By David J. Holcombe, M.D., M.S.A.
Every spring, the Robert Wood Johnson Foundation publishes their “County Health Rankings” report, which ranks all 64 parishes in Louisiana according to “Health Outcomes” and “Health Factors.”
“Health Outcomes” measures morbidity and mortality (premature death, low birthweight, and poor self-reported physical and mental health days). “Health Factors” include a wide variety of indicators: “Health Behaviors” (smoking, obesity, inactivity, drinking, STDs and teen birth) and “Clinical Care” (uninsured rates, availability of providers, preventable hospital stays and screening tests for diabetes and breast cancer).
Health Factors also include: “Social and Economic Factors” (high school graduation rates, poverty, violent crime rates, injury deaths and single-parent households) and “Physical Environment” (air pollution, drinking water violations, housing problems and long commutes).
The health outcomes demonstrate a cause and effect relationship, with poorer factors generally resulting in worse outcomes. How do parishes in Central Louisiana stack up against others in the state? Results show there are three groups:
This has held true for several years. The unhealthiest parishes are along the Mississippi River, similar to counties across the river.
Since health factors and health outcomes are so closely related, you would expect a similar grouping for health factors. For the most part, that does hold true, but not completely.
Avoyelles has better outcomes than would be predicted by their health factors, while Rapides is the exact opposite.
What’s obvious from looking at these statistics is their stability over time, with only a few positive trends. Grant has improved its health factors, as have LaSalle and Vernon Parish. There have also been improvements in outcomes in Grant (probably related to increased access to care.) Otherwise, both factors and outcomes appear to be rather static, notably for Natchitoches Parish and not unlike Louisiana’s national health rankings.
While there is merit in looking at individual parishes/counties, it’s important to put these statistics in the context of Louisiana results when compared with other states. Alas, in the latest America’s Health Rankings, Louisiana ranked 49/50 overall (47/50 in outcomes and 49/50 in health factors).
While we have a host of poor results (40/50 or worse for obesity, inactivity, smoking, chlamydia (STI) rates, occupational deaths, violent crime, lack of insurance, and preventable hospitalizations, among others), we have very good rankings for adolescent vaccinations (12/50 or better) for meningococcus and Tdap (tetanus, diphtheria and pertussis). Vaccinations have always been a Louisiana bright spot, mostly related to LINKS (Louisiana Immunization Network for Kids) and our strict “no shots, no school” policies. Such favorable statistics for one aspect of health prove that improvements can be made with the proper programs, policies and adequate investments. Louisiana is not doomed to be last.
Another bright spot for Central Louisiana is its very low infant mortality rates. CENLA (OPH Region VI not including Natchitoches Parish) can boast a rate of 4.7 infant deaths/1,000 live births. This is the lowest in Louisiana and lower than the national rate of 5.9/1,000. The state rate is 7.7/1,000. CENLA health units have among the highest coverage of contraceptive needs among all state parishes (over 30% satisfaction of needs and higher than state goal of 20%.) Natchitoches Parish falls in OPH Region VI (Northwest Louisiana), which lags behind in infant mortality with regional rate of 9.0/1,000. This is higher than national and state rates.
Our state and parish statistics often hide tragic disparities in outcomes between groups based on income and education (often complicated by race). These disparities, as persistent as they have been, should be targeted for elimination by health providers, policy makers and civic leaders in all locations. Let’s hope we can build on our strengths and continue to improve health factors and their resulting health outcomes. Partnerships and persistence will help us raise our regional and state rankings so Louisiana will no longer be located at the bottom of the health statistical barrel.
Dr. David J. Holcombe was born in San Francisco, Cali. in 1949. He attended medical school at the Catholic U. of Louvain in Brussels, Belgium. After residency in Internal medicine at a Johns-Hopkins affiliated clinic, he and his wife moved to Alexandria in 1986. After 20 years with a prominent internal medicine clinic, he transitioned to public health in 2007. He writes extensively about medical and non-medical subjects.