Social determinants of health

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.


Black women in Ohio 2.2 times more likely to die from pregnancy-related causes, data shows

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According to the most-recent data, Black women in Ohio are 2.2 times more likely to die from a cause related to pregnancy and have a 1.85 times higher rate of maternal morbidity (i.e., health problems related to pregnancy and childbirth) than white women.
 
Differences in healthcare access and conditions such as housing, transportation and income, as well as the cumulative impacts of toxic stress and discrimination, all contribute to stark disparities in maternal outcomes across the state.
 
Improving maternal health and eliminating disparities are priorities of the Ohio Department of Health’s 2020-2022 State Health Improvement Plan.
 
Next week is the fifth annual Black Maternal Health Week, an event that coincides with National Minority Health Month. As part of its annual recognition of Minority Health Month, the Ohio Commission on Minority Health has released an extensive calendar of events. Throughout the month, HPIO is releasing new data graphics exploring health disparities in the state. More information and resources about health equity in Ohio are available on HPIO’s website.
 
HPIO plans to release a fact sheet on maternal mortality and morbidity in Ohio later this month.


DeWine announces funding for housing assistance program aimed at improving birth outcomes

Gov. Mike DeWine announced this week that $2.5 million is going to the Coalition of Homelessness and Housing in Ohio “to help improve birth outcomes and reduce infant mortality by providing stable housing for low-income families” (Source: “Ohio Gov. Mike DeWine announces $2.5 million for program to help pregnant women, improve birth outcomes,” WKYC-TV (Cleveland), April 6).
 
Gov. DeWine’s office said the Housing Assistance to Improve Birth and Child Outcomes Program will assess the impact of rental assistance on factors that contribute to infant mortality. The project aims to increase housing stability of low-income households with children while improving maternal and infant health outcomes.
 
The program is an expansion of Healthy Beginnings at Home (HBAH), a housing stabilization pilot project designed to improve maternal and infant health outcomes for low-income families that launched in 2017 with funding from the Ohio Housing Finance Agency. That program, which provided 49 pregnant women in Columbus with rental assistance and other services, was implemented by CelebrateOne, a Columbus-based infant mortality prevention collaborative.
 
CelebrateOne contracted with HPIO to complete a final report summarizing the outcome and process evaluation results of HBAH. 


Latest data show racial disparities in housing cost burden persists in Ohio

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Recently released data shows that Ohioans continue to experience substantial financial burdens when paying for housing, and that Ohioans of color are disproportionately impacted.  

Last year, HPIO released a fact sheet on housing affordability and health equity that described how stable, affordable and safe housing is critical for good health. Above is a graphic from the publication, updated with the most-recently available data. 

The connections between housing and health are clear. Limited high-quality, affor 
dable housing stock forces many Ohioans into stressful and unsafe housing situations that can lead to long-term negative health consequences, such as high blood pressure and poor birth outcomes. 

HPIO’s fact sheet “Connections between Racism and Health: State and Local Policymakers,” further explains the connection between racism, housing and health: “Decades of racist housing policies, such as historical redlining and present-day predatory lending practices, have resulted in neighborhood segregation, concentrated poverty and disinvestment from Black communities in Ohio that continue to this day. As a result, Ohioans of color are more likely to experience harmful community conditions — such as food deserts and unsafe, unstable housing — that impact health.”  

The fact sheet includes action steps 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. 

The fact sheet is one in a series of three that are companions to the HPIO policy brief “Connections between Racism and Health: Taking Action to Eliminate Racism and Advance Equity.” The other fact sheets in the series address private-sector organizations and individuals and community groups.


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.


Cincinnati program that improves family living conditions leads to better child health outcomes, study finds

A new study has found that a child health-law partnership program in Cincinnati that helps improve living conditions for families with children who have chronic conditions has led to a nearly 40% drop in hospital admissions (Source: “Doctor-lawyer advocacy gives Cincinnati area kids better health outcomes, study shows,” Cincinnati Enquirer, March 23).
 
Child Help, the Cincinnati Child Health-Law Partnership, which was created by Cincinnati Children’s Hospital and Legal Aid of Greater Cincinnati, has assisted kids in more than 20,000 advocacy cases since the partnership started in 2008. Many of its cases involve kids whose living environment exacerbated chronic health conditions, such as an apartment with mold or cockroaches. Others address evictions that could leave children homeless. And some involve special needs children in schools. Left unheeded, the problems could end in poor health and repeated hospital admissions for children.
 
A study published March 7 in Health Affairs shows a 38% reduction in the hospitalization rate among children who got Child Help assistance from 2012 through 2017. 
 
Study co-author Dr. Andrew Beck of Cincinnati Children's division of general and community pediatrics said he wasn't surprised to find a drop in readmissions for the kids who were helped by the partnership. He just didn't know how great the drop would be.
 
“It reinforces the notion that our surroundings, socioeconomic and social determinants, impact health outcomes," he said. "It highlights the importance of clinical-community partnerships. It shows that support of these programs in new and innovative ways of reimbursing is important.”


CMS proposes adding Health Equity Index to Medicare Advantage, Part D star ratings

The annual rule governing Medicare Advantage and Part D is putting a focus on health equity, the Biden administration announced earlier this month (Source: “CMS puts focus on health equity in Medicare Advantage, Part D Advance Notice,” Fierce Healthcare, Feb. 3).

The Centers for Medicare and Medicaid Services (CMS) issued its proposed Advance Notice for Medicare Advantage and Part D in 2023, and in the regulation the agency proposes updating the MA and Part D star ratings to account for how well a plan tackles health equity.

CMS is seeking comment specifically on a potential quality measure for the star ratings that would assess how often plans are screening for common social needs such as food insecurity, housing insecurity and transportation challenges.

CMS Deputy Administrator and Center for Medicare Director Meena Seshamani, M.D., said in a statement that the proposed Heath Equity Index aims to enhance transparency around how MA plans are treating "our most vulnerable beneficiaries" as well as encourage improvements in their care.


Study links cardiovascular disease risk for African Americans with social determinants of health

A new study has found that social determinants such as age, sex, marital status, and education level were associated with risk of cardiovascular disease for American Africans (Source: “SDOH Drive Cardiovascular Mortality Disparities for African Americans,” Patient Engagement HIT, Jan. 6).

The study from Mayo Clinic Proceedings found a higher occurrence of cardiovascular disease and associated clinical and social determinant risk factors than past studies, suggesting these issues are worse than previously understood.

The study analyzed 644 African American individuals from Minnesota, using data gathered from May to December 2019 to examine the association between age- and sex-adjusted cardiovascular disease risk factors, sociodemographic characteristics and health beliefs.