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Health Affairs’ May Issue: Social Determinants, Children & More

As health systems increasingly pay attention to the social determinants of health, the May issue of Health Affairs examines the relationship among programs, policies, living conditions, and the health and well-being of children and families.

This issue was supported by the Robert Wood Johnson Foundation.

Periods Of Homelessness Increase Infants’ Health Risks Up To Age Six.

Children born during a period of family homelessness have significantly greater health risks from birth through early childhood, according to Robin Clark and coauthors of the University of Massachusetts Medical School. The researchers linked Massachusetts emergency shelter records for the period 2008–15 with Medicaid claims data to compare 5,762 infants whose families experienced a homeless episode with a group of 5,553 infants who did not. According to the authors, infants born into homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual health care spending. Most of these adverse impacts were found to have persisted for two to three years, with asthma diagnoses, emergency department visits, and overall health care spending significantly higher through age six. The authors conclude that while screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.

Exposure To Neighborhood Violence Negatively Affects A Child’s Physical And Mental Health.

Using data from the 2016 National Survey of Children’s Health, Dylan Jackson of the University of Texas at San Antonio and coauthors explored whether neighborhood conditions—particularly violence exposure and perceptions of danger—were associated with child health status and health risks across four dimensions: health difficulties (for example, headaches, stomachaches, or breathing problems), chronic physical conditions, developmental disorders, and mental health conditions. The authors found that children exposed to neighborhood violence who were also perceived by parents to be unsafe in their neighborhood experienced almost three times the rate of multiple chronic physical conditions and five times the rate of multiple mental health conditions relative to children who had not been exposed to neighborhood violence and were perceived by parents to be safe in their neighborhood. The authors note that these findings underscore the need to invest in public safety and community violence prevention as a means of promoting health among children.

External Reference Pricing Would Save Medicare Billions On Prescription Drugs. 

So-Yeon Kang and coauthors of the Johns Hopkins Bloomberg School of Public Health compared prices across the United States, the United Kingdom, Japan, and the Canadian province of Ontario for seventy-nine top-selling single-source brand-name drugs that had been on the market for at least three years. Using external reference pricing, or prices based on what other countries pay for drugs, the authors found that the prices averaged 3.2–4.1 times higher in the US than in the comparison countries, after rebates were considered, and the price differential for individual drugs varied from 1.3 to 70.1. The longer the drug had been on the market, the greater was the price differential. The authors noted that if Medicare Part D adopted the average price of drugs in the reference countries, the estimated cost savings would be as much as $72.9 billion in 2018. They recommend that Medicare use external reference pricing in Part D to improve affordability of drugs for patients.

Evaluating the wages and health of early child care and education workers.

In the United States, some ten million children under the age of six are enrolled in early care and education (ECE) programs. However, little is known about the health of the 2.2 million workers responsible for their care. Using baseline data from an ongoing study, Jennifer Otten of the University of Washington and coauthors surveyed workers in the Seattle and Austin metropolitan areas. The authors found high rates of poor mental health and food insecurity (23 percent reported using public food assistance). According to the authors, lower-wage workers were employed at centers with more children enrolled in subsidy programs. These centers frequently failed to offer health insurance, paid sick leave, or parental or family leave. The authors suggest that the culture of health in ECE settings and equity-related outcomes could be improved by helping centers provide more support and flexibility to teachers (for example, offsetting workers’ benefit costs or reducing teacher-to-child ratios to reduce stress), who are managing their own health in the context of demanding work.

Also of interest in the May issue:

China’s Health Expenditure Is Projected To Grow Annually.

If recent trends continue, health expenditure in China is projected to grow 8.4 percent annually, from 5.3 percent of gross domestic product (GDP) in 2015 to 9.1 percent of GDP in 2035. To understand how demographic factors, changes in health programs and other policy changes affect health spending in China, Tiemin Zhai of the China National Health Development Research Center and coauthors projected health expenditure by disease and function in the period 2015–35. The authors found that the expected growth will be largely driven by inpatient services, which are projected to grow 9.2 percent annually, from 46 percent of total health expenditure in 2015 to 53 percent in 2035. According to the authors, circulatory disease expenditure is projected to account for the largest percentage of health expenditure by disease type, growing from 18.7 percent in 2015 to 23.4 percent in 2035. The authors projected cumulative savings of 3,858 billion yuan from reducing the smoking rate by 50 percent and of 3,653 billion yuan in cumulative savings from reducing the rate of high blood pressure by 25 percent. To avoid unreasonable health expenditure growth in China, they recommend focusing on increasing growth in outpatient, primary health, and preventive health services; moderating growth in inpatient services; and reducing the rates of high blood pressure, tobacco smoking, and other risk factors.

Also in the issue: 

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