Health equity

Medicare eligibility drives down racial disparities, study finds

Access to Medicare may help address racial disparities in insurance coverage, access and self-reported outcomes, according to a new study (Source: “Medicare eligibility erases many healthcare disparities in US,” Healthcare Dive, July 26).

The research, published in JAMA Internal Medicine, tracked more than 2.4 million Americans and found that immediately after turning 65, and thus becoming eligible for Medicare, coverage for Black respondents increased from 86.3% to 95.8%. Among Hispanic respondents, coverage increased from 77.4% to 91.3%.

The JAMA study has validated the importance of Medicare in terms of leveling the playing field for Americans when it comes to healthcare access — a gap that has been exacerbated by the COVID-19 pandemic. Whereas there are significant gaps in access to healthcare and disparities among ethnic groups, reaching Medicare age wipes much of them out.

Disparities in insurance coverage were cut by 53% between Black people and white people, and 51% for Latino people versus white people. The proportion of Black and Latino people who self-reported their health as poor also dropped significantly after they became eligible for Medicare.


Organizations aim to connect patients, therapists of color

A number of new organizations aim to digitally connect patients with mental health providers who value and understand different cultures (Source: “It’s Hard to Search for a Therapist of Color. These Websites Want to Change That.,” New York Times, July 16).

In recent years there has been an expanding number of digital companies and nonprofits created to help people of color find a therapist they can trust — someone who is not only skilled in the best evidence-based treatments but also culturally competent. In other words, a provider who is aware of their own world views, knowledgeable about diversity and trained to connect with different types of clients.

The founders of these organizations say there has always been a need for such services, and even more so now that people are coping with the stressors of the pandemic and the racial reckoning that followed the killing of George Floyd by the Minneapolis police.

Studies have shown that mental health treatments can be more effective when a client feels that their therapist values culture.

It can be difficult for people of color to locate a therapist with a shared cultural background.  An American Psychological Association report found that only 5% of psychologists are Hispanic and 4% are Black — 86% are white. A similar disparity exists among the country’s social workers and psychiatrists.


Study finds link between neighborhood disadvantage and COVID-19 disparities

New research has found a strong link between COVID-19 and neighborhood disadvantage, a finding that supports earlier contentions of the connection between social factors and coronavirus disparities (Source: “How Neighborhood Disadvantage Drove COVID Health Disparities,” Patient Engagement HIT, July 21).

The study examined the connection between COVID-19 inequity and subway ridership in New York City. Neighborhoods that ranked higher on a COVID-19 inequity index — meaning that the neighborhood saw more factors that could put inhabitants at risk — also had higher subway ridership even after COVID-19 forced city-wide shutdowns.

Daniel Carrión, a researcher from Mount Sinai, said needing to ride the subway — or work an essential job — had a strong link to the unequal infection rates seen during the height of the coronavirus pandemic, largely because it limits the ability to socially distance.

“For us, subway utilization was a proxy measure for the capacity to socially distance,” Carrión, a postdoctoral researcher in the Department of Environmental Medicine and Public Health at the Icahn School of Medicine, told PatientEngagementHIT in an interview.

Although public health experts have made the link between the social determinants of health leading to actual infection, not just poor outcomes, Carrión and his colleagues put some data behind that. Social disadvantage was linked with higher subway utilization, and ultimately to higher infection rates and starker disparities.

“Folks like me were able to stay home for the majority of the pandemic and work from home. I didn't need to use public transit whereas others did. What we found was that areas that had higher COVID inequity indices were also riding the subways more after the stay-at-home orders compared to folks that were low in the COVID inequity index.”


Low number of Black dermatologists could hurt quality of care, providers warn

For people of color, basic dermatological conditions sometimes go undiagnosed or misdiagnosed by doctors unfamiliar with treating darker skin, healthcare professionals say (Source: “Skin color matters: In dermatology, patients' diversity calls more Black doctors,” Columbus Dispatch, July 29).

According to a June 2017 study published in the Dermatology Journal of the American Medical Association, 3% of dermatologists in the United States were Black. In 2020, 13.4% of the U.S. population was Black or African American, according to the U.S. Census.

A lack of diversity in any medical field can hurt the quality of care given. And a doctor from one ethnic or racial background might be able to offer information not necessarily taught in school.


