04/06 - RX for Louisiana: Healthcare in Focus

Why does health data for our youth rival those of third-world countries?

Check in with Louisiana Public Square as it diagnoses the health of some of the state's most vulnerable citizens -- its younger population. "Rx for Louisiana: Healthcare in Focus" examines why the health data for our infants to young adults rival those of third-world countries as well as why 10 million children world-wide, under the age of three, die each year. The program will explore why Louisiana's rates of infant mortality, West Nile Virus, HIV, and other health risks are among the highest in the nation, and what can be done to improve diagnosis and treatment in a world where disease knows no border.

Partial funding for this program came from grants from RX For Survival and Remaking American Medicine.

RX For Survival...A Global Health Challenge

Remaking American Medicine - (Look for the premiere of Remaking American Medicine in September 2006.)

Backgrounder

Rx for Louisiana: Healthcare in Focus (download entire backgrounder in pdf format)

Much of the information contained in this document comes from the following sources:

* Materials provided in conjunction with the PBS series, “Rx for Survival.” (http://www.pbs.org/wgbh/rxforsurvival/)View “Rx For Survival: The Heroes” on Wednesday, April 12th at 8 p.m. on LPB.
* Materials provided in conjunction with the PBS series, “Remaking American Medicine.” (http://www.ramcampaign.org/).Watch for the “Remaking American Medicine” series coming to LPB in the fall of 2006.
* The Department of Health and Hospitals publication, “2005 Louisiana Health Report Card” (http://www.dhh.louisiana.gov)
* The upcoming Public Affairs Research Council report “Hurricanes and Healthcare Reform: Can Louisiana Turn a Disaster into an Opportunity?”(http://www.la-par.org)

Over the past 150 years, due to breakthroughs in public health, science, and technology, humans can now live longer, healthier and more productive lives. Clean drinking water, modern sanitation and good nutrition combined with highly effective vaccines and antibiotics have increased average western life expectancy by 35 years.

But, in the past twenty years, infectious diseases that had nearly been conquered such as tuberculosis (TB) have come surging back. Devastating new diseases such as AIDS, SARS, West Nile Virus and the avian flu have appeared. And with global travel, the latest epidemic is only a plane ride away.

Rx For Children
Unfortunately, children bear the brunt of the world’s global health problems. Across the world, more than 10 million children die every year. Ninety percent of these deaths occur among children under the age of 5. Newborn conditions, pneumonia, and diarrhea rank near the top of the list of causes followed by malaria and AIDS. Malnutrition such as vitamin A deficiencies affect about 140 million children and contribute to blindness and an increased risk of death.

While child mortality rates in the United States are much lower than developing countries, in Louisiana - compared oftentimes to a “third world country”- the health statistics are less than outstanding. In “America’s Health: United Health Foundation State Health Rankings 2003,” Louisiana ranked 49th- as the second least healthy state in the nation. Part of this ranking was due to the state’s deficiency in areas such as:

* Infant mortality. Louisiana ranks third in the nation with 9.4 deaths per 1,000. The national average is 6.9 deaths.
* Low Birth weight. Louisiana ranks second in the nation, behind Mississippi. 10.7% of Louisiana’s live births in 2003 were low birth weight babies. The national average is 7.9%.
* HIV/AIDS. Louisiana ranked fifth highest in state AIDS case rates and tenth in the number reported in 2002. Perinatal transmission rates of 5% remain higher than in other southern state.
* Obesity. Over the last decade, the percentage of overweight and/or obese Louisiana residents increased from 49% to 63%. One out of three U.S. adolescents is physically unfit.
* West Nile Virus. According to the CDC, in 2005, Louisiana had the 5th highest number of West Nile virus cases in the U.S. According to a Louisiana Health and Hospitals spokesperson, “Everyone everywhere is at risk for West Nile during mosquito season.”

