Health equity

Walmart expands doula services for employees to address racial disparities in birth outcomes

Walmart is expanding health care coverage for employees who want to enlist the services of a doula, a person trained to assist women during pregnancies, to address racial inequities in maternal care (Source: “Walmart expands health services to address racial inequality,” Associated Press, June 22).

After first offering doulas to employees in Georgia last year, the nation’s largest retailer said Wednesday that it will expand the same benefit to its employees in Louisiana, Indiana and Illinois.

Black women are three times more likely to die from a pregnancy-related cause than white women, largely due to differences in the quality of health care, underlying chronic conditions and structural racism, according to the Centers for Disease Control and Prevention. Employing a doula as a part of a birthing team decreases C-sections by 50%, shortens the time of labor by 25% and decreases the need for other medical interventions by more than 50%, according to the National Black Doulas Association.

Earlier this month, the Ohio House passed a bill that would provide Medicaid coverage for licensed doula services. (Source: “Doula services could soon be covered by Medicaid after racial equity bill passes Ohio House,” Ohio Capital Journal, June 9).


Ohio House approves Medicaid coverage of doulas in attempt to address racial disparities

A bill that is aiming to combat racial disparities in infant and maternal mortality rates passed the Ohio House during a session Wednesday (Source: “Doula services could soon be covered by Medicaid after racial equity bill passes Ohio House,” Ohio Capital Journal, June 9).

House Bill 142 would provide Medicaid coverage for licensed doula services.

Between 2008 and 2017, Black women died during birth about two and a half times more than white women, according to the Ohio Department of Health. Black women also have twice the amount of birth complications, which ODH data show cannot be attributed to factors such as the pregnant person’s income, education, marital status, tobacco/ alcohol use and insurance coverage.

Doulas “can save lives,” said Dorian Wingard, partner and COO of Restoring Our Own Through Transformation (ROOTT), an organization dedicated to addressing the needs of women of color. “They can prevent the death of mothers, they can prevent the death of children.”

Doula services can also result in lower rates of preterm births, as well as help save money for families, according to Wingard.

Republican state Rep. Tom Brinkman, one of the bill’s sponsors, said he convinced his fellow Republicans to vote for the bill by explaining that it could allow Ohio to save money, since doula services lead to fewer preterm births, which are expensive for the state.

“The hardest thing was to talk to my colleagues and say, ‘look, we are going to expand Medicaid, which we don’t necessarily want to do because we’re trying to restrain costs, but what it’s going to do is result in overall savings because we won’t be paying for [as many complications],” Brinkman said.


HHS launches office of environmental justice to address health inequities

The Department of Health and Human Services (HHS) has announced it is establishing an Office of Environmental Justice (OEJ), bringing awareness to the impact of environmental health inequities (Source: “HHS Launches Office of Environmental Justice, Tackles Health Inequity,” Patient Engagement HIT, June 3).
 
“The blunt truth is that many communities across our nation – particularly low-income communities and communities of color – continue to bear the brunt of pollution from industrial development, poor land-use decisions, transportation, and trade corridors,” HHS Secretary Xavier Becerra said in the press release. “Meeting the needs of these communities requires our focused attention. That’s why HHS is establishing the Office of Environmental Justice.”
 
Until June 18, 2022, the OEJ will be seeking public comment to identify the best strategies for addressing environmental injustices and health inequities for disadvantaged communities.


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.


Policy experts call for better Medicaid data collection to address health inequity

A team of healthcare policy experts is calling for an overhaul of the ways in which Medicaid data is collected and analyzed to address health equity issues (Source: “Health Policy Experts: Medicaid Data Processes Must Be Improved to Achieve Equity,” Heathcare Innovation, May 25).

Writing in Health Affairs, the researchers say that “the COVID-19 pandemic has highlighted and exacerbated health care inequities in the United States. Calls to address health care disparities have intensified, and the Biden Administration has made equity a central component of its policy agenda. The confluence of these social and political forces has reinvigorated discussion about how to address health care inequities in public insurance programs, and refocused attention on Medicaid — which now covers more than 86 million Americans — as a lever for advancing health equity.”

