Health equity

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.


HPIO fact sheet outlines link between K-12 student wellness, health equity

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 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.


COVID vaccination rates lag for Black Ohioans

Of the more than 1.8 million Ohioans who have received at least one COVID-19 vaccination dose, only 5.6% went to Black Ohioans, who comprise about 13% of Ohio’s population (Source: “Black Ohioans are 13% of state population, but 5.6% of the vaccine recipients,” Ohio Capital Journal, March 5).

Part of the explanation for the gap: Black people comprise 14.3% of the general population in the U.S., according to 2019 census estimates. However, because of lower life expectancy, they comprise just 9.7% of the 65-and-up population, which most states have prioritized for the vaccines.

“It is likely a conglomeration of a number of different factors,” said Reem Aly, a vice president at the Health Policy Institute of Ohio. “It is going to be inequities we see in access to care, historically, we know that there is racism within the health care system and there is an understandable mistrust in Black communities of health care providers. That is certainly contributing to the issue.”


U.S. Senate bill would support campaigns to address COVID-19 disparities

As public health officials across the country struggle to get vaccination shots to the people hardest hit by the coronavirus pandemic, a Senate bill aims to address health inequities among communities disproportionately affected by the virus (Source: “Senate bill aims to reduce health disparities related to Covid-19,” NBC News, Feb. 25).

The COVID-19 Health Disparities Action Act, introduced Thursday by Sens. Bob Menendez, D-N.J., and Ben Cardin, D-Md., would support targeted and "culturally competent" public awareness campaigns about vaccines and preventive measures in underserved communities, such as wearing masks and maintaining social distance.

The bill would direct the Department of Health and Human Services, acting through the Centers for Disease Control and Prevention, to develop public awareness campaigns to address disparities in testing, hospitalizations and deaths among racial and ethnic minority groups. It would also instruct the health department to create grant programs for community-based public awareness campaigns about vaccinations, testing and preventative measures.