disparities

Graphic of the week

Dashboard_DisparitiesGraphic_StandAlone

 

HPIO’s 2021 Health Value Dashboard concluded that one reason Ohio ranks poorly (47th out of the 50 states and D.C.) is that many Ohioans experience poorer outcomes and live shorter lives because of policies, systems and beliefs that discriminate against and unfairly limit access to resources. According to the Dashboard, racism and other forms of discrimination drive troubling differences in outcomes across Ohio. This includes racist and discriminatory beliefs and interactions among Ohioans and structural racism and discrimination embedded within systems and across sectors, rooted in ageism, ableism, xenophobia, homophobia and other “isms” or “phobias.”  As the graphic above shows, Ohioans experiencing the worst health outcomes are also more likely to be exposed to risk factors for poor health. These include trauma and adversity, toxic stress, violence and stigma, and inequitable access to resources.

Earlier this week, HPIO hosted the first meeting of its Health Value Dashboard Advisory Group as it begins planning for the 2023 Dashboard. The new edition is expected to be released in March or April 2023.


In rural areas, COVID hits Black, Hispanic communities hardest, although gap appears to be narrowing

At the peak of the Omicron wave, Covid killed Black Americans in rural areas at a rate roughly 34% higher than it did white people, new research has found, although the gap appears to be narrowing in recent months (Source: “In Rural America, Covid Hits Black and Hispanic People Hardest,” New York Times, July 28).

Across the small towns and farmlands, new research has found, Covid killed Black and Hispanic people at considerably higher rates than it did their white neighbors. Even at the end of the pandemic’s second year, in February 2022, overstretched health systems, poverty, chronic illnesses and lower vaccination rates were forcing nonwhite people to bear the burden of the virus.

In towns and cities of every size, racial gaps in Covid deaths have narrowed. That has been especially true recently, when major gains in populationwide immunity have tempered the kind of pressure on health systems that appears to hurt nonwhite Americans the most.


Insurer reduces healthcare disparities after tying executive bonuses to the issue

A California-based Medicare Advantage plan is touting its success at improving health disparities by tying its executives’ bonuses to the issue (Source: “How one insurer tied executive performance bonus to reducing healthcare disparities,” MedCity News, July 25).

One aspect SCAN Health Plan looked at was medication adherence among its members, numbering  270,000 across Arizona, California and Nevada. While medication adherence exceeded 80% for all of SCAN’s members, there was still a difference between races. About 86% of the company’s White members took cholesterol medications as prescribed, compared to 83% of Black members and 81% of Hispanic members, according to an essay from the company published in Harvard Business Review.

A year after launching the initiative, SCAN Health brought cholesterol medication adherence up to 87.4% for Black members, 86.6% for Hispanic members and 89.6% for White members. Similar improvements were seen in diabetes medication adherence.

SCAN officials say the company achieved the improvement in disparities by tying about 10% of its senior managers’ bonuses to their success in achieving this disparity reduction.

The company chose this course of action “to make it real,” SCAN CEO Sachin Jain said. “It’s not real until you make it real for people. Otherwise, it’s kind of like ‘Oh, yeah, it’d be great if we did this.’ And we wanted to send a strong signal to our organization that this was not something that was nice to have. This is a must do.”


Health systems leaders from across U.S. detail health equity initiatives

As the COVID-19 pandemic exacerbated existing health equities, health systems nationwide have implemented a series of initiatives to reduce disparities (Source: “13 leaders on health equity initiatives launched in the last year,” Becker Hospital Review). 

Leaders from 13 health systems from across the country answered a series of questions on their health equity initiatives and shared lessons learned so far with editors of Becker Hospital Review.


Report finds flawed Medicare data inhibits analysis of health disparities

Inaccuracies in Medicare's race and ethnicity data have hurt the program’s ability to assess health disparities, a new federal report found (Source: “Flawed Medicare data hampering analysis of health disparities, inspector general says,” Becker’s Payer Issues, June 15).

According to a report from the HHS Office of the Inspector General, Medicare's enrollment data is inconsistent with federal data collection standards, and the inconsistencies "inhibit the work of identifying and improving health disparities within the Medicare population,"

By comparing Medicare data to other federal sources, the report found that Medicare's race and ethnicity data is less accurate for certain groups, particularly for beneficiaries who identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic. 

