Health equity

American Heart Association removes race as predictor for heart disease

The American Heart Association announced this week plans to release a new clinical tool that removes race as a factor in predicting who will have heart attacks or strokes (Source: “Race Cannot Be Used to Predict Heart Disease, Scientists Say,” New York Times, Nov. 14).
Doctors have long relied on a few key patient characteristics to assess risk of a heart attack or stroke, using a calculus that considers blood pressure, cholesterol, smoking and diabetes status, as well as demographics: age, sex and race. Now, the American Heart Association is taking race out of the equation.
The overhaul of the widely used cardiac-risk algorithm is an acknowledgment that, unlike sex or age, race identification in and of itself is not a biological risk factor. The scientists who modified the algorithm decided from the start that race itself did not belong in clinical tools used to guide medical decision-making, even though race might serve as a proxy for certain social circumstances, genetic predispositions or environmental exposures that raise the risk of cardiovascular disease.
The revision comes amid rising concern about health equity and racial bias within the U.S. health care system and is part of a broader trend toward removing race from a variety of clinical algorithms. “We should not be using race to inform whether someone gets a treatment or doesn’t get a treatment,” said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine, who chaired the statement writing committee for the American Heart Association.

Upcoming HPIO forum to explore economic benefits of eliminating racial disparities and inequities

Join HPIO on Thursday, Oct. 26, from 11 a.m.-12:30 p.m., for an online forum to explore how Ohio can grow its workforce, increase consumer spending, strengthen communities and reduce fiscal pressures on state and local budgets.

This forum will take a closer look at HPIO's recent brief, "Unlocking Ohio’s economic potential: The impact of eliminating racial disparities on Ohio businesses, governments and communities." Speakers will discuss the factors that contribute to racial disparities in Ohio, offer data and insight about the economic benefits Ohio could gain by eliminating disparities and provide examples of actions Ohioans can take to eliminate racism, improve health and increase economic vitality.

For more information and to register, click here.

Updated HPIO analysis finds deaths among working-age Ohioans still much higher than 15 years ago


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Updated analysis from the Health Policy Institute of Ohio found that working-age Ohioans are dying at a much higher rate than they were 15 years ago, despite a drop in deaths in 2022 as the state emerged from the pandemic.

The analysis, which is compiled in a new data snapshot, “Death Trends among Working-age Ohioans,” found that the number of deaths among working-age Ohioans increased 32% from 2007 to 2022, from 25,885 to 34,146, as illustrated above. If the annual number of deaths had remained constant since 2007, 66,637 fewer working-age Ohioans would have died.

“These mostly preventable deaths have a tremendous impact on Ohio families, communities and society,” according to the data snapshot. “In addition, the loss of a large number of working-age adults negatively affects Ohio’s economy and businesses.”

The leading cause of death for working-age adults remains unintentional injuries, which included unintentional drug overdoses and motor vehicle crashes.

“Unintentional drug overdose deaths continue to play a major role in Ohio’s increased death rate, accounting for 14% of all deaths among Ohioans ages 15-64 in 2022,” the analysis found.

The analysis concludes that “There are many effective strategies to address substance use, promote mental health and support access to healthy food and physical activity, all of which can help reduce deaths among working-age Ohioans… Public and private partners can work together to ensure more Ohio workers have the opportunity to live a healthy and productive life.”

Graphic of the week

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September is National Hispanic Heritage Month, and analysis from HPIO’s 2023 Health Value Dashboard has found that the uninsured rate for Hispanic Ohioans is 2.5 times worse than for white Ohioans, and Hispanic Ohioans are 2.4 times more likely than white Ohioans to be unable to see a doctor due to cost. If disparities were eliminated, 23,892 fewer Hispanic Ohioans would be uninsured and 32,000 fewer Hispanic Ohioans would face cost barriers to seeing a doctor, according to Dashboard analysis.

Included in the Dashboard are equity profiles, which explore gaps in outcomes among groups of Ohioans and analyze the barriers to health that contribute to these gaps. “Every Ohioan should have the opportunity to live a long and healthy life, free from environments and experiences that expose them to harm,” the report states. “However, many Ohioans continue to face unhealthy conditions and barriers to health in their homes, schools, workplaces and communities.”

HPIO releases action guide on policies to eliminate racism and reduce infant mortality

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

Earlier this year, HPIO 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.

This action guide takes a closer look at the recommendations related to racism in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps. The guide, and additional tools posted on the HPIO website, can be used to prioritize, advocate for and implement the recommendations.
Everyone deserves to live a long, healthy and fulfilling life. However, Black infants in Ohio are over 2.5 times more likely to die before their first birthday compared to white infants, as illustrated in the graphic above.
“Racism (including internalized, interpersonal, institutional and structural racism) is at the root of racial health disparities, such as the racial differences in infant mortality rates,” according to the guide.

