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May 2021

New tool tracks health disparities in U.S.

A coalition of researchers and advocates launched a tool this week they hope will fill some of the gaps in data on racial disparities in the U.S. health system (Source: “A new tool tracks health disparities in the U.S. — and highlights major data gaps,” Stat News, May 26).

The Health Equity Tracker is a portal that collects, analyzes and makes visible data on some of the inequities entrenched in U.S. medicine.

“For far too long it’s been ‘no data, no problem,’” said Nelson Dunlap, chief of staff at the Satcher Health Leadership Institute at Morehouse School of Medicine, which developed the tool with funding and resources from Google.org, Gilead Sciences, Annie E. Casey Foundation and CDC Foundation.

By making data accessible that highlights racial health disparities, the tracker aims to empower local advocates to drive change in their communities — and inspire action to fill in holes in data that are themselves reinforced by structural racism. In the tracker’s display, 38% of federally-collected COVID-19 cases report unknown race and ethnicity.


AMA announces plan to combat racism in U.S. health system

The nation’s largest doctors group earlier this month released a  plan aimed at dismantling structural racism inside its own ranks and within the U.S. medical establishment (Source: “US doctors group issues anti-racism plan for itself, field,” Associated Press, May 11).

The American Medical Association’s plan has been in the works for more than a year. The group’s leaders said health inequities highlighted by the pandemic, ongoing police brutality and recent race-based crimes have given the effort a sense of urgency.

The AMA plan calls for more than diversifying its staff and adding members who are from Black, Hispanic, Indigenous and LGBTQ communities. It aims to embed anti-racist activities and education at every level of the organization. The influential advocacy group also plans to use its clout to advocate for health equity public policies and to create and deliver anti-racist training for medical students, doctors and health systems.


Most and least racially inclusive hospitals often in same city, new analysis finds

A new ranking of U.S. hospitals’ racial inclusivity suggests that many of the country’s most segregated hospitals are in urban areas and that top and bottom performers are frequently located within the same city (Source: “In many U.S. cities, most and least racially inclusive hospitals are neighbors, Lown Institute says,” Fierce Healthcare, May 25).

Further, the Lown Institute analysis placed more than twice as many “elite hospitals” named to U.S. News’ Honor Roll in the bottom third of the racial inclusivity ranking than it did in the upper third.

“The difference between the most and least inclusive hospitals is stark, especially when they are blocks away from each other,” Vikas Saini, M.D., president of the Lown Institute. “As the nation reckons with racial injustice, we cannot overlook our health system. Hospital leaders have a responsibility to better serve people of color and create a more equitable future.”

Announced today by the Lown Institute, the list ranks more than 3,200 hospitals using Medicare claims and U.S. Census Bureau data from 2018. The group awarded higher scores if the hospital served a greater proportion of non-white Medicare patients compared to the demographics of its surrounding community.

Both Cincinnati and Cleveland made the Institute’s list of the 25 U.S. cities with the most segregated systems.


Rural areas of Ohio, U.S. lag behind in COVID-19 vaccine rates

Just 32% of the eligible population in Ohio’s 15 least populous counties are vaccinated, on average, according to an analysis of data from the Ohio Department of Health (Source: “In Ohio and U.S., vaccine coverage lags in rural areas,” Ohio Capital Journal, May 20).

This trails both the statewide and national average (about 48%), adding another piece to a vexing puzzle of vaccine hesitancy.

On Tuesday, the CDC published research finding the trend holds nationwide: COVID-19 vaccination coverage was lower in rural counties (38.9%) than urban counties (45.7%), according to an analysis of data from adults aged 18-and-up between Dec. 14 and April 10.

For Ohio, the split was slightly broader: 37.2% in rural counties vs. 45.3% in urban counties, according to the CDC.


Surprise billing laws may lead to increased health care costs, experts warn

New state laws designed to protect patients from being hit with steep out-of-network medical bills may contribute to higher health care costs and premiums, some researchers warn (Source: “Laws to Curb Surprise Medical Bills Might Be Inflating Health Care Costs,” Stateline, May 20).

Lawmakers and advocates who pushed for surprise billing laws say the measures have protected consumers from some of the most egregious bills, which can climb into the hundreds of thousands of dollars. But some researchers recently have raised alarms that doctors and other medical providers are leveraging state laws that rely on arbitration to increase in-network fees, thereby raising health care costs for everyone.

Eighteen states (including Ohio) have passed surprise billing laws since 2014, most of them in the past three years. Last year, former President Donald Trump signed a federal version that covers self-funded health plans, including those offered by many employers, as opposed to the individual and commercial health plans regulated by states.


Study links air pollution to reduced cognitive ability

New research suggests that even short-term exposure to polluted air, at levels generally considered “acceptable,” may impair mental ability in the elderly (Source: “Air Pollution Takes a Toll on the Brain,” New York Times, May 17).

The study of 954 men, average age 69, living in the greater Boston area found that higher levels of PM 2.5, particles of soot and other fine particulate matter with a diameter of up to 2.5 microns, were consistently associated with lower cognitive test scores. The study, in Nature Aging, adjusted for age, BMI, coronary heart disease, diabetes, alcohol consumption, smoking, high blood pressure and other factors.

