United Health Foundation recently published its 2012 America’s Health Rankings. All of the states are ranked according to a collection of “health determinants” (or factors) and “health outcomes.” Determinants include many aspects of behavior, community characteristics, policy and clinical care that determine health outcomes (such as diabetes, infant mortality, cardiovascular deaths, cancer deaths and premature deaths).
Louisiana, with its high percentage of Medicaid (25%) and uninsured (20%) and its low median income ($40,000 vs. $50,000 nationally) has always struggled with its ranking. Since 1990 when the rankings first began, Louisiana has been 49th or 50th much of the time. Mississippi has helped boost Louisiana’s ranking for several years, although it appears that we are now tied with our Southern neighbor for that unenviable 49th position.
We are in the fourth quartile (worst) for the following health determinants: smoking, obesity, sedentary lifestyle, low high school graduation rates, violent crimes, occupational fatalities, infectious diseases (including sexually transmitted diseases and HIV/AIDS), children in poverty, lack of health insurance, low birthweight babies and preventable hospitalizations.
As far as health outcomes are concerned, we are in the fourth quartile (worst) for diabetes, poor self-reported mental health days and poor physical health days, infant mortality, cardiovascular deaths, cancer deaths and premature deaths.
On a more positive note, we are at or near the top quartile (best) for low binge drinking, high immunization rates and high per capita spending on public health. The latter fact bears comment since it clearly indicates, much as does our high per capital expenditures on Medicaid, that the money spent does not necessarily translate into better health determinants or outcomes. The obvious exception appears to be childhood vaccinations, where Louisiana is a remarkable 7/50 in our immunization rates, largely due to a progressive and comprehensive electronic record for vaccinations (LINKS) and a well-organized immunization program.
Although Louisiana has made modest progress in high school graduation rates (63.5 % to 67.3%), we still remain significantly below the national average (around 80%). Ambitious efforts have also been undertaken to rationalize the Medicaid delivery system with the implementation of Bayou Health, private administrators of the significant funds devoted to Medicaid. It is hoped that these new private partners will succeed in making health care utilization more cost effective and achieve better results. Mental health services have also been reformed with Coordinated System of Care and an outside administrator, Magellan. The Birth Outcomes Initiative targeted prematurity by reducing unnecessary deliveries prior to the critical 39 week date, and appears to be improving outcomes.
In short, Louisiana still ranks poorly, but positive initiatives have been undertaken to improve our dismal statistics. Sometimes it takes years, if not decades, to see the statistical fruits of such initiatives. It is hard to ask for patience, however, given the long history of poor outcomes and the massive amounts of money and manpower that have been devoted to improving them. Perhaps the most ominous development has been the inexorable increase in obesity in the state that threatens to submerge the healthcare delivery system in a tidal wave of poor health, especially uncontrolled diabetes. As with all health problems, all we can do is to study the facts, apply evidence-based improvement techniques where possible, and not be discouraged by our significant opportunities for improvement.
For more information on the national health rankings, visit www.americashealthrankings.org.