Social determinants of health

HPIO fact sheet explores COVID-19 impact on ACEs

The Health Policy Institute of Ohio has released a new fact sheet, “The impact of the COVID-19 pandemic on Adverse Childhood Experiences (ACEs).”

The COVID-19 pandemic has resulted in unprecedented health, social and economic challenges for all Ohioans. These challenges are far-reaching, including loss of loved ones, unemployment, business closures, disruption to K-12 education and increased stress and social isolation.

The full extent of the impacts of the pandemic on children and youth will take years to discern. However, early indicators of childhood adversity signal the impact of the pandemic on potential challenges to Ohio’s health, well-being and economic vitality for years to come. The fact sheet includes links to recent reports that provide evidence-informed policies that can be implemented in Ohio to prevent and mitigate the impacts of ACEs and eliminate disparities.

The fact sheet is the latest in a series of HPIO publications and an online resource page to examine the impact of adverse childhood experiences (ACEs) in Ohio. Other publications include:


HPIO fact sheet outlines link between transit, health equity

The Health Policy Institute of Ohio released a new fact sheet titled “Transit and Health Equity,” which explores the connection between transportation access and health.

According to the fact sheet, “Transportation access is critical for good health across the lifespan.” The fact sheet notes:

  • Transportation to prenatal care and healthy food can improve birth outcomes and reduce infant mortality disparities.
  • Reliable transportation offers better access to jobs which supports self-sufficient employment, and in turn, can lead to higher income and better physical and mental health.
  • Transportation access connects older adults to friends and family, health care, volunteer opportunities and other activities and supports necessary for healthy aging.

The fact sheet also includes links to existing state plans that include strategies for policymakers to consider for improving transit.


ACEs cost Ohio $10 billion a year in healthcare costs, new HPIO analysis finds

First-of-its kind analysis by the Health Policy Institute of Ohio has found that if adverse childhood experiences (ACEs) are eliminated, more than $10 billion in annual healthcare and related expenses could be avoided in Ohio.

The analysis is included in a new HPIO policy brief, Adverse Childhood Experiences (ACEs): Economic Impact of ACEs in Ohio. The study also found that focusing action on reducing ACEs, particularly those associated with behavioral health, can yield significant savings. For example, more than $4.5 billion in annual spending to treat depression in Ohio is attributable to ACEs.

“The research is clear that ACEs result in both significant health and economic impacts,” the brief states. “Economic costs from ACEs are incurred across the public and private sectors, including substantial costs to the healthcare system. The economic burden of ACEs also impacts the state child protection, behavioral health, criminal justice and education systems, as well as private sector businesses. By preventing and mitigating the impacts of ACEs, policymakers and others can put Ohio on a path towards improved health value.”

The brief is the second in three planned briefs as part of HPIO’s Ohio ACEs Impact Project. In August 2020, HPIO released the first brief, Adverse Childhood Experiences (ACEs): Health impact of ACEs in Ohio.


ACA, Medicaid expansion reduce income inequality, study finds

Coverage gains made and subsidies offered under the Affordable Care Act reduced income inequality by more than 10% in 2019, according to a new study (Source: “ACA's coverage gains decreased income inequality: study,” Fierce Healthcare, Jan. 7).

The study from the left-leaning think tank Urban Institute, backed by the Robert Wood Johnson Foundation and published in Health Affairs, found that for a typical person in the bottom 10th percentile of income, those who enrolled in a plan under the ACA saw their incomes increase by an average of 18.8%.

In states that expanded Medicaid, their incomes rose by an average of 22%, the study found. The study also found that coverage gains led to reductions in income inequality within and between age and racial groups.


Studies confirm social, environmental factors driving COVID-19 racial disparities

Recent studies confirm that social and environmental factors, rather than underlying health conditions, are the reason for racial disparities in COVID-19 hospitalizations and deaths (Source: “Social Inequities Explain Racial Gaps in Pandemic, Studies Find,” New York Times, Dec. 9).

The new findings do not contradict an enormous body of research showing that Black and Hispanic Americans are more likely to be affected by the pandemic, compared with white people. The coronavirus is more prevalent in minority communities, and infections, illnesses and deaths have occurred in these groups in disproportionate numbers.

But the new studies do suggest that there is no innate vulnerability to the virus among Black and Hispanic Americans, experts said. Instead, these groups are more often exposed because of social and environmental factors.

A study of more than 11,000 New York patients in March and April found that, among many other vulnerabilities, Black and Hispanic communities and households tend to be more crowded; many people work jobs requiring frequent contact with others and rely on public transportation. Access to health care is poorer than among white Americans, and rates of underlying conditions are much higher. The study found that Black patients accounted for 76.9 percent of those hospitalized with Covid-19, although they made up just 31 percent of the health system’s population.

study of patients in Veterans Affairs hospitals found that underlying health conditions had no impact on fatality rates among Black and Hispanic Patients. In the study, nine of 1,000 white veterans had a positive coronavirus test, compared with 16.4 of 1,000 among Black patients. 

These disparities found in both studies are entirely explained by socioeconomic factors, researchers said.


Study finds link between neighborhood noise levels, dementia risk

Long-term exposure to noise may be linked to an increased risk for Alzheimer’s disease and other forms of dementia, a new study found (Source: “Living in Noisy Neighborhoods May Raise Your Dementia Risk,” New York Times, Oct. 28).

After controlling for education, race, smoking, alcohol consumption, neighborhood air pollution levels and other factors, researchers found that each 10 decibel increase in community noise level was associated with a 36% higher likelihood of mild cognitive impairment, and a 29 percent increased risk for Alzheimer’s disease. The associations were strongest in poorer neighborhoods, which also had higher noise levels, according to the study published in the journal Alzheimer’s & Dementia.

The reasons for the connection are unknown, but the lead author, Jennifer Weuve, an associate professor of epidemiology at Boston University, suggested that excessive noise can cause sleep deprivation, hearing loss, increased heart rate, constriction of the blood vessels and elevated blood pressure, all of which are associated with an increased risk for dementia.


Study: Residential segregation significant factor in COVID-19 spread

A new national study found that counties with the highest percentage of white residents have had the lowest rates of coronavirus infections, an indication that residential segregation is a significant factor in the pandemic’s spread (Source: “Residential segregation plays a role in coronavirus disparities, study finds,” Washington Post, Aug. 17, 2020).

That doesn’t mean white people have more immunity but rather that they have been better able to limit their exposure than have Black people, Latinos and Native Americans, who have been disproportionately infected by the novel coronavirus and killed by COVID-19, the disease the virus causes.

Neither does it mean that people of color are engaging in reckless behavior, according to the study by amfAR. Rather, their higher rate of infection is due to “poverty and living in densely occupied households, living in localities with greater air pollution, lack of health insurance and being employed in jobs that increase exposure to” the coronavirus.

“We need to stop victim-blaming communities of color for these types of diseases,” Greg Millett, vice president and director of public policy for amfAR, the Foundation for AIDS Research, said in a recent interview about the study, which notes a similar pattern for infection rates for HIV. “Where you live determines your health in the United States … and we need to take immediate action to make sure we reduce these disparities in communities of color.”

The Health Policy Institute of Ohio last week released a new data brief, "Connections between Racism and Health: Taking Action to Eliminate Racism and Advance Equity" and an accompanying resource page to support state and local efforts to eliminate racism. 


HPIO brief outlines action steps to address health impact of racism, DeWine releases Blueprint to address disparities

The Health Policy Institute of Ohio has released a new data brief, "Connections between Racism and Health: Taking Action to Eliminate Racism and Advance Equity" and an accompanying resource page to support state and local efforts to eliminate racism. 

As state and local leaders commit to address racism as a public health crisis, this publication outlines action steps that can be taken to eliminate racism and advance equity. This brief provides:

  • A definition and explanation of racism
  • A brief summary of research on the connections between racism and health
  • Action steps that individuals, groups, public and private organizations and state and local government leaders can take to eliminate racism and advance equity

On Thursday, Gov. Mike DeWine announced the release of the COVID-19 Ohio Minority Strike Force Blueprint (Source: “DeWine: ‘Racism is a public health crisis',” Dayton Daily News, Aug. 13, 2020), a document that includes 34 recommendations to address racism and promote long-term health equity in Ohio.

“It is wrong that in Ohio today, the overall life expectancy of African American Ohioans is four years shorter than white Ohioans. It’s wrong that African American Ohioans have a higher rate of heart disease, higher rates of hypertension and diabetes. It’s wrong that our African American citizens are two and half times more likely to live in poverty, and African American children in Ohio are three times more likely to live in poverty than their white brothers and sisters,” DeWine said during his press conference.

DeWine also announced the creation of the Governor’s Equity Advisory Board and released Ohio’s Executive Response: A Plan of Action to Advance Equity. The plan includes 10 commitments from the DeWine administration designed to begin addressing the recommendation’s in the Strikeforce’s blueprint.


Fighting climate change could avoid 4.5 million early deaths in U.S., study finds

The U.S. stands to avoid 4.5 million premature deaths if it works to keep global temperatures from rising by more than 2 degree Celsius, according to new research from Duke University (Source: “U.S. could avoid 4.5M early deaths by fighting climate change, study finds,” The Hill, Aug. 5).

The same study found working to limit climate change could prevent about 3.5 million hospitalizations and emergency room visits and approximately 300 million lost workdays in America.

Drew Shindell, a professor at Duke University, informed lawmakers during testimony Wednesday that action to limit climate change would amount to “over $700 billion per year in benefits to the U.S. from improved health and labor alone, far more than the cost of the energy transition.”

Shindell, who conducted the study alongside researchers at NASA, unveiled the findings during a House Oversight Committee hearing on the economic and health consequences of climate change. 


Heart Association statement ties poor housing quality to cardiovascular problems

The American Heart Association released a scientific statement detailing the many correlations between homelessness, low-quality housing and neighborhood environment with the prevalence of cardiovascular disease and its risk factors (Source: “AHA: Housing status significant risk factor in development of CVD,” Cardiology Today via Healio, July 15, 2020).

According to the statement, which was published in the journal Circulation, adults who are homeless may experience up to 70% higher rates of cardiovascular events compared with the general population.

This association may be a result of the lack of cardiovascular risk factor diagnosis in this population, the inherent barriers to care, medication initiation and adherence and access to healthy foods.

"The disparities in cardiovascular health among people who are homeless and marginally housed are largely due to psychosocial stressors, unhealthy behaviors used as coping mechanisms and barriers to health care, including lack of insurance and stigmatization among this population,” Mario Sims, a professor in the department of medicine at the University of Mississippi Medical Center in Jackson and chair of the writing group for the scientific statement, said in a press release.