disparities

CDC: Life expectancy drop in 2020 largest since WWII

U.S. life expectancy fell by a year and a half in 2020, the largest one-year decline since World War II, public health officials said Wednesday (Source: “US life expectancy in 2020 saw biggest drop since WWII,” Associated Press, July 21).

The decrease for both Black Americans and Hispanic Americans was even worse: three years.

The drop, spelled out in a new report from the Centers for Disease Control and Prevention, is due mainly to the COVID-19 pandemic, which health officials said is responsible for close to 74% of the overall life expectancy decline. More than 3.3 million Americans died last year, far more than any other year in U.S. history, with COVID-19 accounting for about 11% of those deaths.

Black life expectancy has not fallen so much in one year since the mid-1930s, during the Great Depression. Health officials have not tracked Hispanic life expectancy for nearly as long, but the 2020 decline was the largest recorded one-year drop.

Causes of death other than COVID-19 also played a role. Drug overdoses pushed life expectancy down, particularly for white Americans; and a rise in homicides was a small but significant reason for the decline for Black Americans, said Elizabeth Arias, the report’s lead author.

Other problems further affected Black and Hispanic people, including lack of access to quality health care, more crowded living conditions and a greater share of the population in lower-paying jobs that required them to keep working when the pandemic was at its worst, experts said.


Medical journals come under increasing criticism for lack of attention to racism

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.


ICYMI: HPIO brief explores connections between criminal justice and health

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

New HPIO brief explores connections between criminal justice and health

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

Study: Death rates from chronic conditions rising in rural America

In rural America, more people die from chronic health conditions and substance abuse than in suburbs and cities, and the gap is widening.

A new study has found that the difference in rural and urban death rates tripled over the past 20 years mostly due to deaths among middle-aged white men and women (Source: “Study: Death rates from chronic conditions, 'deaths of despair' rising in rural U.S.,” United Press International, June 9).

This gap is partly due to access to care, but other factors also contribute, said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital in Boston and the VA Boston Healthcare System. In terms of access, rural areas have seen a wave of hospital closures driven largely by economics, especially during the COVID-19 pandemic, he said.

"But it's hard to disconnect health from other factors in our societies," Warraich said. "I think it's linked to the overall economic outlook of rural America as well, and also, health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, substance use, etc."

For the study, which was published in the Journal of the American Medical Association, Warraich and his colleagues used federal government health data for 1999 through 2019. They found that age-adjusted death rates dropped in both rural and urban areas over that period. But the gap widened dramatically as death rates rose among white rural residents between 25 and 64.

Over the study period, rural death rates increased 12% for that group. Although death rates dropped among rural Black residents, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.


Study: Americans with lower incomes more likely to have respiratory illnesses

Despite improvements in air quality and other advances, Americans with low incomes more often have asthma, lung disease and related illnesses, a new study has found (Source: “Poor Americans More Likely to Have Respiratory Problems, Study Finds,” New York Times, May 28).

In recent decades, air quality has improved in the United States, smoking rates have plummeted and government safety regulations have reduced exposure to workplace pollutants. But rich and poor Americans have not benefited equally, scientists reported in a paper on Friday.

While wealthier Americans have quit smoking in droves, tobacco use remains frequent among the poor. Asthma has become more prevalent among all children, but it has increased more drastically in low-income communities. And Americans with lower incomes continue to have more chronic lung disease than the wealthy.

The analysis, which was published in JAMA Internal Medicine, included data from national health surveys conducted by the Centers for Disease Control and Prevention periodically from 1959 to 2018. The study did not examine disparities in respiratory health by race or ethnicity, though it assessed both income-based and education-based differences in lung health.

Before the 1980s, smoking rates did not vary much by income, and they only slightly varied by education level: 62% of the wealthiest adults and 56% of the poorest were either current or former smokers. But that has changed drastically. By the survey period 2017-18, current and former smoking rates among the wealthiest dropped by nearly half to 34% — while rates among the poorest inched up to 57.9%.


