Objective: Health planners and policy makers are increasingly asking for a feasible method to identify vulnerable persons with the greatest health needs. We conducted a systematic review of the association between a single item assessing general self‐rated health (GSRH) and mortality. Data Sources: Systematic MEDLINE and EMBASE database searches for studies published from January 1966 to September 2003. Review Methods: Two investigators independently searched English language prospective, community‐based cohort studies that reported (1) all‐cause mortality, (2) a question assessing GSRH; and (3) an adjusted relative risk or equivalent. The investigators searched the citations to determine inclusion eligibility and abstracted data by following a standarized protocol. Of the 163 relevant studies identified, 22 cohorts met the inclusion criteria. Using a random effects model, compared with persons reporting “excellent” health status, the relative risk (95% confidence interval) for all‐cause mortality was 1.23 [1.09, 1.39], 1.44 [1.21, 1.71], and 1.92 [1.64, 2.25] for those reporting “good,”“fair,” and “poor” health status, respectively. This relationship was robust in sensitivity analyses, limited to studies that adjusted for co‐morbid illness, functional status, cognitive status, and depression, and across subgroups defined by gender and country of origin. Conclusions: Persons with “poor” self‐rated health had a 2‐fold higher mortality risk compared with persons with “excellent” self‐rated health. Subjects' responses to a simple, single‐item GSRH question maintained a strong association with mortality even after adjustment for key covariates such as functional status, depression, and co‐morbidity.

Objective. We compared single-and multi-item measures of general self-rated health (GSRH) to predict mortality and clinical events a large population of veteran patients. Data Source/Study Setting. We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality-of-care interventions. Study Design. We created an age-adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c-statistic for the single-and multi-item measures. Data Collection/Extraction Methods. All patients were sent a baseline assessment that included a multi-item measure of general health, the 36-item Medical Outcomes Study Short Form (SF-36), and an inventory of comorbid conditions. We compared the predictive and discriminative ability of the GSRH to the SF-36 physical component score (PCS), the mental component score (MCS), and the Seattle index of comorbidity (SIC). The GSRH is an item included in the SF-36, with the wording: ''In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?'' Principal Findings. The GSRH, PCS, and SIC had comparable AUC for predicting mortality (AUC 0.74, 0.73, and 0.73, respectively); hospitalization (AUC 0.63, 0.64, and 0.60, respectively); and high outpatient use (AUC 0.61, 0.61, and 0.60, respectively). The MCS had statistically poorer discriminatory performance for mortality and hospitalization than any other other predictors ( po.001). Conclusions. The GSRH response categories can be used to stratify patients with varying risks for adverse outcomes. Patients reporting ''poor'' health are at significantly greater odds of dying or requiring health care resources compared with their peers. The GSRH, collectable at the point of care, is comparable with longer instruments.

Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.

Our single-item, GSRH questions demonstrated good reproducibility, reliability, and strong concurrent and discriminant scale performance with an established health status measure.

OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross-sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty-five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m 2 ) was estimated using the fourvariable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score 1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (Po.05). In addition, participants with advanced CKD (eGFRo30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI 5 1.1-3.9), naming (AOR 5 1.9, 95% CI 5 1.0-3.3), attention (AOR 5 2.4, 95% CI 5 1.3-4.5), executive function (AOR 5 2.5, 95% CI 5 1.9-4.4), and delayed memory (AOR 5 1.5, 95% CI 5 0.9-2.6) but not on category fluency (AOR 5 1.1, 95% CI 5 0.6-2.0) than those with mild to moderate CKD (eGFR 45-59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment. J Am Geriatr Soc 58: 338-345, 2010.