Social determinants of health

Study: Families with child with special needs lose an average $18k a year in lost wages

New research has found that families with a child with special needs lost an average of $18,000 a year in household income (Source: “Leaving Work to Care for Special Needs Child Takes Big Financial Toll,” Health Day News, Aug. 30).

Households that lost income while providing care for a child were more likely to live in poverty, be enrolled in a government assistance program and more likely to spend over $5,000 a year in out-of-pocket expenses for their child's health care, according to the study published in the August issue of the journal Pediatrics.

The study found that households of children with intellectual disability, cerebral palsy or brain injury had the highest levels of lost wages, and that lost wages were high in families with children under 5 and in Hispanic families.


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.


Children could face long-term education and health challenges following pandemic, experts warn

After more than a year of isolation, widespread financial insecurity and the loss of an unprecedented amount of classroom time, experts say many of the youngest Americans have fallen behind socially, academically and emotionally in ways that could harm their physical and mental health for years or even decades (Source: “Damage to Children’s Education — And Their Health — Could Last a Lifetime,” Kaiser Health News, July 1).

“This could affect a whole generation for the rest of their lives,” said Dr. Jack Shonkoff, a pediatrician and director of the Center for the Developing Child at Harvard University. “All kids will be affected. Some will get through this and be fine. They will learn from it and grow. But lots of kids are going to be in big trouble.”

Many kids will go back to school this fall without having mastered the previous year’s curriculum. Some kids have disappeared from school altogether, and educators worry that more students will drop out. Between school closures and reduced instructional time, the average U.S. child has lost the equivalent of five to nine months of learning during the pandemic, according to a report from McKinsey & Co. that was released in December.

Educational losses have been even greater for some minorities. Black and Hispanic students — whose parents are more likely to have lost jobs and whose schools were less likely to reopen for in-person instruction — missed six to 12 months of learning, according to the McKinsey report.


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.


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: 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.


Study finds widespread racial disparities in air quality

A new national study has found racial and ethnic disparities in the quality of air that Americans breathe (Source: “People of Color Breathe More Hazardous Air. The Sources Are Everywhere.,” New York Times, April 28).

According to the study, Black Americans are exposed to more pollution from every type of source, including industry, agriculture, all manner of vehicles, construction, residential sources and even emissions from restaurants. People of color more broadly, including Black and Hispanic people and Asian Americans, are exposed to more pollution from nearly every source.

The findings, which were published Wednesday in the journal Science Advances, came as a surprise to the study’s researchers, who had not anticipated that the inequalities spanned so many types of pollution.

The study builds on a wealth of research that has shown that people of color in America live with more pollution than their white neighbors. Fine particulate matter air pollution, known as PM 2.5, is harmful to human health and is responsible for 85,000 to 200,000 excess deaths a year in the United States.


Study: 4 in 10 Americans live in cities with unhealthy air

More than 40% of Americans live with unhealthy air, with certain cities and types of Americans far more prone to be affected, according to a new national study (Source: “More than 40% in U.S. live in cities with unhealthy air, study says,” United Press International, April 21).

The American Lung Association's annual "State of the Air" report, which was released this week, found that people of color are 61% more likely to live in a county with unhealthy air than are white people and three times more likely to live in a county with failing air-quality grades across the board.

Moreover, the report says climate change continues to worsen air pollution in much of the country. Research also shows that air pollution can make COVID-19 worse, the authors pointed out.


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.