Ohio Health Policy News

Analysis by HPIO earlier this year found that stark differences in maternal health outcomes signal that not everyone has what they need to live a healthy life before, during and after pregnancy.

The graphic above, from the HPIO fact sheet “Racial and Geographic Disparities in Maternal Morbidity and Mortality,” shows urban and Appalachian counties have the highest rates of maternal morbidity in Ohio. Additionally, across both urban and Appalachian counties, Black mothers have the highest rates of maternal morbidity

According to the fact sheet, “High maternal morbidity and mortality rates are preventable. State and local policymakers have many options to address racism and discrimination, inequitable community conditions, toxic stress and poor prenatal care access.”

As Columbus contemplates becoming the first city in Ohio to ban the sale of menthol cigarettes, data is starting to come in from areas that have implemented similar bans.

A new Canadian study has found that a ban on menthol has led to increased rates of quitting the use of tobacco products (Source: “Researchers find bans on menthol cigarettes sales can lead to higher tobacco quit rates,” WOSU Public Media, Nov. 14).

Menthol is a chemical tobacco companies began adding to cigarettes broadly in the 1950s, used to mask the harshness of cigarettes in efforts to expand the base of smokers.

The research found cigarette sales decreased by 11% and Canadians who smoked menthol cigarettes quit smoking at a rate of 22%, compared to 15% of non-menthol smokers. In Canada about 5% of smokers used menthols before the ban. But in the U.S., as many as 40% of smokers use menthols, and most Black smokers use menthol cigarettes, meaning a U.S. ban could lead to even greater increases in quitting.

With few medical student showing interest in practicing in rural areas, Ohio is facing a potential workforce shortage in coming years (Source: “Decline of rural doctors may leave parts of Ohio with too few physicians,” Columbus Dispatch, Nov. 14).

Just 1% of medical students in their final year of study in 2019 said they wanted to practice in a rural area, according to a survey from the physician recruiting firm Merritt Hawkins. The survey showed that 2% wanted to practice in a town of 25,000 people or less.

The trend is a reflection of a larger one that could result in too few doctors to meet patient demand in Ohio. By 2025, the U.S. Department of Health and Human services estimates, Ohio will fall 1,200 primary care doctors short of the number needed to treat patients throughout the Buckeye state.

The shortage of rural physicians is a longstanding issue that stems from a decline in the number of independent medical practices, said Todd Baker, chief executive officer of the Ohio State Medical Association, an organization that advocates for physicians and health policy reform.

For the past two decades, the Health Policy Institute of Ohio has provided Ohio’s public- and private-sector leaders with the tools they need to make evidence-informed health policy decisions.

HPIO’s work is made possible through the steadfast support and generosity of organizations and individuals throughout the state.

Please consider making a tax-deductible donation today to support HPIO’s mission of advancing evidence-informed policies that improve health, achieve equity, and lead to sustainable healthcare spending in Ohio.

We appreciate your consideration and look forward to celebrating HPIO’s 20^th anniversary with you in 2023!
 
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On Tuesday, the nonprofit March of Dimes released its 2022 Report Card, which found that the U.S. preterm birth rate reached 10.5% of live births in 2021, marking a 4% increase from the previous year's rate, and the highest rate since 2007 (Source: “A nonprofit says preterm births are up in the U.S. — and it's not a partisan issue,” NPR, Nov. 15).

Preterm birth rates increased in 45 states, as well as Washington, D.C., and Puerto Rico, based on 2021 vitality data from the National Center for Health Statistics.

Drilling down, the report only gives one state, Vermont, a score in the A range (meaning its preterm birth rate is between 7.7 and 8.1%). With a preterm birthrate of 10.6%, Ohio received a grade of D+.

The main takeaways of the report are the increase in preterm births and the widening racial disparities in maternal and infant health, says Dr. Zsakeba Henderson, March of Dimes' senior vice president and interim chief medical and health officer.

But there are also some encouraging signs that infant mortality is dropping, and that states are taking action to improve health outcomes. Coming on the heels of the midterms, the report also outlines what policymakers can do to help.

In September, HPIO released a policy brief that explores the impact of pretrial incarceration and the money bail system on the health, safety and well-being of Ohioans and their communities. It is the latest in a series of HPIO publications on the connections between criminal justice and health.

Analysis from 2019 found the number of Ohioans incarcerated pretrial has increased since 2016, and 61% of people in local jails have not been convicted of a crime (outlined in graphic above).

The issue of how bail is determined in now before Ohio voters, who next week will decide on Issue 1. If passed, the issue would add language to the Ohio Constitution requiring Ohio courts to consider public safety when setting bail amounts, including the seriousness of the offense, a person’s criminal record, the likelihood a person will return to court and any other factor that the Ohio General Assembly may prescribe.

HPIO created an online resource page to make information on Ohio Issue 1 easily accessible. The resource page includes background on the initiative, information on the connections between criminal justice and health, research and analysis of Issue 1 and media coverage of the issue. The page also includes position statements from both proponents and opponents of the initiative.

The Centers for Disease Control and Prevention on Thursday softened its guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers (Source: “US agency softens opioid prescribing guidelines for doctors,” Associated Press, Nov. 14).

The new CDC recommendations are an update to 2016 guidelines that added momentum to a decline in opioid painkiller prescriptions.

The previous guidance succeeded in reducing inappropriate and dangerous prescribing, some experts say. But they also were seen as a barrier to care, with some pharmacists refusing to fill prescriptions as doctors wrote them.

The new guidelines are designed to ensure that patients get compassionate and safe pain care, CDC officials said.

A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including no longer suggesting limiting opioid treatment for acute pain to three days; dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day; and urging doctors to not abruptly halt treatment for patients receiving higher doses of opioids unless there are indications of life-threatening danger.

An estimated one in eight deaths of Americans ages 20 to 64 in the years 2015-19 was the result of injuries or illness caused by excessive alcohol use, according to a new study from the Centers for Disease Control and Prevention (Source: “Alcohol Deaths Claim Lives of Working-Age Americans,” New York Times, Nov. 1).

The study was published on Tuesday in the journal JAMA Network Open, assessed the effects of alcohol on people of working age, who accounted for nearly two-thirds of the country’s annual average of 140,000 alcohol-related deaths.

The rates of excessive alcohol use and related deaths have most likely climbed since the period of the CDC analysis. After the onset of the pandemic, a variety of data showed Americans drank more frequently, and deaths due to a narrower set of causes attributable to alcohol rose 25% in 2020 over the previous year.

Alcohol is a leading cause of preventable death in the United States, but it is often overshadowed by tobacco or opiates. And its effects on Americans’ health has been growing. Nearly a decade ago, a similar study found one in 10 deaths of working-age people was due to drinking, although researchers have changed the methodology, so a perfect apples-to-apples comparison is not possible.

This summer, HPIO released a Data Snapshot on death trends among working-age Ohioans.

New evidence suggests that the shrinking gap in U.S. COVID-19 racial death disparities is being driven by political division and increasing total deaths — mostly among white people — rather than by decreasing deaths among Black Americans (Source: “Study: US political divide may help explain shrinking racial COVID death gap,” Center for Infectious Disease Research and Policy, University of Minnesota, Nov. 1).

According to a new University of Wisconsin and UCLA study published in PLOS One, Black people still bear a larger COVID-19 death burden than white people, despite a relatively younger population, but suggest that a wider political chasm likely drove more deaths in the latter group as the pandemic evolved.

Researchers examined COVID-19 death disparities since the early months of the pandemic when Black Americans had far higher death rates than their white peers.

Black and Hispanic Americans are much more likely to work in jobs that must be done in person, leading to much higher exposure to the virus. "That didn't change as the racial differences in the mortality rate shifted," lead author Adeline Lo said. "Other factors — like geographical distribution, healthcare access, income equality — that contributed to the initial higher rate of Black deaths didn't go away either."

What did change was that levels of concern about COVID and adherence to protective public health measures (eg, lockdowns, closures, prohibitions on gathering) widened along political lines, with increasing deaths among white Americans. After initially issuing similar state mandates in the first few weeks of the pandemic, within one month, Republican-controlled states began lifting public health restrictions, lessening virus containment and leading white deaths to surpass those of Black people from April to October 2020.