Ohio’s plan for targeted naloxone distribution raises questions

Ohio’s plan to launch a targeted deployment of naloxone is being questioned by one of the state’s partners that says it does not distribute the drug to communities most in need (Source: “Ohio's plan to distribute an anti-OD drug triggers questions, claims of racial bias,” Cincinnati Enquirer via Columbus Dispatch, May 12).

The idea in sending 60,000 doses of the antidote for an opioid overdose to 23 counties is to get ahead of a usual summertime rise in overdoses. Yet one of its partners in distributing the naloxone questions the equity of the plan, calling it racially biased.

Harm Reduction Ohio says the state’s plan excludes some areas that have high overdose death rates for Black Ohioans. It also charges the plan gives an insufficient amount of the drug to rural areas.

The Ohio Department of Mental Health and Addiction Services will use $2.5 million in general revenue for naloxone to go to the 23 counties it identified with 80% of overdose deaths in Ohio. The plan, announced May 5 with RecoveryOhio and the Ohio Department of Health, included a list of ZIP codes in the counties "demonstrating the highest need for enhanced overdose reversal supplies among residents."

The state's analysis used overdose death counts, hospital emergency department overdose visits and population counts to help figure out where to deploy naloxone, officials said.

Harm Reduction Ohio, though, provided a list of the ZIP codes that had the most Black overdose deaths per capita from 2018-2020 because of a growing rate of overdose deaths among people who are Black. The death rate comes from an analysis of Ohio Health Department death data from 2018-2020, done for Harm Reduction Ohio by Orman Hall, a former drug policy adviser to Gov. John Kasich. 


CDC director declares racism ‘a serious public health threat’

In a statement released earlier this month, the director of the Centers for Disease Control and Prevention declared racism a “serious public health threat” (Source: “CDC Director Declares Racism A 'Serious Public Health Threat',” National Public Radio, April 8).

In the statement, Dr. Rochelle Walensky said that, “Racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color."

The CDC also launched a new web portal, Racism and Health, that's designed to be a hub for public and scientific information and discourse on the subject.


Study finds widespread racial disparities in air quality

A new national study has found racial and ethnic disparities in the quality of air that Americans breathe (Source: “People of Color Breathe More Hazardous Air. The Sources Are Everywhere.,” New York Times, April 28).

According to the study, Black Americans are exposed to more pollution from every type of source, including industry, agriculture, all manner of vehicles, construction, residential sources and even emissions from restaurants. People of color more broadly, including Black and Hispanic people and Asian Americans, are exposed to more pollution from nearly every source.

The findings, which were published Wednesday in the journal Science Advances, came as a surprise to the study’s researchers, who had not anticipated that the inequalities spanned so many types of pollution.

The study builds on a wealth of research that has shown that people of color in America live with more pollution than their white neighbors. Fine particulate matter air pollution, known as PM 2.5, is harmful to human health and is responsible for 85,000 to 200,000 excess deaths a year in the United States.


Maternal morbidity higher in majority-Black neighborhoods, study finds

People who live in majority-Black neighborhoods have a higher likelihood for maternal health complications, according to a study released earlier this month (Source: “Majority-Black Neighborhoods See Maternal Health Disparities,” Patient Engagement HIT, April 13, 2021).

The new data from Penn Medicine, published in Obstetrics and Gynecology, found a 2.4% increase in maternal morbidity for every 10% increase in Black residents within a given neighborhood.

Previous data has shown that maternal morbidity, or any unexpected labor outcome with major long- or short-term consequences, have a disproportionate impact on Black women compared to white women. This health disparity exists even after controlling for factors such as education level and income, prompting many health equity experts to consider the role that structural racism and implicit bias can play in health outcomes.

“This study gives us a blueprint for addressing racial disparities in health care at the neighborhood and population-level,” said co-author Lisa Levine, MD, an assistant professor of Obstetrics and Gynecology at Penn. “Investing in neighborhoods that have been historically segregated, lacked access to government services, and subjected to racism will help to improve not only severe maternal morbidity, but also a host of other health outcomes for patients.”