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domains/health/Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md

@@ -34,14 +34,14 @@ This data powerfully validates [[the epidemiological transition marks the shift
 
 
 ### Additional Evidence (extend)
-*Source: [[2026-03-20-annals-internal-medicine-obbba-health-outcomes]] | Added: 2026-03-20*
+*Source: 2026-03-20-annals-internal-medicine-obbba-health-outcomes | Added: 2026-03-20*
 
 OBBBA adds a second mechanism for US life expectancy decline: policy-driven coverage loss (16,000+ preventable deaths annually, per Annals of Internal Medicine peer-reviewed study). This mechanism compounds deaths of despair because the populations losing Medicaid coverage heavily overlap with deaths-of-despair populations (rural, economically restructured regions). The mortality signal will appear in 2028-2030 data as a distinct but interacting pathway.
 
 ---
 
 ### Additional Evidence (extend)
-*Source: [[2026-03-10-abrams-bramajo-pnas-birth-cohort-mortality-us-life-expectancy]] | Added: 2026-03-24*
+*Source: 2026-03-10-abrams-bramajo-pnas-birth-cohort-mortality-us-life-expectancy | Added: 2026-03-24*
 
 PNAS 2026 cohort analysis shows the deaths-of-despair framing is incomplete: post-1970 US birth cohorts show mortality deterioration not just in external causes (overdoses, suicide) but also in cardiovascular disease and cancer simultaneously. The problem is multi-causal across all three major cause categories, not primarily driven by external causes.
 

domains/health/SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action.md

@@ -19,37 +19,37 @@ The near-term trajectory: mandatory outpatient screening by 2026, Z-code adoptio
 
 
 ### Additional Evidence (extend)
-*Source: [[2024-09-19-commonwealth-fund-mirror-mirror-2024]] | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
+*Source: 2024-09-19-commonwealth-fund-mirror-mirror-2024 | Added: 2026-03-12 | Extractor: anthropic/claude-sonnet-4.5*
 
 The Commonwealth Fund's 2024 international comparison provides quantified evidence of the population-level cost of not operationalizing SDOH interventions at scale. The US ranks second-worst on equity (9th of 10 countries) and last on health outcomes (10th of 10), with the highest healthcare spending (>16% of GDP). This outcome gap relative to peer nations with lower spending demonstrates the opportunity cost of the US healthcare system's failure to systematically address social determinants. Countries with better equity and access outcomes (Australia, Netherlands) achieve superior population health despite similar or lower clinical quality and lower spending ratios. The international comparison quantifies what the SDOH adoption gap costs: the US achieves worst population health outcomes among wealthy peer nations despite world-class clinical care, suggesting that the 3% Z-code documentation rate represents billions in foregone health gains.
 
 
 ### Additional Evidence (challenge)
-*Source: [[2025-04-07-tufts-health-affairs-medically-tailored-meals-50-states]] | Added: 2026-03-18*
+*Source: 2025-04-07-tufts-health-affairs-medically-tailored-meals-50-states | Added: 2026-03-18*
 
 The JAMA Internal Medicine 2024 RCT testing intensive food-as-medicine intervention (10 meals/week + education + coaching for 1 year) found NO significant difference in HbA1c, hospitalization, ED use, or total claims between treatment and control groups. This challenges the assumption that SDOH interventions produce strong ROI—the RCT evidence shows null clinical outcomes despite addressing food insecurity directly.
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-09-01-lancet-public-health-social-prescribing-england-national-rollout]] | Added: 2026-03-18*
+*Source: 2025-09-01-lancet-public-health-social-prescribing-england-national-rollout | Added: 2026-03-18*
 
 England's social prescribing provides international counterpoint: 1.3M annual referrals with 3,300 link workers represents the operational infrastructure that US SDOH interventions lack. However, UK achieved scale without evidence quality - 15 of 17 economic studies were uncontrolled, 38% attrition, SROI ratios of £1.17-£7.08 but ROI only 0.11-0.43. This suggests infrastructure alone is insufficient without measurement systems.
 
 
 ### Additional Evidence (extend)
-*Source: [[2025-01-01-nashp-chw-state-policies-2024-2025]] | Added: 2026-03-18*
+*Source: 2025-01-01-nashp-chw-state-policies-2024-2025 | Added: 2026-03-18*
 
 Community health worker programs demonstrate the same payment boundary stall: only 20 states have Medicaid State Plan Amendments for CHW reimbursement 17 years after Minnesota's 2008 approval, despite 39 RCTs showing $2.47 ROI. The billing infrastructure bottleneck is identical to Z-code documentation failure — SPAs typically use 9896x CPT codes but uptake remains slow because community-based organizations lack contracting infrastructure and Medicaid does not cover provider travel costs (the largest CHW overhead expense). 7 states have established dedicated CHW offices and 6 enacted new reimbursement legislation in 2024-2025, but the gap between evidence (strong) and operational infrastructure (absent) mirrors the SDOH screening-to-action gap.
 
 
 ### Additional Evidence (challenge)
-*Source: [[2025-01-01-produce-prescriptions-diabetes-care-critique]] | Added: 2026-03-18*
+*Source: 2025-01-01-produce-prescriptions-diabetes-care-critique | Added: 2026-03-18*
 
 The Diabetes Care perspective challenges the 'strong ROI' claim for SDOH interventions by questioning whether produce prescriptions—a specific SDOH intervention—actually produce clinical outcomes. The observational evidence showing improvements may reflect methodological artifacts (self-selection, regression to mean) rather than true causal effects. This suggests the ROI evidence for SDOH interventions may be weaker than claimed, particularly for single-factor interventions like food provision.
 
 
 ### Additional Evidence (challenge)
-*Source: [[2026-03-20-ccf-second-reconciliation-bill-healthcare-cuts-2026]] | Added: 2026-03-20*
+*Source: 2026-03-20-ccf-second-reconciliation-bill-healthcare-cuts-2026 | Added: 2026-03-20*
 
 The RSC's second reconciliation bill proposes site-neutral payments that would eliminate the enhanced FQHC reimbursement rates (~$300/visit vs ~$100/visit) that fund CHW programs. Combined with OBBBA's Medicaid cuts, this creates a two-vector attack on the institutional infrastructure that hosts most CHW programs. The challenge is not just documentation and operational infrastructure—the payment foundation itself is under legislative threat. Even if Z-code documentation improved and operational infrastructure was built, the revenue model that makes CHW programs economically viable within FQHCs would be eliminated by site-neutral payments.
 

inbox/queue/2025-05-01-jama-cardiology-cardia-food-insecurity-incident-cvd-midlife.md

@@ -41,9 +41,9 @@ Published: JAMA Cardiology 10(5):456-462, May 2025 (released online March 2025).
 
 **KB connections:**
 - [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]] — food insecurity as co-mechanism
-- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic]] — UPF as the specific food insecurity mechanism
-- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate]] — food insecurity here is a SDOH, not a medical factor
-- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent]] — clinical integration gap
+- Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic — UPF as the specific food insecurity mechanism
+- medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate — food insecurity here is a SDOH, not a medical factor
+- SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent — clinical integration gap
 - From Session 16: UPF → inflammation → hypertension (AHA REGARDS cohort) + five SDOH factors for hypertension non-control
 
 **Extraction hints:**