Spending or streamlining
About 6 million children around the world could be saved each year with basic measures such as vaccines; antibiotics; vitamins; rehydration packets to help reduce diarrhea-related deaths and insecticide-treated bed nets to prevent exposure to mosquitoes carrying malaria. And these items aren’t expensive. According to the World Bank, for as little as $20 to $30, a child can be protected from a host of deadly diseases through vitamins and immunizations. But as the global population of children under 5 has grown in the last several years by 11%, U.S. funding for worldwide child maternal health has only risen by 4%.

But is more money the solution? Over $6 billion, or about one third of Louisiana’s 2005 budget, went to the Department of Health and Hospitals. Yet, our health statistics are less than ideal.

Remaking Medicine
Inefficiency in delivery and usage of services may be the culprit. According to recent statistics from health policy experts, approximately $400 billion is wasted in America on health care that doesn’t advance a patient’s condition. Even worse, medical errors kill more people each year than breast cancer, AIDS or motor vehicle accidents. And in Louisiana, a history of near total reliance on the state’s charity hospital system by its uninsured population means that some 900,000 citizens don’t have a primary care physician. The Emergency Room has replaced the doctor’s office for many – Louisiana has the 4th highest rate of ER usage of the 50 states.

To address these problems, a movement is growing in the U.S. and Louisiana to “remake” American medicine – to transform the physician/patient relationship and use proactive solutions and technology to improve the delivery, safety and quality of healthcare. Some examples:

* Clinton Nurse Practitioner Ginger Hunt has opened three community-based health centers and created a nonprofit of Primary Care Providers to better treat underserved parishes. She’s also helped to secure a grant for the Florida and Feliciana Parishes to begin electronically recording medical records to assist patients that move or become displaced such as after a hurricane.
* Some Louisiana hospitals are using new technologies to “e-prescribe” drugs. By having a direct internet link to the outpatient pharmacy, prescription errors are reduced.

Points to Consider
Addressing how to most effectively combat the healthcare concerns of Louisiana, the nation and the world can raise issues that may need to be debated before action can be taken. Consider the following:

* Funding: Does the U.S. government fund international health programs at the expense of health care problems at home? Would you be willing to pay more in federal income taxes if the money went to international health programs targeting children? Is more money the solution?
* Public Health Care: Hurricane Katrina has provided an opportunity to reexamine the state’s charity hospital system. A key question in planning the rebuilding of Louisiana’s health care system is whether to continue to rely on a costly hospital-centered system of care or design a new model of health care delivery that would shift the focus to maintaining health and preventing chronic disease. Should funding go to the building of more Community Health Centers? Proponents claim their non-profit, patient-driven approach reduces costs, increases accessibility and improves quality.
* Chronic Disease Management: The treatment of chronic illnesses consumes nearly 70% of all health care resources, yet doctors are often unable to prevent needless suffering or even death. How can closer patient/provider/family relationships be developed to more effectively address these conditions? Do healthcare providers need to be trained to think more along these lines? How can patients become more involved to get better health care results?
* Physician Shortage: Some Louisiana parish residents, like those of third-world countries, face physician shortages that can mean delays in diagnosis and treatment of health conditions. Is the solution spending money to attract more physicians to underserved communities? Or should the focus be on building more efficient healthcare delivery systems?

The Future
SARS was isolated in four weeks and eradicated thanks to thorough surveillance, good communications and worldwide cooperation. As Louisiana tackles longstanding health concerns, emerging threats and rethinks how to rebuild its public healthcare delivery system, the participation of providers, patients and the public in every step of the process can bring the state one step closer to receiving a “clean bill of health.”

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Posted by Anushka  on  02/09  at  10:31 AM

I think West Nile Virus, HIV, and other health risks are among the highest in the nation, and what can be done to improve diagnosis and treatment in a world where disease knows no border. The treatment of chronic illnesses consumes nearly 70% of all health care resources, yet doctors are often unable to prevent needless suffering or even death. Some Louisiana parish residents, like those of third-world countries, face physician shortages that can mean delays in diagnosis and treatment of health conditions. Thanks!

Posted by David Nathan  on  03/19  at  05:04 AM
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