Once a year, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute publish their annual “County Health Rankings & Roadmaps”. This report establishes rankings for “Health Outcomes,” (length of life and quality of life criteria) and “Health Factors” (health behaviors, clinical care, social and economic factors and physical environments) for each parish. “Health Factors” (sometimes called “Health Determinants”) are weighted differently, with more importance on social and economic factors (40%) than on the others (health behaviors 30%, clinical care 20% and environment 10%). Each of Louisiana’s 64 parishes is ranked from 1 (the best) to 64 (the worst) for both outcomes and factors. How do our parishes stack up for 2016 and how is this different from previous years?
The “healthiest” Louisiana parish (1/64) is Cameron (a low-population, low minority parish), with St. Tammany (2/64) close behind. Our “unhealthiest” parish is Madison (64/64), with Concordia (63/64) slightly ahead. As for health factors (which ultimately determine health outcomes), St. Tammany comes in at 1/64 and East Carroll, 64/64. Although there is a close correlation between factors and outcomes, it is not perfect. We can, however, see that the location of parishes with poor health factors (snaking up the Mississippi and across Northern Louisiana, with an arc around Shreveport/Bossier City) looks remarkably similar to that of parishes with poor health outcomes.
So, how about Cenla? How do we rank and what has happened over the last seven years? Cenla is roughly divided into three groups with respect to outcomes. The “healthiest” Cenla parishes are Vernon (9/64) and LaSalle (19/64), with the least healthy being Avoyelles (48/64), Catahoula (56/64) and Concordia (63/64). All three of these latter parishes lie along the Mississippi River in the poverty belt extending up into Arkansas and across to Mississippi. Winn (32/64), Grant (18/64) and Rapides (40/64) fall somewhere in between.
As far as “Health Factors” are concerned, we see our “unhealthiest” parishes also have the worst factors (i.e. Avoyelles 52/64, Catahoula 53/64 and Concordia 57/64). Our best parishes for factors are LaSalle (17/64), Rapides (20/64) and Vernon (22/64), with Grant (27/64) and Winn (42/64) fall somewhere in between. Again, there is not a perfect correlation between factors and outcomes—as we can see from Rapides, which has excellent health factors (20/64), but less impressive health outcomes (40/64).
So what has happened over time to our state and region? Sadly, there does not appear to be any dramatic changes in parish rankings over the last seven years. Our “healthiest” parishes remain the healthiest and our “unhealthiest” remain the most unhealthy. There are a few notable exceptions, with Grant Parish going from a high of 50/64 to a much better 18/64. While both LaSalle and Vernon were 2/64 at one time, but are now 19/64 and 9/64 respectively, a worsening, but not a dramatic one. Health factors bounce around in a fairly narrow range with the exception of Vernon Parish, which had a high of 44/64 and now has a much more respectable 22/64.
What does this all mean? First, within the context of national health rankings, Louisiana still ranks poorly, with a 50/50 state status in 2015. Since its inception in the 1990’s, America’s Health Rankings has ranked Louisiana at the bottom or near bottom for U.S. states (47th or below) every year. That means that parishes doing well in Louisiana (such as Cameron or St. Tammany) are doing okay by national standards, but parishes doing poorly (such as Madison and Concordia) are scraping the bottom of the health outcomes barrel.
Despite decades of work and billions of dollars in expenditures, Louisiana’s health outcomes remain mediocre at best. Our health factors, including poor health behaviors (obesity, smoking, STDs, teen pregnancies and physical inactivity), significant access issues (high rates of uninsured), and overwhelming social and economic factors (low high school graduations rates, high violence and omnipresent poverty) all conspire to keep us in the cycle of poor health outcomes. To aggravate the situation, Louisiana suffers from a chronic persistence of disparities, with much poorer outcomes and worse factors for its African-American population. This absence of “health equity” makes prospects of improvement even more challenging.
Recent changes in insurance, with the Affordable Care Act (a.k.a. Obamacare) and Medicaid Expansion, promising to offer some hope for those trapped in poverty and poor health. Around 300,000 Louisiana citizens or more will benefit from Medicaid Expansion, financed 100% by the federal government this year and 90% in the years to come. While having an insurance card does not necessarily insure access to care, it certainly doesn’t hurt. And with the multiplication of Federal Qualified Health Centers (FQHCs) and Rural Health Clinics in Cenla, and the development of Private-Public Partnerships with Rapides Regional and Christus St. Frances Cabrini, more opportunities for care exist.
Louisiana need not remain 50th in its state health rankings, and Cenla can surely do better as well, especially with its more challenging areas (Avoyelles, Catahoula and Concordia). With a combination of healthier living, increased access, and the will to encourage and sustain changes in our system, we can rise in the ranks of health and fulfill our potential as individuals and a region.