HPIO recently released similar action guides on housing, education, transportation and employment.

Support for this project was provided by the Bruening Foundation and HPIO’s other core funders.

Joint Commission announces voluntary health equity certification for hospitals

The Joint Commission is kicking off a new advanced, voluntary certification for hospitals with processes in place to address healthcare disparities and promote equity among staff, the accreditation organization announced this week (Source: “Joint Commission unveils voluntary health equity certification, strengthens existing standard,” Fierce Healthcare, June 28).
Effective July 1, hospitals and critical access hospitals accredited by the organization or in compliance with applicable federal laws will be able to apply for the group’s Health Care Equity Certification Program. An abbreviated pre-application questionnaire may be submitted prior to July 1.
The Joint Commission has also launched a curated resource center for organizations seeking to pursue the certification, which includes strategies, toolkits, templates, videos and synopses of the requirements.

HPIO releases transportation action guide to address Ohio’s infant mortality rate

TransportationActionGuideFig2_StandaloneThe Health Policy Institute of Ohio has released an action guide that highlights policy options for improving transportation, 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 transportation recommendations in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps.

The guide highlights how transportation affects health and overall well-being in several ways, including by impacting access to care, health behaviors and health outcomes through the ability to get to health care, jobs, school, child care, social services, grocery stores, parks, libraries and other destinations. As illustrated above, Ohioans who are insured through Medicaid face particular challenges with avoiding or delaying care due to a lack of transportation.

Earlier this spring, HPIO released similar action guides on housing and education. In the coming weeks, HPIO plans to release guides on employment and eliminating racism.
The guide and additional tools posted on HPIO’s website can be used to prioritize, advocate for and implement the recommendations.

Study: Racial disparities persist even at highest-rated hospital systems

Even the highest-performing hospitals see racial health disparities in adverse patient safety events, according to a new report (Source: “Even At Top Hospitals, Racial Health Disparities in Patient Safety Are Steep,” Patient Engagement HIT, June 7).
The report from the Leapfrog Group and Urban Institute showing that, regardless of a hospital’s rating in the Leapfrog Group’s scorecard, white patients were less likely to experience an adverse patient safety event than their Black and Hispanic peers.
The consistency of health disparities across all hospital rating grades indicates that the Leapfrog Group reports “cannot be used to convey information on the underlying disparity in safe inpatient care,” the researchers said. That means patients who fall into the groups facing more adverse events may need additional tools to help with care access decision-making.

Graphic of the week


HPIO’s 2023 Health Value Dashboard includes, for the first time, an equity profile for LGBTQ+ Ohioans. Among the data highlighted in the profile is that LGBTQ+ adults in Ohio are much more likely to be diagnosed with depression than their heterosexual and/or cisgender peers, as displayed above.

Homophobia and transphobia are primary drivers of poor outcomes experienced by LGBTQ+ Ohioans, the Dashboard states. Experiencing these forms of discrimination can cause toxic stress, leading to poor health outcomes over time. Thus, LGBTQ+ Ohioans often experience worse outcomes than heterosexual and/or cisgender Ohioans across measures of health and the social environment. Policies and practices that limit access to necessary health care and a lack of protections for Ohioans based on sexual orientation and gender identity contribute to worse health outcomes for LGBTQ+ people compared to their heterosexual and/or cisgender peers.

As national celebrations begin for Pride Month, it is important to note that there are evidence-informed strategies that Ohio leaders can adopt to improve health disparities for LGBTQ+ Ohioans. By ensuring access to developmentally appropriate care, improving provider education and including sexual orientation and gender identity in anti-discrimination laws, Ohio can close gaps in health outcomes for LGBTQ+ Ohioans.

Graphic of the week


HPIO has updated data first included in its January Health Value Dashboard policy brief, “A closer look at outdoor air pollution and health.” 

The updated 2020 data (the most-recent year for which data is available) shows that racial disparities persist in exposure to air pollution, with the index of exposure for Black Ohioans being almost 1.5 times higher than white Ohioans, as displayed in the graphic above.

Much of that difference can be explained by historic zoning policies and redlining that placed industrial plants and highways closer to predominantly Black neighborhoods and prohibited Black people from moving to areas farther away from these sources of pollution.

These policies increased both past and present risk of exposure to air pollution for Black Ohioans. Similar policy decisions made by federal, state and local officials left Black neighborhoods with less maintenance services (e.g., garbage removal and street cleaning) and without green spaces like parks. Because of these discriminatory policies and their lasting impact, people of color across the U.S. and in Ohio are exposed to higher levels of harmful air pollution.