Ohio Health Policy News

The Case Western Reserve University School of Medicine and University Hospitals Harrington Heart & Vascular Institute have received an $18.2 million federal grant from the National Institutes of Health to lead a multi-organizational effort addressing cardiovascular health disparities (Source: “CWRU, UH receive $18.2 million federal grant to address social determinants of health in Black neighborhoods,” Cleveland.com, Oct. 12).

The initiative involves CWRU, UH and Wayne State University in Detroit. The institutions will work to address social drivers of health in Black communities in Cleveland and Detroit, according to a joint statement from CWRU and UH.

The initiative’s goal is to reduce cardiovascular complications and hospitalizations by improving blood pressure, lipids and glucose targets for Black patients who are at high risk for poor heart health, said Dr. Sanjay Rajagopalan, the principal investigator of the initiative.

Education, socio-economic status, geography and environmental factors contribute to the burden of cardiovascular disease in the United States, Rajagopalan said in the statement.

“There are seismic gaps that exist in health care for Black Americans that continue to result in disproportionate and disappointingly poor outcomes,” he said. “This transformative grant will help to address some of these health disparities.”

New research from the U.S. Centers for Disease Control and Prevention found disparities in vaccination coverage prior to the COVID-19 pandemic (Source: “Disparities Found in Vaccination Coverage by Age 24 Months Before COVID-19,” HealthDay News, Oct. 18).

The study, which was published in the CDC’s Morbidity and Mortality Weekly Report, found that in 2017 and 2018, coverage disparities were seen for race/ethnicity, poverty status and health insurance status. Children who were not privately insured had lower coverage with most vaccines.

"Persistent disparities in vaccination coverage by health insurance status, race and ethnicity, and poverty status indicate that improvement is needed to achieve equity in the national childhood vaccination program," the authors write.

Despite coming to an end in the 1960s, institutionally racist policies like redlining still contribute to poor health outcomes and Black maternal health disparities, according to new research (Source: “Decades-Old Policy Fuel Black Maternal Health Disparities,” Patient Engagement HIT, Oct. 5).

A relic of the 1930s, redlining was a discriminatory practice in which the US Home Owners’ Loan Corporation designated thousands of areas as “unsafe” for issuing a homeowner’s loan. “Unsafe” usually meant there was a higher proportion of Black people living in a given neighborhood, creating a system of divestment that made it harder for Black people to own a home.

The study, which was published in the Journal of the American Medical Association, found that poor outcomes happening today were largely concentrated in areas that in the 1940s had been deemed “hazardous” for homeowner’s loans by the HOLC. In other words, the racist policymaking of the mid-20th century is still having negative health equity impacts today.

“This structure of disinvestment, which formally stretched forward into the 1960s, has far-reaching impacts,” the researchers explained. “The legacy of historic redline racial discrimination correlates with modern social and health inequities.”

Several recent HPIO publications and events have focused on the connections between race and health:

• Last month, HPIO released a fact sheet, titled “State and Local Policymakers: Ensuring Ohioans of Color Have a Fair Opportunity for Good Health,” that outlines actions state and local policymakers can take to support the health and well-being of Ohioans of color and move Ohio toward a more economically vibrant and healthier future. The fact sheet is the first in a series of three that provides action steps that can be taken to address the health impacts of racism. The publication highlights eight action steps that policymakers can take, including examples from policymakers in Ohio and across the country.
• Also in September, HPIO released two new fact sheets that detail the impact of the addiction crisis on different groups of Ohioans. One of the fact sheets, “HPIO Addiction Evidence Project: Insights on Addiction and Race,” provides data and information on differences in addiction outcomes by race, and the factors that drive those differences, with a focus on Black Ohioans. The second fact sheet explores differences in addiction outcomes across Ohio communities based on region and county type.
• This week, HPIO hosted a forum titled “What’s on the Horizon: Connections between Racism and Health.” The online forum provided an overview of the role racism has played in shaping the health of Ohioans of color. Ohio and national speakers discussed barriers to learning about racism and provided new strategies for communicating on health equity. A recording of the event is posted on the event page.

The Health Policy Institute of Ohio has released a new fact sheet, Refocusing Ohio’s Approach to Overdose Deaths.

“Drug overdose deaths are preventable and there are many ways to deter and reverse overdoses,” the fact sheet states. “Recent upward trends in overdose deaths are troubling. Without a comprehensive policy response that takes into consideration the many factors that contribute to overdose, Ohioans will continue to die, leaving behind grieving families and untapped potential.”

