicide was prevented. In a separate analysis of a 6,800 orders from six states (CA, CO, CT, FL, MD, WA), researchers found 10% of ERPOs were issued in response to a threat of mass violence.  

Passing these laws is the first step. Implementing them is equally as important to reduce gun violence 30% by 2030. In 2023, the Center for Gun Violence Solutions worked with the Department of Justice to launch the National ERPO Resource Center . Center experts offer training and technical assistance to implementers across the country in states that already have passed ERPO laws.   

Domestic Violence Protection Orders (DVPOs), go hand-in-hand with “red flag laws.” These laws have been in place for decades to disarm those with a history of domestic violence and who are at the highest risk of causing harm to others. This policy is a key step in protecting some of those most vulnerable to gun violence. Evidence shows nearly half of all women murdered in the United States are killed by a current or former romantic partner. More than half of those homicides are by firearm.  

Domestic violence can also indicate a risk for mass violence. Researchers have found that perpetrators of 68.2% of mass shootings from 2014-2019 either killed family or intimate partners or had a history of domestic violence.   

Safe and Secure Gun Storage  

Gun owners are responsible for keeping their firearms out of the wrong hands. Evidence indicates 380,000 guns are stolen every year. Many of those firearms lead to injury and suicide. An estimated 82% of adolescent firearm suicides involve a gun belonging to a family member. 80% of school shooters under 18 years old used a firearm from their own home or the home of a family member or friend.  

Safe and secure gun storage laws require owners to lock firearms when not being used. Strong policies require firearms to be stored locked, unloaded and separate from ammunition. Certain laws focus specifically on children, Child Access Prevention laws create criminal penalties for unresponsible firearm storage that leads to a child gaining access to the firearm. Multiple studies have shown Child Access Prevention laws lead to statistically significant reductions in teen firearm suicides and unintentional injuries among children.   

Regulating Public Carry of Firearms  

The research is clear – the higher rate of firearm ownership, the higher risk of firearm violence. When people are allowed to bring firearms in public with permissive concealed carry laws, violence rates increase. Over the past 40+ years, many states have moved in the wrong direction – making it easier to carry a firearm in public without a license. Various studies have found weakened concealed carry policies are associated with higher rates of overall firearm assaults, violent crime, shootings by police and rates of firearm homicide in the workplace.   

To create an equitable and effective solution, states and municipalities should pass laws prohibiting open carry of firearms entirely. Furthermore, states should strongly regulate concealed carry of firearms by requiring a rigorous permitting process. This includes mandatory live firearm safety training and a ban on those with violent misdemeanors from obtaining a concealed carry license. Additionally, states should prohibit concealed carry in sensitive places like government buildings, polling places and protests.  

Community Violence Intervention  

The Center understands that gun violence disproportionately affects certain communities, especially Black Americans. As a whole, Black Americans suffer from a 14 times higher gun homicide rate than their white peers. Community Violence Interventions can help reduce this problem.  

The Center recommends two types of programs. Violence interruption programs use credible members of the community who are trained to help interrupt the cycle of violence. They help connect people who are at the highest risk of causing and being victimized by gun violence to social services. Similarly, Violence Reduction Councils are cooperative groups of law enforcement, community members, and service providers who analyze firearm violence in their city. The group identifies gaps in the system and opportunities to intervene. After their examination, the council develops policy recommendations to improve how the city addresses the underlying risk factors for violence.   

Improving a community’s environment can also lower risk factors. Research shows that reducing blighted lots, alcohol outlets, and vacant buildings can also reduce gun violence in a community. Better street lighting and community gardens can also make a big difference.   

The Way Forward

The Johns Hopkins Center for Gun Violence Solutions is charting a transformative path to reduce gun violence by 30% by 2030. Through a rigorous, evidence-based public health approach, the Center is spearheading key initiatives such as Firearm Purchaser Licensing, Extreme Risk Protection Orders, Domestic Violence Protection Orders, safe storage laws, public carry laws, and Community Violence Intervention. These measures are supported by research and data demonstrating their efficacy in saving lives. The Center’s goal also emphasizes the importance of addressing underlying risk factors and community-specific interventions to create safer environments.  

As the Center continues to collaborate with policymakers, law enforcement, and community organizations, it remains committed to driving meaningful change through advocacy efforts and implementing effective solutions nationwide. By treating gun violence as a public health emergency, we hope to create a safer future for all people in the United States.   

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Degree In Sight

The science of creativity

Use these empirically backed tips to capture your next big idea.

Print version: page 14

Stress is a well-known creativity killer, says psychologist Robert Epstein, PhD. Time constraints are another, he says. Unfortunately, graduate school has both in spades, and that can sap the inspiration of even the most imaginative students.

"When you're in graduate school, there are so many constraints on you. It's detrimental to creative expression," says Epstein, author of "The Big Book of Creativity Games" (McGraw-Hill, 2000).

Yet it's almost impossible to conquer any graduate school activity without at least some innovative thinking. Collaborating with other researchers, finding a subfield that excites you, maneuvering your way through an unexpected set of findings, and balancing the demands of your work and home life all require creative problem-solving.

Despite the widely held belief that some people just aren't endowed with the creativity gene, "There's not really any evidence that one person is inherently more creative than another," Epstein says.

Instead, he says, creativity is something that anyone can cultivate.

Routine creativity

Epstein, a visiting scholar at the University of California, San Diego, has conducted research showing that strengthening four core skill sets leads to an increase in novel ideas.