Dr. Andrea A. Baccarelli, the senior author and a professor of environmental science at the Columbia Mailman School of Public Health, said that these short-term effects may be reversible. “When air pollution goes down,” he said, “the brain reboots and goes back to normal. However, if repeated, these episodes produce long-term damage to the brain.”

“Some of these particles come from natural sources — sea salt, for example, soil and pollen,” Dr. Baccarelli added. “We’ll never be completely free of them. But the ones generated by humans are much worse. The good news is that we’re at a point where we have the technology to reduce air pollution even further.”


Ohio updates mask mandate to align with new CDC guidance

Vaccinated Ohioans will no longer need to wear masks under state health orders that will be revised to align with guidance from the Centers for Disease Control and Prevention (Source: “Ohio will change mask mandate for vaccinated Ohioans to follow CDC guidance,” Columbus Dispatch, May 14).

The orders will still require masks and social distancing for people who have not been vaccinated, Gov. Mike DeWine said Friday in a statement.

The revised order will stay in place until June 2, when remaining health orders that don't apply to long-term care or data collection will be lifted.

DeWine said Ohioans will have ample time before then to get vaccinated, and the state is awarding cash prizes and college scholarships to individuals who get at least one dose of a coronavirus vaccine.


Biden administration announces $7.4 billion in public health spending

The White House announced Thursday that it is investing $7.4 billion to hire more public health workers to deal with the coronavirus pandemic and future health crises (Source: “Biden announces $7.4 billion to hire more public health workers amid pandemic,” Washington Post, May 13).

The money will come from the $1.9 trillion coronavirus relief package, which Congress passed in March.

The Biden administration said $4.4 billion will go toward boosting states’ overstretched public health departments, allowing them to hire disease specialists to do contact tracing, case management, and support outbreak investigations and school nurses to help schools reopen. Some of the money will also go to expanding the Epidemic Intelligence Service at the Centers for Disease Control and Prevention — which plays a critical role in containing outbreaks.

The remaining $3 billion will be used to create a new grant program to train and modernize the country’s public health workforce. Applicants for those grants will be asked to prioritize recruiting staff from the communities they will serve, especially those from underrepresented backgrounds.

HPIO’s 2021 Health Value Dashboard, which was released last month, found that one reason Ohio ranks poorly on health value (47th out of the 50 states and D.C.) is that the state’s sparse public health workforce leads to missed opportunities for prevention. Data in the Dashboard shows that only three states spend less on public health than Ohio.


Ohio’s plan for targeted naloxone distribution raises questions

Ohio’s plan to launch a targeted deployment of naloxone is being questioned by one of the state’s partners that says it does not distribute the drug to communities most in need (Source: “Ohio's plan to distribute an anti-OD drug triggers questions, claims of racial bias,” Cincinnati Enquirer via Columbus Dispatch, May 12).

The idea in sending 60,000 doses of the antidote for an opioid overdose to 23 counties is to get ahead of a usual summertime rise in overdoses. Yet one of its partners in distributing the naloxone questions the equity of the plan, calling it racially biased.

Harm Reduction Ohio says the state’s plan excludes some areas that have high overdose death rates for Black Ohioans. It also charges the plan gives an insufficient amount of the drug to rural areas.

The Ohio Department of Mental Health and Addiction Services will use $2.5 million in general revenue for naloxone to go to the 23 counties it identified with 80% of overdose deaths in Ohio. The plan, announced May 5 with RecoveryOhio and the Ohio Department of Health, included a list of ZIP codes in the counties "demonstrating the highest need for enhanced overdose reversal supplies among residents."

The state's analysis used overdose death counts, hospital emergency department overdose visits and population counts to help figure out where to deploy naloxone, officials said.

Harm Reduction Ohio, though, provided a list of the ZIP codes that had the most Black overdose deaths per capita from 2018-2020 because of a growing rate of overdose deaths among people who are Black. The death rate comes from an analysis of Ohio Health Department death data from 2018-2020, done for Harm Reduction Ohio by Orman Hall, a former drug policy adviser to Gov. John Kasich. 


HPIO releases Ohio Medicaid Basics 2021

Earlier this week, the Health Policy Institute of Ohio released Ohio Medicaid Basics 2021.

Medicaid pays for healthcare services for more than three million Ohioans with low incomes, including almost 1.3 million children. Federal and state expenditures on Medicaid accounted for about 38% of Ohio’s budget in state fiscal year 2020. And $1 out of every $6 spent on health care in the U.S. is spent on Medicaid.

As the payor of healthcare services for more than a quarter of all Ohioans, Medicaid can be leveraged to make large-scale policy changes that impact the health of residents. 

Released to coincide with the state biennial budget, Ohio Medicaid Basics provides a foundational summary of the state-federal program. The 2021 edition provides an overview of Ohio Medicaid eligibility, enrollment and financing. The brief also includes an update of significant changes to Ohio Medicaid in the past year.

HPIO has created Medicaid Basics every two years since 2005.