The United Health Foundation recently published their most recent “America’s Health Rankings 2014”. As in the past, such state-to-state comparative statistics (which always lag a year behind) help situate Louisiana with respect to other states and the United States with respect to other countries.
First, the good news! Louisiana rose from 49th to 48th in its ranking. Sadly, we have hovered at or near the bottom of the barrel since 1990 when this ranking was initiated. Any upward improvement, however slight, is still welcome.
The rankings are broken into two components: “Health Outcomes” and “Health Determinants” (sometimes called “Health Factors” in other studies). Health outcomes include morbidity and mortality data such as cancer deaths, premature deaths, cardiovascular deaths, infant mortality, as well as percent diabetics, and poor physical and mental health days. Thankfully, we rank 44th in outcomes, somewhat better than what would be expected from our “Health Determinants”.
“Health Determinants” (or factors which contribute to outcomes) include elements of personal behavior such as smoking, obesity, physical inactivity and high school graduation rates, combined with clinical care (including preventable hospitalizations and low birth weight babies), and environmental factors (such as violent crime, occupational fatalities, chlamydia rates, salmonella rates and percent children in poverty). For all of the previously mentioned health determinants, Louisiana ranks 44th or below among states, while our global ranking in such determinants is 48th. There are, however, some bright spots, including relatively low rates of binge drinking (21/50), high rates of childhood vaccinations (31/50), number of primary care doctors (20/50), and public health expenditures per capita (27/50).
Although our overall position among states has remained largely unchanged, there have also been significant decreases. Children in poverty has dropped from 31 to 26.5%, drug deaths have dropped from 17.1 to 12.9/100,000 inhabitants and infant mortality has dropped from 11.8 to 8.2/1,000 live births. Many initiatives from both government and private sector, including Well-Ahead and Well-Spots (DHH), 39 Week Birthing Initiative (DHH), the proliferation of Smoke Free City Ordinances (now including New Orleans), Breast Feeding Initiatives, and the continued use of the state’s excellent vaccination registry—LINKS—seek to move the needle toward better health outcomes.
The frustration over our stagnant health outcomes relates to the tenacity of the underlying contributors: poverty, low educational outcomes and low socio-economic status of many of our citizens. Louisiana’s median income—$39,622—falls well below national average of $51,939, and is itself unequally distributed among the population, with a tenacious 25% or more in poverty, many of them African-American. We struggle with a 70% high school graduation rate, despite herculean efforts and millions of dollars of expense. Under-educated citizens, stuck in low wage, dead-end jobs, more easily succumb to disease and disability which may be inadequately treated for any number of reasons.
A subtle balance between individual initiatives and public policy offers the best hope for long-lasting improvements in personal and population health. A better educated and prosperous public, with higher individual social status, is necessary for a healthier society. This has been well established in major population studies. As a state, we do not want to remain at the back of the pack, nor do we, as a nation, want to remain 34th out of industrialized countries in health outcomes. Our unimpressive international ranking occurs despite massive health expenditures over the last decades of $8,000 per person, or $2.7 trillion dollars total, representing 18% of our gross domestic product annually. Let’s move forward to a healthier state in a healthier nation by all becoming better educated and more prosperous.