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February 2023

Graphic of the week


New data analysis by the Health Policy Institute of Ohio shows that more Ohioans report having high blood pressure than people in other states (as illustrated in the graphic above).
The analysis also found that hypertension is more common among Black Ohioans and Ohioans with lower incomes, groups that often experience high rates of chronic stress, a leading contributor to high blood pressure.
There is emerging research establishing a link between higher rates of hypertension among African Americans and the chronic stress of discrimination and racism.

According to an HPIO policy brief on the connections between racism and health, “chronic exposure to racism renders communities of color more vulnerable to negative health outcomes across the life span and can lead to early death.”

The data graphic is the second produced by HPIO in February, which is American Heart Month, a designation designed to spotlight heart disease.

States test adding ‘food as medicine’ programs to Medicaid

More states are testing Medicaid programs that’ll provide more people with healthy foods and, potentially, lower health care costs (Source: “Can food cure high medical bills? Pilot 'food as medicine' programs aim to prove just that.” USA Today, Feb. 15). 
Medicaid typically only covers medical expenses, but ArkansasOregon and Massachusetts received approval from the Centers for Medicare & Medicaid Services last year to use a portion of their Medicaid funds to pay for food programs, including medically tailored meals, groceries and produce prescriptions (fruit and vegetable prescriptions or vouchers provided by medical professionals for people with diet-related diseases or food insecurity). The aim is to see whether providing people with nutritious foods can effectively prevent, manage, and treat diet-related diseases.  
study published last fall estimated that if all patients in the U.S. with mobility challenges and diet-related diseases received medically tailored meals, 1.6 million hospitalizations would be avoided, with a net savings of $13.6 billion annually. Another study in 2019 found that over the course of about a year, the meals resulted in 49% fewer inpatient admissions and a 16% cut in health care costs compared with a control group of patients who did not receive the meals. 
This spring, the American Heart Association and the Rockefeller Foundation plan to launch a $250 million “Food is Medicine” Research Initiative to determine if such programs can be developed cost-efficiently enough to merit benefit coverage and reimbursement for patients.

Growing list of states consider ways to regulate ‘forever chemicals’

State lawmakers across the country are looking for ways to address “forever chemicals” that don’t break down naturally and are shown to cause a myriad of  health issues (Source: “A Slew of State Proposals Shows the Threat of 'Forever Chemicals',” Pew Stateline, Feb. 14).
Several states have passed landmark laws in recent years, and now dozens of legislatures are considering hundreds of bills to crack down on using such compounds. The legislation would strengthen product disclosure laws, increase liability for polluters, bolster testing plans and enact water quality standards. 
Thousands of chemicals make up the group known as perfluoroalkyl and polyfluoroalkyl substances, or PFAS. The chemicals have been found in an increasing number of watersheds and aquifers — as well as in the blood of nearly every American. 
Some PFAS compounds, research shows, can increase the risk of cancer, damage immune systems, cause metabolic disorders and decrease fertility. 
Safer States, an alliance of environmental health groups focused on toxic chemicals, has tracked more than 260 proposals in 31 states related to toxic chemicals, many focused on PFAS (there are no bills being considered in Ohio, according to the group’s bill tracker). Eleven of those states will consider sweeping restrictions or bans of PFAS across many economic sectors. Those bills follow a Maine law passed in 2021 that was the first in the country to ban PFAS in all new products, which will take effect in 2030.

Expansion of health AI could be hindered by racial bias, Google, Microsoft executives warn

As new generative AI models like ChatGPT gain popularity, some experts are saying that to ensure such tools work in healthcare, implicit racial biases baked into health data must be accounted for (Source: “Google, Microsoft execs share how racial bias can hinder expansion of health AI,” Fierce Healthcare, Feb. 23). 
The goal is for AI to one day “support clinical decision-making [and] enhance patient literacy with educational tools that reduce jargon,” said Jacqueline Shreibati, M.D., senior clinical lead at Google. 
However, there are gaps around the use of these models in healthcare. Chief among them is that clinical evidence is always evolving and changing. Another key problem is the data themselves may have racial bias that needs to be mitigated. 
“A lot of our data has structural racism baked into the code,” Shrebati said.

Graphic of the week


New data analysis by HPIO shows that Ohio has a higher rate of heart disease mortality than most other states (as illustrated in the graphic above).

The rate in Ohio is 67% higher than Minnesota, the state with the lowest rate.

Heart disease is the leading cause of death in both Ohio and the U.S., according to CDC data. Last year, HPIO released a Data Snapshot on death trends among working-age Ohioans that found heart disease is also the third-leading cause of death among Ohioans ages 15-64. Ohio ranked 42nd in heart disease in HPIO’s 2021 Health Value Dashboard (the 2023 Dashboard is expected to be released in early May).

February is American Heart Month, a designation designed to spotlight heart disease.

