United Health Foundation published its 2013 America’s Health Rankings. 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—for example, 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 health ranking. Since 1990, when the rankings first began, Louisiana has been 49th or 50th much of the time.
We are in the worst fourth quartile (from 37/50 to 50/50) for the following health determinants (factors): low high school graduation rates, smoking, obesity, sedentary lifestyle, children in poverty, violent crimes, occupational fatalities, infectious diseases (including sexually transmitted diseases and HIV/AIDS), lack of health insurance, preventable hospitalizations, and low birth weight babies.
As far as health outcomes (related to morbidity and mortality) are concerned, we are in the fourth quartile (worst) for cancer deaths, cardiovascular deaths, premature deaths, diabetes, and poor self-reported mental health days.
On a more positive note, Louisiana ranks in the top half (best) for low binge drinking, high immunizations rates for children and adolescents, good numbers for primary care physicians and high per capita spending on public health (although it has dropped slightly). One place that Louisiana shines is our a remarkable 25/50 in immunization rates for children and 6/50 for adolescents, largely due to a progressive and comprehensive electronic record for vaccinations (LINKS) and a well-organized immunization program. Despite our high per capita expenditures on public health and Medicaid, that money does not necessarily translate into better health determinants or outcomes. Poor health outcomes may be related to social and economic disparities more than absolute spending.
Although Louisiana has made progress in high school graduation rates (now 68.8%), we still remain significantly below the national average (around 80%). Ambitious efforts are also still underway to transform the Medicaid delivery system with the implementation of Bayou Health, private administrators of Medicaid. These new private partners are striving to make healthcare utilization more cost effective, accessible and associated with better health outcomes. Mental health services have come under the auspices of local governing entities—Central Louisiana Human Services District in our region, and an outside mental health 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.
Despite statewide and local initiatives, there has been an inexorable increase in obesity in the state (now in last place at 50/50) that threatens to submerge the healthcare delivery system in a tidal wave of poor health, especially uncontrolled diabetes. As with all health problems, we can focus on the facts, apply evidence-based improvement techniques and not be discouraged by our significant opportunities for improvement.
In short, Louisiana still ranks only 48/50, but positive initiatives have been undertaken to improve our statistics. It may take years, if not decades, to see the statistical fruits of such initiatives. Given our long history of poor outcomes and the massive amounts of money and manpower that have been devoted to improving them, patience can sometimes be hard to come by.
For more information, visit www.americashealthrankings.org.