Each April, the Robert Wood Johnson Foundation and the University of Wisconsin publish their County Health Rankings. Each county (or parish) is ranked with respect to others in the state in two broad categories: health outcomes and health factors. The former, health outcomes, deals with mortality and morbidity results, which are obtained from the National Center for Health Statistics and the Behavioral Risk Factor Surveillance System. Health factors, which determine health outcomes, are divided into four general categories:
1. Health Behaviors—Tobacco and alcohol use, diet and exercise and sexual activity as measured by STDs and teen birth rates;
2. Clinical Care—Access to care and quality of care, including diabetic screening and mammography;
3. Social and Economic Factors—Education, employment, children in poverty, family and social support and violent crime rates;
4. Physical Environment—Air pollution, access to health food and recreational facilities, and number of fast food restaurants per capita.
Central Louisiana, as it has for 2010 and 2011, offers a mixed bag of results. The number is the ranking of the parish out of the 64 Louisiana parishes. As far as health outcomes are concerned, Vernon (2) and LaSalle (10) parishes consistently rank in the top quartile of parishes in Louisiana, while Grant (50), Catahoula (53) and Concordia (63) rank in the bottom quartile. Rapides (24) and Winn (32) fall somewhere in between, as does Avoyelles (40). Trends in health outcomes over the past three years have shown a worsening in Grant, Concordia and Vernon, and improvements in Avoyelles, LaSalle, Rapides and Winn.
Since outcomes generally reflect health factors, there is a general correlation, which has remained fairly constant. Those parishes in the lower quartile for health factors are Catahoula (59), Concordia (53), Avoyelles (54) and Winn (47). While Rapides (18), LaSalle (23) and Vernon (25) have the best health factor rankings, Grant (34) falls somewhere in between.
Problems of access to care, whether they be related to unavailable medical resources, or problems related to transportation, plague many parishes along the Mississippi and have roots in demographics and poverty. Since ill-health disproportionately affects populations with low incomes and minorities are over-represented in that group, there are worse statistics in parishes with higher minority populations. This remains consistent across the state, where racial disparities exist in longevity, murder rates, death from cancer, HIV and infant mortality rates.
Although the problems can be easy to identify, the solutions remain persistently elusive. Despite good faith efforts and considerable expenditures in public and private heath delivery, Louisiana has remained 49/50 in America’s Health Rankings most years since the 1990’s. Only Mississippi consistently keeps us from the unenviable 50th position.
Knowing the parish ranking is always useful for allocation of resources and policy changes at the state and local level. Parishes in the state with better rankings must always put them in perspective to Louisiana’s national rankings, as depressing as that may be. Even number one in Louisiana (St. Tammany Parish) has opportunities for improvement. Change first requires a recognition of a problem and second, a commitment to the idea that the problem is neither inevitable, nor desirable. Louisiana, with the highest percentage of native-born citizens in the United States, always runs the risk of accepting the status quo as unpleasant as that may be. Let us recognize the rankings for what they are, a call to action for everyone to strive for better health outcomes not just for our individual parishes, but for the entire state of Louisiana.