This fact sheet explores:

• What drives overdose deaths
• Why overdose deaths continue to increase
• What Ohio can do to improve overdose prevention

This fact sheet was released in conjunction with the HPIO policy brief, Taking Action to Strengthen Ohio’s Addiction Response.

Ohio child advocacy groups and doctors are pushing for more state funding to add additional school-based health clinics in the state (Source: “Child advocacy groups, doctors want to see more state funding for school-based health clinics,” News 5 Cleveland, Oct. 20).

The Children’s Defense Fund-Ohio and other child advocacy groups are asking the state to allocate $25 million from the American Rescue Plan Act for the next two years to help set up clinics for additional districts in the state.

Ohio received about $5 billion from the federal government as part of the American Rescue Plan Act. So far, about $3 billion has yet to be allocated. According to the Treasury Department, funds must be incurred by Dec. 31, 2024.

Health problems tied to climate change are getting worse, according to two reports published Wednesday (Source: “Reports: Health problems tied to global warming on the rise,” Associated Press, Oct. 21).

The annual reports commissioned by the medical journal Lancet tracked 44 global health indicators connected to climate change, including heat deaths, infectious diseases and hunger. All of them are getting grimmer, said Lancet Countdown project research director Marina Romanello, a biochemist.

This year’s reports — one global, one just aimed at the United States — found that in the U.S., heat, fire and drought caused the biggest problems. An unprecedented Pacific Northwest and Canadian heat wave hit this summer, which a previous study showed couldn’t have happened without human-caused climate change.

People who are Black, Hispanic or American Indian/Alaska Native are more likely than white people to be hospitalized with a case of the flu in the United States, according to a recent study from the Centers for Disease Control and Prevention and other institutions (Source: “The flu proves more deadly for children of color than for White youths, study says,” Washington Post, Oct. 11).

Young children in these groups, along with Asian and Pacific Islander children, are also more likely to die of flu than white children.

The study, published in the journal JAMA Network Open, took a close look at 113,352 flu hospitalizations between 2009 and 2019 from across the country. Researchers found clear disparities in those hospitalizations as well as among those who were ultimately admitted to the intensive care unit or who died.

Overall, Black people had the highest rates of hospitalization and ICU admission, followed by American Indians or Alaska Natives and Hispanic people, although the trends varied within age groups. Except in the youngest children, Asian and Pacific Islander people had hospitalization rates similar to or slightly lower than non-Hispanic white people. Across racial and ethnic groups, researchers found few differences in hospitalization, ICU admission and death from flu among adults 75 and older.

Coronavirus cases are continuing to decline, with Ohio’s two-week cases per 100,000 people dropping from 560.5 cases per 100,000 people on Oct. 7 to 507.4 cases per 100,000 people on Thursday, according to the state health department (Source: “Ohio continues to see decrease in COVID-19 transmission rate,” Dayton Daily News, Oct. 14).

The transmission rate has been declining for at least three weeks and has decreased by nearly 200. On Sept. 23, Ohio reported 698.7 cases per 100,000 people over two weeks.

As of Thursday, only five counties had more than 1,000 cases per 100,000: Guernsey, Coshocton, Muskingum, Gallia and Jackson counties. On Sept. 23, Ohio had 30 counties with more than 1,000 cases per 100,000.

More than 54.5% of Ohioans have started the COVID-19 vaccine, including 65.97% of adults and 63.88% of those 12 and older. Nearly 51% of residents have finished the vaccine, including 61.66% of adults and 59.56% of Ohioans 12 and older.

In recent years, hundreds of jurisdictions across the country have faced lawsuits or entered settlement agreements after failing to meet ADA requirements for pedestrians and mass transit users (Source: “Reluctant Localities Are Being Dragged Into Court to Fix Sidewalks for People With Disabilities,” Kaiser Health News, Oct. 13).

The sheer number of noncompliant sidewalks, curb ramps, pedestrian signals and subway stations illustrates the challenges for people with disabilities. It also leaves cities in a legal and financial squeeze, with the average curb ramp costing between $9,000 and $19,000. When the court requires a jurisdiction to build thousands of them to catch up, it can strain budgets.

The American Disabilities Act (ADA) and the 1973 Rehabilitation Act resulted in significant changes that improved access and accommodations for people with disabilities. The ADA is clear that people with disabilities have the same right to pedestrian infrastructure as anyone else.

Under the ADA, new sidewalks must be built for accessibility. There are requirements covering a curb ramp’s width, slope and other specifications. As for existing sidewalks, a federal appeals court in 1993 ruled that curb ramps must be installed or regraded when the road is altered, such as when it is repaved.