Ohio Health Policy News

The U.S. Centers for Disease Control and Prevention announced earlier this month that it has awarded the Ohio Department of Health and Columbus Public Health a total of nearly $34.5 million to address COVID-19-related health disparities (Source: “Ohio receives nearly $34.5 million from CDC to address COVID-19 related health disparities,” Cleveland Plain Dealer, June 10).

ODH will receive $31,011,053, which includes $7,169,724 earmarked for rural communities. Columbus Public Health receives $3,396,978.

The grants are part of a $2.25 billion federal spending to promote health equity by expanding services and capacity at the state and local level, the CDC said. This is the agency’s largest investment to date to improve health equity in the United States.

The funds also will be used to increase COVID-19 testing and contact tracing among high-risk and underserved populations, including racial and ethnic minority groups and people living in rural communities, in Ohio and across the country.

Saying structural racism is a chronic problem throughout biomedical research and within their own walls, leaders of the National Institutes of Health earlier this month unveiled a plan intended to eliminate a big gap in grants awarded to white and minority scientists and boost funding for research on health disparities (Source: “NIH releases a plan to confront structural racism. Critics say it’s not enough,” Stat News, June 10).

The agency, the largest funder of biomedical research in the United States, said its plan would be accompanied by an expansion of a program to recruit, mentor and retain researchers from underrepresented racial and ethnic groups and appoint diversity and inclusion officers at each of its 27 institutes and centers.

The report says NIH leaders failed to acknowledge numerous firsthand accounts of racism in the workplace and the organization has failed to attract, retain and promote scientists from underrepresented racial and ethnic groups. Less than 2% of NIH senior investigators are Black.

Following controversial comments from the top editor of JAMA, criticism is growing for medical journals to address their lack of attention to structural racism and how it impacts health (Source: “Medical Journals Blind to Racism as Health Crisis, Critics Say,” New York Times, June 2).

The top editor of JAMA, the influential medical journal, stepped down earlier this month amid controversy over comments about racism made by a colleague on a journal podcast. But critics saw in the incident something more pernicious than a single misstep: Blindness to structural racism and the ways in which discrimination became embedded in medicine over generations.

“The biomedical literature just has not embraced racism as more than a topic of conversation, and hasn’t seen it as a construct that should help guide analytic work,” said Dr. Mary Bassett, professor of the practice of health and human rights at Harvard University. “But it’s not just JAMA — it’s all of them.”

Following an outcry over the incident, editors at JAMA on Thursday released a plan to improve diversity among its staff, as well as in research published by the journal.

The longstanding issue has gained renewed attention in part because of health care inequities laid bare by the pandemic, as well as the Black Lives Matter protests of the past year. Indeed, an informal New York Times review of five top medical journals found that all published more articles on race and structural racism last year than in previous years.

It was only in 2013 that racism was first introduced as a searchable keyword in PubMed, the government’s vast medical library. Since then, however, the five journals have published many more studies mentioning race than those mentioning racism. JAMA published the fewest studies mentioning racism, the review found.

The New England Journal of Medicine rarely addressed racism until the arrival of Dr. Eric Rubin, its current top editor, in 2019. The British Medical Journal and The Lancet, both based in Europe, published more studies on the topic, while the American Journal of Public Health published the most.

After years of work by researchers, advocates and clinicians, a calculator that used race as a factor to determine the likelihood of having a successful vaginal birth after cesarean has been replaced by a newly validated version that is the same in almost every way — except for eliminating race and ethnicity as a risk factor (Source: “Changing the equation: Researchers remove race from a calculator for childbirth,” Stat News, June 3).

The previous tool takes into account a patient’s age, height, weight and history of vaginal and cesarean delivery. It also asks two yes-or-no questions: “African-American?” “Hispanic?” The answers can predict a drastically lower chance of success for patients of color. But now, that racialized calculator has been replaced by a newly validated version that does not include inputting race or ethnicity information.

The VBAC calculator is just one of several clinical algorithms that have recently been challenged over their use of race adjustment. Providers across specialties have questioned the inclusion of race and ethnicity — which are social, not biological factors — in their decision-making tools, pointing to the risk of perpetuating existing health inequities. But because obstetricians access the VBAC calculator online, it could prove much easier than with other corrected tools to get the updated calculator quickly into use across the country.

“I think it’s powerful that this is, in some ways, the first example of race correction being abandoned systematically in a tool in response to these equity concerns,” said Darshali Vyas, a resident at Massachusetts General Hospital.

The Health Policy Institute of Ohio last week released a new brief titled, Connections between Criminal Justice and Health.

According to the brief, “The research evidence is clear that poor mental health and addiction are risk factors for criminal justice involvement and that incarceration is detrimental to health.”

