Evidence-based policy

Newly released County Health Rankings spotlights connection between income and health

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Newly released data from County Health Rankings show that Black Ohioans have the lowest median household income among groups of Ohioans and have, by far, the highest rate of premature death (years of potential life lost before age 75, which reflects the burden of deaths that potentially could have been prevented).
 
Between 2018 and 2020, Black Ohioans collectively lost 13,374 years of life before turning 75 years old (see graphic above). That is nearly as many years lost as Hispanic (5,858) and white Ohioans (8,224) combined.  At the same time, the median household income for Black Ohioans is $12,352 less than Hispanic Ohioans, $28,065 less than white Ohioans and $43,782 less than Asian Ohioans.
 
“Individual efforts alone cannot overcome the structural barriers that maintain the racial wealth divide,” County Health Rankings states. “Structural barriers include laws, policies, institutional practices, and economic arrangements that create unequal conditions.”
 
The latest edition of the County Health Rankings, released this week, includes a new curated list of strategies to address racial wealth building, a key to eliminating health disparities.
 
“Research shows that income inequality has a negative effect on overall population health,” according to the Rankings. “Economically unequal societies often have higher rates of physical and mental illness, violence, and incarceration.”

Throughout April, HPIO has marked National Minority Health Month by creating a series of data visualizations to illustrate health disparities in Ohio.


FDA moves to ban menthol cigarettes with aim of reducing smoking-related disparities

The Food and Drug Administration (FDA) on Thursday announced a plan to ban sales of menthol-flavored cigarettes in the United States, a measure many public health experts hailed as the government’s most meaningful action in more than a decade of tobacco control efforts (Source: “F.D.A. Moves to Ban Sales of Menthol Cigarettes,” New York Times, April 28).
 
The ban would most likely have the deepest impact on Black smokers, nearly 85% of whom use menthol cigarettes, compared with 29% of white smokers, according to a government survey. If effective in reducing smoking, the ban could significantly diminish the burden of chronic disease and limit the number of lives cut short by one of the most hazardous legal products available.
 
Public health experts say menthol cigarettes have been heavily marketed to Black people, to devastating effect: African American men have the highest rates of lung cancer in America, according to the Centers for Disease Control and Prevention.


White House plan to reduce drug overdose deaths leans on harm reduction strategies

President Joe Biden is sending his administration’s first national drug control strategy to Congress as the U.S. overdose death toll hit a new record of nearly 107,000 during the past 12 months (Source: “Biden drug control plan stresses harm reduction, treatment,” Associated Press, April 21).

The strategy, released Thursday, is the first national plan to prioritize harm reduction, said White House drug czar Dr. Rahul Gupta. The strategy calls for changes in state laws and policies to support the expansion of harm reduction.

For an overview of harm reduction policy in Ohio, see HPIO’s “Ohio Addiction Policy Scorecard: Overdose Reversal and Other Forms of Harm Reduction.”


Ohio ranks near bottom in latest HPIO Health Value Dashboard

Ohio ranks 47 in the nation in health value compared to other states and D.C. according to the latest edition of the Health Value Dashboard, which was released earlier this week by the Health Policy Institute of Ohio.

“Ohioans live less healthy lives and spend more on health care than people in most other states,” according to the Dashboard.

Ohio has consistently ranked near the bottom on health value in each of the four editions of the Dashboard. Ohio’s overall health value ranking was 47 in 2014, 46 in 2017 and 46 in 2019. 

The Dashboard found that Ohio’s healthcare spending is mostly on costly downstream care to treat health problems. This is largely because of a lack of attention and effective action in the following areas:

  • Children. Childhood adversity and trauma have long-term consequences
  • Equity. Ohioans with the worst outcomes face systemic disadvantages
  • Prevention. Sparse public health workforce leads to missed opportunities for prevention

The Dashboard is a tool to track Ohio’s progress toward health value — a composite measure of Ohio’s performance on population health and healthcare spending. In ranked profiles, the Dashboard examines Ohio’s rank and trend performance relative to other states across seven domains. In addition, through a series of equity profiles, the Dashboard highlights gaps in outcomes between groups for some of Ohio’s most systematically disadvantaged populations.

The Dashboard includes examples of nine evidence-informed policies that could be adopted by Ohio policymakers and private-sector partners to make Ohio a leader in health value.


HPIO fact sheet highlights connection between affordable housing, health equity

The Health Policy Institute of Ohio released a new fact sheet titled “Housing Affordability and Health Equity,” which explores the connection between affordable and safe housing and health.

According to the fact sheet, “Quality, affordable housing is vital for Ohio families to maintain stable employment and long-term health. Low wages, a lack of safe and affordable housing and the impacts of racism and housing discrimination result in many Ohioans spending a significant portion of their income on poor quality housing in neighborhoods that are disconnected from necessary resources, including high-quality health care and high paying jobs.”

The fact sheet notes:

  • About one-fifth of white Ohio renters (21%) spent over 50% of their income on housing in 2017. This housing cost burden was even higher for Latino and Black Ohioans.
  • Many workers were not paid enough to afford a 2-bedroom apartment at fair market rent (FMR) in Ohio in 2020.
  • There were only 42 affordable rental units for every 100 renter households with incomes at or below the poverty line or 30% area median income in Ohio in 2019.

The fact sheet also includes links to existing state plans and resources that include evidence-based strategies policymakers can focus on to improve housing affordability in Ohio.


HPIO fact sheet outlines link between transit, health equity

The Health Policy Institute of Ohio released a new fact sheet titled “Transit and Health Equity,” which explores the connection between transportation access and health.

According to the fact sheet, “Transportation access is critical for good health across the lifespan.” The fact sheet notes:

  • Transportation to prenatal care and healthy food can improve birth outcomes and reduce infant mortality disparities.
  • Reliable transportation offers better access to jobs which supports self-sufficient employment, and in turn, can lead to higher income and better physical and mental health.
  • Transportation access connects older adults to friends and family, health care, volunteer opportunities and other activities and supports necessary for healthy aging.

The fact sheet also includes links to existing state plans that include strategies for policymakers to consider for improving transit.


New HPIO, OSU policy brief explores link between clinician wellbeing and patient care and safety

The Health Policy Institute of Ohio, in partnership with the Ohio State University College of Nursing Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, has released a new policy brief titled A Call to Action: Improving Clinician Wellbeing and Patient Care and Safety.

A growing body of research indicates that healthcare clinicians face serious problems related to their overall health and wellbeing, including high rates of burnout, depression, addiction and suicide. Understanding the relationship between clinician well-being and patient care and safety enables state policymakers and healthcare leaders to implement evidence-informed policies and programs that improve outcomes for clinicians and their patients.

This brief serves as a call to action to improve clinician wellbeing and its impacts on patient care and safety, providing a:

  • Framework for the relationship between clinician wellbeing and patient care and safety
  • Summary of research findings
  • Review of evidence-informed policies, programs and practices that improve clinician wellbeing and support high-quality, safe patient care
  • Set of evidence-informed state policy options

New County Health Rankings highlights housing, health link

The 2019 County Health Rankings and Roadmap report was released this week, and this year the rankings are focusing attention on the link between health and housing (Source: “Stable housing a key factor in improving health in Ohio’s counties,” Columbus Dispatch, March 19, 2019).

The 2019 County Health Rankings are the ninth iteration of the rankings, with data compiled for every county in the U.S. by researchers with the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

“We know that a safe and secure and affordable place to call home is a critical foundation for good health,” said Karen Odegaard, an associate researcher at the Population Health Institute.

The cost of housing plays a significant role, especially with low-income families and people of color who are disproportionately burdened, she said.

Housing was one of four focus areas in “A New Approach to Reduce Infant Mortality and Achieve Equity,” a report HPIO published in late 2017 under contract with the Legislative Services Commission.


New HPIO brief explores link between work, health

The Health Policy Institute of Ohio's latest publication explores the link between employment and health and outlines 20 policy options that have the potential to increase self-sufficient employment in Ohio.

What Works to Increase Self-Sufficient Employment is published at a time when Ohio policymakers wait for federal approval to require work as a condition of Medicaid eligibility for some beneficiaries and are seeking ways to increase the number of Medicaid enrollees who transition to employer-sponsored coverage.

The report analyzes the relationship between health and work, describes Ohio's employment and workforce landscape and outlines evidence-based state policy options that can contribute to self-sufficient employment and improved health.

Self-sufficient employment is defined in the brief as employment that pays workers a wage that covers basic needs, such as housing, food, transportation, child care and health care and offers health insurance.

The publication outlines policy options Ohio policymakers can take, regardless of the decision made by federal officials on Ohio's current Medicaid work requirement proposal, to ensure more Ohioans have the opportunity to thrive economically and achieve better health. Examples include:

  • Increasing participation in secondary and postsecondary career and technical education
  • Expanding income support policies, such as the state Earned Income Tax Credit
  • Establishing clear policy goals and measurable desired outcomes for state- and federally-funded workforce programs, including employment services coordination models

Latest HPIO education brief explores school-based drug, violence prevention

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.