The Users' Guide to the Health Reform Galaxy

New County Health Rankings Highlight Opportunities for Quality Improvement

Lisa Letourneau, executive director of Quality Counts, considers the implications of a new series of reports on county-by-county health variations.

No matter how healthy a community is, there is always room for improvement. For proof, just look at the County Health Rankings released recently by the Robert Wood Johnson Foundation and the University of Wisconsin’s Population Health Institute.

At first glance, the report on my home state of Maine in many ways confirms what health reformers have long understood: health follows wealth. With a few exceptions, the more affluent counties on the comparatively urbanized, southern coast of our state have better overall health profiles than the less-affluent counties in the densely wooded, rural parts of the state. For example, in Lincoln County, a coastal community in the mid-coast area, 9% of the population reports itself to be in “poor” or “fair” health. By comparison, that is a relatively low level and puts the county in the 90th percentile of results overall. But in Aroostook County, all the way at the rural north end of the state, the figure is 18%, twice the target level.

On health, and health care, everywhere

As you know, we like to keep busy over here at RWJF and so I've got two posts to offer you today, cross-posted from elsewhere.  First we have our president and CEO, Risa Lavizzo-Mourey, posting on the Health Care Blog about last week's release of county-by-county health rankings, for all 50 states, and then we share a post from our Pioneering Ideas blog, related to a report released on Monday about hospital-acquired infections and the costs in lives and dollars.   

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Thanks to a new set of reports, we now know that where you live matters to your health.  People who call Prince George’s County Maryland home are twice as likely to die prematurely from disease as their neighbors just across the line in Montgomery County.  The data cut both ways.  People who live in the healthiest counties, such as Montgomery or Howard County Maryland have a two-to-three times better chance of living longer than people who live in less healthy counties such as Prince Georges or Baltimore.  

These important new facts aren’t just for the Washington area, because the same disparities are happening across the country. This story unfolds in 50 state reports – The County Health Rankings – that the Robert Wood Johnson Foundation just released with the University of Wisconsin Population Health Institute.   

The data tell a story of our health that doesn’t take place in the doctor’s office, but where we live, learn, work and play.  This story reveals multiple factors— beyond access to health insurance and medical care – that influence how healthy we are and how long we live.  Factors like whether we have access to healthy foods, safe places to be active, our level of education, the number of children living in poverty, and even the number of liquor stores on our block. 

Obama's Budget Includes Modest Increases for Public Health and Prevention

Jeffrey Levi, executive director of Trust for America's Health, writes about advancing the agenda of prevention and public health in tough economic times.

In a time of very tight financial constraints, we all need to be realistic about our expectations. In the context of a freeze on overall domestic non-defense/security discretionary spending, the Obama Administration did show its commitment to a strong public health system that focuses on prevention. Obviously, we'd love to see big increases for public health; however, this budget, combined with large investments about to be released under the American Recovery and Reinvestment Act (ARRA), will significantly increase the capacity of communities to respond to pressing prevention needs.

But the question of health reform still looms large. Unless we take action to improve the health of Americans, we'll lose an important opportunity to rein in health spending. Treating chronic diseases is
one of the biggest drivers of health care costs,  and until we focus more on prevention in a sustained and comprehensive way, we're never going to get these costs under control.

Prevention - An Impetus for Moving Health Reform Forward

Jeffrey Levi, executive director of Trust for America's Health, writes about how strong public support for expanded disease prevention programs could help jumpstart the legislative process. This column first appeared in Huffington Post.

As we turn the page to the next stage of debates around health reform, we should remember there is a whole lot in the current Senate and House bills that is popular, already in close agreement, and could be the impetus for moving forward.

The prevention and wellness sections of the bills could help do just that.

A public opinion survey released in November 2009 by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that disease prevention is one of the most popular parts of health reform. In fact, 71 percent of Americans favor an increased investment in disease prevention.

Investing in disease prevention receives majority support from across the political spectrum (85 percent of Democrats, 59 percent of Republicans, and 68 percent of Independents) and across the country (72 percent in the Northeast, 73 percent in the South, 71 percent in the West, and 69 percent in the Midwest), according to the poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies.

What H1N1 taught us about public health preparedness

Richard Hamburg, deputy director of Trust for America's Health, writes about the H1N1 flu outbreak as a test of the nation's public health system with important lessons for emergency preparedness and health reform.

The H1N1 flu outbreak has been a real-world test of the nation’s public health system, and the results are mixed at best.  The good news is that earlier investments in emergency preparedness created a larger stockpile of antiviral medications. But the outbreak also revealed serious, underlying gaps, including a lack of real-time disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity and a shrinking public health workforce.

The seventh annual edition of  Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism  shows that a band-aid approach to public health is inadequate.  The report found that 20 states scored six or less out of 10 key indicators of public health preparedness. Montana had the lowest score of all with three out of 10.

Variation in preparedness means that where people live can determine how well they are protected from health threats.  In the case of a pandemic or infectious disease outbreak, one weak link in the public health chain – including providers’  reluctance to treat those who are uninsured or underinsured - could result in disaster for everyone.