The authors point to the 2021 decision by the Center for Medicare and Medicaid Innovation (CMMI) to explicitly add health care equity as one of its five core objectives. CMMI also specifically prioritized initiatives to improve care and outcomes for vulnerable and underserved populations in Medicaid.

“These efforts depend, however, on the ability to measure disparities in access to care, quality of care, and health outcomes by race and ethnicity,” the authors wrote. “Due to lack of high-quality data, it remains impossible to fully evaluate the state of health equity in the Medicaid program.”


Newly released County Health Rankings spotlights connection between income and health

MedianIncome_YPLL_StandAloneGraphic_Final
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.


States adopt policies to require implicit bias training for health workers

In the past three years, states have begun training medical providers to stop acting on unconsciously held beliefs, known as implicit bias (Source: “With Implicit Bias Hurting Patients, Some States Train Doctors,” Pew Stateline, April 21).
 
Since 2019, at least four states — California, Maryland, Michigan and Washington — have adopted policies requiring at least some healthcare workers to take implicit bias training, some as a prerequisite for professional licensure or renewal.
 
Bills on implicit bias training in health care have been introduced in state legislatures over the past two years in many other states, including Illinois, Indiana, Nebraska, New York, Oklahoma, South Carolina, Tennessee and Vermont. Minnesota passed a law last year requiring obstetrics units to offer implicit bias training.
 
Even without laws, some health systems in recent years began offering or requiring training in implicit bias, as have some medical schools, including Harvard, Icahn School of Medicine at Mount Sinai in New York and Ohio State University.


Suicide rates for young Ohioans climb, sharpest rise is among Black Ohioans

SuicideDisparities_StandAloneGraphic_04.14.2022

While suicide deaths among young Ohioans have risen overall in Ohio over the past two decades, the increase has been sharpest among Black Ohioans. 

In 1999, the suicide rates for both white Ohioans and Black Ohioans ages 10 to 24 were the same: 6.8 per 100,000 people. By 2020 (the most recent year for which data is available), the rate for white Ohioans had risen to 11.2 (an increase of 64%) and the rate for Black Ohioans had risen to 12.8 (an increase of 88%).  

More-recent national research indicates that the disparity in suicide rates may have increased during the COVID-19 pandemic.  

Reducing suicide and eliminating disparities are priorities of the Ohio Department of Health’s 2020-2022 State Health Improvement Plan (SHIP). Public- and private-sector leaders can implement strategies identified in the SHIP and Ohio’s 2020-2022 Suicide Prevention Plan, including suicide fatality review boards, behavioral health integration with primary care and education on safe storage of lethal means (i.e., firearms and medications). 

This April, HPIO is spotlighting health disparities in Ohio as part of National Minority Health Month.  

If you or someone you know is experiencing emotional distress or a suicidal crisis, please call the National Suicide Hotline toll-free at 1-800-273-8255


Black women in Ohio 2.2 times more likely to die from pregnancy-related causes, data shows

MaternalMortality_MorbidityRates_StandAloneGraphic_04.08.2022
According to the most-recent data, Black women in Ohio are 2.2 times more likely to die from a cause related to pregnancy and have a 1.85 times higher rate of maternal morbidity (i.e., health problems related to pregnancy and childbirth) than white women.
 
Differences in healthcare access and conditions such as housing, transportation and income, as well as the cumulative impacts of toxic stress and discrimination, all contribute to stark disparities in maternal outcomes across the state.
 
Improving maternal health and eliminating disparities are priorities of the Ohio Department of Health’s 2020-2022 State Health Improvement Plan.
 
Next week is the fifth annual Black Maternal Health Week, an event that coincides with National Minority Health Month. As part of its annual recognition of Minority Health Month, the Ohio Commission on Minority Health has released an extensive calendar of events. Throughout the month, HPIO is releasing new data graphics exploring health disparities in the state. More information and resources about health equity in Ohio are available on HPIO’s website.
 
HPIO plans to release a fact sheet on maternal mortality and morbidity in Ohio later this month.