Social determinants of health

USDA: Millions more Americans faced food insecurity in 2022

Millions more Americans had difficulty securing enough food in 2022 compared to the year prior, including 1 million more households with children, a new report from the U.S. Department of Agriculture (USDA) showed (Source: “Millions more Americans were food insecure in 2022 than 2021 – USDA,” Reuters, Oct. 25).
The increase interrupted a years-long trend of declining hunger in the United States. Previous reports from food banks and the U.S. Census Bureau have indicated that hunger is increasing as Americans with lower incomes struggle to recover from the pandemic and from the end of expanded food assistance.
"The report is a stark reminder of the consequences of shrinking our proven safety net," Agriculture Secretary Tom Vilsack said in a statement.
The USDA report, which did not provide an explanation for the rise, found that 12.8% of households - equivalent to 17 million households - struggled to get enough food in 2022, up from 10.2%, or 13.5 million households, in 2021.

Graphic of the week


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Consistent with national research findings and previous HPIO work, new analysis from the Institute finds that Ohioans who reported experiencing more adverse childhood experiences (ACEs) were also more likely to report negative outcomes that contribute to poor health. For example, as illustrated above, the percent of Ohioans who were exposed to two or more ACEs were almost twice as likely to smoke (23%) as those exposed to no ACEs (13%). Similarly, the percent of Ohioans with depression who were exposed to two or more ACEs (34%) was more than three times higher than Ohioans with depression who reported no ACEs (11%).

Exposure to ACEs affects many children in Ohio and across the country. National data and analysis provide clear evidence that ACEs exposure is linked to poor health and well-being through adulthood, including disrupted neurodevelopment, social problems, disease, disability and premature death. In addition, ACEs exposure has severe long-term cost implications at the individual and societal levels, including increased medical, child welfare, criminal justice and special education expenditures. However, the negative effects of ACEs can be mitigated. HPIO has presented 12 key strategies to intervene early and prevent the poor health outcomes associated with ACEs.

Click here to learn more about HPIO’s Ohio ACEs Impact project

Subsidized meals at childcare centers boost health of kids and their families, new study finds

A new analysis suggests that a federally-funded, state-administered initiative to provide meals to children in daycare settings positively affects not just children but also their families, tying subsidized child-care meals to better child health and lower rates of household food insecurity (Source: “Subsidized meals in child care tied to healthier kids and families,” Washington Post, Sept. 24).

The study of the Child and Adult Care Food Program (CACFP), published in the Journal of the Academy of Nutrition and Dietetics, found children who received subsidized meals in child-care settings were 30% less likely to have household food insecurity, 39% less likely to have poor or fair health, and 41% less likely to be admitted to the hospital from the emergency room than their peers who ate meals provided by their parents while in care.

Researchers interviewed primary caregivers of 3,084 young children receiving ER or primary care in Baltimore, Boston, Little Rock, Minneapolis and Philadelphia between 2010 and 2020. All of the children were between 13 and 48 months old and lived in low-income households, and all received subsidized care outside the home for 20 hours or more per week. Most of the children were eligible for CACFP.

Census Bureau: U.S. child poverty spikes following end of pandemic relief

The poverty rate in the U.S. has risen dramatically in the year since pandemic benefits ran out — and the child poverty rate has more than doubled, according to U.S. Census Bureau's annual data on poverty, income and health insurance released Tuesday (Source: “Child poverty more than doubles — a year after hitting record low, Census data shows,” NPR, Sept. 12).

Just a year ago, child poverty hit a historic low of 5.2%. The latest Census Bureau figures put it at 12.4%, the same as the overall poverty rate. The surge happened as record inflation was rising and a lot of pandemic relief was running out, but Census officials and other experts say a key was the child tax credit.

In 2021, Congress increased the amount of the credit as part of the American Rescue Plan and expanded eligibility to include millions more families with low incomes.

When the tax credit ended, surveys found many parents had trouble paying bills and covering basic expenses like rent and groceries.

Drug use, homelessness contribute to spike in heat-related deaths, CDC data shows

Heat-related illness and deaths in the U.S. are on the rise, and an increase in drug use and homelessness is a significant part of the problem, according to public health officials and data from the Centers for Disease Control and Prevention (Source: “Heat-Related Deaths Are Up, and Not Just Because It’s Getting Hotter,” KFF Health News, Sept. 8).

Heat was the underlying or contributing cause of about 1,670 deaths nationwide in 2022, for a rate of about 5 deaths per million residents, according to provisional data from the CDC. That’s the highest heat-related death rate in at least two decades. The next-highest death rate was logged in 2021.

The simplest explanation for the increase is that it is getting hotter. The last eight years were the hottest on record, according to NASA figures dating to the late 1800s. But factors other than climate change also play a role.

Substance abuse, especially misuse of methamphetamines, has emerged as a major factor in heat-related illness. Methamphetamines can cause body temperature to increase to dangerous levels, and the combination of meth abuse, heat, and homelessness can be fatal.

“With any environmental crisis, people experiencing homelessness experience it first, they experience it worst, and they experience it longest,” said Katie League, behavioral health manager for the National Health Care for the Homeless Council.

HPIO forum to explore prevention of ACEs

The Health Policy Institute of Ohio is hosting a webinar from 1 p.m. to 1:30 p.m. on Tuesday, Sept. 19 to discuss strategies to prevent adverse childhood experiences (ACEs) in Ohio through building skills and strengthening connections to caring adults.

Click here to register

This forum will walk through HPIO's recent ACEs publication that highlights four cost-effective, evidence-informed strategies being implemented across the state that build important skills to handle stress, manage emotions, and tackle everyday challenges and connect youth to caring adults and activities. 

Improving assets and resources can buffer children and families from the well-documented harmful effects of toxic stress and adversity and promote the ability to withstand, adapt and recover from trauma. Increasing these protective factors can lead to stronger families, better health, educational and employment outcomes and benefits to society at large.

HPIO releases action guide on policies to eliminate racism and reduce infant mortality

The Health Policy Institute of Ohio has released an action guide that highlights policy options for addressing racism, one of the social drivers of infant mortality in Ohio. 

Earlier this year, HPIO produced the Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio report as an update to the 2017 A New Approach to Reduce Infant Mortality and Achieve Equity report.

This action guide takes a closer look at the recommendations related to racism in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps. The guide, and additional tools posted on the HPIO website, can be used to prioritize, advocate for and implement the recommendations.
Everyone deserves to live a long, healthy and fulfilling life. However, Black infants in Ohio are over 2.5 times more likely to die before their first birthday compared to white infants, as illustrated in the graphic above.
“Racism (including internalized, interpersonal, institutional and structural racism) is at the root of racial health disparities, such as the racial differences in infant mortality rates,” according to the guide.

HPIO recently released similar action guides on housing, education, transportation and employment.

Support for this project was provided by the Bruening Foundation and HPIO’s other core funders.

Speaking at HPIO forum, former Ohio legislators urge continued focus on reducing infant mortality

Speaking last week at an online forum hosted by HPIO, two former legislators who worked to bring the problem of Ohio’s high infant mortality rate to the forefront urged the state to do more (Source: “Former legislators join call to action on infant mortality in Ohio,” Ohio Capital Journal, Aug. 21).
Former Democratic state senator Charleta Tavares and former Republican senator Shannon Jones were a bipartisan duo who spent 2017 getting Senate Bill 332 through the General Assembly. The bill directed the Legislative Service Commission to work with the Health Policy Institute of Ohio on a new approach to addressing infant mortality.
“If we don’t do something as a state, we’re never going to see the changes for infants and moms, but also for the state of Ohio,” Tavares said of her motivation for prioritizing the issue.
Getting the public, along with policymakers and providers, to connect the health issues with outside impacts such as housing, transportation, and the systemic racism that still exists within state institutions, is important in driving home the need for policy changes, according to Jones and Tavares.
“There is not a Staples ‘easy’ button when it comes to advocacy, I think you just have to be relentless,” Jones said. “…This has been 10 years since I’ve been talking about it and I’m way late to the party, so I don’t know what it’s going to take.”
For those who were unable to attend the event, a recording of the forum can be found on HPIO’s website.

Graphic of the week


New analysis from HPIO has found that in 2021, 88% of Ohio adults reported that all or most of the time during their childhood, they had an adult in their household who made them feel safe and protected (as illustrated in the graphic above). The data will be included in an HPIO policy brief, the second in a series on strategies to prevent adverse childhood experiences (ACEs) in Ohio, that is expected to be released in August.
Nurturing and responsive caregivers -- and a safe, stable family environment in which basic needs are met -- give children a strong foundation. These are powerful protective factors that can decrease substance misuse, mental health problems and violent and risky behaviors in adolescence and later in life. Also, research has shown that having at least one nurturing, stable caregiver can mitigate the negative effects of ACEs. 
HPIO has created a recap of its December 2022 forum titled “Preventing ACEs in Ohio: Ensuring a strong start for children and strengthening economic supports for families.”

For several years, HPIO has led the Ohio ACEs Impact project, which is informed by a multi-sector advisory group and includes a number of policy briefs, fact sheets and a resource page to build on and amplify current efforts to address ACEs in Ohio.

New state budget includes funding for affordable housing, one of the social drivers of health

Ohio's latest biennial budget, which was signed into law earlier this month by Gov. Mike DeWine, includes new affordable housing initiatives, including $100 million for a state tax credit program to help finance 4,000 rental units and tax credits for single-family housing (Source: “Ohio budget provides first 'comprehensive housing policy.' Here's what's in it” Columbus Dispatch, July 20).

"It's the first time the state has had a comprehensive housing policy like this," said Dan Tierney, spokesman for Gov. Mike DeWine, who proposed the $100 million for the tax credit, which the House had boosted to $500 million before the legislature scaled it back.

State legislators also decided to save the Ohio Housing Finance Agency, which determines what developers receive federal low-income housing tax credits and now will make decisions on the state credits.

HPIO recently released an action guide that highlights policy options for improving housing, one of the social drivers of infant mortality in Ohio. The action guide is based on recommendations from HPIO’s report Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio.