This issue of the Journal is devoted to adult health. As with other essential public health priorities, this vital topic rarely makes headlines. Perhaps more disquieting an oversight is that adult health is often relegated to the background rather than promoted as the theme title of health journals, including this one. Part of the reason for this dearth of attention may be that adults themselves often take their health for granted—that is, of course, until illnesses or disabilities preclude them from engaging in their usual activities as income earners, caretakers, and homemakers.
According to the US Census Bureau, adults aged 18 years or older comprise three quarters of the US population and adults aged 18 to 64 years constitute nearly two thirds (see http://www.census.gov). When the aging of the population is discussed, the conversation tends to focus on the one eighth of the population aged 65 years and older. Yet to meaningfully prevent chronic diseases and injuries in later years and ensure that the majority of people live healthy lives free from pain and disability, adult health requires increased public health attention throughout the life course. Hence, the collection of papers in this issue is intended to bring the health and health care of adults to the forefront of concern.
Using new insights, methodologies, and analyses, the determinants of adult health at multiple levels are articulated and tested by the scientists whose work appears herein. At the US national level, meritocratic ideology—the notion that personal and societal rewards are equitably bestowed to those who work hard—may act as a negative health determinant for African Americans, as argued by Kwate and Meyer (p. 1831). At the community level, Burton et al. found that adults living in impoverished census tracts are at increased risk of bacteremic pneumonia and should be targeted for prevention efforts (p. 1904). Finally, at the organizational and individual levels, injuries from assaults to nursing assistants were strongly associated with mandatory overtime and not having enough time to assist nursing home residents with their activities of daily living; hence, Tak et al. (p. 1938) recommended prioritizing interventions at nursing homes that care for cognitively impaired patients.
Certain groups of adults suffer disparities in health compared with the general population given unequal access to health-promoting resources and elevated exposure to adversity. For instance, Peterman et al. determined that Cambodian refugee women who experienced extensive food deprivation and insecurity may be more likely to engage in unhealthful eating practices and more likely to be overweight or obese than would those who experienced less extreme food deprivation and insecurity (p. 1930). Further, Conron et al. concluded that sexual orientation disparities in chronic disease risk and victimization, as well as in health care access, mental health, and smoking, merit increased attention, while calling for research on heterogeneity in health and health determinants among sexual minorities (p. 1953).
It is never too early to intervene to promote adult health and address health disparities. Neidell et al. found that community water fluoridation (CWF) levels in the county of residence at the time of the respondent's birth were significantly related to tooth loss, but current CWF levels were not (p. 1980). Moreover, the impact of CWF exposure was larger for lower versus higher educated individuals and for African Americans versus Whites, suggesting that the “universal coverage” provided by CWF may have reduced socioeconomic and racial disparities in oral health.
With the aging of the population in the United States and around the world, adult health can no longer be an afterthought. Only through collective action to address the social determinants of health and eliminate social disparities in health can adults fulfill their essential societal and personal roles and enjoy health as the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.