Public health

Children of color more likely to die from flu, study finds

People who are Black, Hispanic or American Indian/Alaska Native are more likely than white people to be hospitalized with a case of the flu in the United States, according to a recent study from the Centers for Disease Control and Prevention and other institutions (Source: “The flu proves more deadly for children of color than for White youths, study says,” Washington Post, Oct. 11).

Young children in these groups, along with Asian and Pacific Islander children, are also more likely to die of flu than white children.

The study, published in the journal JAMA Network Open, took a close look at 113,352 flu hospitalizations between 2009 and 2019 from across the country. Researchers found clear disparities in those hospitalizations as well as among those who were ultimately admitted to the intensive care unit or who died.

Overall, Black people had the highest rates of hospitalization and ICU admission, followed by American Indians or Alaska Natives and Hispanic people, although the trends varied within age groups. Except in the youngest children, Asian and Pacific Islander people had hospitalization rates similar to or slightly lower than non-Hispanic white people. Across racial and ethnic groups, researchers found few differences in hospitalization, ICU admission and death from flu among adults 75 and older.


State lawmakers begin revisiting vaccine exemption bill

State lawmakers this week listened to public testimony for the first time on a fast-tracked bill to limit COVID-19 vaccine mandates and expand exemptions, after the bill failed to get enough support in the Ohio House (Source: “COVID-19 vaccine exemption bill gets another look from Ohio lawmakers,” Akron Beacon-Journal, Oct. 6).

Hearings on Wednesday and Thursday were "informal hearings," said Rep. Dick Stein, R-Norwalk, House Commerce and Labor Committee chairman, only to determine "the line between personal freedom and companies' rights... and where that lies."

Republican leadership tried to rush House Bill 435 and pass it out quickly last week, but the speedy timeline resulted in pushback. Legislators are now taking more time to revisit the bill's details.


More than half of states have rolled back public health powers, analysis finds

Republican legislators in more than half of U.S. states, including Ohio, spurred on by voters angry about lockdowns and mask mandates, are taking away the powers state and local officials use to protect the public against infectious diseases (Source: “Over Half of States Have Rolled Back Public Health Powers in Pandemic,” Kaiser Health News, Sept. 15).

A Kaiser Health News review of hundreds of pieces of legislation found that, in all 50 states, legislators have proposed bills to curb such public health powers since the COVID-19 pandemic began. While some governors vetoed bills that passed, at least 26 states pushed through laws that permanently weaken government authority to protect public health. In three additional states, an executive order, ballot initiative or state Supreme Court ruling limited long-held public health powers. More bills are pending in a handful of states whose legislatures are still in session.

In at least 16 states, legislators have limited the power of public health officials to order mask mandates, or quarantines or isolation. In some cases, they gave themselves or local elected politicians the authority to prevent the spread of infectious disease. At least 17 states passed laws banning covid vaccine mandates or passports, or made it easier to get around vaccine requirements. At least nine states have new laws banning or limiting mask mandates. Executive orders or a court ruling limit mask requirements in five more.


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.”


CDC extends national moratorium on evictions

The Centers for Disease Control and Prevention (CDC) has extended a moratorium on evictions until the end of July (Source: “CDC Extends Eviction Moratorium Through July,” National Public Radio, June 24).

The ban had been set to expire next week, raising concerns that there could be a flood of evictions with some 7 million tenants currently behind on their rent.

The Biden administration says the extension is for "one final month" and will allow time for it to take other steps to stabilize housing for those facing eviction and foreclosure. The White House says it is encouraging state and local courts to adopt anti-eviction diversion programs to help delinquent tenants stay housed and avoid legal action.

The federal government will also try to speed up distribution of tens of billions of dollars in emergency rental assistance that's available but has yet to be spent. In addition, a moratorium on foreclosures involving federally backed mortgages has been extended for "a final month," until July 31.


Study: Death rates from chronic conditions rising in rural America

In rural America, more people die from chronic health conditions and substance abuse than in suburbs and cities, and the gap is widening.

A new study has found that the difference in rural and urban death rates tripled over the past 20 years mostly due to deaths among middle-aged white men and women (Source: “Study: Death rates from chronic conditions, 'deaths of despair' rising in rural U.S.,” United Press International, June 9).

This gap is partly due to access to care, but other factors also contribute, said lead researcher Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital in Boston and the VA Boston Healthcare System. In terms of access, rural areas have seen a wave of hospital closures driven largely by economics, especially during the COVID-19 pandemic, he said.

"But it's hard to disconnect health from other factors in our societies," Warraich said. "I think it's linked to the overall economic outlook of rural America as well, and also, health behaviors that contribute to poor health, such as poor nutrition, lack of exercise, smoking, substance use, etc."

