RISE looks at recent headlines concerning social determinants of health (SDoH).

Study links SDoH to mortality disparities in the US

In a large, diverse study of more than 6,800 U.S. adults, Johns Hopkins Medicine researchers and colleagues describe the impact of common social disparities that are often linked to race and ethnicity, such as a person’s neighborhood, education, income and access to health care, as important predictors of longevity.

The findings, recently published in Circulation, reveal that Black adults had a 34 percent greater risk of death from any cause compared with white adults followed for the same period of time. After adjusting for social disparity factors, by comparing adults with similar household income, neighborhood wealth, education and health insurance, the relative excess risk of death in Black adults fell by about half, to 16 percent greater mortality. Similar reductions were seen for cardiovascular disease death and were also noted among Hispanic and Chinese Americans compared with white adults. 

“We have experienced tremendous improvements in public health in recent decades; however, these study results demonstrate continued mortality inequities among racial and ethnic minorities in our country. We demonstrate that social determinants of health explain many of these differences,” Wendy Post, M.D., M.S., corresponding author of the study and director of cardiovascular research at the Johns Hopkins University School of Medicine, said in the study announcement.

The Multi-Ethnic Study of Atherosclerosis (MESA) included 6,814 adults age 45–84 who initially had no diagnosis of cardiovascular disease and have been followed for nearly 16 years. The four racial and ethnic groups included were white (38 percent), Black (28 percent), Hispanic (22 percent) and Chinese (12 percent) individuals. During the study period, MESA collected detailed assessments of social determinants of health, in addition to multiple lifestyle, psychosocial and clinical risk factors. During the follow-up period, 1,553 (23 percent) of the participants died of various causes, with 364 dying from cardiovascular disease.

The study also found Hispanic and Chinese Americans had the lowest overall risk for death during the study period. However, that trend was partly reversed after considering immigration history. Researchers found that among foreign-born Hispanic and Chinese adults, living in the U.S. for a shorter time was linked to lower risks of cardiovascular death. Post and colleagues note that it wasn’t clear whether that may be due to these participants being healthier or having less time to adopt to some of the unhealthy factors associated with an American lifestyle.

Feds issue guidance to expand mental health care for children, proposes quality measures for children, adults

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced it has taken three actions to strengthen and expand access to high-quality, comprehensive health care for children across the country:

  • Issued a new guidance document to remind states of their mandate to cover behavioral health services for children in Medicaid and urged states to leverage every resource to strengthen mental health care for children.
  • Released a second guidance document that urges states to expand school-based health care for children, including mental health care
  • Proposed a new rule that would require states to report certain quality measures to strengthen Medicaid and the Children’s Health Insurance Program (CHIP) to ensure that the millions of children and families enrolled in these programs have access to the highest quality of care

HHS noted that the country facing an unprecedented mental health crisis, particularly among children. Even before the pandemic, rates of depression, anxiety and suicidal thoughts were on the rise, with up to one in five children ages 3 to 17 in the U.S. having a mental, emotional, developmental, or behavioral disorder. The pandemic only exacerbated these issues, with increased isolation and disrupted learning, relationships, and routines. More than 40 percent of high school students struggle with persistent feelings of sadness or hopelessness, and more than half of parents and caregivers are concerned about the mental well-being of their children.

“As we begin the school year, a top priority of the Biden Administration is to ensure all children have access to the full range of care and support they need to stay healthy and thrive–including mental health services,” HHS Secretary Xavier Becerra in the announcement. “For the millions of children who are covered by Medicaid and CHIP, this means working with states to ensure they are pulling every lever to strengthen and expand comprehensive access to mental health care for children.”

3 more abortion trigger bans loom

Thirteen states had legislation designed to automatically outlaw abortions if the U.S. Supreme Court ruled to overturn Roe v. Wade. In the wake of that Supreme Court’s decision to overturn the constitutional right to abortion, several states have codified near-total abortion bans or bans after six weeks of pregnancy. Some of these trigger bans took effect immediately after the Supreme Court ruling, others had to wait 30 days for enforcement measures to take effect or required certification from the state’s attorney general. NPR reports that Tennessee, Idaho, and Texas are expected to implement these strict bans beginning August 25 unless the courts intervene.  Since the Supreme Court’s decision, President Biden has issued an executive order to protect access to abortion and contraception and HHS has issued guidance that providers must offer abortions in emergency situations. Furthermore, in a letter to providers, HHS Secretary Xavier Becerra, said that Emergency Medical Treatment and Active Labor Act (EMTALA) preempts state law restricting access to abortion in emergency situations.  That 1986 law requires hospitals and physicians to provide screening and stabilizing treatment—including abortion, if necessary—in emergency situations.

But it’s unclear how seriously potential EMTALA violations will be investigated in states where officials have embraced strict limits on any medical services they deem abortion related. Kim Puterbaugh, M.D., an OB/GYN at the University Hospitals Cleveland Medical Center and president of the Society of OB/GYN Hospitalists, told Kaiser Health News earlier this month that women’s lives will be endangered as providers wait for advice from their organization’s lawyers on how to comply with state anti-abortion laws while seeing pregnant patients with emergency and near-emergency complications.

HHS expands access to home and community-based services

This week HHS, through CMS, awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) demonstration program. The grants will allow 41 states and territories across the country to participate in the program and ensure that seniors and people with disabilities receive care in the setting of their choice and reduce unnecessary reliance on institutional care.

The grants will support the early planning phase for MFP programs, including:

  • Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations
  • Conducting system assessments to better understand how HCBS support residents
  • Developing community transition programs
  • Establishing or enhancing Medicaid HCBS quality improvement programs
  • Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance