Ohio Health Policy News

More than 1 in 5 U.S. adults without access to a vehicle or public transportation missed or skipped a medical appointment in the previous year, according to a new national study (Source: “Over 1 in 5 skip health care due to transportation barriers,” Axios, April 28).

The new study found that while telehealth may have reduced transportation barriers for mental health, primary care and some other services, it's not accessible to all and can't substitute for in-person care for some medical needs, the Urban Institute researchers wrote.

The findings point to gaps that could be filled by Medicaid coverage of nonemergency medical transportation, which varies by state, or expanded access to telehealth where public transit options are limited, they said.

Transportation is one of the social drivers of health that HPIO examined in its recently released policy brief, Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio.

The Health Policy Institute of Ohio has released a new policy brief, Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio, that builds upon recommendations first included in a report the Institute completed 5 years ago.
 
For many years, policymakers and community leaders across Ohio have worked to reduce high rates of infant mortality. Decisionmakers have explored this issue through multiple advisory committees, collaborative efforts, investments, legislation and other policy changes. For example, the Ohio General Assembly passed Senate Bill 322 in 2017, which adopted recommendations from the Ohio Commission on Infant Mortality’s 2016 report and required the creation of the 2017 Social Drivers of Infant Mortality (SDOIM) report: A New Approach to Reduce Infant Mortality and Achieve Equity, which was completed by HPIO under contract with the Ohio Legislative Service Commission.

Despite the efforts of many in both the public and private sectors, progress since 2011 has been minimal and uneven (as illustrated in the graphic above), and Ohio’s infant mortality rate remains higher than most other states.

Infant mortality prevention efforts have largely focused on public health and healthcare interventions for pregnant women, such as safe sleep education and prenatal care access. While these efforts have likely contributed to the overall reduction in infant mortality, healthcare services alone are not enough to close gaps in birth outcomes in Ohio.

Improvements in factors beyond access to care are needed to reinvigorate Ohio’s stalled progress on infant mortality reduction.

The new HPIO report prioritizes specific and actionable steps leaders can take to create change in five areas: Housing, transportation, education, employment and racism.

More states are testing Medicaid programs that’ll provide more people with healthy foods and, potentially, lower health care costs (Source: “Can food cure high medical bills? Pilot 'food as medicine' programs aim to prove just that.” USA Today, Feb. 15). 
 
Medicaid typically only covers medical expenses, but Arkansas, Oregon and Massachusetts received approval from the Centers for Medicare & Medicaid Services last year to use a portion of their Medicaid funds to pay for food programs, including medically tailored meals, groceries and produce prescriptions (fruit and vegetable prescriptions or vouchers provided by medical professionals for people with diet-related diseases or food insecurity). The aim is to see whether providing people with nutritious foods can effectively prevent, manage, and treat diet-related diseases.  
 
A study published last fall estimated that if all patients in the U.S. with mobility challenges and diet-related diseases received medically tailored meals, 1.6 million hospitalizations would be avoided, with a net savings of $13.6 billion annually. Another study in 2019 found that over the course of about a year, the meals resulted in 49% fewer inpatient admissions and a 16% cut in health care costs compared with a control group of patients who did not receive the meals. 
 
This spring, the American Heart Association and the Rockefeller Foundation plan to launch a $250 million “Food is Medicine” Research Initiative to determine if such programs can be developed cost-efficiently enough to merit benefit coverage and reimbursement for patients.

State lawmakers across the country are looking for ways to address “forever chemicals” that don’t break down naturally and are shown to cause a myriad of  health issues (Source: “A Slew of State Proposals Shows the Threat of 'Forever Chemicals',” Pew Stateline, Feb. 14).
 
Several states have passed landmark laws in recent years, and now dozens of legislatures are considering hundreds of bills to crack down on using such compounds. The legislation would strengthen product disclosure laws, increase liability for polluters, bolster testing plans and enact water quality standards. 
 
Thousands of chemicals make up the group known as perfluoroalkyl and polyfluoroalkyl substances, or PFAS. The chemicals have been found in an increasing number of watersheds and aquifers — as well as in the blood of nearly every American. 
 
Some PFAS compounds, research shows, can increase the risk of cancer, damage immune systems, cause metabolic disorders and decrease fertility. 
 
Safer States, an alliance of environmental health groups focused on toxic chemicals, has tracked more than 260 proposals in 31 states related to toxic chemicals, many focused on PFAS (there are no bills being considered in Ohio, according to the group’s bill tracker). Eleven of those states will consider sweeping restrictions or bans of PFAS across many economic sectors. Those bills follow a Maine law passed in 2021 that was the first in the country to ban PFAS in all new products, which will take effect in 2030.