The brief highlights the many factors that impact both criminal justice and health outcomes, finding that:

• There is a two-way relationship between criminal justice and health. Mental health and addiction challenges can lead to arrest and incarceration, and incarceration contributes to poor behavioral and physical health for many Ohioans.
• Racism and community conditions contribute to criminal justice involvement and poor health. Racist and discriminatory policies and practices and community conditions, such as poverty, housing instability and exposure to trauma, lead to increased criminal justice involvement and drive poor health outcomes.
• Improvement is possible. There are evidence-informed policy solutions to combat the drivers of criminal justice involvement and poor health outcomes.

The brief includes 15 specific evidence-informed policy options focused on:

• Supporting mental well-being and improving crisis response for people at higher risk of criminal justice involvement
• Reducing the number of people incarcerated in Ohio
• Improving health for people who are currently or formerly incarcerated
• Improving community conditions for people who are at higher risk of criminal justice involvement

After more than a year, Ohio will no longer be in a state of emergency, Gov. Mike DeWine announced Thursday (Source: “Ohio’s state of emergency, more health orders to end tomorrow, DeWine says,” Middletown Journal News, June 17).

The governor declared a state of emergency due to the coronavirus pandemic last March after three Ohioans tested positive for coronavirus.

The state is also lifting more health orders related to nursing homes, including restrictions on visitation, starting Friday. The only requirement that will remain in place is testing unvaccinated staff at nursing homes and assisted living centers for the virus twice a week.

Hospital prices are cited most frequently by state plans as their top cost driver, but state negotiators are more likely to target other forms of health care spending when it comes to curbing costs, a new study found  (Source: “States don't want to tackle high hospital costs,” Axios, June 17)

According to a new study by Georgetown's Center on Health Insurance Reforms, state health plan administrators are “fully aware that hospital prices are the primary driver of the steady increase in the cost of employee health benefits. Yet they remain focused on secondary drivers such as excessive or inappropriate utilization.”

State employee health plans are often the largest employer purchasing insurance in their state, so in theory, should have significant clout when negotiating prices. But according to the report, plan administrators say it is hard to go after these prices because of a lack of competition between hospitals, hospitals' political clout and employee pressure to keep broad provider networks.

The Health Policy Institute of Ohio is seeking candidates for its Board of Directors.

The call for candidates and application are posted on the HPIO website. 

The HPIO Board of Directors is comprised of leaders from the nonprofit, for-profit and public sectors who are dedicated to the organization’s mission and share our commitment to equity. HPIO and its board are built on a foundation of shared values — fact-based and data-driven analysis; integrity and transparency; diversity and inclusion; ethical decision-making; relevancy; and collaboration and partnership.  

Selected board directors will understand how state policy is created and will have achieved leadership stature in healthcare, business, government, philanthropy or the nonprofit sector. Their accomplishments will allow them to attract other well-qualified, high-performing board directors. 

This is an extraordinary opportunity for an individual who is passionate about HPIO’s mission, is supportive of HPIO’s commitment to advancing equity and has a track record of board leadership and/or health policy leadership. 

Service on the HPIO Board of Directors is without remuneration.

The Health Policy Institute of Ohio has released a new brief titled  Connections between Criminal Justice and Health.

According to the brief, “The research evidence is clear that poor mental health and addiction are risk factors for criminal justice involvement and that incarceration is detrimental to health.”

The brief highlights the many factors that impact both criminal justice and health outcomes, finding that:

• There is a two-way relationship between criminal justice and health. Mental health and addiction challenges can lead to arrest and incarceration, and incarceration contributes to poor behavioral and physical health for many Ohioans.
• Racism and community conditions contribute to criminal justice involvement and poor health. Racist and discriminatory policies and practices and community conditions, such as poverty, housing instability and exposure to trauma, lead to increased criminal justice involvement and drive poor health outcomes.
• Improvement is possible. There are evidence-informed policy solutions to combat the drivers of criminal justice involvement and poor health outcomes.

The brief includes 15 specific evidence-informed policy options focused on:

• Supporting mental well-being and improving crisis response for people at higher risk of criminal justice involvement
• Reducing the number of people incarcerated in Ohio
• Improving health for people who are currently or formerly incarcerated
• Improving community conditions for people who are at higher risk of criminal justice involvement

The U.S. saw remarkable increases in the death rates for heart disease, diabetes and some other common killers in 2020, and experts believe a big reason may be that people stayed away from the hospital for fear of catching COVID-19 (Source: “US deaths from heart disease and diabetes climbed amid COVID,” Associated Press, June 9).

The death rates — posted online this week by federal health authorities — add to the growing body of evidence that the number of lives lost directly or indirectly to the coronavirus in the U.S. is far greater than the officially reported COVID-19 death toll of nearly 600,000 in 2020-21.

Earlier this year, the Centers for Disease Control and Prevention reported that nearly 3.4 million Americans died in 2020, an all-time record. Of those deaths, more than 345,000 were directly attributed to COVID-19. The CDC also provided the numbers of deaths for some of the leading causes of mortality, including the nation’s top two killers, heart disease and cancer.

Earlier research done by demographer Kenneth Johnson at the University of New Hampshire found that an unprecedented 25 states, including Ohio, saw more deaths than births overall last year (most states typically have more births than deaths).