Officials say air quality returns to normal following East Palestine train derailment

In the week since officials conducted what they called a "controlled release" of vinyl chloride from five derailed train cars in East Palestine near the Ohio-Pennsylvania border, concern has grown among some over the quality of the air in and around the village of nearly 5,000 people (Source: “Is the air in East Palestine safe to breathe? Here's what experts and officials say,” Columbus Dispatch, Feb. 14).

Some East Palestine residents who have since returned to their homes after being evacuated have reported experiencing headaches and nausea. Others say the air has a foul odor to it.

Dr. Bruce Vanderhoff, Director of the Ohio Department of Health, said during a news conference Tuesday that most of the chemicals on the Norfolk Southern train that derailed Feb. 3 are volatile organic compounds (VOCs). VOCs are emitted during everyday activities like pumping gas, burning wood or natural gas, he said.

Low levels of VOCs can be smelled and sometimes cause headaches and irritation, said Vanderhoff, who noted that most people can be around VOCs at low levels without feeling ill. High levels can result in longer-term health effects, he said.

Vanderhoff said recent testing shows the air in East Palestine was just like it was prior to the train derailment.

Last month, HPIO released a new Health Value Dashboard fact sheet titled “A closer look at outdoor air pollution and health.” The fact sheet focuses on the importance of clean air and provides additional information on the outdoor air quality metric in the Dashboard.

Study: Food insecurity increases risk of heart disease

A new study suggests that lack of access to food and the stress caused by food insecurity were associated with an increased risk of cardiovascular disease (Source: “Food insecurity can affect heart disease, research says,” Dayton Daily News, Feb. 13).

A recent JAMA study found economic food insecurity was associated with risks of coronary heart disease and these associations persisted after further adjustment for diet quality and perceived stress. High frequency of unfavorable food stores was not associated with coronary heart disease, heart failure, or stroke, researchers said. Researchers pointed to economic food insecurity as a potential target for intervention to improve health outcomes.

Food insecurity disproportionately impacts Black, Hispanic and single-parent households. The U.S. Department of Agriculture found in 2018 that 11.1% of all U.S. households were food insecure — with 13.9% of all households with children also food insecure.

Opioid settlement dollars could come to Ohio communities by fall

Funding from the OneOhio National Opioid Settlement could begin to come to local communities this fall, but policy delays could impede funding until 2024 (Source: “Target date set for opioid dollars,” Youngstown Vindicator, Feb. 13).

OneOhio Recovery, a private nonprofit, was created out of the National Opioid Settlement. It is tasked with distributing 55% of the money Ohio will receive from the pharmaceutical industry as a result of its role in the national opioid epidemic.

“This is the chance of a lifetime for Ohio. We have to do a good job,” said interim executive director of the Foundation, Kathryn Whittington.

Much of the structure and processes still are being decided by the 29-member board governing the foundation. The foundation was created in December 2021, but most board appointments were not finalized until May 2022.

According to a timeline provided to the members before their meeting Feb. 8, if a grant policy is approved in April, then funds should be distributed for regional projects and statewide initiatives in October. If the policy does not pass by April, funds may not go out until 2024.

Graphic of the week


Oral Health Ohio, a coalition of statewide partners who educate and advocate to improve the state’s oral and overall health, last week released the 2023-2027 State Oral Health Plan, a roadmap for Ohio to elevate oral health to the same priority as overall health.

Oral Health Ohio contracted with the Health Policy Institute of Ohio to facilitate and create the 2023-2027 State Plan, which is designed to guide actions taken by policymakers, advocates, educators, providers and funders. The vision of the state plan is that all Ohioans will have optimal oral health during every stage of their life.

The plan highlights a number of obstacles to good oral health, including community conditions such as poverty, food security, toxic stress and discrimination, as well as health behaviors and access to care and affordability. Ohioans of color and Ohioans with low incomes experience worse dental care and oral health outcomes when compared to Ohioans overall. The graphic above provides examples of these disparities.

HPIO briefs explore taking lessons from successful pilot programs to develop policy, systems change

The Health Policy Institute of Ohio has released a pair of reports designed to assist stakeholders and policymakers in taking lessons learned from promising health and human services pilot programs and developing policy and systems change.

The two reports, which examine how evidence-informed programs can be taken “from pilot to policy,” contain considerations for state and local policymakers and tools for program staff, philanthropy and other stakeholders.

“Approaches being taken by health and human services pilot programs can result in positive change in the lives of Ohioans, and policymakers can invest resources strategically,” the reports state.
To develop “From Pilot to Policy,” HPIO conducted 11 key-informant interviews with 13 experts in Ohio, including current and former policymakers, program staff and individuals involved with state policymaking. Insights shared in the key-informant interviews, as well as key quotes from the interviews, are included throughout these documents.