Ohio Health Policy News

The Health Policy Institute of Ohio has released an action guide that highlights policy options for improving education, one of the social drivers of infant mortality in Ohio. 

HPIO recently produced the Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio report as an update to the 2017 A New Approach to Reduce Infant Mortality and Achieve Equity report.
 
The action guide takes a closer look at the education recommendations in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps.
 
Despite the efforts of many in both the public and private sectors, progress in reducing infant mortality since 2011 has been minimal and uneven, and Ohio’s infant mortality rate remains higher than most other states.

Infant mortality prevention efforts have largely focused on public health and healthcare interventions for pregnant women, such as safe sleep education and prenatal care access. While these efforts have likely contributed to the overall reduction in infant mortality, healthcare services alone are not enough to close gaps in birth outcomes in Ohio.

Last week, HPIO released a similar housing action guide.
 
The guide and additional tools posted on HPIO’s website can be used to prioritize, advocate for and implement the recommendations.

Children experienced learning deficits during the Covid pandemic that amounted to about one-third of a school year’s worth of knowledge and skills, according to a new global analysis, and had not recovered from those losses more than two years later (Source: “Students Lost One-Third of a School Year to Pandemic, Study Finds,” New York Times, Jan. 30).

Learning delays and regressions were most severe in developing countries and among students from low-income backgrounds, researchers said, worsening existing disparities and threatening to follow children into higher education and the work force.

The analysis, published Monday in the journal Nature Human Behavior and drawing on data from 15 countries, provided the most comprehensive account to date of the academic hardships wrought by the pandemic. The findings suggest that the challenges of remote learning — coupled with other stressors that plagued children and families throughout the pandemic — were not rectified when school doors reopened.

Despite billions of dollars in federal covid-relief money available to upgrade heating and air-conditioning systems and improve air quality and filtration in K-12 schools, U.S. public schools have been slow to begin projects that have the potentional to improve the overall health of students (Source: “Covid Funding Pries Open a Door to Improving Air Quality in Schools,” Kaiser Health News, June 13).

According to a report released this month from the Centers for Disease Control and Prevention, fewer than 40% of public schools had replaced or upgraded their HVAC systems since the start of the pandemic. Even fewer were using high-efficiency particulate air, or HEPA, filters in classrooms (28%), or fans to increase the effectiveness of having windows open (37%).

Both the CDC and White House have stressed indoor ventilation as a potent weapon in the battle to contain covid. And a wealth of data shows that improving ventilation in schools has benefits well beyond covid.

Good indoor air quality is associated with improvements in math and reading; greater ability to focus; fewer symptoms of asthma and respiratory disease; and less absenteeism. Nearly 1 in 13 U.S. children have asthma, which leads to more missed school days than any other chronic illness.

A report released this week from advocacy group Mental Health America found that a majority of states are not ready to address youth mental health as schools prepare to reopen for in-person learning in the fall (Source: “Analysis: Most states not ready to tackle youth mental health ahead of fall,” The Hill, July 20). 

The analysis reports that just 14 states have fully expanded Medicaid to cover mental health services in schools, and only a handful have legislation requiring mental health education. The lack of access and education make states unprepared to deal with mental health issues among children, which were exacerbated by the pandemic, the report said. 

Children of color are more likely to receive school-based mental health services than white children, so limited resources can also lead to disparities in who is getting care. And although Black and Latino children are less likely than white children to get mental health treatment for depression, they made up the largest increases in the proportion of youth experiencing suicidal ideation between 2019 and 2020, the report said.

Advocates say the coronavirus pandemic worsened an already existing mental health crisis devastating young people. The percentage of 12- to 17-year-olds who reported a past-year major depressive episode doubled over the past 10 years, according to the National Survey on Drug Use and Health. 

The Health Policy Institute of Ohio released a new fact sheet titled “K-12 Student Wellness and Health Equity,” which explores the connection between student wellness and health.

According to the fact sheet, “Research has shown that schools can positively impact academic success and educational attainment through student wellness and health improvement efforts, such as school-based health care, drug and violence prevention and social-emotional learning programs.”

The fact sheet notes:

• Nearly one quarter of Black children in Ohio (22%) were chronically absent during the 2019-2020 school year, compared to 8% of white children in Ohio.
• The percent of high school students in Ohio who did not graduate in four years was 3.2 times higher for students with low incomes compared to peers with higher incomes.
• Among children in Ohio with special healthcare needs who needed care coordination, 41% did not receive needed care coordination in 2018-2019.
• The suicide rate for youth, ages 8-17, in Appalachian counties in Ohio was 1.5 times higher than the overall youth suicide rate in 2018.

The fact sheet also includes links to existing state plans and resources that include strategies policymakers can focus on to improve K-12 student wellness.

HPIO has released Connections Between Education and Health No. 4: School-Based Drug and Violence Prevention and Mental Health Promotion.

As thousands of Ohioans struggle to recover from opiate addiction, policymakers are increasingly aware of the importance of stopping addiction before it starts. Many school-based drug prevention approaches also improve other outcomes of interest to policymakers and educators such as:

• Increased on-task behavior, school engagement and high school graduation
• Decreased school behavior problems and disciplinary incidents
• Decreased depression, anxiety and suicide
• Decreased school violence and bullying

This fourth and final policy brief in HPIO’s Connections Between Education and Health series focuses on policies and programs that support foundational protective factors for children, such as health literacy, impulse control, communication skills, school engagement and opportunities for positive social involvement including:

• Prevention education
• Social-emotional learning and positive behavior programs
• School climate improvement initiatives

The brief describes the extent to which Ohio is implementing these approaches and presents policy options to improve education and health outcomes through school-based prevention.

Young children of color or who live in rural Appalachia are more at risk of starting behind — and staying behind, well into adulthood — than their more-affluent peers elsewhere in Ohio, a new report shows (Source: “Minority, Appalachian kids at greater risk of remaining poor for life, report says,” Columbus Dispatch, July 25, 2018).

Groundwork Ohio released the Ohio Early Childhood Race & Rural Equity Report 2018 on Wednesday. Shannon Jones, executive director of the nonpartisan child-advocacy organization, said it was the most-comprehensive early childhood report in the state’s history. (Jones serves on the Board of Directors for the Health Policy Institute of Ohio)

The report used statewide and regional data collected from multiple state agencies to analyze 26 measures, ranging from prenatal care to post-secondary educational attainment. The data show that kids who have poor outcomes in one measure share the same profile as kids who have poor outcomes in another — whether the measure is education or health-related.

Ninety percent of brain development occurs between birth and age 5. Gaps between advantaged and disadvantaged children begin emerging as early as 9 months, and the gaps widen as kids grow older — leaving disadvantaged kids up to two years behind their higher-income peers by age 5, the report says.

Ohio lawmakers are considering changes to standardize the way schools collect data on student vaccinations — including requiring that a doctor sign off when a parent wants to opt out — as many schools still struggle to meet state standards for immunizations (Source: “Lawmakers seek changes as school vaccination rates remain low,” Dayton Daily News, March 22, 2018).

Medical professionals backing the effort say Ohio needs a more streamlined process to ensure health professionals and parents have accurate data on vaccination rates. But the proposal is already drawing criticism from some parents, who want to protect their ability to choose not to vaccinate without interference from a doctor.

Schools are required to report that information for all students in kindergarten, seventh and twelfth grades, and for students who enter a new school. House Bill 559 would create a standardized form that every school in Ohio would use to collect vaccine information from each student at the required grade levels. A health care professional — whether a physician, nurse practitioner or health department nurse — would complete the form to show what vaccines the child has received.

Parents wishing to opt their child out of certain vaccines would still be able to do so for religious or personal beliefs, but they would need a health care professional to fill out the same form, acknowledging that they had a conversation prior to opting out. The bill also calls for the school-level data collected by the Ohio Department of Health each year to be published online, so that public health officials, stakeholders and parents can know the opt-out rate by school building.

Medicaid, created in 1965 to provide health insurance to the poor, now functions as a lifeline for millions of American students, as well as hundreds of school districts across the country (Source: “How Medicaid Became A Go-To Funder For Schools,” Kaiser Health News, March 9, 2018).

The public insurance program has evolved so that it now finances myriad education-related services, including transportation for kids with disabilities, school clinics and counseling for children from turbulent backgrounds. Medicaid funds are now woven into the nation’s educational system.

But as Congress seeks to cut federal health spending, the use of Medicaid dollars in schools could come under new scrutiny.

Medicaid spends only $4 billion of its $400 billion annual budget in schools — a “very small portion of the pie,” said Jessica Schubel, a senior policy analyst at the bipartisan Center on Budget and Policy Priorities. But for the school districts providing an array of services that have quietly become vital to students and families, losing this funding source would be immense, she said, “a big deal.”

As part of its ongoing exploration of the links between health and education, the Health Policy Institute of Ohio this week released fact sheets addressing  suspensions and expulsions among young children and Positive Behavior Interventions and Supports (PBIS). 

The fact sheets are included -- along with a series of HPIO policy briefs and a collection of other education and health resources -- on HPIO’s online resource page Intersections between Education and Health. 

Health and education are areas of significant focus for Ohio policymakers, representing the largest shares of Ohio’s biennial budget. With support from the United Way of Central Ohio, HPIO has explored for the past year the intersections of education and health. 

In the fall, HPIO released its third policy brief on the subject, titled “The Importance of Early Learning.” The first brief in the series gave an overview of the connections between education and health and the second brief examined health services in schools. A fourth brief is planned for early 2018.