Racism and health

New HPIO fact sheet highlights opportunities for policymakers to support health, well-being of Ohioans of color

The Health Policy Institute of Ohio has released a new fact sheet that outlines actions state and local policymakers can take to support the health and well-being of Ohioans of color and move Ohio toward a more economically vibrant and healthier future.

“Ensuring that every Ohioan has a fair opportunity to achieve good health and well-being is a shared value in both the public and private sectors,” the fact sheet states. “However, Ohioans of color continue to face barriers to health where they live, work, learn, play and age.”

The fact sheet, titled “State and Local Policymakers: Ensuring Ohioans of Color Have a Fair Opportunity for Good Health,” is the first in a series of three that provides action steps that can be taken to address the health impacts of racism. The publication highlights eight action steps that policymakers can take, including examples from policymakers in Ohio and across the country. 

“Government can play a strong role in educating, encouraging and creating opportunity for private sector partners and the public to take action,” according to the fact sheet.  “Many states, counties and municipalities are promoting health by understanding and addressing unfair and unjust policies and practices.”

The remaining two fact sheets in the series will provide information on how private sector partners, community groups and individuals can take action to advance equitable opportunities for Ohioans of color.

New report highlights health inequities by state

Earlier this month, the creators of the America’s Health Ranking report released the first edition of a companion document focused on health disparities in the U.S. (Source: “United Health’s inaugural ‘Disparities Report’ highlights health inequities,” MinnPost, Aug. 4).

The inaugural edition of the United Health Foundation’s “American’s Health Ranking Disparities Report” described the breadth, depth and persistence of health disparities in the U.S.

While previous reports have focused on the health of seniors, the health of women or on those who’ve served in the U.S. military, this year’s report focused on areas where one group has a disadvantage compared to another. The study’s results were broken down by all 50 states and the District of Columbia.

White Americans got disproportionate share of healthcare dollars in 2016, study finds

White Americans received 72% of all healthcare spending in 2016 despite making up 61% of the population, according to a new study that found major disparities in racial and ethnic health spending (Source: “Study: White Americans got disproportionate amount of healthcare dollars in 2016,” Fierce Healthcare, Aug. 17).

The study, published last week in the Journal of the American Medical Association and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, found that African Americans make up 12% of the population and accounted for 11% of healthcare spending. However, the spending was skewed based on how African Americans were getting care. African Americans got 26% less outpatient care compared to whites but spent 12% more on emergency department care, the study found. This likely contributed to African Americans getting more expensive care when conditions worsened instead of getting more preventive outpatient care, experts said.

“Hispanic and Asian Americans received the least spending relative to their proportion of the population: Hispanic patients benefited from 11% of healthcare spending despite accounting for 18% of the population, while Asian, Native Hawaiian and Pacific Islander individuals received 3% of spending while making up 6% of the population,” according to a release on the study.

Increased access to care insufficient for closing racial health gap, new studies find

A series of studies in the Journal of the American Medical Association found that while access to care has improved in recent years, the racial health gap has remained (Source: “Racial Inequities Persist in Health Care Despite Expanded Insurance,” New York Times, Aug. 17).

The new issue of JAMA offers studies on disparities in the utilization of health care services and in overall health spending. Together, the findings paint a portrait of a nation still plagued by medical haves and have-nots whose ability to benefit from scientific advances varies by race and ethnicity, despite the fact that the ACA greatly expanded insurance.

The racial health gap did not significantly narrow from 1999 to 2018, despite decreases in uninsured rates due to the passage of the Affordable Care Act, according to one study whose author said it was tantamount to “a comprehensive national report card.”

Despite innovations like Medicare Advantage, which increased access to health care overall, Medicare beneficiaries who are minorities — defined as Black, Hispanic, Native American or Asian-Pacific Islander — still have less access than white or multiracial individuals to a physician who is a regular source of care.

Overall, Black women face a much higher risk of dying from pregnancy complications than white women, with maternal mortality rates of 41.7 per 100,000 live births for Black women, compared with 13.4 per 100,000 live births for white women.

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.

CDC: Life expectancy drop in 2020 largest since WWII

U.S. life expectancy fell by a year and a half in 2020, the largest one-year decline since World War II, public health officials said Wednesday (Source: “US life expectancy in 2020 saw biggest drop since WWII,” Associated Press, July 21).

The decrease for both Black Americans and Hispanic Americans was even worse: three years.

The drop, spelled out in a new report from the Centers for Disease Control and Prevention, is due mainly to the COVID-19 pandemic, which health officials said is responsible for close to 74% of the overall life expectancy decline. More than 3.3 million Americans died last year, far more than any other year in U.S. history, with COVID-19 accounting for about 11% of those deaths.

Black life expectancy has not fallen so much in one year since the mid-1930s, during the Great Depression. Health officials have not tracked Hispanic life expectancy for nearly as long, but the 2020 decline was the largest recorded one-year drop.

Causes of death other than COVID-19 also played a role. Drug overdoses pushed life expectancy down, particularly for white Americans; and a rise in homicides was a small but significant reason for the decline for Black Americans, said Elizabeth Arias, the report’s lead author.

Other problems further affected Black and Hispanic people, including lack of access to quality health care, more crowded living conditions and a greater share of the population in lower-paying jobs that required them to keep working when the pandemic was at its worst, experts said.

CDC awards $34.5 million to Ohio to address COVID-related health disparities

The U.S. Centers for Disease Control and Prevention announced earlier this month that it has awarded the Ohio Department of Health and Columbus Public Health a total of nearly $34.5 million to address COVID-19-related health disparities (Source: “Ohio receives nearly $34.5 million from CDC to address COVID-19 related health disparities,” Cleveland Plain Dealer, June 10).

ODH will receive $31,011,053, which includes $7,169,724 earmarked for rural communities. Columbus Public Health receives $3,396,978.

The grants are part of a $2.25 billion federal spending to promote health equity by expanding services and capacity at the state and local level, the CDC said. This is the agency’s largest investment to date to improve health equity in the United States.

The funds also will be used to increase COVID-19 testing and contact tracing among high-risk and underserved populations, including racial and ethnic minority groups and people living in rural communities, in Ohio and across the country.

NIH announces plan to confront structural racism

Saying structural racism is a chronic problem throughout biomedical research and within their own walls, leaders of the National Institutes of Health earlier this month unveiled a plan intended to eliminate a big gap in grants awarded to white and minority scientists and boost funding for research on health disparities (Source: “NIH releases a plan to confront structural racism. Critics say it’s not enough,” Stat News, June 10).

The agency, the largest funder of biomedical research in the United States, said its plan would be accompanied by an expansion of a program to recruit, mentor and retain researchers from underrepresented racial and ethnic groups and appoint diversity and inclusion officers at each of its 27 institutes and centers.

The report says NIH leaders failed to acknowledge numerous firsthand accounts of racism in the workplace and the organization has failed to attract, retain and promote scientists from underrepresented racial and ethnic groups. Less than 2% of NIH senior investigators are Black.

Medical journals come under increasing criticism for lack of attention to racism

Following controversial comments from the top editor of JAMA, criticism is growing for medical journals to address their lack of attention to structural racism and how it impacts health (Source: “Medical Journals Blind to Racism as Health Crisis, Critics Say,” New York Times, June 2).

The top editor of JAMA, the influential medical journal, stepped down earlier this month amid controversy over comments about racism made by a colleague on a journal podcast. But critics saw in the incident something more pernicious than a single misstep: Blindness to structural racism and the ways in which discrimination became embedded in medicine over generations.

“The biomedical literature just has not embraced racism as more than a topic of conversation, and hasn’t seen it as a construct that should help guide analytic work,” said Dr. Mary Bassett, professor of the practice of health and human rights at Harvard University. “But it’s not just JAMA — it’s all of them.”

Following an outcry over the incident, editors at JAMA on Thursday released a plan to improve diversity among its staff, as well as in research published by the journal.

The longstanding issue has gained renewed attention in part because of health care inequities laid bare by the pandemic, as well as the Black Lives Matter protests of the past year. Indeed, an informal New York Times review of five top medical journals found that all published more articles on race and structural racism last year than in previous years.

It was only in 2013 that racism was first introduced as a searchable keyword in PubMed, the government’s vast medical library. Since then, however, the five journals have published many more studies mentioning race than those mentioning racism. JAMA published the fewest studies mentioning racism, the review found.

The New England Journal of Medicine rarely addressed racism until the arrival of Dr. Eric Rubin, its current top editor, in 2019. The British Medical Journal and The Lancet, both based in Europe, published more studies on the topic, while the American Journal of Public Health published the most.