"As strange as it sounds, creativity can become a habit," says creativity researcher Jonathan Plucker, PhD, a psychology professor at Indiana University. "Making it one helps you become more productive."

Epstein recommends that you:

Capture your new ideas. Keep an idea notebook or voice recorder with you, type in new thoughts on your laptop or write ideas down on a napkin.

Seek out challenging tasks. Take on projects that don't necessarily have a solution—such as trying to figure out how to make your dog fly or how to build a perfect model of the brain. This causes old ideas to compete, which helps generate new ones.

Broaden your knowledge. Take a class outside psychology or read journals in unrelated fields, suggests Epstein. This makes more diverse knowledge available for interconnection, he says, which is the basis for all creative thought. "Ask for permission to sit in on lectures for a class on 12th century architecture and take notes," he suggests. "You'll do better in psychology and life if you broaden your knowledge."

Surround yourself with interesting things and people. Regular dinners with diverse and interesting friends and a work space festooned with out-of-the-ordinary objects will help you develop more original ideas, Epstein says. You can also keep your thoughts lively by taking a trip to an art museum or attending an opera—anything that stimulates new thinking.

A study last year in the Creativity Research Journal (Vol. 20, No. 1), found that working on these four areas enhances creativity. Seventy-four city employees from Orange County, Calif., participated in creativity training seminars consisting of games and exercises developed by Epstein to strengthen their proficiency in these four skill sets. Eight months later, the employees had increased their rate of new idea generation by 55 percent—a feat that led to more than $600,000 in new revenue and a savings of about $3.5 million through innovative cost reductions.

Happy, rested and bright

Many practices that lead to better overall well-being also boost innovative thinking. For instance, creativity researchers suggest you:

Sleep on it. In a 1993 study at Harvard Medical School, psychologist Deidre Barrett, PhD, asked her students to imagine a problem they were trying to solve before going to sleep and found that they were able to come up with novel solutions in their dreams. In the study, published in Dreaming (Vol. 3, No. 2), half of the participants reported having dreams that addressed their chosen problems, and a quarter came up with solutions in their dreams.

"We're in a different biochemical state when we're dreaming, and that's why I think dreams can be so helpful anytime we're stuck in our usual mode of thinking," Barrett says.

A 2004 study in Nature (Vol. 427, No. 6,972) also shows just how powerful sleep may be in helping people solve problems. Researchers at the University of Lübeck in Germany trained participants to solve a long, tedious math problem. Eight hours later, when participants returned for retesting, those who had slept during the break were more than twice as likely to figure out a simpler way to solve the problem than those who had not slept.

Collaborate—in writing. Plucker notes that much psychological research has shown that we overestimate the success of group brainstorming. Instead of working together to generate great ideas, group members often fail to share their ideas for fear of rejection. Yet research led by psychologist Paul Paulus, PhD, of the University of Texas at Arlington, points to the surprising effectiveness of group "brainwriting," in which group members write their ideas on paper and pass them to others in the group who then add their own ideas to the list. In a 2000 Organizational Behavior and Human Decision Processes (Vol. 82, No. 1) study led by Paulus, an interactive group of brainwriters produced 28 percent more possible uses for a paper clip than a similar group of solitary brainwriters. This may be because group members tend to build off one another's ideas, leading to increased creativity and innovation. The effects of group brainwriting may even extend to groups that collaborate via e-mail, Paulus notes.

Let the sunshine in. Research by Washington State University professor of interior design Janetta Mitchell McCoy, PhD, suggests that spending time in natural settings may boost creativity. In a 2002 Creativity Research Journal (Vol. 14, No. 3.4) study led by McCoy, high school students designed more innovative collages—as judged by six independent raters—in a setting high in direct sunlight and natural wood than in a space mainly finished with manufactured materials such as drywall and plastic.

Get happy. A 2004 Creativity Research Journal (Vol. 16, No. 2.3) study with undergraduates found that sadness inhibits new ideas. This may be because when people are sad, they are more wary of making mistakes and exercise more restraint, says study author Karen Gasper, PhD, a social psychology professor at Penn State University.

Past research also supports the creativity boost gained from happiness. Compared with people in sad or neutral moods, those in happy moods are better at coming up with unusual word associations, developing patient diagnoses, solving moral dilemmas, generating story endings and writing numerous answers to divergent thinking tasks, Gasper notes.

To avoid being overly cautious and stagnant in their work, Gasper recommends that students remember to have fun. "Take a walk, see a comedy, go out with a friend," she says. "These breaks may help you feel better and see your work in a new light."

By Amy Novotney gradPSYCH Staff

FURTHER READING, RESOURCES

Robert Epstein's empirically validated online creativity test can be found at http://mycreativityskills.com .

Barrett, D. (2001). The committee of sleep: How artists, scientists, and athletes use dreams for creative problem-solving—and how you can too . New York: Crown.

Epstein, R. (2000). The big book of creativity games . New York: McGraw-Hill.

Richards, R. (Ed.). (2007). Everyday Creativity and New Views of Human Nature: Psychological, Social, and Spiritual Perspectives . Washington, DC: APA.

Runco, M.A., Pritzker, S. (1999). Encyclopedia of creativity . San Diego, CA: Academic Press.

Sawyer, R.K. (2006). Explaining Creativity: The Science of Human Innovation . New York: Oxford University Press.

Sternberg, R.J., Grigorenko, E.L., Singer, J.L. (Eds.). (2004). Creativity: From Potential to Realization . Washington, DC: APA.

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