The report includes recommendations that CMS develop its own source of race and ethnicity data, use self-reported race and ethnicity information to improve data for current beneficiaries, develop a process to ensure that the data is as standardized as possible and educate beneficiaries about CMS efforts to improve the race and ethnicity information.


Study finds race, ethnicity are seldom mentioned in pediatric clinical guidelines

Race and ethnicity were unexplored in most American pediatric clinical practice guidelines published in the last 5 years, according to the results of a systematic review (Source: “Race unexplored in most pediatric clinical care guidelines, review finds,” Helio, June 13).

According to the study, which was published in JAMA Pediatrics, 70% of the guidelines did not mention race or ethnicity at all. The researchers also found that when race or ethnicity was mentioned, 57% of the time it was used in a way that could exacerbate or have a negative impact on inequities and only 15.1% of clinical practice guidelines include language specifically intended to reduce disparities in medicine.

“I think that shows a missed opportunity for us as medical organizations to be proactive in talking about health care inequities and systemic racism in our field,” said Courtney A. Gilliam, MD, a member of the division of hospital medicine in the department of pediatrics at Seattle Children’s Hospital and a co-author of the review. “We have a long way to go in interrogating clinical practice guidelines.”


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Baby formula shortage puts spotlight on long-standing health disparities

As parents across the United States struggle to find formula to feed their children, the pain is particularly acute among Black and Hispanic women, who have historically faced obstacles to breastfeeding, including a lack of lactation support in the hospital, more pressure to formula feed and cultural roadblocks (Source: “Baby formula shortage highlights racial disparities,” Associated Press, May 27).

Low-income families buy the majority of formula in the U.S. and face a particular struggle: Experts fear small neighborhood grocery stores that serve these vulnerable populations are not replenishing as much as larger retail stores, leaving some of these families without the resources or means to access formula.

The Centers for Disease Control and Prevention estimates that 20% of Black women and 23% of Hispanic women exclusively breastfeed through six months, compared to 29% of white women. The overall rate stands at 26%. Hospitals that encourage breastfeeding and overall lactation support are less prevalent in Black neighborhoods, according to the CDC.

The racial disparities reach far back in America’s history. The demands of slave labor prevented mothers from nursing their children, and slave owners separated mothers from their own babies to have them serve as wet nurses, breastfeeding other women’s children. In the 1950s, racially targeted commercials falsely advertised formula as a superior source of nutrition for infants. And studies continue to show that the babies of Black mothers are more likely to be introduced to formula in the hospital than the babies of white mothers.


Study: Communities of color have much higher air pollution rates

A block-by-block analysis of air quality in the San Francisco Bay area found that communities of color are exposed to 55% more of a chemical that contributes to smog than mostly White communities (Source: “Block-by-block data shows pollution’s stark toll on people of color,” Washington Post, May 25).

The data released Tuesday by Aclima, a California-based tech company that measured the region’s air quality block-by-block for the first time. While the Environmental Protection Agency gauges an area’s air quality with fixed monitors, the new survey unearthed more granular data by sending low-emission vehicles equipped with sophisticated technology to traverse neighborhoods at least 20 times each.

These forays revealed that poor people of all ethnicities experience a 30% higher exposure to nitrogen dioxide compared to wealthier residents, and concentrations can vary up to 800% from one end of a block to the next.


Year after federal funds announced to fight COVID disparities, states still not moving forward

A year after the Biden administration announced $2.25 billion would be sent to states to address COVID health disparities, little of the money has been used (Source: “States Have Yet to Spend Hundreds of Millions of Federal Dollars to Tackle COVID Health Disparities,” Kaiser Health News, May 16).

The Biden administration in March 2021 announced it was allocating the money to address COVID health disparities, the largest federal funding initiative designed specifically to help underserved communities hardest hit by the virus.

Two months later, the Centers for Disease Control and Prevention awarded grants to every state health department and 58 large city and county health agencies. The money is intended to help limit the spread of COVID-19 among those most at risk in rural areas and within racial and ethnic minority groups, as well as improve their health. The CDC initially said the grant had to be spent by May 2023, but earlier this year told states they could apply to extend that time.

A year after the funding was announced, little of the money has been used, according to a Kaiser Health News review of about a dozen state and county agencies’ grants (Ohio was not included in the analysis).