New HPIO brief explores connections between criminal justice and health

The Health Policy Institute of Ohio has released a new brief titled  Connections between Criminal Justice and Health.

According to the brief, “The research evidence is clear that poor mental health and addiction are risk factors for criminal justice involvement and that incarceration is detrimental to health.”

The brief highlights the many factors that impact both criminal justice and health outcomes, finding that:

  • There is a two-way relationship between criminal justice and health. Mental health and addiction challenges can lead to arrest and incarceration, and incarceration contributes to poor behavioral and physical health for many Ohioans.
  • Racism and community conditions contribute to criminal justice involvement and poor health. Racist and discriminatory policies and practices and community conditions, such as poverty, housing instability and exposure to trauma, lead to increased criminal justice involvement and drive poor health outcomes.
  • Improvement is possible. There are evidence-informed policy solutions to combat the drivers of criminal justice involvement and poor health outcomes.

The brief includes 15 specific evidence-informed policy options focused on:

  • Supporting mental well-being and improving crisis response for people at higher risk of criminal justice involvement
  • Reducing the number of people incarcerated in Ohio
  • Improving health for people who are currently or formerly incarcerated
  • Improving community conditions for people who are at higher risk of criminal justice involvement

Study: Americans with lower incomes more likely to have respiratory illnesses

Despite improvements in air quality and other advances, Americans with low incomes more often have asthma, lung disease and related illnesses, a new study has found (Source: “Poor Americans More Likely to Have Respiratory Problems, Study Finds,” New York Times, May 28).

In recent decades, air quality has improved in the United States, smoking rates have plummeted and government safety regulations have reduced exposure to workplace pollutants. But rich and poor Americans have not benefited equally, scientists reported in a paper on Friday.

While wealthier Americans have quit smoking in droves, tobacco use remains frequent among the poor. Asthma has become more prevalent among all children, but it has increased more drastically in low-income communities. And Americans with lower incomes continue to have more chronic lung disease than the wealthy.

The analysis, which was published in JAMA Internal Medicine, included data from national health surveys conducted by the Centers for Disease Control and Prevention periodically from 1959 to 2018. The study did not examine disparities in respiratory health by race or ethnicity, though it assessed both income-based and education-based differences in lung health.

Before the 1980s, smoking rates did not vary much by income, and they only slightly varied by education level: 62% of the wealthiest adults and 56% of the poorest were either current or former smokers. But that has changed drastically. By the survey period 2017-18, current and former smoking rates among the wealthiest dropped by nearly half to 34% — while rates among the poorest inched up to 57.9%.


New tool tracks health disparities in U.S.

A coalition of researchers and advocates launched a tool this week they hope will fill some of the gaps in data on racial disparities in the U.S. health system (Source: “A new tool tracks health disparities in the U.S. — and highlights major data gaps,” Stat News, May 26).

The Health Equity Tracker is a portal that collects, analyzes and makes visible data on some of the inequities entrenched in U.S. medicine.

“For far too long it’s been ‘no data, no problem,’” said Nelson Dunlap, chief of staff at the Satcher Health Leadership Institute at Morehouse School of Medicine, which developed the tool with funding and resources from Google.org, Gilead Sciences, Annie E. Casey Foundation and CDC Foundation.

By making data accessible that highlights racial health disparities, the tracker aims to empower local advocates to drive change in their communities — and inspire action to fill in holes in data that are themselves reinforced by structural racism. In the tracker’s display, 38% of federally-collected COVID-19 cases report unknown race and ethnicity.


CDC director declares racism ‘a serious public health threat’

In a statement released earlier this month, the director of the Centers for Disease Control and Prevention declared racism a “serious public health threat” (Source: “CDC Director Declares Racism A 'Serious Public Health Threat',” National Public Radio, April 8).

In the statement, Dr. Rochelle Walensky said that, “Racism is a serious public health threat that directly affects the well-being of millions of Americans. As a result, it affects the health of our entire nation. Racism is not just the discrimination against one group based on the color of their skin or their race or ethnicity, but the structural barriers that impact racial and ethnic groups differently to influence where a person lives, where they work, where their children play, and where they worship and gather in community. These social determinants of health have life-long negative effects on the mental and physical health of individuals in communities of color."

The CDC also launched a new web portal, Racism and Health, that's designed to be a hub for public and scientific information and discourse on the subject.


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.