State's health ranks No. 38

Based on the latest rankings from the United Health Foundation, the overall health of Missouri's citizens is in need of a checkup.

The Show-Me State ranked 38th in citizen health among the 50 states and the District of Columbia, according to America's Health Rankings 2008, a study from the United Health Foundation.

Among the study's findings: About a quarter of Missourians smoke, and 28 percent of state residents - including 16 percent of children ages 10 to 17 - are considered obese. The study also says that there are 88.6 unnecessary hospitalizations per 1,000 Medicaid enrollees annually.

The numbers are even more telling when looking at year-to-year health improvement; Missouri is last on the list ranked by improvement between 1990, the first year of the study, and 2008.

According to Kristofer Hagglund, interim director of University of Missouri's Master of Public Health program, improving those numbers is not going to be easy.

"Most of the data ... has found that Missouri citizens are not among the healthiest in the nation," Hagglund said. "The reasons for that are multifaceted, and the methods needed to improve our health are also multifaceted. We're going to have to take a long, hard look at what got us into this situation."

Brooks Miller, director of Jordan Valley Community Health Center, said that while access to care has improved in his 26 years in Missouri health care, it probably hasn't kept up with demand - especially with state Medicaid cuts in 2005 that reduced access to health care for thousands.

"The overall state of health, not only in Springfield but in southwest Missouri as a whole, is decreasing," Miller said. "In Springfield, I think we have many of the same issues - we have a lot of people who still smoke, and we know the problems with that. But I wouldn't say the problem is different here than it is elsewhere. Those problems are, unfortunately, the norm."

The role of public health

Hagglund, whose program is advocating for additional state funding, said one of the keys to improving those dismal health statistics is prevention, specifically through local public health organizations.

"This is an economic development issue," he said. "We know that if we could get people to manage cholesterol, hypertension, weight and smoking, there would be a substantial reduction in health care costs and a significant increase in productivity - and those are all public health programs."

The numbers are even drearier when looking at state health funding - Missouri ranked 47th in per-capita state funding for public health programs, according to a 2008 report by Trust for America's Health. Missouri programs received $10.20 per person from the state in fiscal 2007, the last year examined in the study.

By comparison, Hawaii, which ranked No. 1 in state health funding, spent $152.66 per capita in 2007. The national median is $33.26.

Springfield-Greene County Health Department Director Kevin Gipson said increased funding has been in the city's list of legislative priorities since he joined the department in 1993, but state appropriations for public health departments have not increased in 10 years.

Gipson said appropriations decreased in 2004, from $9.5 million to $9 million statewide, and have not been increased since. Greene County receives about $250,000 annually from the state for "core functions," including food protection, disease prevention and child health programs. That equates to about 96 cents per person, which Gipson called "pretty sad."

"I think we'd do a better job with disease prevention and do better work in our internal and child health programs, offering more immunization services and working with more at-risk pregnant women," Gipson said. "There's just a laundry list of things we could do if we had those dollars."

Funding outlook

Gipson said he's not optimistic that a new state administration means additional health funding. Gov. Jay Nixon's recommended budget, as stated in his Jan. 27 State of the State address, includes the same amount of funding for public health as in previous years, and $18 million in additional funding requested by the Missouri Association of Local Public Health Agencies likely will not gain approval because of the current economic crisis.

"All of us in public health would like to see improved funding for work force training and for our public health agencies," Hagglund said. "The governor and the state legislature are going to be facing some difficult challenges, and I wouldn't want to presume to suggest to them exactly what needs to be done. But anything that could be aimed at improving public health would be beneficial in the long run."

Gipson, however, hopes that state decision-makers take a long look at the potential benefits of increased state investment in health care - and the potential drawbacks of not increasing that funding.

"What concerns me is that we spend billions of dollars on direct health care, but we don't make an investment in prevention," Gipson said, noting that studies indicate a return of anywhere from $4 to $7 for every dollar spent on health prevention programs. "We know prevention pays if we just invest in it. It takes a while, but those things pay off in the long run."