Policy Basics

The Ohio Health Value Review is a quarterly electronic update from the Health Policy Institute of Ohio designed to strengthen connections between public health and healthcare partners in Ohio and highlight opportunities for different sectors to work together to improve health value in our state. If you have questions about the newsletter or have suggested tools or resources you would like to see included in future editions, please contact Nick Wiselogel, HPIO’s Vice President of Strategic Communications. 

To reduce infant mortality, policymakers must address social determinants

The Health Policy Institute of Ohio’s 2017 Health Value Dashboard identified infant mortality as one of Ohio’s greatest health challenges. New data released just after the start of the new year found that the state still has a great deal of work to do to address the issue, particularly the significant racial disparities faced by Ohioans.

Infant mortality is viewed as a “tip of the iceberg” health issue because it serves as an indicator of the overall health and wellbeing of a state. Infant deaths signal the presence of other community problems just below the surface, such as poor child health, racism and families struggling to make ends meet. Policies that address these root causes of infant mortality have the added benefit of also addressing other health challenges the state faces, such as depression, addiction and food insecurity.

Ohio’s black infant mortality rate of 13.46 deaths for every 1,000 live births from 2013 to 2015 was worse than all states except Wisconsin, according to data released earlier this month by the National Center for Health Statistics. More recent state data indicates that Ohio’s black infant mortality rate was 15.2 in 2016, which is nearly triple the state’s infant mortality rate of 5.8 for babies born to white mothers (see graphic below).

Organizations throughout Ohio have worked tirelessly in recent years to address the state’s disturbingly high infant mortality rate, with most of the energy focused on initiatives that tackle the problem through improved medical care. However, we continue to see the state’s infant mortality rate moving in the wrong direction.

Ohio’s struggle to make progress suggests that the solution to improving Ohio’s performance may need to come from addressing the root causes of infant mortality, factors outside of the healthcare system. Researchers estimate that of the modifiable factors that impact overall health, 20 percent are attributed to clinical care (e.g., healthcare access and quality) and 30 percent to health-related behaviors. The remaining 50 percent are attributed to the social, economic and physical environment. Programs and policies impacting these social and economic factors, such as housing, transportation, education and employment, hold untapped promise for increasing the number of Ohio babies who survive past their first birthday and improving the health of all Ohioans.

Earlier this year, Gov. Kasich signed a law requiring the state’s Legislative Service Commission (LSC) to contract with a nonprofit organization to explore the social factors that impact infant mortality. The Health Policy Institute of Ohio was commissioned by LSC to produce the report, titled “A New Approach to Reduce Infant Mortality and Achieve Equity: Policy Recommendations to Improve Housing, Transportation, Education and Employment.”

Addressing these upstream, or social determinant, causes of infant mortality makes sense. It is difficult, if not impossible, for pregnant women to maintain a healthy pregnancy and for parents to keep their newborns healthy when a family, for example, is homeless or lives in an unsafe home or lacks reliable transportation for doctor’s visits.

HPIO convened a group of more than 100 stakeholders from across the state to develop a list of concrete policy recommendations that state and local leaders can pursue to address these issues.

The report concluded that in order to truly impact the state’s infant mortality rate and reduce disparities, policymakers need to implement policies to improve community conditions that are particularly challenging for African-American and rural families in Ohio.

The good news is that state and local policymakers have many options to address the community conditions and inequities that contribute to infant mortality. In fact, HPIO’s report includes a menu of 127 policy recommendations that state and local leaders can choose from to address housing, employment, education and transportation challenges facing pregnant women and their families. Among the priorities in that list of recommendations are actions that would:

• Prioritize housing and employment because they address foundational, basic human needs
• Better connect low-income families to jobs, transportation, post-secondary education and social capital
• Ensure all children have the opportunity to thrive by extending the reach of early childhood programs, decreasing education disparities, preventing violence and supporting marriage
• Acknowledge the roles of racism, discrimination, violence and toxic stress
• Innovate and leverage private-public partnerships and join forces across sectors
• Coordinate, collaborate, monitor and evaluate state and local infant mortality efforts to ensure their effectiveness and step in with improvements to programs when needed
• Balance short-term fixes, such as addressing homelessness, with longer-term change, such as pursuing fundamental changes to housing, transportation, education and employment sectors

By focusing on the social drivers of Ohio’s infant mortality problem, the state can move the needle and see real results, not just for infant mortality but for many of the State’s other greatest health challenges.

Health value graphic

The 2017 Health Value Dashboard found that Ohio ranks 46 out of 50 states and the District of Columbia on health value, landing in the bottom quartile. This means that Ohioans are living less healthy lives and we spend more on health care than people in most other states. The resources below can be used to help improve health value in Ohio.

Population health and healthcare spending

• State of Ohio Health Facts – Ohio Department of Health
• State Population Health Strategies that Make a Difference – Milbank Memorial Fund
• High-Deductible Health Plans Reduce Healthcare Cost and Utilization, Including Use of Needed Preventive Services – Health Affairs
• 2016 Health Care Cost and Utilization Report – Health Care Cost Institute
• Mortality in the United States, 2016 – National Center for Health Statistics
• Federal Spending Priorities Shifted Toward Health Over Past Decade – Pew Charitable Trust

Social and economic environment

• Building Blocks for Addressing Social Determinants of Health – JAMA Forum
• Connections between education and health No. 3: The importance of early learning – HPIO
• It takes a community: Community schools provide opportunities for all – Phi Delta Kappan
• Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients – Commonwealth Fund

Physical environment

• Evaluation of Housing for Health Permanent Supportive Housing Program – Rand Corporation
• Listening to Low-Income Patients: Where We Live Matters to Our Health – Commonwealth Fund
• Unstable Housing and Caregiver and Child Health in Renter Families – Pediatrics
• Association of Short-term Exposure to Air Pollution With Mortality in Older Adults – JAMA
• Unstable Housing and Diabetes-Related Emergency Department Visits and Hospitalization: A Nationally Representative Study of Safety-Net Clinic Patients – American Diabetes Association

Access to care

• State-Level Trends in Employer-Sponsored Health Insurance, 2012-2016: Chartbook and State Fact Sheets – State Health Access Data Assistance Center (SHADAC)
• Private Health Insurance Basics 2017 Update: Current policy issues impacting the individual health insurance market in Ohio – HPIO
• Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not – Commonwealth Fund

Healthcare system

• Hospital Community Benefit Scorecard – Ohio Department of Health
• Price Transparency and Physician Quality Report Card 2017 – Altarum’s Center for Payment Innovation and Catalyst for Payment Reform
• Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA – Health Affairs
• Doctors Feel Excluded from Health Care Value Efforts – Harvard Business Review
• 2017 Hospital Safety Grade – Leapfrog

Public health and prevention

• Community Health Improvement Plans – Ohio Department of Health
• Public Health Consequences of E-Cigarettes – The National Academies of Sciences, Engineering and Medicine
• Evaluating Community-Based Health Improvement Programs – Health Affairs
• What the World Can Learn from Chile’s Obesity-Control Strategies– Rand Corporation

Health equity 

• Health Departments with a Commitment to Health Equity: A More Skilled Workforce and Higher-Quality Collaborations – Health Affairs
• Geographical Health Priority Areas For Older Americans –  Health Affairs

State Health Improvement Plan (SHIP) priority topics

Mental health and addiction

• Addiction Overview and Project Description – HPIO Addiction Evidence Project
• Evidence resource page: Prevention, treatment and recovery – HPIO Addiction Evidence Project
• The Opioid Epidemic’s Impact on Children Services in Ohio – Public Children Services Association of Ohio
• Drug Overdose Deaths in the United States, 1999-2016 – National Center for Health Statistics
• To Combat the Opioid Epidemic, We Must Be Honest About All Its Causes – Harvard Business Review
• Marijuana Buyers in the United States, 2010-2014 – Rand Corporation
• Teenage cannabis, cigarette use may heighten risk for later psychosis – Psychiatric Annals 

Chronic disease

• Chronic disease care: Family helpers play key roles, but feel left out by providers– University of Michigan via Medical Xpress
• Association of Exposure to Communities With Higher Ratios of Obesity with Increased Body Mass Index and Risk of Overweight and Obesity Among Parents and Children – JAMA Pediatrics
• America Experiences More Pain Than Other Countries – The Atlantic

Maternal and infant health

• A new approach to reduce infant mortality and achieve equity: Policy recommendations to improve housing, transportation, education and employment – HPIO report to the Legislative Service Commission
• An Overview of State Funding Addressing Maternal and Infant Health – Center for Community Solutions
• Vital Signs: Trends and Disparities in Infant Safe Sleep Practices – United States, 2009-2015 – Centers for Disease Control and Prevention
• Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis – Health Affairs