In Donald Trump’s America, public health is not a priority. Depending on factors like location and demographics, each state will experience unique health outcomes as a result of the 2020 election. This piece examines the potential effects of another Trump administration on Ohio’s existing health disparities.
Even though most Ohioans report having good health, plenty will endure negative health consequences if Trump is reelected. The potential repeal of the Affordable Care Act (ACA) would result in nearly a million Ohio residents losing healthcare coverage. Prolonged mismanagement of the COVID-19 pandemic threatens to leave thousands without access to healthcare, safe housing, and healthy food. And further, COVID-19 is most deadly to already vulnerable populations.
Joe Biden will make healthcare and treatment for substance use disorder services more accessible, address racial health-related inequities, and protect the rights of coal workers and their families as he transitions America to cleaner energy sources.
The overlap between Ohio’s poorest and least healthy counties suggests that there is a significant relationship between one’s income and wellbeing: poverty is a social determinant of health (SDOH). While the majority of Ohio residents say that they’re healthy and have adequate healthcare access, nearly 25% do not. Most Ohioans who reported putting off medical care did so because of cost.
Differences in reported food security also illustrate health disparities within the state: a fifth of Ohio residents can’t “easily” access nutritious food, citing cost and distance as barriers. High-poverty areas have doubled in Ohio since 2000 and exist in both rural and urban regions.
Along with income and income-driven factors, unhealthy lifestyle choices (like drinking alcohol, smoking, poor diet, and inactivity), often learned from friends and family, can also contribute to chronic diseases. Many chronic conditions have more fatal health outcomes for people of color than whites; for example, Black Americans aged 18-49 are twice as likely to die from heart disease than whites, and Mexican adults are twice as likely to die from diabetes and liver cirrhosis than white adults.
Racism is also a social determinant of health. As Ohio Governor Mike DeWine stated this past August, “racism is a public health crisis.” A 2014 study of Black teenagers found that perceived discrimination can be emotionally and physically stressful, resulting in diminished health over time. Additionally, people of color who experience discrimination within the healthcare system may be discouraged from using healthcare services again. Institutionalized racism affects other health risks, such as those associated with reduced employment, wage, and housing opportunities.
Trump’s explicitly racist language won him support in the 2016 election, and he continues to agitate racial tensions as the next election looms; he has expressed no intention to reduce racial health disparities. Contrastingly, Joe Biden wants to bolster economic stability for communities of color and will prioritize broadened healthcare access to address racial inequity.
Further, the COVID-19 pandemic has a disproportionate impact on people of color in Ohio, bringing pre-existing racial health disparities to light. Greater likelihood of having serious chronic health conditions, experiencing reduced healthcare access, working in high exposure roles, and living with multiple family generations put people of color at greater risk.
Over 5,300 Ohioans have already died from COVID. Trump’s withdrawal from the World Health Organization (WHO) means Americans won’t have timely access to a vaccine. Joe Biden would protect vulnerable populations by establishing a clear and cohesive response plan, rejoining the WHO, and encouraging state leaders to require masks.
It’s evident that socioeconomic factors impact health. It would save both lives and money to address the root causes of health inequity and related barriers to healthcare. Joe Biden wants to add 150,000 community health workers to communities that experience racial health disparities. He has a long-term plan to tackle SDOH by investing in home and community healthcare services that make preventive and primary care more accessible and affordable. Healthcare costs and coverage rates are expected to improve under Biden, as he plans to keep and improve the ACA.
Many Ohioans report concern regarding the state’s opioid crisis, a clear threat to public health: there were 4,100 fatal overdoses in 2019, and this past May, over 500 Ohio residents fatally overdosed. Along with substance use disorders, COVID has worsened mental health conditions for many. More adults in Ohio report serious mental illness than the national average, and five Ohioans commit suicide every day.
Treating substance use disorders and mental health conditions require access to affordable healthcare services. The ACA has dramatically expanded mental health coverage, and Medicaid covers up to half of Ohio’s medication-assisted treatment (MAT) for opioid use disorder. Expanded Medicaid also covers cigarette smoking cessation treatment, which is notable given nearly one in four children in Ohio live with a smoker.
While the ACA certainly helped thousands of Ohioans get Medicaid coverage, just as many residents received private insurance through the ACA. Along with increased healthcare access, many enrollees have financial aid benefits available to them, such as subsidies and cost-sharing reductions.
Trump wants the ACA to be dismantled, though he has no plan to replace it. He has allowed more Ohioans to access short-care health plans during his presidency, but uninsured rates have risen since his election. Biden understands that strengthening the ACA is crucial to improving American health equity.
Along with health policy, climate action will be influenced by the next presidential administration. The rising global temperature will make floods, heat waves, and winter storms more intense. Climate change threatens the wellbeing of all Americans, but some are at a disproportionate risk.
Floods can spread diseases like typhoid fever and cholera, and pollute drinking water with bacteria, which is especially dangerous to vulnerable populations.
Heat waves exacerbate chronic lung conditions and are associated with higher rates of heat stroke and dehydration; urban residents without air conditioning and people who have chronic conditions are especially at risk.
Worsening winter storms can cause immediate injury and death (from poor road conditions or extreme cold), and power outages leave people without generators at greater risk of food poisoning. Additionally, carbon monoxide poisoning is most common in prolonged periods of bitter weather.
Two-thirds of Ohio’s power comes from coal. When coal is burned, the health outcomes can be serious: in 2015, pollution from coal plants killed over 2,000 Ohioans. Coal plants tend to be located around poor and/or non-white communities.
To mitigate the effects of climate change on public health, America must stop relying on fossil fuels for power. The transition to clean energy is inevitable: even during Trump’s presidency, unemployment among Ohio coal workers has been on the rise. Biden recognizes the role that the coal industry plays in Ohio’s economy and pledges that coal workers will receive the benefits and pensions they have earned. He’ll invest in coal communities and create a task force to help them thrive without relying on coal.
And further, safe and consistent employment is a social determinant of health: people who spend their lives working in coal mines are likely to develop lung disease. Biden will reform the Black Lungs Benefits program to help identify lung disease in coal workers.
The election of Joe Biden would connect more Ohio residents with the healthcare services that they need to lead healthier lives. Biden will commit resources to reducing racial health disparities, addressing SDOH, and improving management of the COVID-19 pandemic