Racism and health

Graphic of the week

Dashboard_DisparitiesGraphic_StandAlone

 

HPIO’s 2021 Health Value Dashboard concluded that one reason Ohio ranks poorly (47th out of the 50 states and D.C.) is that many Ohioans experience poorer outcomes and live shorter lives because of policies, systems and beliefs that discriminate against and unfairly limit access to resources. According to the Dashboard, racism and other forms of discrimination drive troubling differences in outcomes across Ohio. This includes racist and discriminatory beliefs and interactions among Ohioans and structural racism and discrimination embedded within systems and across sectors, rooted in ageism, ableism, xenophobia, homophobia and other “isms” or “phobias.”  As the graphic above shows, Ohioans experiencing the worst health outcomes are also more likely to be exposed to risk factors for poor health. These include trauma and adversity, toxic stress, violence and stigma, and inequitable access to resources.

Earlier this week, HPIO hosted the first meeting of its Health Value Dashboard Advisory Group as it begins planning for the 2023 Dashboard. The new edition is expected to be released in March or April 2023.


Study finds race, ethnicity are seldom mentioned in pediatric clinical guidelines

Race and ethnicity were unexplored in most American pediatric clinical practice guidelines published in the last 5 years, according to the results of a systematic review (Source: “Race unexplored in most pediatric clinical care guidelines, review finds,” Helio, June 13).

According to the study, which was published in JAMA Pediatrics, 70% of the guidelines did not mention race or ethnicity at all. The researchers also found that when race or ethnicity was mentioned, 57% of the time it was used in a way that could exacerbate or have a negative impact on inequities and only 15.1% of clinical practice guidelines include language specifically intended to reduce disparities in medicine.

“I think that shows a missed opportunity for us as medical organizations to be proactive in talking about health care inequities and systemic racism in our field,” said Courtney A. Gilliam, MD, a member of the division of hospital medicine in the department of pediatrics at Seattle Children’s Hospital and a co-author of the review. “We have a long way to go in interrogating clinical practice guidelines.”


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Baby formula shortage puts spotlight on long-standing health disparities

As parents across the United States struggle to find formula to feed their children, the pain is particularly acute among Black and Hispanic women, who have historically faced obstacles to breastfeeding, including a lack of lactation support in the hospital, more pressure to formula feed and cultural roadblocks (Source: “Baby formula shortage highlights racial disparities,” Associated Press, May 27).

Low-income families buy the majority of formula in the U.S. and face a particular struggle: Experts fear small neighborhood grocery stores that serve these vulnerable populations are not replenishing as much as larger retail stores, leaving some of these families without the resources or means to access formula.

The Centers for Disease Control and Prevention estimates that 20% of Black women and 23% of Hispanic women exclusively breastfeed through six months, compared to 29% of white women. The overall rate stands at 26%. Hospitals that encourage breastfeeding and overall lactation support are less prevalent in Black neighborhoods, according to the CDC.

The racial disparities reach far back in America’s history. The demands of slave labor prevented mothers from nursing their children, and slave owners separated mothers from their own babies to have them serve as wet nurses, breastfeeding other women’s children. In the 1950s, racially targeted commercials falsely advertised formula as a superior source of nutrition for infants. And studies continue to show that the babies of Black mothers are more likely to be introduced to formula in the hospital than the babies of white mothers.


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.


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.


Federal legislation proposed to reduce maternal deaths

The push to reduce poor maternal health outcomes has seen new momentum as federal lawmakers and Biden administration officials previewed their priorities — including reversing a rise in maternal disparities among Black women (Source; “Lawmakers, advocates hopeful for more bills to curb maternal deaths,” Roll Call, April 20).
 
The United States leads among developed nations in its poor maternal mortality rates, referring to deaths during or up to one year after childbirth. These deaths — alongside maternal morbidity, or long-term health problems arising from pregnancy or childbirth — are growing problems nationally.
 
Last week, HPIO released a fact sheet titled “Racial and geographic disparities in maternal morbidity and mortality.” The fact sheet includes an analysis of the drivers of maternal morbidity and mortality in Ohio and descriptions of what works to reduce disparities.


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.


Ohio University study links COVID death rates to residential segregation

A new study has found that COVID-19 death rates among both Black and white people were higher in areas with more residential segregation, with rates for Black individuals almost twice as high (Source: “Study links racism, segregation to increased COVID deaths,” Atlanta Journal-Constitution, March 14).
 
The study from an Ohio University researcher, published in the journal Ethnicity & Disease, looked at systemic racism measures, as well as socioeconomic factors between Black and white residents, in every state. Using data on deaths through December 2020, they assessed whether state-level systemic racism and residential segregation predicted the probability of COVID-19 deaths among Americans, considering sociodemographic factors in the process.
 
“We were interested in doing this study because racial and ethnic disparities have been apparent amid COVID-19, and for some Americans, this may have been one of the first times they’ve learned about disparities,” said study author Berkeley Franz. “Health disparities are present with almost every illness and have persisted for years, and the gap isn’t closing, especially between Black and white Americans. We wanted to understand what was driving those disparities to find better ways to reduce them.”
 
What they found was the death rate was higher among Black individuals because of social environments rather than physiology or genetics. They hypothesized that in segregated neighborhoods, residents are less likely to have access to good quality schools, employment opportunities, health care and other resources.