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Social Services and Community Health: Health Affairs' November Issue

Bethesda, MD--The November issue of Health Affairs includes a number of studies looking at how social services and community support programs can improve the health of local residents. Other subjects covered: the potential for pay-for-performance payment models to create a market that values health, not just health care; how one safety-net accountable care organization is uniquely improving care coordination; a three-year progress report on a regional health collaborative; and more. 
This issue of Health Affairs is supported by The Kresge Foundation, the Robert Wood Johnson Foundation, and the Annie E. Casey Foundation. 
A new index finds that minority children are more likely to live in neighborhoods less conducive to healthy development. Dolores Acevedo-Garcia of Brandeis University and coauthors developed a surveillance system, coined the "Child Opportunity Index," to gauge neighborhood-based opportunities conducive to healthy development. Researchers scored neighborhoods using nineteen indicators--ranging from the presence of quality early-childhood education, to poverty, to proximity to parks and healthy food. They found that, across the one hundred largest metropolitan areas, 40 percent of black children and 32 percent of Hispanic children reside in the lowest opportunity neighborhoods within their metropolitan areas, compared with 9 percent of white children and 12 percent of Asian and Pacific Islander children. Black and Hispanic children are even more concentrated in very low-opportunity neighborhoods in areas with higher levels of racial segregation. The authors say that the index could inform collaborations between the health care sector and community development programs that seek improved child health equity. Index maps for the one hundred metropolitan areas are available at
Are housing code violations correlated to childhood asthma morbidity? Andrew F. Beck of Cincinnati Children's Hospital Medical Center and coauthors conducted a review of nearly 4,500 children who visited the emergency department (ED) or were hospitalized for asthma at Cincinnati Children's Hospital Medical Center over a four-year period. Census tract density of housing code violations was significantly associated with population-level rates of children's asthma-related ED visits and hospitalizations, independent of poverty. Of the approximately 1,500 children hospitalized for asthma during the study period, nearly 75 percent resided in census-defined "poverty areas." Despite this socioeconomic homogeneity, those living in census tracts with a high density of housing code violations were significantly more likely to return to the ED or hospital within one year. The authors conclude that "geomarker"-based data such as this could help target interventions to improve health care delivery and overall health in at-risk communities. 
Which hospitals will be most affected by cuts in Medicaid DSH payments? Disproportionate-share hospital (DSH) payments, a long-standing feature of the Medicaid program, are intended to partially offset the cost of providing uncompensated care to the uninsured. Between 2017 and 2024, federal DSH payments will decline by more than $35 billion under the Affordable Care Act. These reductions are in tandem with the expansion of insurance coverage through the Marketplaces, including for those newly eligible for Medicaid, which is expected to reduce hospital uncompensated care costs. Evan S. Cole of Georgia State University and coauthors from Tulane University sought to identify the hospitals most likely to be affected. They found that 529 acute care hospitals may be significantly impacted by the Medicaid DSH cuts. Financial data showed that 225 of these hospitals are in a weak financial condition, which may affect their ability to provide vulnerable populations with access to care.
Researchers identify "pharmacy deserts" as a potential explanation for disparities in the use of prescription medications. Disparities in medication adherence in the United States have long been attributed to affordability, but a study by Dima M. Qato of the University of Illinois School of Pharmacy in Chicago and coauthors finds that pharmacy deserts, or neighborhoods with limited access to pharmacies, are more common in largely black and Hispanic communities. The authors conclude that racial and ethnic minorities may face barriers other than cost in accessing prescription medications and note the need to address factors beyond insurance coverage and medication affordability. The authors suggest that incorporating pharmacies into community health centers and offering financial incentives for pharmacies to locate in these areas could be two policy options.
Other papers of interest in the November issue include:  
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.