Media digest: States plan for CHIP funds to run out, extreme inequities in maternal mortality, and the patchwork of local efforts to address opioids

The San Francisco Chronicle reported on what will happen in California if funding for the Children’s Health Insurance Program runs out: “If CHIP is not renewed, most of the roughly 1 million children and young adults who receive coverage through the program would continue receiving coverage through Medi-Cal, the state’s insurance program for the poor. However, under that scenario, the state would receive billions of dollars less from the federal government because of the way the federal government reimburses the state for the health programs… ‘You can’t lose $2.4 billion and not have it have a huge impact… We’d ideally not want to throw a million kids off of coverage. But that means there would have to be cuts in some other area — education, child care or some other program. This loss of funds would literally mean California policymakers would have to choose among our children.’”

A new video from Vox and ProPublica examines the ways that the legacy of slavery and racist medical experimentation and abuse continue to “haunt the medical system,” affecting quality of healthcare and producing worse health outcomes for people of color, with a particular focus on black women, who are three to four times more likely to die in childbirth than their white peers. Yesterday, National Public Radio aired an investigative report on black mothers dying of pregnancy-related causes, following the story of Shalon Irving, a Public Health Service Corps member, who died of pregnancy-related hypertension three weeks after giving birth: “At 36, Shalon had been part of their elite ranks — an epidemiologist at the Centers for Disease Control and Prevention, the pre-eminent public health institution in the U.S. There she had focused on trying to understand how structural inequality, trauma and violence made people sick. "She wanted to expose how people's limited health options were leading to poor health outcomes," said Rashid Njai, her mentor at the agency. "To kind of uncover and undo the victim-blaming that sometimes happens where it's like, 'Poor people don't care about their health.' " Her Twitter bio declared: "I see inequity wherever it exists, call it by name, and work to eliminate it."… The dangers of sporadic postpartum care may be particularly great for black mothers. African-Americans have higher rates of C-section and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They have disproportionate rates of hypertensive disorders and peripartum cardiomyopathy (pregnancy-induced heart failure), two leading killers in the days and weeks after delivery. They're twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment. If they experience discrimination or disrespect during pregnancy or childbirth, they are more likely to skip postpartum visits to check on their own health (they do keep pediatrician appointments for their babies). In one study published earlier this year, two-thirds of low-income black women never made it to their doctor visit.”

The United Nations has dispatched a special envoy to investigate extreme poverty in the US, which will include investigations in California, Alabama, Georgia, West Virginia, Puerto Rico, and Washington, DC., and look at poverty-related disease, healthcare access, water quality and sanitation, voter suppression, and civil rights.

In the absence of a well-coordinated and funded federal strategy, cities and counties have launched thousands of local initiatives to address the opioid epidemic, according to the Robert Wood Johnson report, Communities in Crisis: Local Responses to Behavioral Health Challenges. Examples include police crisis intervention teams; diversion programs in hospitals, jails, and courts; and programs that focus first on establishing safe and sustainable housing. Writing in Health Affairs, the report’s authors note that the most successful initiatives take a comprehensive approach that creates “client-centric systems of care that align law enforcement, criminal justice, public health, and community resources to coordinate, improve access to, and deliver a broad spectrum of treatment, recovery, health, and social services.” The report also found that in a time of limited funding availability, Medicaid appears to be an underused resource for covering both treatment and services to help individuals access social, educational, and housing supports.

The New Yorker looks at how problems can spiral when incarcerated youth are placed in solitary confinement. Lisa Armstrong profiles Jermaine Gotham, a teen who has cycled in and out of solitary confinement during his imprisonment in New York correctional facilities that began when he was arrested as a teen for robbery, burglary, and kidnapping. Gotham has received a series of sentences for restrictive confinement for as many as 200 days at a time for offenses that include entering a cell without permission, ignoring orders to return to his cell, and throwing his food tray and challenging correctional officers. Gotham, who has an I.Q. of 70, has been diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, and bipolar disorder, and was abused by a relative when he was a child. Roughly two-thirds of youth in detention facilities have at least one mental health problem, Armstrong reports, and many of those youth are placed in solitary confinement during their incarceration. The practice of placing youth in solitary confinement has been a subject of dispute in New York’s jails and prisons. Mental health experts say the stress of isolation can worsen mental health problems. Correctional officers argue the measure is necessary to protect themselves and others.  Gotham said he has become somewhat used to solitary. “But I’m not gonna lie, it never becomes easier. It messes with my mind. You become depressed, angry, aggressive. You think of killing yourself, though I would never tell anyone here that.”

Richard Florida of CityLab writes about a Brookings Institution study that examines how low-income Americans fare in different states with respect to “key indicators of desperation”: pain, worry, and optimism. The research segments the populations studied into low-income whites and low-income people of color, and finds different patterns for both groups. Poor whites, for example, generally report more instances of pain in states with lower education and income levels, while people of color report more pain in states with higher levels of income and education. He notes that for whites, high rates of worry and low rates of optimism tend to map to states hardest hit by the opioid epidemic. “America is not only beset by growing spatial inequality, it also suffers from a widening geography of desperation,” he writes. “For poor whites, desperation is highest in Appalachia and the Rust Belt, places hard hit by an ongoing economic transformation. Poor minorities suffer more in relatively affluent and knowledge-based states on the coasts.”

Herb Kuhn, president and CEO of the Missouri Hospital Association, proposes that hospitals consider looking beyond measures focused only on disease to consider geographic and community factors that contribute to adversity when they conduct health needs assessments. In an interview with Hospitals & Health Networks, Kuhn shares some of what his community has learned by looking at community conditions like educational opportunity and availability of affordable and healthy foods from one zip code to the next.

A new study in the Lancet finds that even moderate levels of pollution can negate the positive health effects of walking and being physically active outside, at least among older people.