Children experienced learning deficits during the Covid pandemic that amounted to about one-third of a school year’s worth of knowledge and skills, according to a new global analysis, and had not recovered from those losses more than two years later (Source: “Students Lost One-Third of a School Year to Pandemic, Study Finds,” New York Times, Jan. 30).

Learning delays and regressions were most severe in developing countries and among students from low-income backgrounds, researchers said, worsening existing disparities and threatening to follow children into higher education and the work force.

The analysis, published Monday in the journal Nature Human Behavior and drawing on data from 15 countries, provided the most comprehensive account to date of the academic hardships wrought by the pandemic. The findings suggest that the challenges of remote learning — coupled with other stressors that plagued children and families throughout the pandemic — were not rectified when school doors reopened.

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The Health Policy Institute of Ohio has released a new 2021 Health Value Dashboard policy brief titled “A closer look at outdoor air pollution and health.”

Clean air and water, safe places to walk outside and access to healthy food are examples of conditions in the physical environment that affect the health and well-being of Ohioans. Outdoor air quality is included in the 2021 Health Value Dashboard™, where Ohio ranked 46th, meaning that most other states have cleaner outdoor air.

The brief found that there are differences in air pollution exposure from county to county, as illustrated in the graphic above. Hamilton and Cuyahoga counties have the highest levels of PM2.5 air pollution in the state, with high levels also reported across western and central Ohio.

Analysis by HPIO has found that the physical environment (including outdoor air quality) is strongly connected to a state’s overall health, only surpassed by public health and prevention. In fact, analysis of 2021 Dashboard data finds that the physical environment has a much stronger correlation with the overall health of a state than access to care or healthcare system performance.

The policy brief focuses on the importance of clean air and provides additional information on the outdoor air quality metric in the Dashboard, including how:

• Air pollution affects health outcomes
• Recent policy changes may affect air pollution
• Outdoor air quality can be improved in Ohio

A critical aspect of preventing adverse childhood experiences (ACEs) is ensuring that children have a strong start in life and home visiting is a key prevention strategy.

According to an estimate from the Ohio Department of Health, more than 83% of Ohioans who need home visiting are not enrolled in a program identified as “evidence-based” by the U.S. Department of Health and Human Services Home Visiting Evidence of Effectiveness (HomVEE) review (as illustrated in the graphic above).

Analysis from HPIO has found that home visiting programs are an evidence-based, multi-generational strategy proven to prevent and mitigate the impacts of ACEs. Trained providers (home visitors) visit expectant parents and families with infants and young children, providing one-on-one support for healthy parent and child development, early education and family needs. Participation in home visiting programs is typically voluntary.

These findings will be included in a new policy brief that HPIO plans to release next month as part of its Ohio ACEs Impact project.

Data released earlier this year 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, which was originally released by HPIO in April). 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 includes a curated list of strategies to address racial wealth building, a key to eliminating health disparities.

The Food and Drug Administration (FDA) on Thursday ordered Juul to stop selling e-cigarettes on the U.S. market, a profoundly damaging blow to a once-popular company whose brand was blamed for the teenage vaping crisis (Source: “F.D.A. Orders Juul to Stop Selling E-Cigarettes,” New York Times, June 23).

The FDA order affects all of Juul’s products on the U.S. market, the overwhelming source of the company’s sales. Juul’s sleek vaping cartridges and sweet-flavored pods helped usher in an era of alternative nicotine products that became exceptionally popular among young people, and invited intense scrutiny from antismoking groups and regulators who feared they would do more harm to young people than good to former smokers.

In its ruling, the agency said that Juul had provided insufficient and conflicting data about potentially harmful chemicals that could leach out of Juul’s proprietary e-liquid pods.

Despite billions of dollars in federal covid-relief money available to upgrade heating and air-conditioning systems and improve air quality and filtration in K-12 schools, U.S. public schools have been slow to begin projects that have the potentional to improve the overall health of students (Source: “Covid Funding Pries Open a Door to Improving Air Quality in Schools,” Kaiser Health News, June 13).

According to a report released this month from the Centers for Disease Control and Prevention, fewer than 40% of public schools had replaced or upgraded their HVAC systems since the start of the pandemic. Even fewer were using high-efficiency particulate air, or HEPA, filters in classrooms (28%), or fans to increase the effectiveness of having windows open (37%).

Both the CDC and White House have stressed indoor ventilation as a potent weapon in the battle to contain covid. And a wealth of data shows that improving ventilation in schools has benefits well beyond covid.

Good indoor air quality is associated with improvements in math and reading; greater ability to focus; fewer symptoms of asthma and respiratory disease; and less absenteeism. Nearly 1 in 13 U.S. children have asthma, which leads to more missed school days than any other chronic illness.