Ohio Health Policy News

We get it, you are busy and it’s hard to keep up with everything that comes into your inbox. Our team at HPIO has been very busy this year too. As 2022 wraps up, we are using this edition of Ohio Health Policy News to share a few highlights of our work from this year, organized by the three main types of work we do. You can also find previews of some of what we have planned for 2023.  

Thank you for your continued interest in our work and your support of our mission to advance evidence-informed policies that improve health, achieve equity and lead to sustainable health care spending. 

HPIO translates complex data and evidence into actionable policy insights. We dig deep into trends and consider the policymaking landscape to inform action, focusing attention on key health needs through data snapshots and visualizations. 

Highlights: 

• Evidence-informed strategies for preventing childhood adversity
• Trends in mental health among Ohioans and workforce mortality 
• Analysis of the connections between criminal justice and health 

Coming in 2023: 

• The fifth edition of the HPIO Health Value Dashboard
• Going upstream to advance equity and improve birth outcomes
• Analysis on the economic impact of eliminating racial disparities

HPIO assesses the strengths and needs of our state and communities and creates actionable plans. We excel at tapping into data from public sources and insights gathered through advisory committees, focus groups, listening sessions and surveys. 

Highlights: 

• The 2023-2026 State Plan on Aging, produced for the Ohio Department of Aging  
• The updated community assessment and plan process, produced for the Ohio Department of Mental Health and Addiction Services 

Coming in 2023: 

• The 2023-2027 State Oral Health Plan, produced for Oral Health Ohio  
• Two equity-focused planning and assessment projects, produced for local Alcohol, Drug, and Mental Health boards 

HPIO conducts evaluations to articulate and measure progress toward program and policy goals and creates tools that enable other organizations to efficiently assess outcomes. 

Highlights: 

• The Strategic Action Plan on Aging Implementation Toolkit, produced for the Ohio Department of Aging, includes several evaluation resources including a basic logic model template and an evaluation plan template 

Coming in 2023: 

• An evaluation of Healthy Beginnings at Home 2.0, produced for the Coalition on Homelessness and Housing in Ohio

The Biden administration this week unveiled a new website that will track non-fatal opioid overdoses (Source: “The White House unveils a new system to track and better prevent opioid overdoses,” NPR, Dec. 8).

The new website will be updated every two weeks with reports collected at the county level by EMS first responders in all 50 states and the District of Columbia. Officials say the information will help shape the medical response when overdose clusters occur in different parts of the country.

Data on the new website will be managed by the National Highway Traffic Safety Administration, which collects EMS data. 

Officials acknowledge this data collection and reporting system will provide a limited snapshot of drug overdoses.

It focuses entirely on opioids — the leading cause of drug deaths — while excluding cocaine, methamphetamines and other substances. The website also won't include information from hospitals, schools, businesses, non-profits and academic programs that collect non-fatal overdose information.

A study released this week found that an often overlooked burden for patients seeking cancer treatment is the ongoing cost of parking (Source: “Cancer patients endure an overlooked financial burden: hospital parking fees,” Stat News, Dec. 7).

A new paper in the Journal of Medical Imaging and Radiation Sciences found that the charges are actually eating into patients’ financial well-being, particularly for people who have cancer and have to make frequent visits to the hospital for treatments like radiation and chemotherapy.

Other research in the U.S. has similarly found hospital parking prices contribute to what’s known as “financial toxicity” — the idea that having a serious illness like cancer is stressful and costly on its own, and only made worse when people may have to cope with other expenses like travel while potentially missing work and losing income.

Many community hospitals in rural and suburban areas of the U.S. don’t charge anything for parking. But if people need or want more specialized care in a larger city, where parking is more scarce, they often will encounter some kind of parking fee. And if a loved one is stuck in the hospital for days, weeks, or months, hospitals can saddle families and visitors with hundreds if not thousands of dollars in parking costs.

Deaths due to substance abuse, particularly of alcohol and opioids, rose sharply among older Americans in 2020, the first year of the coronavirus pandemic, as lockdowns disrupted routines and isolation and fear spread, federal health researchers reported on Wednesday (Source: “Deaths From Substance Abuse Rose Sharply Among Older Americans in 2020,” New York Times, Nov. 30).

Deaths from opioids increased among Americans aged 65 and older by 53% in 2020 over the previous year, the National Center for Health Statistics found. Alcohol-related deaths, which had already been rising for a decade in this age group, rose by 18%.

Alcohol and opioid deaths remained far less common among older people than among those middled-aged and younger, and rates had been rising in all groups for years. But the pronounced uptick surprised government researchers.

Physiological changes that occur with aging leave older adults more vulnerable to the ill effects of alcohol and drugs, as metabolism and excretion of substances slow down, increasing the risk of toxicity. Smaller amounts have bigger effects, researchers have found.

New analysis from the Health Policy Institute of Ohio has found air quality across the country, including Ohio, has improved in recent years because of federal policy changes, such as the Clean Air Act. Ohio’s air quality is now better than the U.S., although the state still has room to improve to ensure that Ohioans are breathing clean air. While much of this improvement results from federal legislation, state and local policymakers have a role to play in improving air quality in the state.
 
The analysis will be included in a new Health Value Dashboard spin-off brief that HPIO plans to release next month. The brief will take a closer look at the link between outdoor air quality and health and provide additional information on the outdoor air quality metric in the Dashboard, including how:

• Air pollution affects health outcomes
• Recent policy changes may affect air pollution
• Outdoor air quality can improve in Ohio 

UPDATED (01.13.2023): Since the publication of this graphic by HPIO, the source updated data for air quality from 2018-2020, which altered the Ohio and US values. Updated data can be found on the America's Health Ranking website. An updated version of the graphic is included in HPIO's January 2023 policy brief Health Value Dashboard: A Closer Look at Outdoor Air Pollution and Health.

In October, HPIO released a publication detailing the state’s progress in taking action on four key evidence-informed strategies to prevent adverse childhood experiences (ACEs): Early childhood education, early childhood home visiting, medical-legal partnerships and family income supports.

Among the findings in the brief are that the need for home visiting services is greater among groups of Ohioans most at risk for childhood adversity (as illustrated in the graphic above). For example, while 38.2% of Hispanic children, ages 0-5, in Ohio were exposed to ACEs, only 8.7% of the pregnant women and primary caregivers receiving ODH- and ODM-funded home visiting services were Hispanic in Federal fiscal year 2021.

HPIO is hosting an online forum from 11 a.m. to 1 p.m. Dec. 13 to highlight the four key strategies from the brief. Speakers at the forum will include:

• Marie Curry, Managing Attorney, Community Legal Aid
• Dr. Robert Kahn, VP for Health Equity Strategy and the Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center
• Robyn Lutz, Administrative Nurse Manager Labor and Delivery, OhioHealth Grant Medical Center
• Jeanne Wickliffe, Program Manager Maternal Infant Home Visiting Program, The Center for Family Safety and Healing at Nationwide Children’s Hospital
• And more to be announced!

Gov. Mike DeWine, who just won his bid for re-election, said he’s going to focus on improving the physical and mental well-being of Ohioans in his second term in office (Source: “DeWine's plans for improving mental health services in Ohio includes paid internships,” Statehouse News Bureau, Nov. 30).

At an Ohio Chamber of Commerce event focusing on health care Wednesday morning, DeWine said his office is working with lawmakers in three key areas during his second term.

“One, growing our behavioral health force so it is the most robust in this country. Two, leading the nation in mental health research and innovation. And three, providing Ohioans with the best access to behavioral health care in this country," DeWine said.

DeWine wants the state to invest more in high school workforce programs and he wants to invest $85 million dollars in federal funds to pay students for internships and residencies for those who are studying to work in these areas at Ohio's universities.

DeWine said he wants the state to do a landmark study on mental health barriers. That information can then be used to come up with ways to break those barriers down. He also said he wants to build a statewide center of innovation for behavioral health along with increasing research capacity for Ohio’s universities. DeWine said these changes would make mental and behavioral health services more accessible for Ohioans.

The Ohio House passed legislation Wednesday that would legalize the possession of test strips used to identify the presence of fentanyl in illicit drugs (Source: “Ohio House votes to decriminalize fentanyl test strips,” Nov. 30).

The policy is aimed at expanding access to the strips, a harm-reduction approach designed to reduce the near-record level of Ohioans who fatally overdose on opioids year over year.

For the last several years, experts have warned that fentanyl – a powerful synthetic opioid – has entered the drug supply and is driving increasing rates of fatal overdoses. It’s often present in drugs without the user’s knowledge. The test strips are a cheap (they cost roughly $1) means of ensuring people know what they’re taking. Current Ohio law, however, classifies them as “drug paraphernalia.” Possession of them can yield a fourth-degree misdemeanor, punishable by up to 30 days in jail.

The legislation passed in the House with just four votes in opposition. It now heads to the state Senate, which has been considering similar legislation.

Improving access to fentanyl test strips is one aspect of harm reduction, a public health strategy aimed at decreasing risks surrounding drug use as opposed to an abstinence-only approach. Other strategies, outlined in an HPIO policy brief last year, include increasing access to naloxone (an overdose reversal drug); expanding syringe exchange programs, which reduce risk of bloodborne diseases; and improving Good Samaritan laws, which provide legal shields to those who help people overdosing seek access to emergency care.

Urban centers are seeing the highest rates of pregnancy complications for Ohio women, followed by Appalachia, with Black women being impacted the most, a report from HPIO found (Source: “Severe pregnancy complications are affecting Black women in Ohio the most,” Ohio Capital Journal, Nov. 28).

The brief, Racial and Geographic Disparities in Maternal Morbidity and Mortality, points to systemic racism, a lack of health care access and poor community conditions as reasons for the disparities.

Not only are there disparities in general maternal health, but also in maternal morbidity: severe complications that happen during or after labor and delivery that can lead to other major health problems, including hysterectomy or the need for a blood transfusion, according to the brief.