For the study, which was published in the Journal of the American Medical Association, Warraich and his colleagues used federal government health data for 1999 through 2019. They found that age-adjusted death rates dropped in both rural and urban areas over that period. But the gap widened dramatically as death rates rose among white rural residents between 25 and 64.

Over the study period, rural death rates increased 12% for that group. Although death rates dropped among rural Black residents, they still had a higher death rate than all other groups in both rural and urban areas, researchers noted.


Biden administration announces $7.4 billion in public health spending

The White House announced Thursday that it is investing $7.4 billion to hire more public health workers to deal with the coronavirus pandemic and future health crises (Source: “Biden announces $7.4 billion to hire more public health workers amid pandemic,” Washington Post, May 13).

The money will come from the $1.9 trillion coronavirus relief package, which Congress passed in March.

The Biden administration said $4.4 billion will go toward boosting states’ overstretched public health departments, allowing them to hire disease specialists to do contact tracing, case management, and support outbreak investigations and school nurses to help schools reopen. Some of the money will also go to expanding the Epidemic Intelligence Service at the Centers for Disease Control and Prevention — which plays a critical role in containing outbreaks.

The remaining $3 billion will be used to create a new grant program to train and modernize the country’s public health workforce. Applicants for those grants will be asked to prioritize recruiting staff from the communities they will serve, especially those from underrepresented backgrounds.

HPIO’s 2021 Health Value Dashboard, which was released last month, found that one reason Ohio ranks poorly on health value (47th out of the 50 states and D.C.) is that the state’s sparse public health workforce leads to missed opportunities for prevention. Data in the Dashboard shows that only three states spend less on public health than Ohio.


Public health officials concerned about sustaining resources after pandemic passes

After the pandemic is over, public health officials across the U.S. fear that they will be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after 9/11, SARS and Ebola (Source: “Public Health Experts Worry About Boom-Bust Cycle of Support,” Kaiser Health News/Associated Press, April 19).

Funding for the federal Public Health Emergency Preparedness program, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, Kaiser Health News and the Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

The recently released HPIO Health Value Dashboard found that one reason Ohio ranks poorly for health value compared to most other states and D.C. is that Ohio’s “sparse public health workforce leads to missed opportunities for prevention.”

The report also found that “Ohioans spend a lot on downstream medical care, but investment in public health infrastructure is limited and prevention policies could be stronger.”


Pandemic could cause more childhood lead poisoning, CDC says

Lead screenings for children plummeted last spring, and stay-at-home orders may have increased household exposure to the toxic metal (Source: “More Childhood Lead Poisoning Is a Side Effect of Covid Lockdowns,” New York Times, March 11).

Over the past half-century, public health officials have made enormous progress in protecting American children from lead poisoning and the irreversible neurological damage it can cause. Since the 1970s, the percentage of children with high levels of lead in their blood has plummeted.

But in 2020, when Covid-19 cases spiked, lockdowns and day care closures confined young children to their homes, where lead exposure can be particularly high. The growing national emergency also delayed lead-removal efforts and disrupted routine childhood lead screenings, leaving health officials unable to identify and treat many children living in lead-laden homes.

Last month, the Centers for Disease Control and Prevention estimated that in the early months of the pandemic, roughly 10,000 children with elevated levels of lead in their blood may have gone undetected.

There is no safe level of exposure to lead, which can disrupt neurological and cognitive development, causing learning disabilities, behavioral problems and developmental delays.


Child vaccine declines amid COVID-19 shutdowns could lead to outbreaks of illnesses

Economic shutdowns implemented to slow the spread of the coronavirus may indirectly lead to outbreaks of other deadly diseases in the coming months, health experts are warning (Source: “COVID shutdowns may lead to outbreaks of measles, mumps as childhood vaccinations decline,” Columbus Dispatch, Oct. 10).

With more people staying home, fewer children got their vaccines for dangerous diseases such as measles, mumps, rubella and pertussis this year.

More than 90% of people need to be vaccinated for a disease to establish herd immunity and prevent an outbreak. In April, pediatric vaccines dropped by more than 45% across Ohio compared to April 2019, according to the state’s Immunization Registry.

And if outbreaks of measles or other diseases occur, Ohio and its health departments could be at a disadvantage financially and manpower-wise. Health departments in Ohio receive less state and federal funding for emergency preparedness than nearly every other state and the District of Columbia, according to HPIO analysis. The state ranks 48th for emergency preparedness dollars per capita in HPIO’s 2019 Health Value Dashboard.